Sitoredüktif Cerrahi İle Kombine Hipertermik İntraperitoneal Kemoterapi Prosedüründe Hemşirelik Bakımı
Özet
Sitoredüktif Cerrahi (SRC) ve Hipertermik İntraperitoneal Kemoterapi (HİPEK) kombinasyonu, kötü prognoza sahip Peritoneal Karsinomatoz (PK) hastalarında sağkalımı ve yaşam kalitesini artıran önemli bir alternatif tedavi yöntemidir. Başarılı sonuçlar için uygun hasta seçimi kritik öneme sahip olup, operasyon süreçleri majör hemodinamik, metabolik ve termoregülasyon değişikliklerine neden olmaktadır. Bu kapsamlı ve riskli cerrahi prosedürde cerrahi başarının yakalanması, komplikasyonların en aza indirilmesi, morbidite ile mortalitenin azaltılması multidisipliner bir ekip çalışması ve kaliteli hemşirelik bakımıyla doğrudan ilişkilidir. Hemşirelik bakımı; ameliyat öncesi fizyolojik ve psikolojik hazırlık, nütrisyonel destek, anemi, derin ven trombozu ile geniş spektrumlu antibiyotik profilaksilerini kapsar. Ameliyat esnasında ise normovoleminin korunması, ısı takibi ile basınç yaralanmalarının önlenmesi kritik adımlardır. Ameliyat sonrasında ise hastaların yoğun bakım ünitelerinde takibi yapılarak hemodinamik stabilitenin sürdürülmesi, sıvı-elektrolit dengesizliklerinin izlenmesi, koagülopati ve kanama takibi, ağrı yönetimi, erken enteral beslenme, DVT ve deliryum profilaksisi ile taburculuk eğitimi gibi hayati aşamalarda hemşireler aktif ve belirleyici bir rol üstlenmektedir.
The combination of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a significant alternative treatment method that improves survival and quality of life in Peritoneal Carcinomatosis (PC) patients with poor prognosis. Proper patient selection is critical for successful outcomes, and operative procedures cause major hemodynamic, metabolic, and thermoregulatory alterations. Achieving surgical success, minimizing complications, and reducing morbidity and mortality in this comprehensive and high-risk surgical procedure are directly related to multidisciplinary teamwork and quality nursing care. Nursing care encompasses preoperative physiological and psychological preparation, nutritional support, and prophylaxis for anemia, deep vein thrombosis, and broad-spectrum antibiotics. During the operation, maintaining normovolemia, monitoring temperature, and preventing pressure injuries are critical steps. In the postoperative period, nurses play an active and decisive role in vital stages such as monitoring patients in intensive care units to maintain hemodynamic stability, tracking fluid-electrolyte imbalances, monitoring coagulopathy and bleeding, pain management, early enteral nutrition, DVT and delirium prophylaxis, and discharge planning education.
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