Nursing Practice: Colorectal Cancer - Essay Example

?NSB025 Nursing Practice in Context 5 INTRODUCTION Colorectal cancer is caused by an abnormal separation of cells in the colon of a human being (Radtke, 2005). Due to the level of damage caused by this disease, both healthy and persons with the symptoms, require regular screening. An early diagnosis helps in removal of polyps way before they grow into cancerous cells. John’s medical history In the case study, John is diagnosed with colorectal cancer. In order to prevent further spread of this terminal disease, he agrees to undergo a surgery and later a chemotherapy treatment by fluorouracil. He therefore has to be educated on how the process of chemotherapy takes place and the importance of maintaining good oral hygiene. Even though John follows all the advice from the doctors, he still developed ulcers in his mouth due to chemotherapy. In response to these side effects, the nurses intervene to prevent the worsening of the side effects. Side effects of fluorouracil Fluorouracil is, a drug used in the treatment of cancer. It performs by making an irremediable reserve of thymidylate synthase. It interrupts the action of enzyme blocks hence hinders synthesis of pyrimidine thymidine which is a nucleoside for DNA replication (Winawer et al, 2003). Chemotherapy is generally used to kill any rapidly growing cells in the body thus killing the cancerous cells (De vita, 2001). Such rapidly multiplying cells are found in the mouth linings hence they fall victims to this chemicals. The reaction between the healthy cells in the mouth linings and the fluorouracil leads to formation of sores and ulcers. Since the occurrences of sores are hard to prevent, the extent of damage caused by the sores can be limited. In order to counter the side effects of chemotherapy, the patients need to be fully educated on the importance of good oral hygiene. They should be encouraged to regularly brush their teeth in order to prevent accumulation of germs in the mouth. In addition, the nurses should intervene so that the patient is given good medical care. They should ensure that the patient gets full nutritional supplements and he/she is free from pain. Discussed below are importance of maintaining good oral hygiene and the nursing interventions of preventing the side effects:- Oral hygiene education as a method of preventing side effects of chemotherapy Oral hygiene entails keeping both mouth and teeth clean as a way of preventing bad breath and tooth decay. It not only involves brushing the teeth but also maintaining the whole mouth including the tongue, gum and the inner skin of the mouth. In the case study, John was constantly advised to have a good oral hygiene before going for the chemotherapy sessions. This is because; the cancer drugs contain some reactive chemicals, which are designed to kill any rapidly growing cells (Bradbury, 2007). In the process of eliminating the rapidly growing cells, these drugs encounter mouth cells that are also multiplying rapidly. The healthy cells in the mouth react with the chemical substances in the drugs hence resulting into a chemical reaction, which damages the skin of the mouth. This chemicals cause sores in the mouth and in the throat, a condition referred to as mucositis. The chemical substances in the drugs make the tissues dry, soft and easily irritable hence it may result to bleeding gums (Lewis, 2007). If oral hygiene were not maintained, the mouth germs would infect the sores. Such germs would lead to further complications for the patient because mouth infections would result to administering of other drugs, which may affect the functioning of the cancer drugs (Drasdo, 2001). In the case study, John is advised to brush his teeth regularly; due to the softness of his gums, he is told to be gentle while brushing and use a toothbrush with soft brittles. He is also advised to ensure the whole mouth including the tongue and the gums are properly cleaned. By ensuring good oral hygiene, there will be minimum damage on John’s mouth hence the worsening of the mouth sores would be curbed. However, this method of using oral hygiene to reduce side effects of chemotherapy has been found to be ineffective in some cases. This is because brushing the teeth regularly does not fully eliminate the presence of germs in the mouth. In addition, some people are hype reactive to the drugs used in chemotherapy hence oral hygiene would not fully prevent mouth sores from occurring. In the case study, John maintained a good oral hygiene as advised by the doctors and yet the mouth sores and ulcers appeared after three weeks. This proves the level of ineffectiveness in this method. In a survey carried out on cancer patients going through chemotherapy found out that patients with good oral hygiene had less mouth sores compared to those who did not maintain good oral hygiene (Jensen, 2006). Through this research, a conclusion was drawn linking good oral hygiene to reduced side effects of chemotherapy. It is therefore advisable that all patients undergoing the chemotherapy to be fully informed and educated on the importance of good oral hygiene since it plays a major role in preventing further problems. Nursing intervention to provide pain relief for John’s sore mouth A nursing intervention is any action taken by a nurse to implement the nursing care plan. It may be planned before treatment starts or may be prompted by the patient’s response to medication. For John’s case, the nursing intervention is prompted by the mouth sore developed after him undergoing chemotherapy. The pain he is going through therefore requires some intervention from his nurses. The following are the interventions to reduce pain for John’s sore mouth:- Issuing a pain relieving medicine Pain relieving medicines play a big role is calming the nerve endings of the sensitive areas hence they assist patients to feel better. Though most of them are short-term pain relievers, their importance cannot be actually ignored. Therefore, a nurse can provide pain relief to John by giving him pain-relieving drugs. However, some pain relieving medicines come with side effects due to their reactions with fluorouracil. These side effects include headache, vomiting, nausea etc in some patients. Such side effects have limited the use of painkillers by nurses when caring for their patients (National cancer institute, 2010). The nurse should therefore be conversant with the various side effects caused by the reaction of the painkillers and the chemotherapy drugs. In the case study, giving John the right painkiller can help to ease the pain he would be feeling due to the mouth sores. Eating cold food or those that are at room temperature Low temperatures have been proved to reduce the transmission of pain in the nerve ending to the brain. Due to cold temperatures, the amount of blood in the nerve endings is reduced, the transmission of pain impulse to the brain is limited hence the painful part of the body would feel better. With cold food in the mouth, such as ice cream, cold soft drinks etc, the pain caused by the sores would be decreased (Hanna, 2001). A nurse can therefore use this method to reduce the pain in John’s mouth. This method of using the numbing effect has faced several setbacks. Among them are; the patient may be unwilling to eat such cold foods or in some cases, the patient may develop allergic reactions from this low temperature foods. In addition, this method is ineffective because it requires the patients to eat continuously. However, for temporary pain relief, a nurse can use this method on John however unpleasant it may be. The bottom line should be to help him ease the pain in his mouth. Nursing intervention for maintaining adequate nutrition for John’s difficulty eating Nutrient supplement tablets John requires many nutrients in order to prevent his mouth condition from worsening. He also needs nutrients for his body to be able to fight the adverse reactions caused by fluorouracil (Fearon, 1990). Considering his mouth condition, he may not be able to consume all these nutrients through the mouth. In addition, chemotherapy may have interfered with his digestive system hence the absorption of nutrients from consumed foods would not be as effective as it should be. Therefore, the nurses should supplement his nutrition requirements by giving him multi-vitamin tablets. These tablets contain a variety of nutrients that would help his body eradicate the sores in the mouth quickly (Powell, 2001). An important advantage of this tablet is that the body easily and quickly absorbs all nutrients. However, the issuance of these multi-vitamins should take into considerations the possible side effects as well as possible allergic reactions the patient may develop after taking them. The nurses can therefore use nutrient supplements to provide for Johns nutritional needs considering the facts that he has a problem in eating food. Eat soft and soothing foods Due to the nature of John’s mouth, it requires tender care to prevent further damage of the mouth tissues. Therefore, soft and nutritious foods such as milk shakes, pudding, baby food, boiled eggs, yoghurt etc would be of help (National cancer institute, 2010). Such foods will not only supply the necessary nutrients but will also help in prevention of the worsening of the condition. Avoid irritating acidic and spicy foods and juices Acidic foods, such as tomatoes, worsen the situation of the sore by causing a burning effect on the wound hence preventing the wound from generate a skin layer (Fodder, 2001). Doctors have proven that spicy foods, for example pepper added food, contain a lot of acidity and can cause damage to even healthy skin. The scouring effect in the acidic foods exposes the sores to more germs hence increasing the number of infections on the mouth. In addition, acidic foods cause a lot of pain to the patient when in contact with the wound. In order to allow the sores in John’s mouth to heal quickly, he should not be allowed to taste any acidic or spicy foods. This should be restricted whether John is at home or in hospital. The communication should also be made to his caregivers as a way of creating a sense of accountability. Moisturized food Moisture makes the food soft and easy to consume. With the help of moisture, it becomes easy for food to be chewed and be swallowed because it is softer compared to dry food. John should be served with a moisturized food in order for him to avoid damaging his soft skin tissue in the mouth. Nutritious moisturized foods may include mashed potatoes, non-acidic fruit juices, green grams etc. If served with a dry and rough food, for example popcorn, hard biscuits and crisps, the sores in his mouth would worsen because of the damage cause by roughness of these foods. The nurses should therefore ensure that the level of moisture content in the food is appropriate for John’s consumption. This advice should also be passed on to his people. Drink plenty of water Water is important because it ensures constant hydration of the mouth. It therefore prevents the drying of the mouth, which would have resulted to cracking of the lips and skin in and around the mouth. John should be encouraged to take a lot of water because water plays a key role in ensuring the body quickly repairs the damaged tissues (Mc Cathy, 1999). Hence, with plenty of water, John would be able to heal his mouth sores quickly. Therefore, the nurses taking care of John should ensure that he is constantly encouraged to drink a lot of water. Nutritious foods The condition of the mouth tissues of John shows a degeneration of the skin tissues hence nutritious foods would be of importance. John should be given foods with less saturated fats and salts so that he can maintain good health. Being a man in his 60’s saturated fats, for example cholesterol, would lead to heart complications and other health problems. In addition, foods rich in minerals such as fish and other seafoods would help maintain his health. Moreover, fruits and vegetable are an important source of vitamins for John’s health. Vitamins are important for the prevention of various illnesses and for quick generation of the damaged skin. In addition, vitamins acts as anti-oxidants hence are important for the digestion of food. John therefore needs the vitamins so that he can be able to heal the sores quickly. With a proper diet, a patient’s appetite is improved and the patient is able to consume more nutritious foods that are necessary for the body to be able to fight diseases (De la Chappell, 2004). This should apply to John too. The nurses should ensure that the foods given to John are of the right nutritional quantities. CONCLUSION Colorectal is a fatal disease that requires quick measures when diagnosed. After undergoing surgery, a patient is always required to undergo radiation or chemotherapy. Chemotherapy normally has many side effects, which should be combated at an earlier stage to prevent worse health problems. The patients undergoing chemotherapy should have a good oral hygiene. Oral hygiene helps to prevent further complications that may result when germs encounters the sores. Nurses normally come up with nursing intervention that helps to care for the patients. This interventions include, provision of multi-vitamin supplements, provision of nutritious foods for patients, provision of smooth and soft foods, provision of painkillers, ensuring that patients drink a lot of water etc. Even though these interventions face different challenges, they have helped in providing good care to patients. The patients should be given maximum care so that they can be able to recover fully. In order to ensure a quick and successful recovery, John should be served with a complete balanced diet: That is, foods should include proteins, carbohydrates, vitamins, and roughage. This would ensure proper digestion and prevent re-occurrence of colorectal cancer. John should also ensure that he goes for constant checkups so that he can be assured that indeed he is free from colorectal cancer. References Bradbury, R. (2007). Cancer. New York: Springer Berlin Heidelberg publishers. De la Chappell, A. (2004). Genetic predisposition to colorectal cancer. Nature reviews journal, 4, 769-780. De vita, V. (2001). Cancer. Philadelphia: Lippincott publishers. Drasdo, D. (2001). Individual based models to growth and folding in one-layered tissues: Intestinal crypts and analysis development. Nonlinear analysis, 47. 245-256. Fearon, E. (1990). A hygienic model of colorectal tumor genesis. Massachusetts, NE: Cell publication. Fodder, R. (2001). APC, signal transduction and genetic instability in colorectal cancer. Nature review journal, 1. 55-67. Hanna, D. (2001). The hallmarks of cancer. Massachusetts, NE: Cell publication. Jensen, O. (2006). Crypt dynamic and colorectal cancer: advance in mathematics model. Massachusetts, NE: Cell publication Lewis, C. 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