STOP LEUKEMIA

Treatment of anticancer drugs is accompanied­nied by a variety of side effects to be aware of the patient to determine the time of their appearance.

Chemotherapy often has unfavorable­effect on the organs of the digestive tract and prevents the normal diet. Patients complying with a balanced, rational que­the better to withstand adverse events.

In the absence of gastrointestinal diseases kishech­Nogo tract, liver and pancreas ezhed­patient-today diet as during chemotherapy, and in the intervals between its courses should contain foods the following four groups: protein, dairy, bread and cereals, and fruit and vegetable.

With any diet during chemotherapy, in between its courses and after completing required intake of multivitamins. It is advisable to soche­thief multivitamin with ascorbic acid.

During chemotherapy, it is desirable to increase fluid intake: vegetable, fruit and berry juices. Particularly useful Carrot­ny, beet, tomato, raspberry and brusnich­ny juices.

In the absence of edema or renal diseases should drink 1.5-2 liters of fluid per day. Edema, fluid presence in the pleural or peritoneal cavity should drink less. Number of­consumes fluid should not exceed the amount of urine more than 300 ml.

Snizhenie

Loss of appetite begins on the day of the procedure and lasts for several days. when PLO­Hamster appetite shown foods koto­rye with a minimum amount possible to obtain the maximum amount of nutrients (nuts, honey, whipped cream), they need to eat between meals. Food should initiate APME­tit. It is advisable to use the cream soups, as they contain more protein. Showing no­fatty meat and fish broth. In the absence of oral diseases and gastro-ki­antiplaque tract allowed to use priprus­you stimulate your appetite: pepper, mustard, as well as the infusion of wormwood herb, leaf shamrock, centaury, oregano. contribute to improve­NIJ appetite pickle, sour and salty vegetables and acidic juices: lemon, cluck­Gov., currant.

Treatment of many anticancer prep­Tami is often accompanied by nausea and vomiting. To reduce nausea, take the following recom­dations:

Perform breathing exercises in the fresh air (or on the balcony with the window open).

• Suck on a piece of ice before breakfast, a slice of frozen lemon, sour plum, plum, Iago­dy cranberry, lingonberry.
• Eat dry foods on an empty stomach: crackers, bagels, toast, biscuits.
• Eat small meals throughout the day, so that the stomach is not a searching­overflow shaft.
• Avoid food that has a specific taste, not eat foods with a strong odor.
• Avoid fried, especially fatty foods, dairy sauces, whole milk (which can be switched on again in the diet when the nausea will pass).
• Do not eat desserts.
• Do not eat too salty, spicy and hot food.
• Avoid the fluid intake during meals, not to fill her stomach.
• Drink one hour before meals cold, not sweetened drinks.
• Eat slowly to the stomach did not fall a large amount of food at a time.
• Avoid eating just prior to administration of the drug.

Another consequence of unpleasant reception of some antitumor drugs is one hundred­Matit – damage to the oral mucosa, leading to its inflammation, and in severe forms – for painful ulcers and infections. Vero­yatnost development stomatitis decreases at a constant­Yann subject to the following rules:

mouth rinse mouthwash ( “Pepsodent”, “Elhadent” et al.);

grease lip oily lipstick (men – colorless hygienic lipstick);

cooling the oral mucosa piece of ice;

to avoid irritation of oral acute pi­boiling, hot, sour and salty foods, as well as fruits and vegetables containing high­Niemi acid (tomatoes, grapefruits, lemons, kitty­lye apple varieties);

rinse the mouth after ingestion of food soda solution (1/2 teaspoon baking soda in a glass water), brine (1 teaspoon of salt in 1 liter of water), as well as infusions camomile, sage, oak bark, St. John’s wort.

After decrease in acute effects Execu stomatitis­zuyte soft foods. Cook steamed, boiled dishes. It is desirable to consume more liquid (up to two liters per day).

The cells of the gastrointestinal tract is very NKM­ble to the toxic effects of certain chemotherapeutic drugs. Their damage leads to frequent and loose stool (diarrhea).

Treatment with an appropriate diet to­rule in the restoration of water and mineral balance of vitamins and protein. It is not­sary to comply with the main condition: the food should be possible to spare the intestinal mucosaka, products must be digestible and be suitably cooked (cooking with water or steam, to use in a shabby), with a limited content of carbohydrates and fats.

Exclude from food: fatty meats, fish, meats, marinades, canned food, hot spices and irritating the intestinal tract vegetables (radishes, onions, radishes, garlic, beans, spinach, sour grades of berries and fruits), fresh whole milk, soft­cue bread, pastries.

Recommended dishes soft consistency, Hea­lye or room temperature, small pore­tions. Useful rice porridge, oatmeal, mashed cottage cheese, soft-boiled eggs, vegetable soup, ba­Nana, pureed apples, mashed potatoes on the water,cooked mashed pumpkin. Effective juices, jellies, mousses blueberry, cherry, chokeberry, “blackcurrant.

It should be more fluid. drinking tep­Loe or room temperature, as hot or cold liquid only enhances diarrhea. You can drink the mineral water without gas. Useful decoctions of dried pear, rose, pomegranate bark, herb St. John’s wort, burnet root, peel Seele­GOVERNMENTAL apples.

When a large fluid loss can cooki­vit next drink:

a liter of boiling mineral water added

1/2 – 1 teaspoon salt

1 teaspoon baking soda,

4 teaspoons of sugar.

Quite rare in patients having constipation while taking chemotherapy drugs. Butif they occur in the morning on an empty stomach is recommended to drink a glass of cold water or fruit­Vågå juice (peach, plum, apricot) or a hot lemon drink, eat grated carrots, apple, 5-7berries prunes, filled with boiling water in the evening.

The diet is necessary to include the products of God­Tide fiber buff gives Vare­naya beet puree of dried fruits. From the first dishes healthy soups, borscht on vegetable broth.

With constipation from the diet excludes kopchenos­ti, pickles, marinades, cocoa, chocolate, restriction­Chiva intake of fried foods, sausages from­dely. Eat less bread and bakery woode­ly from wheat flour, pasta­GOVERNMENTAL products, dishes from semolina. It is from­sound of spicy dishes, as well as with products­holding tannins (strong tea, cocoa, teas, jelly). Contraindicated: onion, Sanchez­nok, radish.

When liver disease is recommended to exclude from the diet of fried, spicy and salty foods, cottage­causeway use fatty meats and fish, pickles, smoked products, fungi and products god­ies cholesterol (brains, egg yolks, fish and mushroom soups, broths). During an exacerbation it is not recommended to eat radishes, turnips, rhubarb, onions, beans, peas. Recommended: vegetarian soup, borscht, cabbage soup with fresh cabbage, milk soups; of dishes: Steam meat and fish cakes, boiled lean meat, poultry. The menu included from­varna vegetables (carrots, beets, cauliflower, pumpkin, zucchini), and ripe fruit, bake­nye apples, fruit and berry juices. Recommended milk porridge: oatmeal, rice, semolina with Izya­IOM or honey, lactic acid products (prostok­your, kefir, fermented baked milk, acidophilus milk, yogurt, not­fat cottage cheese).

If the kidney function is assigned low-protein diet with sharply limited Included Quantity­stvom salt. Recommended dairy dishes, including­tea cheese, cheese paste. From the first dishes – borscht, beetroot, vegetables, cereals soups without hot spices. meat consumption limit. Especially useful raw vegetables: carrots, protein­channaya cabbage, cucumbers, fresh green peas, parsley, green onions in a small amount, etc.

Showing fruits and berries, juice, jelly, component­you, broth hips, cranberry juice. expedient­Miscellaneous Avoid the usual bake bread­ki (i.e., salt), meat, fish and fungal broths, as well as sausages, pickles, marinades,mushrooms, horseradish, mustard, chocolate.

When cystitis caused by chemotherapy drugs, you need to drink plenty of liquids. blah­gotvorno are milk, milk tea, alkalis­nye mineral water. Particularly useful watermelonsmelons. Not recommended for alcoholic beverages, spicy dishes, sauces, seasonings, meats, canned fish.

During treatment, can develop adverse reactions that are caused by the radiation. Most often, reactions occur in 2-3weeks after the end of radiotherapy. Patients mo­Gut the following changes occur.

1. Changes in the skin: dryness, flaking­of itching, redness, occurrence of bubbles.

For the prevention and treatment of these reactions use spray “Panthenol” ointment “Rescuer”, any modern baby oil on to care for­ments.

2. Changes that occur in the treatment of Paci­ENTOV with tumors of the head: hair loss, hearing loss, feeling of heaviness in the head.
3. Side effects that may occur in the treatment of patients with tumors of the face and neck: dry mouth, sore throat, pain or constant eating, spasm, hoarseness, loss of appetite.

To reduce dry mouth and PersheNia recommended throat gargle decoction of chamomile, calendula, peppermint, burying an empty stomach in the morning and at night Sea buckthorn oil with sunflower oil in the ratio of 1: 2 in the nasal cavity.

Teeth treated daily gel and penalties­schimisya toothpaste with a soft tooth­hydrochloric brush.

To reduce the pain when receiving the food rec­pouts:

• light diet with exception of spicy, salty, acidic, roughage;
• food should be cooked well milled­Noah;
• eat frequently in small portions;
• When cooking use to grow­tion and butter;
• drink plenty of fluids in the form of vegetable and Fruko­tovyh juices, broth hips, non-acidic cluck­vennogo Morse, etc.

4. Side effects of radiation therapy in the OPU­Hawley’s chest cavity: Breast tumor; gland, muscle soreness, swelling and bolez­nennost breast pain and difficulty in swallowing, dry cough, shortness of breath, skin reaction in the irradiated region.

Treatment and prevention are the same as in paragraph 1 of.

5. Adverse effects occurring at leche­SRI patients with tumors of the abdomen and pelvis: loss of appetite, weight loss, Tosh­Note, vomiting, diarrhea, abdominal bands in the area of ​​pain­ti, impaired urination (often involuntary­Noah) with a burning sensation, pain in the rectum, vaginal dryness, discharge from the puts­schA.

When irradiated during the first week recom­pouts:

• food taken frequently, small meals 4-6 times a day;
• food to be boiled or cooked­hydrochloric steamed, pureed;
• eliminate fried, salty, spicy foods;
• exclude the dairy products the appearance of bloating;
• Diet № 4 (vegetarian soups lean meat or fish broth, cereal, jelly, meat boiled, white bread from flour of higher grades, better in the form of crumbs, freshly made cheese, broths blueberry, rose, ripe pears, non-acidic apple, tea cocoa water, black coffee).

6. Side effects may occur at about­awns radiation limbs, pelvis, spine: brittle bone (mostly – konechnos­Tei), changes in blood parameters, muscle soreness, the reaction of the mucous membranes of the esophagus, ki­shechnika – it depends on the body part that is under the­jected to irradiation.

Patients receiving radiation therapy must to rest for three hours after the procedure to transfer the treatment well. Balanced diet can prevent weight loss. req­Dimo wear loose clothing, not a pressure on an­region of irradiation. Underwear should be soft­Kim (linen or cotton). In the shower, use moderately warm water. irradiation area protected from sunlight.

Mammary gland – hormone-dependent organ. As its normal development and function, and pathological changes occur in it

under the influence of certain hormones. The development of breast due not so much to increase or decrease the concentration of individual hormylnew blood as with their discharge rhythm disturbances, changes their normal ratio in the body, hormonal regulation of biochemical processes in the cells and breast tissues.

These disharmonious disorder is usually not visible to the patient, but may persist th­rows. Factors that could cause and support them to increase the risk of developing breast cancer.

One factor is age: 40 – 60 years.1 At this time in a woman’s body occur Mountainsmonalnye changes caused by the development of menopause and menopause. development cus­Max – a normal physiological process, but there is a reduction in the period of adaptation! stability of the organism and the endocrine system.

At present, many women for the prevention of pregnancy using various | birth control pills (contraceptive) agents including hormonal pills that protect against unwanted pregnancy. For a long time, for many years, their use, especially in the very young age or before the first birth, it is undesirable because it can disrupt the hormonal metabolism in the body and stimulate the development of existing precancerous changes in the mammary gland MO.

The development of breast cancer may method­update themselves excessive consumption of animal fats­of origin of foods high in cholesterol, sugar, concentrated broths, egg yolk, butter.

Vitamins play an important role in metabolic processes, including having a protective anti-tumor character. chronic insufficient­current in the body of certain vitamins, such as beta-carotene, is a cause of cancer mo­mammary gland.

Psychoneurogenic disorders, neurosis, neuritis­Walls, dystonia can STI­formulated the tumor changes in the body. Theyoccur after psycho, psychological ne­overloads.

Often the patients themselves attribute the appearance at the tumor changes in the breast with herbs­Mami (bruises, squeezing, wound). mechanical­cal trauma of breast, especially neodnok­Conversely repetitive, can stimulate swelling­Left changes.

Smoking and alcohol use increase the risk of of developing breast cancer, especially in women who smoked before the onset of permanent IU­nopauzy.

Every woman should:

• observe the rules of good nutrition, CCA­cially during the menopause and climacterium;
• monitor the body weight;
• Do not neglect the anti-tumor activity of vitamins – beta-carotene, vitamin C;
• protect the mammary gland from bruises, bumps and squeezing;
• wear a loose and well maintained mo­mammary glands bras through which pre­duprezhdaetsya their sagging, concussion of the motion;
• treated promptly ovary disease, thyroid, liver;

“Restrict or eliminate smoking, use of alcohol.

Early diagnosis of precancerous and tumor­O breast disease depends ca­my woman. It is recommended that profilak­matic inspection once a year after reaching the age of 30.

The best time for self-study – the first week after the end of menstruation. The mammary gland during this period is in most softened state.

Women in menopause, you must select BSE is one of the days! month, remember (and it is better to write down) the date of the survey and its results. It is convenient to examine the breasts, standing in front of a mirror.

Skills Training includes the following:

• inspection of linen in contact with milk! glands. Slight discharge from the teat leave traces on the bra in patches of yellow, brown, reddish, or greenish colors watery;
• Inspect the nipple. Pay attention to their shape and color. To see if they are extended, do not get wet whether, whether cracks or sores;
• Inspect the skin of the breast: for redness entire surface or selected areas, rashes, diaper rash, “lemon peel” skin. It is necessary to determine whether there is bulging, retracted, ulcerated and shriveled breast track. Attention is drawn to the shape and size of breast (whether increase or decrease in size, surface roughness) on the symmetry (one if they raised the level of­toil at the institution hands behind his head, whether to fix one of them, to tighten up and b side). Inspect the gland when turning right and Nala­in.

Feeling.

Feeling (samopalpatsiyu) is carried out three or four pads serried fingers (in dependenceing on the size of the breast), standing before the mirror methodically penetrating circular movements. Beginning with the probing of surface. This makes it possible to identify formations located directly under the skin. Then comes a deep probing] fingertips when moving in a circle gradually reach the surface of the ribs.

Samopalpatsiya.

A woman is on a bed in a supine position. If the surface is soft, under the right shoulder blade puts a firm pillow or cushion of towels (Figure 6). Right arm extended along the body, the left hand is carried out probing­of the right breast. Then, the position of­menit palpation for the left breast.

Samopalpatsiya squares method.

Mentally entire surface of the anterior chest wall­ki from the collarbone to the costal margin and the right breast is divided into squares. Palpated consistently each square, down from top to bottom as if the stairs, do not forget to test the armpit and nipple.

Samopalpatsiya spiral method.

Probing the anterior chest wall lactic­hydrochloric gland being spirally concentric circles converging starting from the armpit (the right arm is placed under the head) to the nipple, without missing any portion of the breast.

When samopalpatsii breast say what they feel and remember those feelings. Because breasts are lobed Straw­ix, under your fingers will feel a certain graininess or tyazhistost, but it is not at­signs of the disease.

When samopalpatsii, as mentioned, be sure examined axillary region where the possibility but swollen lymph glands. front piles­Naya wall is palpable breast due to the possible presence of additional lobes, in which the same changes may occur, as in the mammary glands.

It is necessary to test the nipple and about podsoskovuyu­domain, as under the nipple may occur OPU­Chol. Most tumor is detected in that quarter of the breast, which is located above and outside.

Survey complete, carefully taking pain­PWM index fingers nipple and pressed on it – so check that there are no selections, and if any say characterized­ter selections.

The procedure is repeated and carried out his right hand for the left breast. Then examine both mo­mammary gland described­hydrochloric procedure in position standing. Better to do it in the shower, lathered obsl­when the wind blows area. Skills Training for menstruating women must be conducted in the first week after the windows­Chania menstruation. For women in menopause – in fixed­Bathing day of the month.

Samopalpatsii main goal – to get proof­of the nonexistence of the disease. In the presence of pack­lotneny in the mammary gland is necessary to pay­Xia to the expert.

Condition after mastoektomii

Thanks to the progress made in the last decade in the treatment and early diagnosis of breast cancer, thousands of women live after the operation for more than 5 years. Statistics in oncology abroad highlights the five-year survival rate when the most likely to relapse. The woman lived­Shaya more than 5 years, it is considered cured.

Unfortunately, diagnosis and treatment of it awareness­NVIRONMENTAL of breast accompanied by high levels of suffering women. after SET­Lenia diagnosis develop severe psychological stress, most of the women in a state of duality. On the one hand, the need to pass through a difficult treatment, transfer crippling operation (removal of the breast), but remain­Xia live, despite the consequences for work and family life; on the other – it is impossible to reconcile with the operation, makes you a “monster.” Sometimes this leads to the disintegration of the family, if the husband or loved one is not as strong in spirit, and dealt with a difficult situation in life at a time when women are especially needed their love and support.

After surgery and other treatments at home, a woman with a “sick” and hand stitch on breast place, poor, deprived of the opportunity to perform many household chores, overtaking­a second psychological shock, depriving as it seems to be no hope of a return to the pre­bo ttom life. Oncologists call this situation psi­hologicheskim collapse since transferred mastoektomiya “knocks out” the majority of women from social habitual and social environment and ve­children to major changes in their mentality and way life. This crisis requires a change­Nia position in life, a woman revising itsof attitude to the world, words and deeds relatives and acquaintances.

Help a woman cope with these difficulties – the main task of doctors, friends, family, colleagues, because in this period the further life of the women in the family and society. Oncologists believe that the climate in the family depends on the attitude of the patient to their slaughtering­Levan: the smaller woman dramatizes situa­tion, the more likely it is to get support from his family. First it is necessary to analyze their old life and try to identify the factors to­torye contributed to the emergence of her cancer slaughtering­Levan and, if possible, eliminate them.

After surgery, the body having anatomical and physiological disorders that may instill­STI to partial disability. The question arises: how to live, to live for a long time, have a happy family, to work actively?

So, what should be done to avoid re­tsidiva diseases to boost the body’s defenses, to feel good, to work on the floor­hydrochloric power to enjoy life?

To do this:

• change the mode of the day;
• Change the diet;
• lose weight and stabilize it;
• engage in physical therapy;
• learn how to make the physical and psycho-emotional overload;
• take care of their appearance;
• do what he likes; h “to undergo regular medical examination.

To restore physical strength, strengthen the nervous system is necessary:

• sleep for 7 – 8 hours with an open window or pane;
• before bedtime take a warm shower, directing a jet of water in the first place on the sore spots;
• the patient’s hand in bed to lay on the pillow, the hand located on a hill (this is the norm­lizuet lymph circulation and its outflow);

sleeping on your back or on the side opposite to the operated side to their weight in the BPE­sleep on me not to squeeze the hand vessels by about­operated seats;

in the event of pain simple­Lebanon nature in operation, your hands, nadplechevoy area should see a doctor (it can be a symptom of bronhopleksita – Sun­Singe brachial plexus);

• Do not lift or carry heavy weights, if possible, not to overtax his hand. When the load increases, the muscles need more oxygen, which increases blood flow to the hand and the already congested venous blood and lymph in the BPE­mja like outflow therefrom is difficult;
• It is recommended to limit the load on the hand from the operation – up to one kg for one year, up to two kg for four years and up to 3 – 4 kg for a lifetime. Better to wear a bag on the Tribes­Th good hand;
• Avoid any work related to the long inclined position with his hands down. Such restrictions are necessary to obstacles­Vat stagnation of lymph in the lymphatic vessels of the hands;
• After the physical work required to do exercises, self-massage of the hands (by stroking fingers to armpit), giving it an elevated position at an angle of 10 ° – 15 °.
• when working near her house, laundry, washing dishes, especially with the use of strong detergents, it is recommended to use protective gloves;
• sewing with thimble;
• Avoid mosquito bites, bee by using insect repellent for protection;
• Do not give injections, take blood for analysis to measure arterial PRESSURE­of the arm from the operation;
• Do not expose the clamping arm: eliminate the tight cuffs on a blouse and a nightgown, monitor, clothes to armhole were too narrow bra straps should not crash into the Tribes­cho. Rings, bracelets and watches should be kept on hand, free, without the girth;
• Avoid burns while cooking, to prevent sunburn. Summer wear shlya­pu, long-sleeved clothing (to protect from the sun);
• Do not use hot water when washing MSRP­dy, taking a bath. Contraindicated in sauna, steam bath, and washing in the bathroom shower is recommended to replace;
• Protect the arm from the operation of the on­cuts, burns, abrasions, cracks, scratches, caused­GOVERNMENTAL animals and plants. these precautions­STIs are important for the prevention of erysipelas are inflamed­Nia. Erysipelas leads to increased swelling and hands;
• when receiving the injury must be rinsed with running water and wound doubly treat antiseptic solution (iodine, 0.01% chlorhexidine bigluconate 70-degree alcohol solution). If the arm at the site of injury flushed, there was a pain at­towered body temperature, increased swelling of the hands, you need to see a doctor;
• After work, remove the bra with a prosthesis, to relax your body, put on its­Bodnya cotton clothing;
• protect the area of ​​the second operation, the healthy hand in the transport market, in crowded places.

In the recovery period (7-8 days after surgery) recommended set of therapeutic exercises to restore maxi­mal range of motion in the hand operated with­Noah side, maintain the correct posture, coordinate­ordination of movements, complete respiration, normalization of the general condition. Exercise better vypol­nyat twice a day – morning and mid-afternoon. Very effective for the recovery of motor Fung­ktsii hands with the operated side sessions in the pool. They can start in 2-3 months after surgery.

Lymphedema – a swelling of the tissues due to limfostazom. In most cases, lymphedema times­Viva after surgery for breast cancer, pelvic cancer, as a result of post-operative infections, radiation therapy, recurrence of cancer in the axillary, inguinal and pelvic areas.

Unlike other types of lymphedema swelling svya­linked to changes in the skin and subcutaneous TKA­nyah, especially when the surface lymphatics heavily overloaded or clogged. The re­result of these changes, the patient has the following symptoms:

• tumor limb (upper or lower);
• feeling of tension in the limbs;
• feeling of heaviness;
• pain and discomfort due to the pressure on the joints and ligaments.

visually:

• lymphorrhea (leakage of lymph fluid);
• keratosis (skin roughness as a consequence of protein fibrosis and infection);
• formation of deep wrinkles in the skin;
• sign Stemler (inability to take the skin of the limbs in the fold);
• cellulite.

A patient experiencing psychological difficulties, associated with changes in shape of the body, an increase in the volume of the upper or lower limbs.

Lymphoedema can not be completely cured, so the sooner treatment starts, the positive result will be achieved soon. effectiveness­ciency of treatment depends on the degree of swelling of the limb, and general physical condition of the patient.

The range of therapeutic measures in lymphedema include psychological support for the patient (training, consulting), skin care, Exercising, gentle massage, lymph drainage.

Chronic lymphedema skin becomes dry and discolored. Microcracks skin spo­Property ingress of bacteria into the ideal for their breeding environment – fixed lymph. Accuracy and compliance with the rules of hygiene can reduce the risk of infection:

• Wash, dry (blotting motion­niyami) swollen limbs, the area between the thumb­E and the folds of skin (to prevent fungus­postglacial infections);

“Lubricate the skin washed limbs softening cream – to moisturize the skin and prevent the appearance of cracks (Remember: the cracks – the entrance gate for infection!).

* Apply a cream, water-based (ointment as emulsions). It is not recommended to use creams

and lotions containing lanolin (warning contact dermatitis), perfumed creams and lotions that cause irritation;

• Wear gloves when working at home or at­manor portion;
• Use a thimble when sewing;
• Take care when trimming nails;
• to protect the skin on the affected limb from sunburn;
• Use an electric razor when shaving hair in the armpit;
• Protect the edematous arm of injection, blood sampling for analysis of pressure measurement;
• treating cuts and abrasions antiseptiche­medication available in a timely manner.

If the skin on the edematous limbs reddened, appeared burning, soreness, a local increase in temperature, swelling, should like to see a doctor as soon as possible. In this case, the prescribed antibiotics, rest, elevated polo­voltage for swollen limbs (pillow under the arm or leg). Unfortunately, cases of acute inflammation ^ is the inevitable consequence of chronic congestive lymphedema.

Special exercises will help improve the core­nazh lymph prevent fibrosis, increase the effect of the contraction, to expand the range of motion swollen limbs, prevent stiffness su­pose. Requires regular systematic motionvoltage swollen limbs, as the contraction of the muscles and stimulates the flow of lymph and blood circulation. If the execution of active movements difficult, the patient should be twice a day to perform sparing exercise.

It must be remembered that too vigorous, requiring effort, exercise can sometimes be at­incur damage as cause dilation of blood vessels and increases the flow of lymph. Patsien­there with swollen feet should not sit or stand for a long time, to move heavy objects – is reducible­dit to stagnation of blood and lymph. Not recommended for­Niemann arms at an angle greater than 90 °. Such a provision reduces the space between Clue­chitsey and the first rib, circulatory disturbance­Nia and leads to increased edema. Avoid at­standing use of support bandages for hands. Use them only during walks.

Self-massage and lymph drainage

Massage is performed in order to lymph flow was starting from (irreducible) lymph vessels to the deeper muscle (abbreviated­schimsya) lymphatic vessels.

The majority of patients with lymphedema after mastektomii have swelling, extending from the fingers to the upper torso. Swelling of the lower part of the body is observed in patients with lymphedema of feet.

Massage – the only way to cope with the swelling of the body, allowing more freely lymph drained from the swollen limb. Methods wt­black: stroking straight, bowing­Suitable strokes in the direction from the hands to the armpit or groin to the foot of­domain. Massage axillary carried slow circles for one minute.

Tracheotomy (incision of the trachea) is carried out in cases where the natural airflow through the trachea is not possible – for tumors of the larynx, vocal cords.

Patients who undergo surgery, both before and after surgery, fear to choke. It is therefore very important to prepare the patient’s tracheostomy. Both the patient and his relatives must realize that after the operation he could not talk because of cough and breathing strifroznogo. The patient will need care for tracheostomy tubes­Coy, so the patient and his family members have to learn to take care of a tracheostomy.

A patient in a permanent tracheostomy The necessity­ma metal tube (Fig. 24). It consists of three parts:

• the outer tube (cannula) having a side opening for ribbons which it is attached wok­pyr patient’s neck;
• guide (guiding unit) from the closed end, which puts the tube in place; Apply­out only with the introduction of the tube;
• inner tube (cannula), standing in traheo­stoma with an outer tube, can be removed for washing.

Models of the inner tube somewhat, but better use a metal tracheostomy tube having a lock-box, allowing to­reliably hold the inner cannula. Constipation-FLA­Joc must always be closed, or on coughing or even during washing, the inner tube may fall out of the outdoor. The outer tube fic­siruetsya ribbons around the neck, so you need to make sure that the ribbon untied Yai, otherwise­ruzhnaya tube may pop out of the tracheostoma when sudden movement or coughing, resulting asfik­these (suffocation) as tracheostomy immediately closed without tubes.

The outer tube can be removed or replaced only by a doctor, an inner tube – at home whisker­loviyah trained member of the family or the patient himself. For the care of a tracheostomy patient must “cook: with sterile cloth bag­mi vial with 70-degree solution of ethyl alcohol, brush, roller, bottle with sterile glycyl­Rene, a container with two percent soda sol­rum (1 teaspoon to 120 ml of water);

• Remove the bandage covering the hole pipe­ki;
• Wash the hands;
• stand up in front of a mirror;
• turn lock-box outer tracheotomy­cal tube to the “up”;
• take the “ears” of the internal tracheal tube between thumb and forefinger and firmly secure them in his hand;
• lock plate outer traheoto­nomic tube on both sides with the other hand (so­the thumb and forefinger)
• extract of the “ears” in the direction of ourselves Dugo­shaped movement of the inner tracheotomy tube from the outer tube;
• lower inner tracheal tube into the container with two percent soda solution, preheated to a temperature of 45 °;
• treat the inner tracheotomy tubes­ku a brush in a container with two percent soda ra­the shots from the crusts and mucus (until you remove all the peel);
• Rinse the inside tracheotomy tubes­ku under running water;
• dry the inside tracheotomy tubes­ku sterile cloth;
• handle doubly inner tracheotomy­ical tube cloth moistened with a solution of 70 -gradusnym ethyl alcohol;
• Moisten a sterile gauze sterilenym glycerol and lubricate the outer surface of the inner tracheal tube;
• Shake before you enter it into the outer tube to her left drops of glycerine \ (drops remaining on the tube, can cause coughing); j
• lock plate outer tracheal tubes thumb and forefinger of the left hand;
• take the “ears” of the internal tracheal tube between thumb and forefinger of his right hand and put into the hole of the outer tube;
• fix the inner tracheotomy tube by moving the lock-box to the “down”;
• remove the container with water, ruff and drugs;
• Wash the hands.

Note:boil in a special emkos­ti 2 ruff (one – substitutes) within 30 minutes of boiling water. Drain after boil­Niya, ruffs dry and wrap in a clean cloth, where it is stored until the next use.

Patient while walking in the winter period is necessary to impose on the tube hole bilayer gauze bandage and bandage should moisturize the water (Fig. 25) in the summer.

Eating the patient should be in a calm state, not talking, no laughing. It is recommended to wear a scarf, scarf or kerchief around the neck. When is it addictive Paci­cient to the tube and appear confident, you can pore­recommended active cover tube collar, tie. In some cases, put an inner tube with a valve that allows you to talk. This tube can be worn during the day as long as there is a need to communicate. On her night­necessity to change an ordinary handset. patient mo­Jet learn to talk, covering the opening of the tracheal cannula finger, wrapped with a sterile cloth. We can use this technique­but short conversation.

To prevent drying of the mucous about­span of the trachea into the trachea poured into 2 – 3 drops of sterile vaseline oil or glycerol. Thinning mucus poured by pipette 0.9 ml of 1-pro­percentage of sodium chloride solution or 1 ml fer­mentha-trypsin.

When intestinal tumors when allocation of IP­EXERCISE through the rectum is not possible, in the or other intestine make an artificial opening. Ileostomy – an opening in the area under­vzdoshnoy intestine. During surgery – ileostomy- the end of a healthy ileum is displayed on the surface of the abdomen and fixed there with forms­tion of new holes for removal’s contents­direct intestine. Usually, it is placed in the right lower abdomen.

Colostomy – a hole in the ascendant about­zling or sigmoid colon. gut hemming­added to the opening in the abdominal wall and form a height­Tupa mucosa in the form of “roses”. On this artificially created back proho­du, and depart stool. Thus pischevari­tion path as well as dri ileostomy, continues to operate normally.

It is important to properly care for the skin around the ka­lovogo fistula to prevent maceration. when the correct­Mr. avoiding the patient does not have an unpleasant smell, ca.­Rouge fistula skin is not irritated.

Discharge from the intestine is most convenient to collect in spe­cially disposable colostomy bags and mnogora­zovogo use. It is important to define the mode of the GRO­bowel rozhneniya since isolation masses are periodically come about in large chunks, usually – postprandial.

Well selected Colostomy bags protects the skin, it placed a bowel movement, it corresponds to the curves of the body, allowing interference-free to bend, do not miss the smell.

The frequency shift is dependent on the type of stoma bags, used by the patient. For example, one component adizivny Colostomy bags should be changed, coh­but the content level reaches half or when the patient begins to feel discomfort from the pouch. Colostomy bags should not be changed without a real ‘need, as this can cause irritation and damage to the skin.

When using the two-component system ,; Clay plate allowed to stand for 3 – 4 days. Kalopriemnik easier to change in the bathroom. one­to learn to change Colostomy bags in toilet Paci­entu is also necessary, as it is most welcome­lemoe place outside the home. All necessary for the care of stoma items should be stored together in a container with a lid and ready for use. To replace the stoma bags should:

• Net Colostomy bags of the appropriate typeand size;
• measurement (stencil) to check – whether the stoma size has changed (Merck gives sister at discharge Hospital);
• Additional materials, which benefit­etsya patient: pasta “Stomageziv ‘, deodorant, etc .;
• paper towels, napkins, soft sponge, soap, scissors, adhesive tape;
• paper bag, plastic bag or newspaper for used stoma bags;
• Cooper scissors (one end is rounded, the other sharp);
• a small mirror.

It is desirable to have a second set of the same, but in a smaller volume and number of components, koto­ing can take with you and wear a small sum­ke (leaving home).

Before beginning the procedure make sure that the container with the material to change contained everything you need. Then you need the following:

• Prepare a clean Colostomy bags;
• Increase scissors central opening of the plate so that it accurately BME­schalo a stoma;
• Separate gently used kalopri­emnik, starting from the top (try not to thee­pull the skin);
• remove Colostomy bags used in the gas­that, in a paper or plastic bag;
• Clean the skin around the stoma using a dry gauze or paper towels;
• rinse with warm water and wipe the stoma and the skin around her blotting movements;
• get wet wipes skin around the stoma dry (do not use cotton wool – it leaves on the skin of the villi);
• apply a protective cream and massage until complete absorption;
• stick to clean the stoma Colostomy bags using manual.

Application of the adhesive (adhesive) stoma bags (single-component):

• Remove the wrapping paper;
• Position the center of the hole over the stoma, Execu­Zuya mirror to check the correct position;
• press down evenly and make sure that the plate is smooth and has no wrinkles, folds;
• check the correct positioning of drainage­of the bag opening (bottom);
• Make sure the latch is in the closed position,

Two-component Colostomy bags worn differently. Adhesive (sticky) plate can remain on the patient for several days, untilyet provides comfort. The plate has a flanged ring of different sizes. To select op­optimality size of the patient is necessary to remember, that the diameter of the flange ring should be approximately 12 mm larger than the diameter of the stoma.