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Samenvatting VMV5- Verpleegkundige methodiek en vaardigheden 5
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Samenvatting VMV5- Verpleegkundige methodiek en vaardigheden 5
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Inhoud1 Oncologie......................................................................................................................................... 6
1.1 Inleiding ................................................................................................................................... 6
1.1.1 Epidemiologie .................................................................................................................. 6
1.1.2 Prognose .......................................................................................................................... 6
1.2 Wat is kanker? ......................................................................................................................... 7
1.2.1 Oncogenese ..................................................................................................................... 7
1.2.2 Beïnvloedende factoren in het ontstaan van kanker ...................................................... 8
1.2.3 Indeling van kanker ......................................................................................................... 9
1.2.4 Erfelijkheid ..................................................................................................................... 10
1.2.5 Preventie ....................................................................................................................... 11
1.3 Diagnosestelling .................................................................................................................... 11
1.3.1 Diagnostische onderzoeken .......................................................................................... 11
1.3.2 Stadiëring....................................................................................................................... 14
1.4 Behandelingsmodaliteiten .................................................................................................... 15
1.4.1 Chirurgie ........................................................................................................................ 16
1.4.2 Radiotherapie ................................................................................................................ 17
1.4.3 Chemotherapie .............................................................................................................. 21
1.4.4 Hormonale therapie ...................................................................................................... 27
1.4.5 Doelgerichte therapie.................................................................................................... 30
1.4.6 Immunotherapie............................................................................................................ 35
1.5 Symptoommanagement ........................................................................................................ 38
1.5.1 Acute nevenwerkingen .................................................................................................. 39
1.5.2 Laattijdige nevenwerkingen .......................................................................................... 50
2 Huid- en wondzorg in de oncologie............................................................................................... 52
2.1 Inleiding ................................................................................................................................. 52
2.2 Onderscheid oncologische wonden – oncologische ulcera................................................... 53
2.3 Oncologische wonden ........................................................................................................... 53
2.3.1 Chirurgie ........................................................................................................................ 53
2.3.2 Radiotherapie: radiodermatitis ..................................................................................... 54
2.3.3 Antitumorale middelen ................................................................................................. 56
2.4 Oncologische ulcera .............................................................................................................. 58
2.4.1 Algemeen: preventie en prevalentie ............................................................................. 58
2.4.2 Kenmerken .................................................................................................................... 58
2.4.3 Gradaties ....................................................................................................................... 58
Pagina 1 van 136
, 2.4.4 Symptomen ................................................................................................................... 59
2.4.5 Wondbeleid ................................................................................................................... 60
2.5 Fixatie van verbanden ........................................................................................................... 61
3 Hematologie .................................................................................................................................. 61
3.1 Hematopoëse ........................................................................................................................ 61
3.2 Hematologische maligniteiten (juist-fout vragen) ................................................................ 61
3.2.1 Leukemie ....................................................................................................................... 61
3.2.2 Multipel myeloom ......................................................................................................... 65
3.2.3 Maligne lymfomen: Hodgkin en non-Hodgkin .............................................................. 67
3.3 Stamceltransplantatie (juist-fout vragen) ............................................................................. 70
3.3.1 Omschrijving .................................................................................................................. 70
3.3.2 Soorten .......................................................................................................................... 70
3.3.3 Verloop .......................................................................................................................... 72
3.3.4 Complicaties → graft-versus-host-ziekte ...................................................................... 73
4 Neurologie ..................................................................................................................................... 75
4.1 Inleiding ................................................................................................................................. 75
4.2 Anatomie en fysiologie van het zenuwstelsel ....................................................................... 75
4.3 Neurologisch onderzoek........................................................................................................ 75
4.3.1 Inleiding ......................................................................................................................... 75
4.3.2 Neurologische observatie .............................................................................................. 75
4.3.3 Technisch neurologisch onderzoek ............................................................................... 77
4.4 Cerebrovasculaire aandoeningen .......................................................................................... 78
4.4.1 Definitie, indeling en voorkomen .................................................................................. 78
4.4.2 Ischemische beroerte of herseninfarct ......................................................................... 79
4.4.3 Hemorragische beroerte of hersenbloeding ................................................................. 81
4.4.4 Postanoxische encefalopathie ....................................................................................... 81
4.5 Intracraniële drukmeting....................................................................................................... 82
4.5.1 De cerebrale bloedflow (CBF) – cerebrale perfusiedruk (CPP) ..................................... 82
4.5.2 Intracraniële druk (ICP).................................................................................................. 82
4.5.3 Intracraniële drukverhoging .......................................................................................... 82
4.5.4 Inklemming .................................................................................................................... 82
4.5.5 Acties bij verhoogde intracraniële druk ........................................................................ 83
4.5.6 Intracraniële drukmeting ............................................................................................... 83
4.6 Epilepsie................................................................................................................................. 84
4.6.1 Definitie-kenmerken-voorkomen .................................................................................. 84
4.6.2 Oorzaken van de epileptische aanval ............................................................................ 84
Pagina 2 van 136
, 4.6.3 Soorten epileptische aanvallen ..................................................................................... 85
4.6.4 Diagnose ........................................................................................................................ 86
4.6.5 Behandeling ................................................................................................................... 87
4.7 Ziekte van Parkinson ............................................................................................................. 88
4.7.1 Parkinsonisme versus de ziekte van Parkinson ............................................................. 88
4.7.2 Oorzaken – voorkomen ................................................................................................. 88
4.7.3 Symptomen ................................................................................................................... 88
4.7.4 Diagnose ........................................................................................................................ 89
4.7.5 Behandeling ................................................................................................................... 89
4.8 Multiple sclerose (MS)........................................................................................................... 90
4.8.1 Definitie-oorzaken-voorkomen ..................................................................................... 90
4.8.2 Symptomen ................................................................................................................... 91
4.8.3 Diagnose ........................................................................................................................ 92
4.8.4 Behandeling ................................................................................................................... 92
4.9 Amyotrofe lateraal sclerose (ALS) ......................................................................................... 93
4.9.1 Definitie-oorzaken-voorkomen ..................................................................................... 93
4.9.2 Symptomen ................................................................................................................... 93
4.9.3 Diagnose ........................................................................................................................ 93
4.9.4 Behandeling ................................................................................................................... 93
4.9.5 Verpleegkundige zorg bij patiënten met ALS ................................................................ 93
4.10 Neurologische tumoren......................................................................................................... 94
4.10.1 Inleiding ......................................................................................................................... 94
4.10.2 Primaire hersentumoren ............................................................................................... 94
4.10.3 Secundaire hersentumoren of cerebrale metastasen................................................... 95
4.10.4 Paraneoplastische neurologische syndromen............................................................... 95
4.11 Normale drukhydrocefalie .................................................................................................... 95
4.11.1 Definitie-soorten-voorkomen........................................................................................ 95
4.11.2 Symptomen ................................................................................................................... 95
4.11.3 Diagnose ........................................................................................................................ 95
4.11.4 Behandeling ................................................................................................................... 95
4.12 Leven na een hersenletsel ..................................................................................................... 95
5 Zorg rond het levenseinde ............................................................................................................ 96
5.1 Inleiding ................................................................................................................................. 96
5.2 Palliatief zorgconcept ............................................................................................................ 96
5.2.1 Wat is palliatieve zorg ................................................................................................... 96
5.2.2 Wie is palliatief .............................................................................................................. 96
Pagina 3 van 136
, 5.2.3 Het palliatieve zorgcontinuüm ...................................................................................... 97
5.2.4 Het ziektestadium bepalen............................................................................................ 97
5.2.5 De palliatieve zorg indicator tool (PICT) ........................................................................ 98
5.3 Wetgeving palliatieve zorg (NK) ............................................................................................ 99
5.4 Palliatief landschap................................................................................................................ 99
5.4.1 Federatie palliatieve zorg Vlaanderen........................................................................... 99
5.4.2 Netwerken palliatieve zorg............................................................................................ 99
5.4.3 De verschillende settings............................................................................................... 99
5.5 Begrippenkader medisch begeleid sterven ......................................................................... 102
5.5.1 Al of niet curatief of levensverlengend handelen ....................................................... 102
5.5.2 Pijn- en symptoomcontrole ......................................................................................... 102
5.5.3 Actieve levensbeëindiging ........................................................................................... 103
5.6 Vroegtijdige zorgplanning ................................................................................................... 103
5.6.1 Wat is vroegtijdige zorgplanning? ............................................................................... 103
5.6.2 Doelstellingen .............................................................................................................. 104
5.6.3 Wat wordt er besproken? ........................................................................................... 104
5.6.4 Wanneer dit gesprek voeren? ..................................................................................... 104
5.6.5 Dynamisch proces........................................................................................................ 105
5.6.6 Aanpak ......................................................................................................................... 105
5.6.7 Wie is betrokken? ........................................................................................................ 106
5.6.8 Waarom vaak uitgesteld? ............................................................................................ 106
5.6.9 Wilsverklaringen .......................................................................................................... 106
5.7 Palliatieve zorg in de praktijk .............................................................................................. 107
5.7.1 Fysieke comfortzorg en symptoomcontrole ............................................................... 107
5.7.2 Psychische ondersteuning ........................................................................................... 117
5.7.3 Sociale begeleiding ...................................................................................................... 118
5.7.4 Spirituele dimensie ...................................................................................................... 118
5.8 Terminale zorg in de praktijk ............................................................................................... 119
5.8.1 Inleiding ....................................................................................................................... 119
5.8.2 Het moment van overleiden voorspellen .................................................................... 119
5.8.3 Aandachtspunten voor een terminaal zorgbeleid....................................................... 120
5.8.4 Comfortzorg de laatste 24u ......................................................................................... 121
5.8.5 Beslissingen rond het levenseinde .............................................................................. 122
5.8.6 Euthanasie ................................................................................................................... 123
5.8.7 Laatste zorg aan de overledene .................................................................................. 125
5.8.8 Na het overlijden ......................................................................................................... 125
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