Question

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1. As a nurse how can you educate client/patient to identify behaviors to reduce the risk for cancer development and cancer death? 2. As a nurse how will you prioritize nursing care for the patient receiving radiation therapy? 3. As a nurse how will you prioritize nursing care for the patient receiving biological response modifiers and growth factors as supportive therapy in the treatment for cancers? 4. As a nurse how will you prioritize nursing care for patient receiving chemotherapy?

Answer 1

1) As a nurse , how can you educate client/patient to identify behaviors to reduce the risk for cancer development and cancer death.

Answer:

Cancer is often unpredictable, but there are things everyone can do to help reduce their cancer risk or improve their chances of beating the disease if they do get it. What’s more, some of those same behaviors can also help lower risk for other serious diseases, and boost odds of living a longer, healthier life. As a nurse, I can explain these to the patient.

a. Get regular cancer screening tests.

Regular screening tests can catch some cancers early, when they’re small, have not spread, and are easier to treat. With cervical and colon cancers, these tests can even prevent cancer from developing in the first place. Talk with your doctor about the tests for breast, cervical, colon, lung, and prostate cancers.

b. Get to and stay at a healthy weight.

Being overweight or obese is a risk factor for many cancers, including breast, colon, endometrium, kidney, esophagus, and pancreatic cancer. You can control your weight through regular exercise and healthy eating.

c. Exercise regularly.

Physical activity has been shown to lower the risk of several types of cancer, including breast, endometrium, prostate, and colon cancer. It also reduces the risk of other serious diseases such as diabetes and heart disease.

• Adults should get at least 150 minutes of moderate-intensity activity (equal to a brisk walk) or 75 minutes of vigorous activity (makes your heartbeat and breathing faster, and makes you sweat) each week, preferably spread throughout the week.
• Kids should get at least 1 hour of moderate- or vigorous-intensity activity each day, with vigorous activity at least 3 days a week

d. Eat a healthy diet.

• Studies show that eating a variety of different vegetables and fruits, whole grains, and fish or poultry is linked with a lower risk of developing certain cancers. On the other hand, eating more processed and red meat is linked with a higher risk of developing certain cancers. The American Cancer Society recommends:

• Eating at least 2½ cups of vegetables and fruits each day
• Eating less red meat (beef, pork, and lamb) and less processed meat (bacon, sausage, luncheon meats, and hot dogs)
• Choosing breads, pastas, and cereals made from whole grains instead of refined grains, and brown rice instead of white
• Eating fewer sweets

e. Avoid tobacco.

Tobacco use in the US is responsible for nearly 1 out of every 5 deaths – about 480,000 premature deaths each year. About 80% of lung cancer deaths and 30% of all cancer deaths are caused by tobacco use.

f. Limit alcohol.

Research has shown that alcohol can increase your risk for certain kinds of cancer, including breast, mouth, throat, voice box, esophagus, liver, colon and rectal cancer. The more alcohol you drink, the higher your risk.

• Men should have no more than 2 drinks a day and women no more than 1.
• One drink is equal to about 12 ounces of beer, 5 ounces of wine, or 1½ ounces of 80-proof liquor.

2) As a nurse, how will you prioritize nursing care for the patient receiving radiation therapy.

Answer

NURSING RESPONSIBILITIES FOR EITHER EXTERNAL OR INTERNAL RADIATION THERAPY

• Carefully assess and manage any complications, usually in collaboration with the radiation oncologist.
• Assist in documenting the results of the therapy; for example, clients receiving radiation for metastases to the spine will show improved neurologic functioning as tumor size diminishes.
• Provide emotional support, relief of physical and psychologic discomfort, and opportunities to talk about fears and concerns. For some clients, radiation therapy is a last chance for cure or even just for relief of physical discomfort.

EXTERNAL RADIATION

Prior to the start of treatments, the treatment area will be specifically located by the radiation oncologist and marked with colored semipermanent ink or tatoos. Treatment is usually given 5 days per week for 15 to 30 minutes per day over 2 to 7 weeks.

Nursing Responsibilities

• Monitor for adverse effects: skin changes, such as blanching, erythema, desquamation, sloughing, or hemorrhage; ulcerations of mucous membranes; nausea and vomiting, diarrhea, or gastrointestinal bleeding.
• Assess lungs for rales, which may indicate interstitial exudate. Observe for any dyspnea or changes in respiratory pattern.
• Identify and record any medications that the client will be taking during the radiation treatment.
• Monitor white blood cell counts and platelet counts for significant decreases.

Client and Family Teaching

• Wash the skin that is marked as the radiation site only with plain water, no soap; do not apply deodorant, lotions, medications, perfume, or talcum powder to the site during the treatment period.Take care not to wash off the treatment marks.
• Do not rub, scratch, or scrub treated skin areas. If necessary, use only an electric razor to shave the treated area.
• Apply neither heat nor cold (e.g., heating pad or ice pack) to the treatment site.
• Inspect the skin for damage or serious changes, and report these to the radiologist or physician.
• Wear loose, soft clothing over the treated area.
• Protect skin from sun exposure during treatment and for at least 1 year after radiation therapy is discontinued. Cover skin with protective clothing during treatment; once radiation is discontinued, use sun-blocking agents with a sun protection factor (SPF) of at least 15.
• External radiation poses no risk to other people for radiation exposure, even with intimate physical contact.
• Be sure to get plenty of rest and eat a balanced diet.

INTERNAL RADIATION

The radiation source, called an implant, is placed into the affected tissue or body cavity and is sealed in tubes, containers, wires, seeds, capsules, or needles. An implant may be temporary or permanent. Internal radiation may also be ingested or injected as a solution into the bloodstream or a body cavity or be introduced into the tumor through a catheter.The radioactive substance may transmit rays outside the body or be excreted in body fluids.

Nursing Responsibilities

• Place the client in a private room.
• Limit visits to 10 to 30 minutes, and have visitors sit at least 6 feet from the client.
• Monitor for side effects such as burning sensations, excessive perspiration, chills and fever, nausea and vomiting, or diarrhea.
• Assess for fistulas or necrosis of adjacent tissues.

Client and Family Teaching

• While a temporary implant is in place, stay in bed and rest quietly to avoid dislodging the implant.
• For outpatient treatments, avoid close contact with others until treatment has been discontinued.
• If the radiologist indicates the need for such measures, dispose of excretory materials in special containers or in a toilet not used by others.
• Carry out daily activities as able; get extra rest if feeling fatigued.
• Eat a balanced diet; frequent, small meals often are better tolerated.
• Contact the nurse or physician for any concerns or questions after discharge.

4) As a nurse how will you prioritize nursing care for patient receiving chemotherapy

Answer

Oncology nurses practice in a variety of settings including acute care hospitals, ambulatory care clinics, private oncologists' offices, radiation therapy facilities, home healthcare agencies, and community agencies. They practice in association with a number of oncologic disciplines, including surgical oncology, radiation oncology, gynecologic oncology, pediatric oncology, and medical oncology.

Patient Assessment

Nurses are expected to be expert in assessing a patient's physical and emotional status, past health history, health practices, and both the patient's and the family's knowledge of the disease and its treatment. The oncology nurse reviews the treatment plan with the oncologist, is aware of expected outcomes and possible complications, and independently assesses the patient's general physical and emotional status. It is essential that a detailed nursing history and physical examination be completed. An oncology nurse is expected to be aware of the results and general implications of all relevant laboratory, pathology, and imaging studies. Assessment of the patient's understanding of the disease and proposed treatment is fundamental in allaying anxiety and formulating a care plan. Obtaining this information will help avoid misunderstanding and confused expectations. Thorough patient preparation improves compliance with treatment programs and may impact treatment outcomes as well.

Patient Education

The nurse often has a better opportunity than any other member of the healthcare team to develop the required rapport for effective educational efforts with patients and their families. Patient and family education starts before therapy and continues during and after therapy. Continual reinforcement throughout the treatment course helps to ensure success. Appropriate written and visual teaching aids may be used, as well as referrals to other professionals or community programs, such as cancer support groups. Such education includes structured and unstructured experiences to assist patients with coping with their diagnosis, long-term adjustments, and symptoms; to gain information about prevention, diagnosis and care; and to develop skills, knowledge, and attitudes to maintain or regain health status. This planned education uses a combination of methods that best meet the needs, capabilities, and learning style of the patient.33 The ONS has enhanced this definition by recommending the following patient education outcome criteria34: The patient and/or family should be able to (1) describe the state of the disease and therapy at a level consistent with the patient's educational and emotional status; (2) participate in the decision-making process pertaining to the plan of care and life activities; (3) identify appropriate community resources that provide information and services; (4) describe appropriate actions for highly predictable problems, oncologic emergencies, and major side effects of the disease and/or therapy; and (5) describe the schedule when ongoing therapy is predicted.

Coordination of Care

The oncology nurse plays a vital role in coordinating the multiple and complex technologies now commonly employed in cancer diagnosis and treatment. This coordination encompasses direct patient care; documentation in the medical record; participation in therapy; symptom management; organization of referrals to other healthcare providers; both patient and family education; as well as counseling throughout diagnosis, therapy, and follow up. The nurse should serve as the patient's first line of communication. Ideally, the patient and family should feel free to contact the oncology nurse by phone during the entire treatment program. Many patients travel long distances, so the importance of communication by telephone must be emphasized. It allows continuous patient communication, early recognition of emergencies, and regular emotional support.

Direct Patient Care

The majority of ONS members provide direct patient care involving chemotherapy. National certification for chemotherapy currently does not exist. Each institution should have written policies for chemotherapy certification, administration of antineoplastic drugs (all routes), safe drug handling and disposal, management of untoward reactions, such as allergic reactions, and methods for documentation. The ONS currently offers a chemotherapy trainers course. These trainers may then offer chemotherapy training courses in the community to oncology nurses based on ONS guidelines and curriculum.

Symptom Management

Oncology nurses are challenged on a daily basis to deal with the numerous symptoms patients with cancer and their families encounter as a result of their cancer or its treatment. Nurses triage patient problems and assist in the evaluation of symptoms and initiation of interventions. For example, subjective and objective data, including information about the last chemotherapy treatment and knowledge of the patient's history, guide the nurse in determining the patient's disposition and treatment.

Supportive Care

Oncology nurses are closely involved with numerous supportive care issues encountered by cancer patients and their families. This chapter does not allow a detailed discussion of the numerous areas of supportive and palliative care, but two areas deserve special mention, that is, the involvement of nurses in pain management and in survivorship.

3) As a nurse how will you prioritize nursing care for the patient recieving biological response modifiers and growth factors as supportive therapy in the treatment for cancers.

Answer

Immunotherapy (Biologic Response Modifiers - Colony-Stimulating Factors & Tumor Vaccines)    

Immunotherapy

Biologic Response Modifiers (BRM), also called immunotherapy, is a type of treatment that mobilizes the body's immune system to fight cancer.   The therapy mainly consists of stimulating the immune system to help it do its job more effectively. Tumor Vaccines also work to stimulate the body's immune system. To help understand the role that biological agents play in cancer treatment some understanding of how the immune system (such as lymphocytes, dendritic cells and macrophages) works is helpful.

Biological response modifiers are substances that are able to trigger the immune system to indirectly affect tumors. These include cytokines such as interferons and interleukins. This strategy involves giving larger amounts of these substances by injection or infusion in the hope of stimulating the cells of the immune system to act more effectively.

An understanding of Biologic Response Modifiers and the immune system components such as lymphocytes, dendritic cells, and macrophages demonstrates how working with the body to treat cancer is a potentially effective strategy in cancer care.  Hormone therapy is another therapeutic method that works with the body to treat cancer.

Side Effects of Biologic Response Modifiers

Like other forms of cancer treatment, immunotherapies can cause a number of side effects. These side effects can vary widely from patient to patient. Biologic response modifiers, may cause flu-like symptoms including fever, chills, nausea, and appetite loss. Rashes or swelling may develop at the site where they are injected. Blood pressure may also be affected, usually decreasing it. Fatigue is another common side effect of biologic response modifiers. Side effects of colony stimulating factors may include bone pain, fatigue, fever, and appetite loss.

Colony-Stimulating Factors

In the body's bone marrow (the soft, sponge-like material found inside bones) blood cells are produced. There are three major types of blood cells; white blood cells, which fight infection; red blood cells, which carry oxygen to and remove waste products from organs and tissues; and platelets, which enable the blood to clot.

Cancer treatments such as chemotherapy and radiation therapy can effect these cells which put a person at risk for developing infections, anemia and bleeding problems. Colony-stimulating factors are substances that stimulate the production of blood cells and promote their ability to function.   They do not directly affect tumors but through their role in stimulating blood cells they can be helpful as support of the persons immune system during cancer treatment.

Tumor Vaccines

Researchers are developing vaccines that may encourage the patient's immune system to recognize cancer cells. These would in theory work in a similar way as vaccines for measles, mumps and small pox. The difference in cancer treatment is that vaccines are used after someone has cancer. The vaccines would be given to prevent the cancer from returning or to get the body to reject tumor lumps. This is much more difficult than preventing a viral infection. The use of tumor vaccines continues to be studied in clinical trials.