NSB334 Caring for a patient with Cancer Assignment Sample

Integrated Nursing Practice 

Prevention and Screening

1. One of the cancer prevention programs that are active in Australia is the National Human Papilloma Vaccination Program. In this program there is seroprevalence among males and vaccination is provided to the females up to the age of 26 years of age which provides protection from types 6, 11, 16 and 18 (Pillsbury et al., 2017). This is one of the few programs in the world that provides protection to males for particular cancer. The program started in 2007 where under universal vaccination of girls aged 12-13 years using 3 doses of quadrivalent HPV vaccine and the year 2013 the boys of the same age were targeted (Pillsbury et al., 2017).

Reference

Pillsbury, A. J., Quinn, H. E., Evans, T. D., McIntyre, P. B., & Brotherton, J. M. (2017). Population-level herd protection of males from a female human papillomavirus vaccination program: evidence from Australian serosurveillance. Clinical Infectious Diseases, 65(5), 827. DOI: 10.1093/cid/cix436.

2. Some cancers can be detected early and screening can help the prognosis of the disease and the two different types of cancer that can be detected by screening are breast cancer and prostate cancer.

For breast cancer, the screening can vary from regular self-check up and mammography but the recent advances have paved the way to biochemical methods for molecular testing which can sense the biochemical markers which for breast cancer. There are a number of biomarkers for breast cancer and the one which is most commonly looked for and tested are BRCA 1 and 2, they are antioncogenes which can be seen in women who have a genetic predisposition to breast cancer (Hasanzadeh, Shadjou & de la Guardia, 2017). A sandwich- based amperometric sensor that immobilizes the anti-BRCA 1 antibody on the surface of GCE modified thionine and polyvinylpyrrolidone protected graphene (Hasanzadeh, Shadjou & de la Guardia, 2017).

For prostate cancer, the tool used is the detection of serum prostate-specific antigen. The antigen is secreted by the epithelium of the prostate which can be detected in the blood of the patient if there is an early stage of prostate cancer (Van Leeuwen, Roobol & Stricker, 2018).

Reference

Hasanzadeh, M., Shadjou, N., & de la Guardia, M. (2017). Early stage screening of breast cancer using electrochemical biomarker detection. TrAC Trends in Analytical Chemistry, 91, 68. DOI:10.1016/j.trac.2017.04.006

Van Leeuwen, P. J., Roobol, M. J., & Stricker, P. D. (2018). Early detection and screening for prostate cancer. Evidence-Based Urology, 257. DOI:10.1002/9781119129875.ch22.

Diagnosis & Treatment

3. The signs and symptoms as explained by Harold are a pain in his chest and breathlessness.

The pain is usually caused by the progression of the disease though it can be caused reasons and it can be present in more than one site of the chest. The pain can be referred to as well as local in nature depending on the location of the tumour. The pain in lung cancer can be either hypoxic or neurogenic, the former in which the pain is caused when the tissue does not get enough oxygen which in neurogenic the pain is caused when the tumour presses on the nerve ending (Mercadante & Vitrano, 2010). The pain is transmitted to the central nervous system by the means of neurotransmitters and the sensation of pain occurs.

In the case of lung cancer, the lung capacity of the patient decreases which can be due to the fact that there is the presence of a tumour causes hypoxia and cause air hunger which leads the patient to gasp for air and lead to breathlessness (Broglio, 2017). The respiratory muscles overwork to compensate for less air and the patient feels breathless and tired.

References

Broglio, K. (2017). Pathophysiology and Mechanisms of Dyspnea. The Clinical Pocket Guide to Advanced Practice Palliative Nursing, 15.

Mercadante, S., & Vitrano, V. (2010). Pain in patients with lung cancer: Pathophysiology and treatment. Lung Cancer, 68(1), 11. DOI:10.1016/j.lungcan.2009.11.004.

4. a. Non-small cell lung cancer on a radiograph is seen as a nodule like lesion and the size of the lesion depends on the stage and grade of cancer. The most commonly used staging and grading are TNM grading and staging. The cohorts have shown that the metagenes form two distinct types of cancer in the patients, that is, adenocarcinoma and squamous cell carcinoma (Zhou et al., 2018). The formation of lesions in the lungs encroaches into the normal lung tissue and reduces the lung capacity making it difficult for the person to breathe.

Reference

Zhou, M., Leung, A., Echegaray, S., Gentles, A., Shrager, J. B., Jensen, K. C., ... & Gevaert, O. (2018). Non–small cell lung cancer radiogenomics map identifies relationships

between molecular and imaging phenotypes with prognostic implications. Radiology, 286(1), 307. DOI: 10.1148/radiol.2017161845.

b. beyond the standard of care chemoradiation the unresectable stage III non-small cell lung cancer have failed to show any improvement when the concurrent chemotherapy was given along with radiotherapy (Ko, Raben & Formenti, 2018). The quality of life of a person suffering from cancer is altered but in the case of Mr Harold when he is given both concurrent chemotherapy and radiotherapy, he has developed dysgeusia and this altered his nutrition. There is an established connection between nutritional deficiency and quality of life as without proper nutrition physical and mental health of the patient also the immunity of the patient (Pola?ski et al., 2017).

References

Ko, E. C., Raben, D., & Formenti, S. C. (2018). The integration of radiotherapy with immunotherapy for the treatment of non–small cell lung cancer. Clinical Cancer Research, 24(23), 5792. DOI: 10.1158/1078-0432.CCR-17-3620.

Pola?ski, J., Jankowska-Pola?ska, B., Uchmanowicz, I., Chabowski, M., Janczak, D., Mazur, G., & Rosi?czuk, J. (2017). Malnutrition and Quality of Life in Patients with Non-Small-Cell Lung Cancer. Advances in Experimental Medicine and Biology, 16. DOI:10.1007/5584_2017_23

c. Place of dwelling affects a person and the challenges faced by a cancer patient are more profound and the geographic location is considered as a health disparity. The challenges faced by the patient are he is farther from a tertiary level care centre for his treatment and he is far from his son and that makes him sad and alone (Salehi, Frommolt & Coyne, 2019). The challenges faced by Mr Harold is not just an individual factor but also a systemic factor, the former is the socioeconomic or other factors due to which he is living there. The latter is the fault in the system that there are no adequate facilities to cater to the needs of all the patients.

References

Salehi, A., Frommolt, V., & Coyne, E. (2019). Factors affecting provision of care services for patients with cancer living in the rural area: An integrative review. The Australian Journal of Cancer Nursing, 20(1), 3 and 11. DOI: 10.33235/ajcn.20.1.3-13

5. a. Standard three states the policies and procedures that are in place to make sure that healthcare-associated infections are reduced and that is to make sure that there the surfaces are clean and the hand hygiene of the healthcare providers is maintained (Australian Commission on Safety and Quality in Health Care, 2012). A patient like Mr Harold who is suffering from cancer and is on chemotherapy and radiotherapy would reduce the immunity of the patient. It is the reason that the person is more prone to infections.

References

Australian Commission on Safety and Quality in Health Care. (2012). Safety and Quality Improvement Guide Standard 3: Preventing and Controlling Healthcare Associated Infections. Page, 15 Sydney. ACSQHC, 2012.

b. 1. Nausea and vomiting: it is an acute adverse effect that can be seen in patients undergoing chemotherapy. The treatment usually releases substance P which effects neurokinin-1 which induces nausea and vomiting (Nurgali, Jagoe & Abalo, 2018).

2. Chemotherapy-induced neuropathy- it is a long-term adverse effect of the chemotherapeutic drugs. The drugs which are given as a part of chemotherapy causes the reactive substance to be in circulation and enter the blood-brain barrier and can cause a cognitive defect in the patient and the effect can be both central and peripheral (Nurgali, Jagoe & Abalo, 2018).

References

Nurgali, K., Jagoe, R. T., & Abalo, R. (2018). Editorial: adverse effects of cancer chemotherapy: anything new to improve tolerance and reduce sequelae? Frontiers in Pharmacology, 9. DOI:10.3389/fphar.2018.00245

c. 1. Nausea and vomiting can be managed by the nursing intervention in which the patient can be administered with anti-emetic drug-like domperidone. The administration of the drug can be either oral or intravenous.

2. For the neuropathy, a multi-disciplinary approach for the management of the patient is necessary and proactive rehabilitation can be considered for the patient (Knoerl et al., 2020).

d. The interventions for both the adverse conditions should be evaluated and the goals made should be SMART. For nausea and vomiting, the patient should be less nauseous after the chemotherapy and the use of antiemetic and will show the effectiveness of the drug. The neuropathy since is it is a long term adverse effect the evaluation of the intervention should be done accordingly. It can be evaluated by subjecting the patients to functional tests for testing his gross and fine motor skills (Knoerl et al., 2020).

References

Knoerl, R., Gilchrist, L., Kanzawa-Lee, G. A., Donohoe, C., Bridges, C., & Lavoie Smith, E. M. (2020). Proactive Rehabilitation for Chemotherapy-Induced Peripheral Neuropathy. Seminars in Oncology Nursing, 150983. DOI:10.1016/j.soncn.2019.150983.

6. a. the normal serum calcium level in an adult is 8.6-10.2mg/dL. The excessive calcium in the serum of the blood of the patient is toxic to cells where the permeability of the cell membrane and the calcium pump activity is affected. The clinical signs that can be seen in the patient with a high level of serum calcium level can be anorexia and lethargy (Schenck et al., 2016).

b. 1. Fluid therapy: depending on the serum calcium level normal saline can be administered with the patient. The normal saline is given for the effective removal of the calcium by the kidneys (Schenck et al., 2016).

2. diuretics: the use of diuretics aid in calciuresis so that there is not dehydration at the same time there is maximum removal of the calcium from the body via kidneys (Schenck et al., 2016).

References:

Schenck, P. A., Chew, D. J., Nagode, L. A., & Rosol, T. J. (2016). Disorders of calcium: hypercalcemia and hypocalcemia. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice, 4, 140 and 161. DOI: 10.1016/B0-72-163949-6/50009-6.

7. Specific: reduction in the occurrence of nausea

Measurable: the frequency reduction

Attainable: it can be attained by the administration of the drug

Realistic: it is realistic to reduce nausea after the administration of the chemotherapeutic drug

Time: after each chemotherapy

Specific: reduction in the level of serum calcium

Measurable: serum calcium level can be measured by a blood test

Attainable: drug administration can lower the level of serum calcium

Realistic: it is a realistic goal

Time: by the course is over the serum calcium returns to normal

Providing Patient Centred Psychosocial Care

8. 1. Interpersonal communication: It is the communication between the healthcare provider and the patient. The rapport should be created with the patient so that he is not stigmatized about the condition and the actual condition can be deduced. The communication and the cessation should be customized and the guideline should be adhered to (Hamann et al., 2018). The communication, in this case, should be in person not in a group where the patient is called upon.

2. The communication between family and the healthcare providers is important and the healthcare providers should have knowledge of the clinicians so that they can effectively make the family members understand the stigma associated. This will make the family members supportive of the cessation method and as well will improve the outcome for the patient (Hamann et al., 2018).

References:

Hamann, H. A., Ver Hoeve, E. S., Carter-Harris, L., Studts, J. L., & Ostroff, J. S. (2018). Multilevel Opportunities to Address Lung Cancer Stigma across the Cancer Control Continuum. Journal of Thoracic Oncology, 13(8), 1070. DOI:10.1016/j.jtho.2018.05.014.

9. The patient is from a low socio-economic background and he needs someone with compassion to help him through the condition. As a nurse, it is required that there is an element of compassion as it is the core of the profession. As a nurse, I would lend an ear and listen to the patient and help him any way I can. There are many support groups that can help him and I will personally make sure that if required he goes to one and I am available to talk to him when he wants.

10. a. Palliative care is the care that is provided to the terminally ill patient or the patients with the life-limiting disease to improve the quality of life of the patients and it includes treatment of pain among other aspects like physical, psychosocial and spiritual (World Health Organization, n.d). In a life-limiting condition the perspective of the patient towards all the aspects of life changes, the patient finds psychological, social and spiritual support.

b.

1. Role of nurses in palliative care: the duty of nurses is to be physically and emotionally available for the patient whenever it is required. Other than the medical role which they play in the provision of care, they have to compassionate and they advocate for the patients when the patients are not able to do it for themselves (Sekse, Hunskår & Ellingsen, 2017). The nurses act as the coordinator of care for the patients and they are expected to do what needs to be done, they are actively present. The nurses should be supportive of the patient and help in any way they can and handle the ethical dilemma which is seen most commonly at the end of life care patients (Sekse, Hunskår & Ellingsen, 2017).

2. Supportive care personnel works on an outpatient basis in the form of palliative care clinics which can provide palliative care to Mr Harold and as he is staying in a rural setting, the voluntary palliative care clinic available nearest to him can be sought out (Bruera, 2016). With this, he can have social support as he mentions his son does not visit him often.

c. Mr Harold feels the pain in his chest due to the presence of tumour lesions in his lungs. The pain can be referred to as well as local in nature depending on the location of the tumour. The pain in lung cancer can be either hypoxic or neurogenic, the former in which the pain is caused when the tissue does not get enough oxygen which in neurogenic the pain is caused when the tumour presses on the nerve ending (Mercadante & Vitrano, 2010). The pain is transmitted to the central nervous system by the means of neurotransmitter and the sensation of pain occurs.

In the case of lung cancer, the lung capacity of the patient decreases which can be due to the fact that there is the presence of a tumour causes hypoxia and cause air hunger which leads the patient to gasp for air and lead to breathlessness (Broglio, 2017). The respiratory muscles overwork to compensate for less air and the patient feels breathless and tired.

d. For the management of pain in lung cancer patients opioid analgesics is the recommended course of treatment but it can lead to dependency and the dose should be given and regulated and it can be given along with low-dose corticosteroids which can help in the reduction of the pain (Bhattacharya, Dessain & Evans, 2018).

In advanced cases like that of Mr Harold, dyspnea is one of the most common signs for the management as a palliative measure thoracentesis with the placement of drain and pericardiocentesis with a pericardial drain can help Mr Harold to breathe a little better and his quality of life can improve (Bhattacharya, Dessain & Evans, 2018).

References

Bruera, E. (2016). The Palliative care team. Oxford American Handbook of Hospice and Palliative Medicine and Supportive Care, 277.

Broglio, K. (2017). Pathophysiology and Mechanisms of Dyspnea. The Clinical Pocket Guide to Advanced Practice Palliative Nursing, 15.

Bhattacharya, P., Dessain, S. K., & Evans, T. L. (2018). Palliative Care in Lung Cancer: When to Start. Current Oncology Reports, 20(11), 90. DOI:10.1007/s11912-018-0731-9.

Mercadante, S., & Vitrano, V. (2010). Pain in patients with lung cancer: Pathophysiology and treatment. Lung Cancer, 68(1), 11. DOI:10.1016/j.lungcan.2009.11.004.

Sekse, R. J. T., Hunskår, I., & Ellingsen, S. (2017). The nurse’s role in palliative care: A qualitative meta-synthesis. Journal of Clinical Nursing, 27(1-2), e24, 32 and 33. DOI:10.1111/jocn.13912

World Health Organization. (n.d.). WHO Definition of Palliative Care. Retrieved from: https://www.who.int/cancer/palliative/definition/en/.

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