Oncology Practice in Nursing - Essay Example

Nursing 200: Oncology Practice in Nursing Year Introduction: The nursing process is a deliberate approach to solve problems in the clinical area that helps the nurse to rationally approach the situations, critically analyze them, allowing considerations of various possibilities and solutions to the problem. By convention the nursing process comprises of steps, namely, assessment and diagnosis, planning, implementation, and evaluation (Needleman, J., Kurtzman, ET., and Kizer, KW., 2007). In this assignment, a topic related to adult oncologic nursing will be dealt with through the nursing process approach utilizing the evidence from current nursing research literature so the best nursing practice in this specific area of oncologic nursing practice is established. Review of Literature: Stanley in her note, "Partners in Cancer Care" published from Oncology Nursing Society has highlighted the importance and availability of best evidence for managing common cancer symptoms. Evidence in support of nursing practice in this area is known to be accumulating exponentially, which demands utilization of these evidences in the clinical practice. Literature consistently demonstrates identifiable evidence base for oncology nursing and the impacts of these evidence-based interventions in patient outcomes as far as the oncology nursing practice is concerned. It is also important to evaluate the effectiveness of these interventions used for cancer symptom management, so recommendations for future practice can be made to result in improvement in patient care that can be measured. (Stanley, KJ., 2006). Nausea and vomiting continues to be significant side effects of cancer therapy that add to the distress of the patients. Optimal antiemetic prophylaxis in cancer patients receiving chemo and radiotherapies has been the subject of many trials. The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC) in their review presents the findings up to the year 2004. Classically, the chemotherapeutic agents have been classified with high, moderate, low, and minimal emetogenic potentials. The current recommendations support a three-drug regimen that includes a 5-HT3 antagonist such as ondansetron 32 mg, dexamethasone 12 mg, and aprepitant 125 mg on day 1, followed by dexamethasone 8 mg daily on days 2 to 4, and aprepitant 80 mg on days 2 to 3 provides a complete response of no emesis with no use of rescue antiemetic in prevention of vomiting and nausea induced by chemotherapy of high emetogenic risk. Likewise, there are recommendations for moderate risk, low risk, breakthrough, and anticipatory vomiting. Apart from certain specific cases, the incidence of emesis or nausea would depend on cycle length, patients psychological condition, and effective prechemotherapy prophylaxis and treatment during the therapy. In moderate cases, both acute and delayed emetogenic response responds to a 5-HT3 receptor antagonist and dexamethasone (MASCC, 2006). OGrady et al. in their "Guidelines for the Prevention of Intravascular Catheter-Related Infections" critically analyze the scientific background in insertion and maintenance guidelines of intravascular catheters in order to prevent infection. Due to disease, malnutrition, chemo and radiotherapy, infections are frequent complicating events in cancer patients. The nursing care should be directed to prevent infection at any cost (O’Grady, NP et al., 2002). Evidence-based recommendations for preventing catheter-related infections include education and training of nursing staff, sterile precautions during insertion, skin antisepsis, avoidance of routine replacements of central venous catheters, and using antiseptic or antibiotic impregnated short-term central venous catheters (Johnson, MB., 2003). Nursing Process: Before going into the literature review, the clinical scenario has to be examined in brief. This is in relation to the management of an adult female post breast cancer mastectomy who had been admitted to the unit for chemotherapy. She had been receiving a chemotherapy regimen, and the management was complicated by nausea and vomiting associated with chemotherapy. Moreover, there has been a question about management of her intravenous line and prevention of any infective event that may complicate her clinical condition further. To begin with relevant literature will be examined to discern the best nursing practice through a nursing process approach (O’Grady, NP et al., 2002). Assessment: This process would include assessment of the patient and the treatment regimen and the modes of administration. A verification of the required dose depending on the patients body surface area is also a must. The intravenous catheter and the surrounding skin need to be inspected and examined with special note of patency, evidence of infection, flow, and chances of extravasation. The assessment, thus, must include absence of blood return from the intravenous catheter, resistance of flow of the intravenous fluid, and swelling or pain at the site, along with assessment of alternate venous sites including neck veins (Fawcett, J., Newman, DML., and McAllister, M., 2004). The history of nausea and vomiting with previous chemotherapy would be assessed. To assess anticipatory vomiting, the patients cognitive functions need to be assessed. The diagnoses that were framed in the given scenario are, (a) chemotherapy, (b) suspected blocked peripheral intravenous catheter, (c) need to insert a new intravenous line, (d) anticipation of nausea (O’Grady, NP et al., 2002) (Cooper, R. and Gent, P., (2002). Planning: Therefore, in this scenario, inserting and securing a patent, easy flowing intravenous line in a very aseptic manner without chances of extravasation and prevention of anticipatory, immediate, and delayed nausea and vomiting with goals of care being no nausea or vomiting before, during, or after chemotherapy will be most important. A new line would need to be inserted and secured and the patient must be assured and if necessary given a benzodiazepine. Followed by this, appropriate antiemetic will be injected. During the chemotherapy, the patient would be observed for extravasation and nausea and vomiting, so rescue medications can be administered. The nurse must be able to anticipate the occurrence of nausea and take adequate precautions against that (Cooper, R. and Gent, P., 2002). Implementation: Everything done in this stage in terms of care given will be documented in the treatment sheet. After a thorough examination, when it was confirmed that the existing intravenous line was blocked indicated by no free flow, swelling in the pericatheter skin, redness around that area, and recording of these findings, a decision to take out the catheter was taken. A new site would be chosen, and plan for central venous catheter could be considered given her future cycles of chemotherapy. A maximal sterile barrier precaution would be used with appropriate hand washing, and 2% chlorhexidine preparation for skin antisepsis would be used in the form of paint, and it would be allowed to dry. A suitably sized intravenous catheter would be chosen, inserted in a vein with appropriate technique and fixed to skin, and the limb would be supported on a splint. This would be connected to saline drip (O’Grady, NP et al., 2002). Following this, ondansetron 32 mg, dexamethasone 12 mg will be injected along with oral aprepitant 125 mg will be given for acute prevention, and chemotherapy would be started, which has been ascertained to be a high risk chemotherapy. The patient would need dexamethasone 8 mg daily on days 2–4 and aprepitant 80 mg days 2 and 3 (MASCC, 2006). Evaluation: The patient would remain free of signs and symptoms of vomiting, nausea, infection, extravasation, or inflammation. She would be able to take oral intake, appear adequately hydrated with no fever, pain or swelling at the site, cooperative, and without any distress (Hooke, MC., 2005). Conclusion: This assignment is an example how the evidence from research can be employed to improve care of a patient in oncology nursing, and this format can be applicable in other areas of oncology nursing care in all stages of cancer diagnosis and treatment, and till date, this can be shared as the best guideline for nursing care as far as chemotherapy care is concerned. This may also be shared with other nurses, so a change in existing practice can be implemented. References Cooper, R. and Gent, P., (2002). An overview of chemotherapy-induced emesis highlighting the role of lorazepam. International Journal of Palliative Nursing: 8(7), 331-335. Fawcett, J., Newman, DML., and McAllister, M., (2004). Advanced Practice Nursing and Conceptual Models of Nursing. Nurs Sci Q,; 17: 135 - 138. Hooke, MC., (2005). Clinical Nurse Specialist and Evidence-Based Practice: Managing Anthracycline Extravasation. Journal of Pediatric Oncology Nursing; vol. 22: pp. 261 - 264. Johnson, MB., (2003). Oncology Nursing and Integrative Care: A New Way of Being. Integr Cancer Ther; 2: 353 - 357. Needleman, J., Kurtzman, ET., and Kizer, KW., (2007). Performance Measurement of Nursing Care: State of the Science and the Current Consensus. Med Care Res Rev; 64: 10S - 43S. O’Grady, NP et al., (2002). Guidelines for the Prevention of Intravascular Catheter-Related Infections. Pediatrics 2002;110;e51, 1-24. Stanley, KJ., (2006). Oncology Nursing Society: Evidence-Based Practice. J. Oncol. Pract; 2: 142. The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC) (2006). Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Annals of Oncology 17: 20–28. Read More