Nursing Practice: Johns - Case Study Example

? Nursing Practice: John’s Case Study         and Introduction Nausea and vomiting are debilitating and common side effects resulting from exposure to chemotherapy. The nausea felt before or after chemotherapy is the sickly sensation experienced at the stomach area, which may end up in vomiting or emesis. On the other hand, the vomiting experienced before or after chemotherapy is the process, where the contents of the stomach are ejected through the mouth (O’Brien, 2008). The relationship between John’s chemotherapy exposure and the side effects of nausea and vomiting could be explained on the basis of the activation of chemical components that stimulate the areas of the brain, which are responsible for triggering vomiting (Jordan, Sippel, & Schmoll, 2007). The chemicals, whose production has been triggered by John’s exposure to chemotherapy, include the neurotransmitters that are used for the transmission of the messages developed at the stomach – to the respective brain area. These neurotransmitters that are triggering John’s nausea and vomiting include dopamine, neurokinin-1 and serotonin (O’Brien, 2008). This paper will explore the case of John, who has been undergoing chemotherapy, and is suffering from nausea and vomiting, which is a side effect of chemotherapy. The areas covered by the study include explaining the causes for his breakthrough and anticipatory nausea, give a nausea assessment, prescribe intervention 1 and 2 and offer conclusive inferences about John’s case. Breakthrough and anticipatory nausea In the case of John, his anticipatory CINV is triggered by the previous experiences that he had, during previous sessions of chemotherapy. This type of CINV is totally controlled and triggered by John’s psychological anticipation and the negative feelings related to the previous experiences (Liau, et al., 2005). Ordinarily, like in the case of John, it will start prior to chemotherapy sessions, mainly due to the adverse experiences he associates with the previous sessions of chemotherapy that he has gone through (Jordan, Sippel, & Schmoll, 2007; O’Brien, 2008). The effect is a conditioned reaction, mainly because John has had numerous cycles of the chemotherapy processes done, to manage his case. It can also be viewed as a learned, conditioned or psychological case of nausea which may end up in vomiting (Jordan, Sippel, & Schmoll, 2007). This is the case, because John has linked the adverse experiences of the previous rounds of chemotherapy to certain smells, tastes, thoughts or the sights. Following the association developed, between these smells, tastes thoughts or sights with the adverse feelings or the symptoms of previous cycles, John develops the nausea or vomiting (O’Brien, 2008). In the case of the breakthrough CINV, it is the one that he experiences, despite his use of drugs or other measures to counter or prevent the nausea and the vomiting that takes place during or after going through the cycles (Liau, et al., 2005). In the case of John, after the doctors learnt that his situation required rescue, he has been given different prescription drugs, which will help counter the nausea and the vomiting. The new prescription drugs to be taken by John are those containing anti-nausea and anti-vomiting treatment components or ingredients (Jordan, Sippel, & Schmoll, 2007). Nausea Assessment The Morrow Assessment of nausea and Emesis (MANE) The MANE nausea assessment is appropriate for the case of John, because taking him through the 17 questions of the MANE questionnaire will help the doctor in finding out the frequency, the duration and the severity of his nausea before and after undergoing chemotherapy (Halpin et al., 2010). Through the questions showing the level of nausea and vomiting, it will be easier to recommend the most effective medication. Through determining the duration of nausea and vomiting, it will be easy to develop anti-nausea medication, depending on its adversity (Crocker & Timmons, 2009). Through rating the severity, it will be easier to decide the corrective processes and the medications to address the problem; a more severe case will require higher power medication (Halpin et al., 2010). Further, the evaluation will help determine, whether the anti-nausea medication offered to John was useful. Using the tool, John can be tested and retested, to determine the effectiveness of the anti-nausea medication administered (Crocker &, Timmons, 2009). MASCC Antiemesis tool (MAT) The MASCC Antiemesis tool (MAT) is appropriate for the assessment of the case of John, mainly because – according to personal reports – he feels nauseated at unpredictable times, especially during the week after he has undergone chemotherapy (Molassiotis et al., 2007). Through the real-time reporting, the doctor will determine his progress and the necessary changes, from the questions revealing the frequency, the duration and the intensity of the nausea (Yamaguchi et al., 2009). Through the MASCC tool, John’s symptoms will be managed and medication change may be necessary (Yamaguchi et al., 2009). Therefore, considering the unpredictable patterns of John’s nausea and vomiting, this tool will offer the best assessment tool (Molassiotis et al., 2007). Intervention 1: Maintain fluid therapy Fluid therapy is provision of fluids to a patient as a way of treating nausea. John can be administered with this kind of intervention through subcutaneous, intraosseous, intraperitoneal, intravenous, or oral means. The reason why it is important to administer him with fluid is because he has lost a lot of body fluid, which is causing nausea. This intervention works by treating dehydration hence restoring intravascular volume. For example, this can be done by replacing dehydration losses within 0.9% saline. As a result, the administered fluid remains in the intravascular or extracellular section, where it helps the patients by supporting his peripheral perfusion and blood pressure. Also, fluid supplementation reduces nausea by enhancing the process of mesenteric perfusion and averting gut ischemia and the resultant release of serotonin. Most preferably, John should be administered with fluids when they are cold, clear and carbonated. Examples of such fluids include lemonade, ginger ale or popsicles. The fluids should be administered in small amounts between meals, preferably by use of a straw (Bischoff & Renzer, 2006). Both fluids and electrolytes can be replaced by drinking orange, mint (tea), and lemon (lemonade). To control the impact of a full stomach, the patient should take the fluid at least 30 minutes before or after taking solid food. The benefits of fluids therapy are multiple. The most important aspect of this intervention is ensuring optimal hydration. The toxins that are channelled into the urinary track by the kidney must be kept dissolved in water for this process to work effectively. Postoperative nausea is a common complication following ambulatory surgery. This condition can expose the patient to an increased level of patient dissatisfaction and distress. Cohen et al. (1984) observes that methods of treatment and prevention of Postoperative nausea remain limited. They add that 25 percent of patients continue to suffer from Postoperative nausea within 24 hours of surgery. Although prophylactic antiemetic therapy is advocated by many for high risk patients, the optimal approach remains unclear, with rescue antiemetic for episodes of Postoperative nausea (Gan, Meyer, and Apfel, et al. 2003). There is a strong need to develop ideally nonpharmacologic, cost effective strategies to reduce the occurrence of Postoperative nausea. A patient like John could be having intravascular volume deficit, which could be contributing to his nausea. Perioperative administration of IV fluids can help him in reducing the occurrence of adverse outcome following his surgery (Yogendran et al. 1995; Cook et al. 1990). This deficit can be corrected by Perioperative administration of an adequate quantity of IV fluids, hence effectively preventing Postoperative nausea, without exposing him to possible side effects experienced with pharmacologic methods of addressing such a problem. Many studies of perioperative fluid administration have applied different approaches and have differing findings (Yogendran et al. 1995; McCaul et al. 2003). In this sense, the effectiveness of IV fluid therapy in reducing Postoperative nausea remains to be persuasively confirmed. Intervention 2: Good Oral Care Measures The nausea that John is suffering from can be managed through good oral measures. In case John becomes unconscious or if he is vomiting, then a carer should suction those substances from him mouth. The care plan that involves oral measures also involves giving the patient things that can relieve nausea, especially if he can consume them through the mouth. Examples of substances that he can be given to consume includes warm tea with lemon, ice chips, or warm tea with ginger ale. Nausea can also be relieved by providing John with some toasts or crackers, and cold cola drinks. Since John is also vomiting, he is losing a lot of fluids and electrolytes, therefore, these substances should be replaced through oral means, lest he will be dehydrated. Therefore, John should be given a lot of fluids and electrolytes through the oral means or any other suitable means, depending on his condition. As a result of chemotherapy, John is likely to develop Xerostomia, which is caused by anticholinergenic medication used to control emesis and nausea. The symptom is typically temporary in nature and it is usually addressed entirely after treatment. John is also likely to complaint of dryness, difficulty in swallowing, and a change in the steadiness of his saliva. Difficulties in eating can be resolved by asking John to take small bites while chewing gradually as well as sipping liquids regularly (Koralewski, P. et al., 2001). As cancer patients, there are a variety of oral health care guidelines that can be followed to manage John’s nausea. Most importantly, John should maintain a very good oral hygiene. He should also be encouraged to brush his teeth and gums when retiring to bed and always after taking his meals. When brushing, John should use a very soft toothbrush and wash it under warm water to kill germs. By doing this, he will be able to avoid injuring his tissues. Also, the toothbrush should be swapped frequently, for example after every 2 months or following an illness. John’s maintenance of oral hygiene is very vital. If he is committed to topical fluoride therapy lifelong painstaking oral hygiene, he cannot lose his teeth die to radiation therapy, though such an occurrence is not common. Since patients with neck and head cancer are usually exposed to risk factors that are associated with failure to comply to good oral health, it is important for John to be assessed for the potential for oral hygiene in the event that radiation therapy is essential (Koralewski, P. et al., 2001). The most frequent side-effects of chemotherapy is nausea and vomiting (Bilgrami & Fallon, 1994). Ondansetron is an example of elective antagonists of peripheral and central serotonin oral drug, which inhibits the vomiting reflex occasioned by serotonin whose release is induced by chemotherapy. The patient’s tolerance of vastly emetogenic chemotherapy is significantly improved by the introduction of 5-HT3. Many clinical tests associated with radiotherapy and chemotherapy has confirmed their efficacy. Antibiotic oral rinses such as chlorhexidine can be given to John with the aim of managing bacterial plaque if he is not able to do flossing or brushing. If he experiences an increase in mouth pain, modification of oral hygiene protocols may be carried out, including requesting him to stop using toothpaste if it is stinging his mouth. Instead, he should be encouraged to use floss holders for patients with mucositis, especially if nausea and vomiting is associated with flowing with hands. Conclusion Nausea and vomiting are among the side effects of chemotherapy procedures. The nausea and the vomiting are caused by the transmission of the neurotransmitters that control the brain areas that control vomiting, from the stomach to the brain. These neurotransmitters include dopamine, neurokinin-1 and serotonin. From the case of John, anticipatory CINV is triggered by the adverse experiences felt during previous chemotherapy sessions, which are brought back to his attention by thoughts, smells, tastes or sights. The breakthrough CINV is the nausea and vomiting that he experiences at the time of the chemotherapy cycles or after the procedures. In the area of nausea assessment, the Morrow Assessment of nausea and Emesis (MANE) tool is appropriate for John’s case. This is because through the review of his condition, his history and the experiences of nausea and vomiting, it will offer the inferences required for further care. The MASCC Antiemesis tool (MAT) is also appropriate for John’s case, because through the real-time evaluation of the unpredictability, the intensity, frequency and the duration of the nausea, the clinician will manage his condition more effectively. The intervention developed for John’s case includes good maintenance of oral health and fluid therapy, which have been found to have many benefits for John. References Bilgrami, S., & Fallon, B.G. (1994). Wymioty i nudnosci. Medycyna po Dylomie, 3, 155-8 Bischoff, S.C., & Renzer, C. (1994). Nausea and nutrition. Autonomic Neuroscience. Basic and Clinical, 129, 22–27. Cook, R., Anderson, S., Riseborough, M., Blogg, C.E. (1990). 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