BENCHMARK- NURSING PROCESS: APPROACH TO CARE NRS 410
BENCHMARK- NURSING PROCESS APPROACH TO CARE NRS 410
The scourge of cancer has been increasingly affecting the patients, their families, and even the community at large. Its prevalence has been increasing, the effects are increasingly being experienced and reported, and the healthcare burden has been worrisome. The global incidence of cancer was 23.6 million as of 2021 with 10 million deaths occurring annually worldwide making it the second leading cost of death in the world only bested by cardiovascular deaths (Sung et al., 2021). The United States is not exempted from these impacts with the annual new cases being approximately 1.75 million and estimated deaths being 0.6 million annually (Cancer data and statistics, 2022). In addition, the affected patients also develop psychosocial effects and physical impacts of the disease that might be debilitating. Due to these high burdens of cancers, the healthcare systems have conducted studies to help in understanding the etiologies of cancer, the reasons for increasing healthcare burden related to disease, and even the preventive healthcare strategies that can be employed in reducing the burden. The objective of this paper is to provide insight into cancer by describing how it is diagnosed and staged, complications arising during its treatment, and the roles that nurses perform in managing cancers.
Cancer Diagnosis and Staging
Diagnosis
Cancer can either be diagnosed at routine screening or during the diagnosis. The screening tests are preferred by the healthcare stakeholders because it guides in the early detection of cancer before it manifests and is therefore associated with a better outcome of care. In contrast, diagnostic tests are employed to identify specific cancer when the patient has presented with the signs and symptoms suggestive of certain cancer. Diagnosis, therefore, begins with history taking and physical evaluation of the patient whose results will guide the specific diagnostic tests to order for. For instance, patients who present with chronic cough and hemoptysis with a history of cigarette smoking can be diagnosed with lung cancer as opposed to another who presents with hematuria, flank pain, and flank mass who would be diagnosed with renal cell cancer (Koo et al., 2020). In either of these cases, the diagnostic tests done are different. These tests can however be broadly considered as imaging studies, laboratory tests, and histological tests.
The laboratory tests that have been employed in cancer diagnosis utilizes specimen such as those that have been collected through biopsy. During the assessment, the structures of the collected samples are compared with the normal structures to identify any abnormalities at the cellular (cytological) or tissue (histological) levels (Wilkinson, 2021). Given the advancements in diagnosis, there is a recent application of molecular studies in the diagnosis of cancers where the molecular characteristics of the oncogenic cells can be identified through immunohistochemistry or flow cytometry to not only help in the qualitative diagnosis of specific cancer but also quantification of the oncogenic cells (Sung et al., 2021). The biopsy and visual tissue inspection are the gold standards for the diagnosis of cancer given the high cost and unavailability of molecular studies. The molecular studies are however more accurate.
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Imaging studies complement the laboratory studies in the diagnosis of cancers. They help in structural visualization and may guide in assessing the local effect of cancer or even its spread. Some of the imaging tests include CT scan, colonoscopy, esophagoduodenoscopy (OGD), MRI, and PET scans. During some of these imaging studies, targeted specimen collection can be done for the affected structures thus increasing the yield of the specimen (Koo et al., 2020). Incorporating both laboratory and imaging studies in cancer diagnosis is encouraged as it promotes accuracy in diagnosis.
Staging
After the diagnosis of cancer has been made, the oncologist helps with the cancer staging to explain the extent of its spread and determine its prognosis. Different staging classification has been in use although most of them are done based on the size of the tumor (T), the number of nodes involved in tumor spread (N), and the presence of metastasis of the tumor to the local or distant structures (M). These TNM staging that employs the three parameters is further subdivided into stages I, II, III, and IV where stage I signifies a disease that is limited locally without metastasis as opposed to stage IV which is advanced cancer with metastasis to the other structures (Padilla-Leal & Medina-Franco, 2019). The stage IV tumor has a poor prognosis and may only be addressed palliatively as compared to stage I which has a better prognosis.
Other staging classifications are dependent on the system affected by the tumor and may be based on other parameters. These stagings include the International Federation of Gynecology and Obstetrics (FIGO) staging for cancers gynecologic cancers, Manchester staging employed for breast cancer, and the Ann-Arbor staging system for lymphomas and leukemias (Sung et al., 2021). Either of these staging criteria helps in determining the severity of cancer, and its prognosis and may therefore influence the choice of therapy to be employed.
Complications resulting from Cancer, Side Effects of Drugs Used, and Methods that can be Employed in Reducing the Physical and Psychological Impacts of Cancer
Cancer Complications
The complications related to cancer can either result from cancer itself or the adverse effects of medications that are used in its treatment. Most of these complications usually present late although their symptoms depend on the affected organs. The organ-specific complications include increased intracranial pressure in brain tumors, jaundice and ascites in liver cancers, hydronephrosis in stage 3 cervical cancer, and anemia due to cancers of the bone marrow (Koo et al., 2020). In contrast, the systemic complications are usually unrelated to the cancers and may include malnutrition, cachexia, and infections. Malnutrition in cancer usually results due to reduced food intake or increased nutrient demand due to the cancer-mediated hypermetabolic state (Jairam et al., 2019). The reduced weight in malnutrition is therefore different from cachexia in which it is due to increased production of cytokines such as tumor necrosis factors that encourage. Malnutrition is responsible for reduced immunity, in addition, to the myelosuppression due to cancer that reduces the leucocyte levels in the body (Padilla-Leal & Medina-Franco, 2019). These impacts of cancer complications would increase the risk of infections.
Side Effects of Drugs used in Cancer Treatment
Chemotherapeutic drugs pose risks to the organs they act on and even other systems due to their toxicity. The drugs especially cell cycle nonspecific agents usually affect the cell cycle of normal body cells thus resulting in their adverse effects. These adverse effects that occur regardless of the agent type include myelosuppression, tumor lysis syndrome, fatigue, mucositis, and hair loss. Myelosuppression, in which the drug suppresses the bone marrow, is responsible for reduced production of blood cells and therefore presents as anemia, increased risks of infections, and bleeding tendencies in patients who are on care (Jairam et al., 2019). Tumor lysis syndrome, on the other hand, occurs especially in the treatment of cancers with high cell turnovers such as leukemias and lymphoma because the increased cell destruction causes electrolyte imbalances such as hyperkalemia, hyperuricemia, and hypercalcemia that may then affect other systemic functions (Nurgali et al., 2018). Organ-specific effects are usually due to toxicity and are also specific to the agents used such as hemorrhagic cystitis, pulmonary toxicity, and cardiotoxicity in patients on cyclophosphamide, bleomycin, and doxorubicin respectively (Sung et al., 2021). These side effects can be addressed by discontinuing the therapy and lowering the drug doses, before managing the complications that the patients present with. For instance, blood transfusion and administration of granulocyte-macrophage colony-stimulating factor (GM-CSF) may be appropriate for myelosuppression whereas adequate hydration and administration of allopurinol are indicated for the management of tumor lysis syndrome (Prieto-Callejero et al., 2020). They should therefore be anticipated, diagnosed promptly, and addressed appropriately to minimize the adverse impact on the patients.
Nursing Interventions to Minimize Physical and Psychological Impacts of Cancer
The physical complications of cancer and the effects of its treatment as well as the consequential psychological impacts should be addressed appropriately to improve patients’ wellbeing. Some of the interventions employed for managing these effects include the administration of analgesia, teaching the patients on relaxation techniques, and even meditation to help them relieve the pain they experience (Tuominen et al., 2019). Family education can also be done to promote their involvement in patient care, improve the psychosocial support system and therefore address psychological effects such as loneliness and depression that are experienced by neglected cancer patients (Wilkinson, 2021). Further, the patients may be linked with social support groups and other healthcare professionals such as nutritionists and clinical psychiatrists to provide other necessary social support and healthcare services (Tuominen et al., 2019). These interventions will strengthen the patient’s physical and psychological status thereby enhancing the outcome of care.
Reason for the Increasing Yearly Incidence and Mortality for Various Cancers in the US.
CDC (2022) reports that there is an upward trend in the incidence and mortality rates of cancer in the US with 0.6million deaths and 1.6million new cases reported annually. It further projects the new cases to rise by up to 49% by 2050 which is approximately a 2.2million new cases annually, especially in the aging population. Some studies suggest that this trend is a consequence of the increasing size of the aging population and lifestyle changes (You & Henneberg, 2018). The lifestyle change includes an increased sedentary lifestyle, more cases of cigarette smoking and alcohol use as well as increased incidences of implicated infections.
Advanced age is a risk factor for most cancers because the aging process is associated with increased cellular damage and decreased effectiveness of repair mechanisms thus more risk of accumulation of defective cells (Koo et al., 2020). This predisposes individuals to cancers. The increased aging population which has quadrupled from 4.1% in 1900 to 16% in 2019 may therefore explain the increased incidences of cancer (Abeliansky et al., 2020).
The sedentary lifestyle that has increasingly led to obesity is also implicated in the upwards trend. Obesity is a risk factor for endometrial, colorectal, and breast cancers, and thus increased incidence of obesity to 41.9% in 2020 up from 30.5% 20 years earlier may be responsible for the increase in the incidences of these cancers (Sung et al., 2021). On the other hand, increased cases of cigarette smoking may have led to increased incidences of laryngeal, lung, throat, and oral cancers in which cigarette smoking is a risk factor. Further, for the cancers which are associated with infections such as Epstein Bar Virus (EBV) and nasopharyngeal cancer, and Burkitt’s lymphoma, increased cases of EBV especially in low socioeconomic status may result in increased incidences of the related cancers (Wilkinson, 2021).
Strategies that address the factors that are responsible for the increased incidences and mortality rates of cancer may guide in reducing both the new cases and their related mortality. Individuals should be encouraged to adopt physical exercise, nutritional modifications, and other weight reduction measures to prevent obesity (Koo et al., 2020). They should also be encouraged to reduce alcohol use and avoid cigarette smoking. Further, healthcare strategies such as screening for infection and prompt treatment of patients may also be adopted (Wilkinson, 2021).
American Cancer Society Education and Support
Patient education is a key component of the fight against cancer. The American Cancer Society is a supporting group that is a non-profit organization (NGO) that contributes to the fight against cancer by offering patient education. Their mode of education is by using flyers and brochures to enlighten the public on cancer prevention measures and encourage them to adopt routine screening and early diagnosis (Prieto-Callejero et al., 2020). Through this enlightenment, the organization prevents disinformation that is responsible for delays in health-seeking by the public.
I noticed that the organization has not been involved in financial support for the patients or research institutions. My recommendation is therefore that they offer financial support to the cancer patients to assist with transport and purchase of drugs, therefore, improving their adherence to therapy sessions. Further, financing research will improve knowledge on how to prevent cancers and treat the patients effectively.
Nursing Processes that are Applied in the Care of Cancer Patients
Management of cancer patients requires a multidisciplinary approach. The nurses are therefore engaged in the care process through their nursing processes including the assessment, diagnosis, planning, implementation, and evaluation (ADPIE). When the patient reports to the facility, the nurses can provide an initial assessment that would help in making the nursing diagnosis that guides patient care (Wilkinson, 2021). The implementation process includes administration of prescribed drugs, monitoring of patient’s vitals, and cooperation with other healthcare professionals during patient management (Jairam et al., 2019). The nurses may also engage in patient education that would increase the acceptance of the diagnosis and enhance their adherence to therapy.
Contributions to the Undergraduate Education in Liberal Arts and Science
Holistic care of the patients not only requires the understanding of medical knowledge but also an understanding of other patient factors that may influence patient care. Liberal art and sciences help the nurses to incorporate other patient-specific characteristics such as their racial factors and socioeconomic status during the care process. Training the nurses in these fields, therefore, equip them with knowledge and skills that they can apply in predicting how socioeconomic factors or the geographical origin of the patient affects their disease presentation and outcome of care (Abeliansky et al., 2020). It may also help the nurses to modify these characteristics to improve the outcome of care.
BENCHMARK- NURSING PROCESS: APPROACH TO CARE NRS 410 Conclusion
Cancer is a malady that has been increasing in incidence and impact due to the increased size of the aging population and lifestyle changes. Early diagnosis and screening may help in better management of patients and prevention of cancer complications although the side effects and toxicity of the chemotherapeutic agents should also be considered and appropriately managed. Among the interventions that the nurses can employ include family education and pain management to promote the physical and psychological well-being of the patients. Their care process should incorporate the knowledge of liberal arts and sciences to promote holistic care for cancer patients.
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