Question

Consider and discuss the learning needs of the following clients: 1. An individual who has recently been diagnosed with lung cancer. 2. A family caring for an elderly individual with Alzheimer's disease. 3. A community in which adolescent cigarette smoking is on the rise. ons

Answer 1

1. Maintaining the best quality of life possible is important to many lung cancer patients. Unfortunately, many patients don’t receive the support of palliative care, which is a medical specialty designed to help patients manage their physical and emotional side effects. Palliative care is often thought of as something that should only be delivered at end-of-life, but it is actually recommended that most lung cancer patients receive it alongside of treatment, regardless of prognosis.

Enroll in clinical trials---Patients enrolled in clinical trials have access to top-notch care and are closely monitored. Enrollees either get the best known standard of care or a new treatment being studied that isn’t yet available. For some patients, a clinical trial is the best treatment option they have available to them.

No person facing lung cancer should go through it alone. Luckily, we have many resources that can connect you with people who are in your shoes.

His lung cancer treatment options are determined by his lung cancer type (including any biomarkers he may have), lung cancer stage, and lung cancer treatment goals.

When making lung cancer treatment goals, ask yourself two questions:

1) What do I want out of lung cancer treatment?

2) Is this a realistic goal with my type of lung cancer?

You will work with your lung cancer care team to decide if the goal of treatment should be curing your lung cancer, controlling your lung cancer or being comfortable. Now is a good time to talk about what is important to you in terms of quality of life. Maybe you want to be able to attend a wedding or graduation. Or maybe you prioritize controlling your cancer over experiencing fewer side effects. Whatever your preferences might be, it is important to discuss them with your doctor.

Once your doctors have determined your lung cancer profile, they will present you with one or a combination of the following options:

• Surgery
• Radiation Therapy
• Chemotherapy
• Targeted Therapy
• Immunotherapy
• Clinical trials
• Supportive/Palliative Care
• Complementary and Alternative Lung Cancer Therapies

Most people are familiar with surgery, radiation and traditional chemotherapy. But targeted therapy and immunotherapy are newer types of treatment that should be explored when you speak with your doctor. Also discuss supportive, or palliative care, which can help with side effects and clinical trials which can potentially give you access to emerging therapies.

When you and your care team decide on treatment, familiarize yourself with what to expect and connect with others who have been through it. This can help ease the anxiety many patients feel before starting a treatment.

Asking for a simple test can expand your treatment options. You may have heard the terms precision or personalized medicine. This is the idea that a person’s tumor has certain characteristics that control the tumor’s behavior (like growth and spread) and some treatments can directly target these characteristics. These characteristics are indicated by specific mutations or biomarkers that can be found by testing your lung tissue.

Be sure to let your doctor know you want your tumor tested using comprehensive genomic testing. Receiving comprehensive testing along with a standard tissue biopsy will give your doctor a fuller understanding of your particular type of lung cancer so they can suggest the best treatment options for you. Asking for this simple test could mean access to potentially life-saving personalized lung cancer treatment.

During this stressful time, receiving lung cancer support from others helps you cope with the many challenges you face. No matter where you are in your journey, you are not alone and the support from family, friends, coworkers, neighbors and even strangers can make the hard times easier.

2. Alzheimer's disease (AD), which is a form of dementia, is a progressive, degenerative disorder that attacks the brain's nerve cells, resulting in loss of memory, thinking and language skills, as well as behavioral changes. Caring for someone with Alzheimer’s disease is both physically and emotionally demanding, a challenge that may take more strength and patience than ever imagined. Look to friends, family and community resources for support.

When caring for someone with Alzheimer’s, consider practical strategies for communicating with them and keeping them safe. As the disease progresses, it becomes even more challenging, so prepare for the tough choices ahead.

How to Handle Difficult Behavior with Alzheimer’s Disease Patients
Although memory loss is the most well-known symptom of Alzheimer’s disease, behavior can also change. It is important to remember that these behaviors are caused by illness, not by intentional willfulness of the person with the disease. As brain damage increases, the patient cannot remember what was once considered normal, acceptable behavior. Below are common behaviors that develop and some tips for handling them.

• Agitated or violent behavior
• Wandering
• Driving
• Changes in hygiene
• Repetitiveness
• Difficulty with money management
• Changes in eating habits
• Inappropriate behavior in public

Agitated or violent behavior
Agitated or violent behavior can be caused by personality changes brought on by dementia. Mild-mannered people can become aggressive or lose inhibitions because of changes in their brain. Aggressive behavior can also be caused by physical discomfort or unexpressed emotions, such as frustration, fear or anger.

Agitation or violent behavior can be overwhelming. Below are several tips that will help address these issues.

• It is important to keep yourself and the patient safe. Remove all firearms and weapons from the reach of the patient, and stay away from someone whose violence puts you in danger. Call for help immediately if you or the patient is in danger of being harmed.
• Environmental changes and medications can help control violence in people with dementia.
• If danger is not an issue, remain calm since patient’s emotions are often a reflection of those close by them. If you escalate your emotions, the patient may also instinctively escalate their emotions.
• Do not argue with someone who is agitated. Patients with dementia often do not have the ability to follow an argument, and this frustrates them further.
• Try to distract the patient. If a certain activity has caused frustration or anger, changing the activity can help. For example, if they do not want to change clothes, switch to another activity and try getting them to change their clothes 15 to 20 minutes later.
• Do not try to negotiate or punish the patient for bad behavior. Cause and effect are beyond the cognitive ability of many with cognitive changes, so punishment will only further frustrate the patient, possibly causing more agitation or violent behavior.
• Try to keep a written account of aggressive or violent behaviors. This might seem overwhelming for a busy caregiver, but the record can help predict outbursts, so they can be prevented.
• Prevent aggression by following these tips:
  • Maintain a daily routine – keep a regular schedule for sleeping, eating and other normal activities. Routines help soothe patients with dementia.
  • Involve the patient in exercise to keep them energized during the day, which will help them sleep at night. Disruptions in sleep and pent up energy can lead to aggressive behavior. Exercise also helps maintain a healthy body and reduces aches and pains that can cause frustration and anger

Patients with Alzheimer’s disease or dementia often become disoriented and begin to wander at some stage of the disease. Common occurrences include wanting to “go home” even when they are home or looking for someone they remember from the past. Sometimes, patients wander away from a new or unfamiliar setting, or forget how to find a familiar and convenient place, such as the bathroom, so they wander out the front door looking for it.

Help prevent wandering by following these tips.

• Maintain a daily routine – keep a regular schedule for sleeping, eating and other normal activities. Routines help soothe patients with dementia, and can help prevent boredom and anxiety, which can lead to wandering.
• Involve the patient in daily exercise to help maintain a healthy body and reduce aches and pains, which can cause agitation and lead to wandering.
• Avoid busy, crowded settings, such as shopping malls, loud sporting events or grocery stores that can be disorienting.
• Pay attention to signs of discomfort, pain, hunger and thirst to prevent patients from wandering to look for these things. Ask them if they are comfortable or need anything.

Driving
At some point, it will no longer be safe for a patient with dementia to drive. There are signs that will indicate when this point is reached. Some common indicators include the patient becoming disoriented while driving in a familiar neighborhood or getting agitated, driving somewhere unintended (such as a previous job), and driving too slow or too fast.

The loss of independence associated with driving can cause anger, disappointment, frustration and a hurt ego. When the decision is made to prohibit driving, you must be sensitive to the patient’s emotions while communicating the decision to them, but also remain firm and unwavering. Consider asking the patient’s doctor to communicate that driving is prohibited for medical reasons.

Changes in hygiene
Bathing can be challenging for patients because the disease may prevent them from understanding that they need to bathe, or they may have a fear of falling on the slippery surface (in the tub or shower). They also may be afraid of getting wet or getting water in their mouth, nose or eyes. There is often a sense of lost privacy and lost control.

Patient hygiene may be addressed with several tips about bathing.

• Provide as much privacy and independence as possible while bathing the patient; ask a son or brother to bathe a male patient and daughter, sister or female friend to bathe a female patient.
• Maintain a calm demeanor to balance the patient’s potential fears.
• Use the bathtub instead of the shower, if possible.
• Put a chair in the bathtub or shower.
• Provide handrails for stability.
• Never leave the patient alone in the bathtub or shower.
• If possible, arrange for a professional caretaker or nurse to come two or three times per week to bathe the patient. In between visits, you can give sponge baths to clean the face and private areas.

Be consistent with medications and physician recommendations.
Even though you are busy, you will find that keeping with structure of medications, treatment and day programs will be better for the patient and ultimately for you.

Choose decorations carefully and allow yourself to make changes from past celebrations.
Look at areas of safety — lighted candles may not be a good idea and large blinking lights can cause disorientation. Create a beautiful home, accepting that it may be different than years before.

Recognize the effects of overstimulation.
Minimize overstimulation and your anxiety level as this can transfer to the patient. Keep things simple. Reduce the number of visitors, simplify the plan and allow a few days before and after an event to be quiet and relaxing.

Care for yourself.
Make a list of the usual things you do during the holidays. Decide which you really want to keep in your plan and what you can let go of. Allow others to help you and be clear in what you need them to do. Include time away for yourself and methods to help you regain your energy.

Exercise and your brain
Aerobic exercise appears to be an effective preventive intervention for dementia. There is also growing evidence that both aerobic and resistance training can help to maintain brain health in old age and perhaps improve cognitive function in Alzheimer’s disease. Studies continue to demonstrate the ability of exercise to enlarge specific areas of the brain, improve cognitive ability and increase lifespans. Exercise has even been shown to increase Mini Mental State Examination scores in patients with Alzheimer’s disease

3.

Health care encounters in paediatric offices should include a screen for sources of tobacco exposure for every child seen. There is adequate evidence to recommend that primary care clinicians provide interventions, including education and brief counselling, to prevent initiation of tobacco use in school-age children and adolescents. Counselling interventions can take many forms, including:

• Face-to-face encounters

• Phone interactions with a health care provider

• Providing printed materials in person, by mail, or by e-mail

• Guidance to computer applications or Internet sources that are known to be effective

Counselling can help counter or address an adolescent’s attitudes, beliefs and knowledge about smoking and its consequences, especially when they are mistaken or influenced by social or environmental factors, such as tobacco marketing. Counselling can also strengthen the development of social competence and social skills, thus helping youth to decline cigarettes.

GUIDANCE FOR PARENTS AND FAMILIES

Smoking and exposure to second-hand smoke are harmful at all stages of life, starting before birth. Some health effects can last a lifetime, and parents and caregivers should be made aware of health risks and ways to reduce or avoid them. Guidance for parents and families must be personalized to age and context and provide messaging that is specifically meaningful for them. For prevention to be successful, the health care provider’s focus should be family-centred. Rather than concentrating on preventing smoking initiation in a child or youth, consider informing parents about the positive effects of smoking cessation during pregnancy and the first years of their child’s life.

The most effective interventions targeted both social competence and social skills development (social influences)

Laws for smoking

• High taxation rates: Making tobacco products less affordable by raising taxes on tobacco products.

• Labelling disincentives: Using explicit photos and smoking-associated health warnings on all tobacco products, packages and labelling.

• Restricted marketing and sales:Banning point-of-sale displays, advertising to minors and the sponsorship of public events by tobacco companies.

• Smoke-free spaces: Smoking bans in public places such as schools, child care centres, workplaces, hospitals, restaurants, hotels and parks, as well as in public transportation and cars transporting minors.