CONSOLIDATED INTRODUCTION

CA NASAL SINUS

DefinitionCavum nasi tumor is benign or malignant tumors found in the nasal cavity.Classification, namely:

1. Benign Tumor # From the soft tissue: fibroma, meurofibroma, memigloma. # From the bone tissue: Osteina, giant cell tumor, fibroma dysplasia. # Odentogenik: cysts, dental cysts, ameloblastoma.

2. Tumor praganas # Inverted papilloma

3. Malignant Tumors # From epithelium: squamous cell carcinoma, limfoepitekoma, basal cell carcinoma, silindroma, and so forth. # From the connective tissue: fibrisarkoma, radobuosarkoma. # From the bone tissue: esteosarkoma, kardrosarkoma.

Etiology until the cause is currently unknown. Cigarette suspected of dealing with this disease. Factors suspected as the cause: • Infection with chronic nasal and paranasal sinuses. • Exposure to wood dust in furniture workers. • Contacts with industrial materials, such as nickel, chromium, mustard gas, and isopropanolol. • Thorium dioxide is used as a contrast fluid in the maxillary sinus X-ray examination.

P athophysiology Tree problem:   not clearly known but presumably the result of several industrial substances such as nickel, wood dust, kranum. nasal (respiratory) mendistruksi aggressively grow bone and enlarged pre surgery mass in the nasal cavity-compression-crisis situations destruction inflammatory substances and processes. excessive secretions of patients fear the disease gets worse, the patient looked confused often asked about his illness, pain nasal area, patients seem grimaced. patients with difficulty breathing, severe respiratory tachycardia.

Clinical Manifestations Symptoms of a malignant tumor may resemble chronic rhinitis and sinositis. Early symptoms resemble chronic rinosinositis. Within the tumor causes symptoms of nasal cavity nose, congestion and epitaksis. Symptoms of blocked nose, nasal secretions vary, purulent and smelly when there is infection, secretions are mixed with blood / of epistaxis showed the possibility of malignancy and pain around your nose can be caused by impaired sinus ventilation. While the constant pain and is generally a result of progressive infiltration of malignant tumors. Other symptoms can also arise if the paranasal sinus tumors such as esophageal and platum cheek swelling, loose teeth as well as disorders of the eye and orbital cavity tumors urgent. sinus, generally gives neorologik symptoms.

Examination Support Examination of photographs of the nasal sinus and lung to see any metastases. Made plain to the position photos Caldwell, waters, lateral, and submentoventrikel. Wanted perselubungan picture sinus, soft tissue masses, skelerosis sinus wall, and bone destruction. With tum gram can be seen clearly the expansion of bone tumors and Liquor. Tumograpi kejaringan computer software can show dilation and intracranial biopsy for definite diagnosis can be done through sinoskopi.

Treatment In benign tumors do eksterpasing as clean as possible. In malignant tumors, therapy is a combination of surgery, radiotherapy (or sebelim after surgery), and chemotherapy. Sometimes necessary after the operation with Prosthetic reconstruction (plastic surgery) and rehabilitation.

Prognosis Improved prognosis in patients presenting with primary ethmoid, early lesions are treated with both radiation and surgery, and with a history of other SCCA papilloma.20 upside the head and neck, lymph node involvement is rare and selective lymph node dissection is not recommended. 5-year survival rates are 60-64%, and the recurrence rate is estimated to 31%.

Therapy Benign tumor: Therapeutic options are surgical approaches include: 1) lateral Rinotomi 2) Caldwell-Luc 3) trans-palatal approach Malignant tumors: 1) Surgery: o Resection: Lateral Rinotomi Maksilektomi partial / total (orbital eksenterasi combination or in combination with radical neck deseksi) o Palliative: reduce the size of the tumor (debulking) prior to radiation.

2) Radiation: o Do If surgery is less radical or recurrent o Pre-surgery on a radio-sensitive tumors (eg, Anaplastic carcinoma, undifferentiated)

3) Chemotherapy: o Done on specific indications (eg, very large tumors / inoperable, distant metastases, in combination with radiation)

Nursing Diagnosis

1. Pain associated with compression / nerve tissue destruction and inflammation process.

Intervention1. Perform basic comfort measures (repositioning, massage your back) and stick to entertainment activities (newspaper, radio) 2. Teach pain management client management (relaxation techniques, deep breath, visualization, imagination guidance) 3. Give appropriate analgesic therapy program. 4. Evaluation of pain (scale, location, frequency, duration)

Rational1. Improve relaxation and shifted the focus of attention from the pain clients. 2. Increasing client participation actively in solving problems and increase the sense of self control / independence. 3. Analgesic reducing pain responses. 4. Assessing the development of client problems.

2) Imbalance nutrition less than body requirements related to disability inclusion of nutrition.

I ntervention: a. increase food intake through: keep the cleanliness of the room.b. keep the client's oral hygiene.c. Serve foods that are digested in warm conditions.d. avoid foods that contain lots of gas.

R ational: a. increased appetiteb. mouth of the net increase of appetitec. increased appetited. because it can reduce the sense of comfort

3) The risk of infection associated with decreased immune.

I ntervention 1. Emphasize the importance of oral hygiene. 2. Give antibiotics according to the therapy program. 3. Emphasize the importance of protein-rich nutritional intake in relation to the decrease in endurance.

4. Assess vital signs and symptoms / signs of infection at all body systems.

Rational1. Infections of the cavum nasi can be sourced from ketidakadekuatan oral hygiene. 2. Antibiotics used to treat infections or prophylaxis in patients given the risk of infection. 3. Protein is needed as a composer prekusor antibody formation of amino acids. 4. Immunosuppressive effects of radiation therapy and chemotherapy may facilitate the emergence of local and systemic infections.

4) Lack of knowledge about disease and treatment related to misinprestasi information, lack familiarnya source of information.

I ntrvensi: a. emphasize the importance of good nutritionb. emphasize the need to evaluate the health and adhere to a therapeutic program.c. encouraged to schedule activities with adequate rest periodsd. entertainment activities that can improve patient enjoyed

R ational: a. appropriate maintenance and avoid foods high ammonia helps improve symptoms and help prevent liver damage.b. nature of chronic disease has the potential to be life-threatening complications.c. Adequate breaks down the metabolic needs of the body.d. prevent boredom minimize the anxiety and depression.

REFERENCES

Adams at al (1997), Textbook ENT Diseases, Ed. 6, EGC, Jakarta

Carpenito (2000), Nursing Diagnosis-Application to Clinical Practice, Ed. 6, EGC, Jakarta

Doenges at al (2000), Nursing Care Plan, Ed.3, EGC, Jakarta

Dr Tim. Atopic Dermatitis (1994), Guidelines for Diagnosis and Therapy Sciences ENT Diseases, Dr. Soetomo, Surabaya.

Price & Wilson (1995), Patofisologi-Concept Clinical Disease Processes, Ed.4, EGC, Jakarta