Care of patients in the advanced stage of disease
The number of patients IV clinical group (in the advanced stage of disease, to be only symptomatic treatment) in the last decade is noticeably reduced. Reducing the number of such patients is due to improved treatments and early detection of recurrence, metastasis, rehabilitation of patients with previous radical treatment.
The main and the only indicator for enrollment for the first time in the sick group, or IV clinical translation of III clinical in IV is the prevalence of the tumor process, which eliminates the possibility of rapid, radical radiation or drug treatment.
This is not a rejection of specialized treatment and transfer to a group of patients requiring skilled symptomatic treatment, including a set of activities: palliative surgery, radiation, medication, psychotherapy, rational nutrition, work, life, care. According to Academician NN Blokhin, clinical examination of patients with clinical group IV - is a heavy page of oncology, since such patients should be especially tactful, must be able to maintain their hope for recovery and do everything possible to reduce suffering by assigning an appropriate treatment.
Patients IV clinical group predicts attributed to seriously ill patients. The general state of needs in health care activities, and this group of patients is not uniform. It can be divided into two subgroups:
1) are in satisfactory condition, often preserved ability to work;
2) are in serious condition, suffering from intoxication, pain, needing constant care.
The former are in need of care. They need an oncologist scheduled treatment: therapeutic manipulation of performance, compliance and diet.
The thoroughness of the implementation of doctor's prescriptions, regularity of treatment, the sequence of pre-planned courses of therapy and the production-control studies contribute to the effectiveness of symptomatic treatment, a factor therapy, offer hope for a cure. In recent years, patients in this group began to hold an outpatient radiation and chemotherapy treatment in a specially developed technique for possible relief (delay) of cancer. This requires the timely appearance of patients for treatment, monitoring of them after the administration of chemotherapy or radiation therapy session, monitoring the timeliness of production assigned to the study, timely information to the oncologist about the reactions and complications.
Patients in serious condition, in need of permanent, skilled care, which is better done in a hospital. It is not always performed because of failure of the patient or relatives and other causes.
Treatment of patients clinical group IV at home by a district physician, and the execution of assignments and patient care - the district nurse. Oncologist clinic should implement a consultation in matters of treatment, and health visitor - instruct the precinct, nurses and patients' relatives in matters of patient care.
Inform patients about the true diagnosis and prognosis from the medical point of view, undesirable. In this situation, assigning the patient, diagnosed at an advanced stage of cancer, in clinical group IV deontological position is most appropriate. Transferring a patient to doctors obschebolnichnoy network as it confirms the legend of the independence of the disease to cancer. More complex relationships with patients, registered in the clinical group III, who found recurrence or metastasis, which showed symptomatic treatment. Involvement of district therapists and district nurses to explain their treatment of concomitant diseases or disorders of the cardiovascular system, etc.
Caring for patients with heavy IV clinical group requires compliance with deontological principles of relations with them to maintain their hope for recovery, knowledge and skills to care. It should relieve the suffering of the patient.
Distinguish general nursing care and special care (see links).