Nursing Care Required for a Patient with Cancer - Case Study Example

Heading: Title Your name Student ID Course title & code Your lecturer/tutor’s name Due Date Executive Summary This report addresses Mr. Smith medical status and the nursing care required for a patient in his situation. Mr. Smith was diagnosed with precancerous cells after undertaking colonoscopy. He was later subjected to a laparoscopic procedure and subsequent chemotherapy for a period of 12 months. A Nursing care plan with goals and outcomes are the focus for Mr Smith, because of the need to ensure that his physical, mental and social issues have been considered throughout the treatment process. The plan of the nursing care focuses on meeting the patient’s unique needs, commencing from diagnosis to the best approach to follow in order to achieve the intended nursing goals. Major recommendations include, the need to increase focus on community groups which provide support for patients with such situations. More so, these focus groups also play an important role in ensuring that the patient accept their situation and work towards self care plan. The mental status of the patient is another factor to consider when administering the medication process, this is because positive mental status is important in helping the patient accept the current medical condition and work towards ensuring that the treatment process is followed. The patient is also required to take personal commitments to strict diet and control alcohol consumption in order to improve immunity. Table of Contents Executive Summary 3 Current diagnosis and treatment 7 Current Care Plan and Recommendations 8 Recommendations for changes of the current care plan 9 Conclusion 10 Reference list 12 Introduction This case study concerns Mr. Smith a 64 year old man diagnosed with evidence of cancer after participating in a National Colorectal Screening Program which he undertook colonoscopy. A Colonoscopy examines the possibility of cancer through examination of the bowel system through the anus and removing small samples of polyps which are then microscopically examined for cancerous cells presence. After the test, Mr. Smith results were positive and he was therefore recommended by his General Practitioner (GP) to see the surgeon. The nurse at the GP clinic therefore prepared Mr. Smith for the surgery process and he was also referred to a multidisciplinary team which further prepared him for the treatment planning. Mr. Smith then underwent a laparoscopic procedure which involved resection of his colon through a course of adjuvant chemotherapy consisting of 5FU and leucovorin. The entire treatment program took about 12 months and it was successful despite the side effects of the program. His wife was also part of the program and was taught how to best care for her husband in his condition. Mrs. Smith however experienced problems coping with her husband’s condition; Mr. Smith himself was troubled by the thought of cancer recurrence. This case study focuses on Mr. Smith needs and nursing management program options aimed at meeting his physical, mental and social needs during the treatment and after the treatment of Mr. Smith. 1. The status of the patient Mr. Smith is a 64 year old man diagnosed with cancerous cells after a successful colonoscopy conducted during a National Colorectal Screening Program which he had participated. People at an elderly age, above 50 years of age are mainly advised by many medical societies such as NCSP to undertake this program because the increased risk of cancer at this age, this program is repeated every 10 years to examine any new detection of cancerous cells. Mr. Smith is considered in this study because of his unique needs considering his age, the fact that cancer is an acute disease and the effect of his diagnosis on himself and his wife. Mr. Smith has no medical record but demonstrates some diet ignorance, a fact that it is made worse by his daily drinking habit which has the potential of reducing his immunity in the body since once alcohol is absorbed into the body, and it inhibits the digestion of useful vitamins like vitamin C which is responsible for strengthening the body’s immunity (Chang & Johnson, 2008, p.435). The role of nurses in caring for Mr.Smith is imperative; the rationale for this is because of the needs of the patient, physically, mentally and socially. According to Skilbeck &Payne (2003) studies indicate that the patient and nurse interaction are complex in nature because of the need to know and understand the patient. The success of the nursing care plan depends on the nurse experience in handling the patient’s emotional needs, the situation of the patient a times affect the nurses themselves and this is where experience and understanding is needed. As Schulman-Green, McCorkle, Cherlin, Johnson-Hurzeler & Bradley (2005) states that other aspects such as family, communication, management of the symptoms as well as the cost of the caring process as main factors which influence the care of the cancer patient. As Schulman-Green, McCorkle, Cherlin, Johnson-Hurzeler & Bradley (2005) elaborates, nurses response to such situations deeply depend on the nurse’s experience and attitudes. The role of nurse thus goes beyond the medical needs of the patient and includes psychological, since most cancer patients suffer from depression and withdrawal from everyday life activities. Current diagnosis and treatment As stated in Chang, E., & Johnson (2008, p.435) Mr. Smith was diagnosed with precancerous signs after the colonoscopy was done. He was referred to a surgeon for treatment, his treatment included laparoscopy, a small surgery in the abdomen and administration if adjuvant chemotherapy, 5FU and leucovorin. Chemotherapy is the most common treatment of cancer, it involves killing of cancerous cells which multiply at an abnormal rate. The entire process lasted for 12 months. 2. The nursing assessment of the patient The patient’s diagnosis in nursing perspective covers physical, mental or psychological and social aspects. The physical needs of the patient are the pain as a result of the chemotherapy process which also incorporates other agents like surgery and radio therapy. The side effects that the patient manifest as shown in this case are lopecia (hair loss) and mucositis which is the inflammation of the digestive track as result of decreased production of blood cells in the digestive track, bone marrow and hair follicles(Chang, E., & Johnson, 2008, p.435). Some instances of diarrhoea are common especially when the patient is not keen on his/her diet as demonstrated by Mr. Smith. Leucovorin treatment is also another cause of physical suffering; it works in conjunction with chemotherapy process by preventing healthy cells from harmful effects of methotrexate by allowing it to kill cancerous cells and not the normal ones (Beadle, 2004). The side effects of leucovorin include rash, diarrhoea, itching and problems when swallowing food. Mr. Smith has been suffering from fatigue as a result of return trips to hospital Emotional or psychological diagnosis of Mr. Smith includes worrying about cancer reoccurrence and the thought of experiencing a painful death as a result of the cancer. He is also worried about his wife, who is affected by her husband’s condition. Mrs. Smith is also trying to cope with the situation of her husband; she also needs psychological help from the nurses as she stands by her husband side, she is suffering from depression and accepting her husband’s condition and the regular trip to hospital (Chang, E., & Johnson, 2008, p.435). Mr. Smith is also socially affected, this is evident by the fact that he resorted to the online community for people suffering from the same condition. This step has proven to be helpful for Mr. Smith; the social community from the local community has proven to be resourceful. Current Care Plan and Recommendations According to Lippincott (2012) nursing care plan entails mainly four fundamentals: identification of the needed nursing issues or nursing diagnosis and articulation of nursing best practise to solve the problems; statement of the benefits that are expected to the patient; identification and statement of a specific course of action by the nurse which are in line with the approach to be taken and achievement goals stated; and assessment of the patient’s response to the nursing care provided and possible amendment of the care needed (Gulanick & Myers, 2010). The process of nursing care is commenced once the patient is admitted into a health care facility or a health care plan and initial nursing evaluation completed. Once the diagnosis is completed, nursing orders are developed. The main goal of this process is to ensure that the nursing care provided is in line with the needs of the patient and progresses towards self-care, the nurse assigned to the patient is responsible for the execution of the nursing care plan. In essence, nursing care plan is aimed at assisting the patient throughout his or her medical situation both physically, emotionally and socially. As noted by Dunne, Sullivan, & Kernohan (2005) the nurse attitude and experience is important as it determines the quality of the care plan. The nurse needs to fully comprehend the situation of the patient including the challenges that the patient faces. In the case of Mr. Smith, he is facing fear of cancer reoccurrence; this issue needs to be addressed by the nursing counseling process. More so, self care processes like healthy diet and minimal drinking needs to be enforced and supported by the nursing care plan. It is imperative to note that every patient has unique needs and thus important for nurses to customize the care plans according to these needs. The success of the health care plan can be measured by the patient’s response to medication and the nursing care plan. More so, the transition to the self-care process also determines the success of the nursing care plan, easy transition means that the nursing care plan was successful or met its goals (Green, 2011). Recommendations for changes of the current care plan Based on the current status of the patient, there are a number of recommendations to be made. As noted by Gulanick & Myers (2010) the mental status of the patient needs to be monitored in order to ensure that the patient accepts the medical status and works with the doctor and the nurse to address the medical issue. In the case of Mr. Smith, his stress level and failure to accept the situation needs to be addressed in order ensure quick recovery process. Social issues as noted by Ackley & Ladwig (2010) needs to be adequately addressed in order to manage emotional and psychological impact of the situation on patients. Social issues can be managed by ensuring that the patient participates both in local community social group as well as online forum. The rationale for this is to provide moral support as well as good preparation grounding for the ongoing patient’s selfcare. Another important recommendation for Mr. Smith status is to ensure that he reduces level of alcohol consumption because of the need to develop a stronger immunity in order to fight back any precancerous cells reoccurrence. Conclusion In conclusion, nursing care for patients with terminal or potentially terminal disease is very essential. This is because of the physical pain, mental and psychological feelings that the patient undergoes and possible social withdrawal. In this case, Mr. Smith was diagnosed with precancerous cells which could easily lead to cancer. The colonoscopy process that Mr. Smith took part in is essential proved essential in addressing the issue before it was too late. The medical process required nursing care and a plan which focused on addressing Mr. Smith needs as well as the need of his wife. Mr. Smith suffered psychologically as evidenced by his fear of cancer reoccurrence, his wife also found it hard to accept the situation. The entire medication process also fatigued Mr. Smith because of the constant long journey to the hospital. Mr. Smith however found nurses and online forums important in his care plan and preparation for medication. The nursing role in his case was to prepare him for the medication process through diagnosis of his nursing needs and how they could be met effectively. The goal of the nursing care process was to address his physical, emotional and social needs. It is thus recommended to ensure that Mr. Smith undergoes a unique caring process that will stimulate his attitude towards a healthy diet and a positive mind in order to recover easily from the illness. Involvement in social programs both local community groups for special needs and online groups are also recommended for Mr. Smith as they are important in aiding quick recovery process. Reference list Ackley, BJ & Ladwig, GB 2010, Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care, Elsevier Health Sciences, Michigan. Beadle 2004, Illusions in advances cancer: The effect of belief systems and attitudes on quality of life, Psychology of Oncology, vol.13, no.pp. 26-36. Chang, E & Johnson, A 2008, Chronic Illness and Disability: Principles for Nursing Care, Elsevier Australia, Sydney. PP. 435-436. Dunne ,K, Sullivan, K &Kernohan, G 2005, Palliative care for patients with cancer: district nurses experiences, Journal of Advanced Nursing, vol. 50, no.4.pp. 372. Green, C 2011, Maternal Newborn Nursing Care Plans, Jones & Bartlett Publishers, Sydney. Gulanick, M &  Myers, JL 2010, Nursing Care Plans: Nursing Diagnosis and Intervention, Elsevier Health Sciences,New York. Lippincott 2012, Nursing Care Planning Made Incredibly Easy! Lippincott Williams & Wilkins, New York. Schulman-Green D, McCorkle R, Cherlin, E, Johnson-Hurzeler, R & Bradley, EH 2005, Nurses communication of prognosis and indications for hospice referral. American Journal of Critical Care 14: 64-70. Skilbeck, J &Payne, S 2003, Emotional support and the role of Clinical Nurse Specialists in Palliative care. Journal of Advanced Nursing, vol.43, no.5. pp.23-45. Read More