Care Approach Discussion Paper

Diagnosis and Staging of Cancer

Early diagnosis of cancer improves treatment outcomes by providing the best probability of cure. In order to ensure correct diagnosis of cancer, it is important to perform a thorough medical history and physical examination, as well as perform diagnostic tests. The diagnostic tests are used to establish if the person has cancer or another condition. Diagnostic examinations for cancer consist of diagnostic imaging, laboratory tests, endoscopic examination, and biopsy (Wockel et al, 2018). Some laboratory examinations involve examining tissue samples or the blood for tumor markers. Tumor markers refer to the substance produced by caner cells or body cells in response to cancer. Imaging tests such as CT scan, ultrasound, and MRI scan are used to create images of areas in the body in order to view if there are tumors present. A PET scan is also used in making detailed 3-D images in areas in the body where glucose is taken up because cancer cells take up more glucose when compared to healthy cells. Biopsy is another test important in cancer diagnosis. During biopsy, a sample tissue is removed and a pathologist analyses the tissue under microscope and performs other tests to determine if the tissue is cancerous. The biopsy is the most definitive method used to confirm a cancer diagnosis (Wockel et al, 2018).

After cancer diagnosis, it is important to perform staging. Cancer staging informs about the extent of cancer, for instance the size of the tumor and how far cancer has spread. Being aware of the stage of cancer is important in understanding the severity of the disease and survival chances for the patients; plan best treatment; and identify the best treatment option. The most common method used to stage cancer is the TNM system. TNM system stages cancer as per the size/extent of the primary tumor (T); the number of neighboring lymph nodes with cancer (N); and if there is cancer metastasis to other parts (M) (Koh & Kim, 2019). The possible stages of cancer include:Care Approach Discussion Paper

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Stage 0: The cancer cells are localized in the site where they began and have not spread

Stage 1: The localized cancer has spread to the bordering tissues but not to lymph nodes or any other area

Stage 2: Cancer has spread to the bordering tissues or adjacent lymph nodes

Stage 3: Cancer has spread more than in stage 2

Stage 4: Cancer has metastasized and spread to distant body parts (Koh & Kim, 2019).

Complications of Cancer Effects

Examples of complications resulting from cancer include tumor lysis syndrome, hypercalcemia, and septic shock. Tumor lysis syndrome occurs when there is fast lysis of the malignant cells which causes a metabolic imbalance that can fast result in fatal renal, neurologic, and cardiac complications (Klemencic & Perkins, 2019). Tumor lysis occurs spontaneously after initiation of chemotherapy where during the lysis of malignant cells, the intracellular contents are discharged into the bloodstream which can be fatal. Signs of tumor lysis include vomiting, lack of appetite, nausea, diarrhea muscle weakness, tetany, convulsions, and cardiac arrest.  Prophylactic treatment using hydration can be used to maintain the appropriate urinary output and encourage excretion of uric acid and phosphate (Klemencic & Perkins, 2019).

Septic shock is also another common complication and common cause of death in cancer patients. Warning signs of septic shock include low blood pressure, high respiratory rate, and high pulse rate. Septic shock can be caused by microorganisms because cancer patients are normally immunosuppressed.  It can result in irreparable multiorgan dysfunction and consequent death. Lastly, hypercalcemia is another complication in cancer patients. This complication can result in kidney failure, cardiac arrest or coma if no intervention is initiated (Klemencic & Perkins, 2019). Hypocalcemia occurs in approximately 10-2-% of cancer patients. Common symptoms of hypercalcemia are agitation, fatigue, restlessness, and confusion. The primary form of treatment for hypercalcemia is hydration. Lack of timely treatment for hypercalcemia is allied to 50% mortality rate. Accordingly, nursing care should focus on early detection and support (Klemencic & Perkins, 2019).

The Side Effects of Cancer Treatment and Methods to Lessen Effects

Cancer treatments are associated with side effects that occur when the treatment affects healthy tissues. The most common form of side effects in cancer treatment consist of anemia, bleeding, constipation, diarrhea, nausea, vomiting, fatigue, edema, fertility/sexual health problems, loss of hair, reduced immunity, lymphedema, cancer pain, changes in skin and nails, nerve problems, sleep problems, confusion, depression, and memory or concentration problems (Quidde et al, 2018).

Methods that can be used to reduce effects of cancer and treatments include emotional and social support for the psychological effects. Approaches used to provide emotional and social support include support groups, training patients how to perform relaxation and meditation exercises; physical exercises, and cancer education sessions. Cancer patients can also be administered with medications and cognitive coping strategies to treat depression associated with cancer (Quidde et al, 2018). Physical effects can be treated with medications such as antiemetics to treat nausea and vomiting.Care Approach Discussion Paper

 Factors Contributing to the Incidence and Mortality Rates of Cancer

Factors contributing to the prevalence and mortality rate of different types of cancer among Americans include tobacco smoking that is associated with throat, lung, and mouth cancer while alcohol consumption is associated with oral, liver, breast cancers and other forms of cancer. In addition, a low diet of vegetables and fruits is also associated with different types of cancer. Lack of physical activity is also associated with higher risk of breast and colon cancers, and conceivably other types of cancers (Felix & Brinton, 2018). On the other hand, increased weight and obesity are associated with endometrial, breast and colon cancer, and perchance other cancers. Lastly risk lifestyle behaviors are associated with different types of cancers; for example, human papilloma virus a sexually transmitted virus is the cause of cervical cancer and other types of cancers such as vaginal cancer, penile cancer, anal cancer, and rectal cancer. Therefore, making lifestyle modifications can reduce the risk for various types of cancer and thus reduce the incidence and mortality rate resulting from cancer (Momenimovahed & Hamid, 2019).

American Cancer Society (ACS) & Education and Support

The ACS provides education and support by providing education programs that promote lifestyle changes and provide prevention information to prevent cancer or lower the risk of developing cancer. The education services provided by the ACS also include in-depth information about diagnosis, management, treatment options and advice on how patients can cope with side effects associated with cancer treatments. The ACS also provides information about health insurance. Regarding support, the ACS has patient support programs that help cancer patients and their families in terms of finances and other forms of support (ACS, 2019). For example, the ACS provides cancer patients with free rides to treatment locations and also provides accommodation services to patients who are getting treatment in locations far from home. The ACS also provides counseling services to provide psychological and emotional support. In addition, the ACS has trained and skilled specialists who are always available to provide correct current cancer information to patients, their caregivers, and family members and connect them with valuable resources and services in their localities. Some of the ACS services I would recommend include the National Cancer Information Center (NCIC), Patient Lodging Program, and Road to Recovery (ACS, 2019). This is because these services provide both psychological support and also eases the financial burden of cancer patients and their families.

Nursing Process in Cancer Patients Across the Life Span

Assessment: A nurse should systematically collect and analyze information from the patient. The assessment should include physiological information, as well as data covering psychological, spiritual, sociocultural, economic and lifestyle factors. This means when assessing a cancer patient, apart from the physical aspects, a nurse should also address the emotional and fears associated with the disease (Li et al, 2018).

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Diagnosis: All nursing diagnosis for cancer patients should cover all actual and potential health needs and conditions for the patient. For instance, it is important to ensure the diagnosis reflects other problems caused by cancer or pain such as anxiety, poor nutrition, reduced quality of life, financial or family burden, or potential complications (Li et al, 2018). Care Approach Discussion Paper

Outcomes/Planning: According to the assessment and diagnosis, a nurse should set measurable an attainable goal for the patient that cover all identified diagnosis such as pain management using adequate medication; ensuring adequate nutritional intake; providing counselling; providing appropriate spiritual support; and maintaining supportive caretaking activities whenever the patient needs them and helping the patient to maintain independence as much as possible (Li et al, 2018).

Implementation: The nursing care should be implemented as per the care plan and documented

Evaluation: Finally, the nurse should continuously evaluate the status/progress of the patient as well as the efficacy of the nursing care and make modifications as required (Bates et al, 2018).

Liberal Arts and Science Studies & Nursing Knowledge

Liberal education provides nursing students with the intellectual and innovative abilities necessary during nursing practice. Nurses who are liberally educated are able to work in a healthcare team and use critical thinking skills to solve problems that emerge during patient care and exercise proper clinical judgment (Kooken & Kerr, 2018). Successful incorporation of liberal education provides nursing students with the knowledge of human cultures, which include spiritual beliefs, as well as physical and natural worlds that support a holistic approach to nursing practice. In addition, the study of fine arts, language, and history forms a fundamental basis for graduate nurses to develop clinical reasoning and cultural competence. Liberal arts have been shown to improve communication skills, decision-making ability and cultural competence of nursing students (Kooken & Kerr, 2018).

Moreover, the incorporation of concepts from natural, behavioral and biological sciences in the nursing curriculum ensures that nurse students understand self, and others, and at the same time contribute to provision of safe and quality care. Arts and sciences provide the basis for nursing students to understand health and disease processes, and more importantly is the foundation of clinical reasoning (Rodgers et al, 2017). Finally, sciences such as mathematics, social and physical sciences are particularly fundamental to the nursing profession because they equip graduates with the capacity to keep pace with healthcare changes prompted by research and new technologies. Moreover, science equips nurses with the ability to per from research and thus ensure evidence-based practice (Kooken & Kerr, 2018).

References

American Cancer Society (ACS). (2019). Treatment & Support. Retrieved from < https://www.cancer.org/treatment.html>

Bates R, Blair L, Schlegel E, Nist M, Collen M & Arcoleo K. (2018). Nursing across the Lifespan: Implications of Lifecourse Theory for Nursing Research. J Pediatr Health Care. 32(1), 92–97.

Felix A & Brinton L. (2018). Cancer Progress and Priorities: Uterine Cancer. Cancer Epidemiol Biomarkers Prev. 27(9), 985–994.

Klemencic S & Perkins J. (2019). Diagnosis and Management of Oncologic Emergencies. West J Emerg Med. 20(2), 316–322.

Koh J & Kim M. (2019). Introduction of a New Staging System of Breast Cancer for Radiologists: An Emphasis on the Prognostic Stage. Korean J Radiol. 20(1), 69–82.

Kooken W & Kerr N. (2018). Blending the liberal arts and nursing: Creating a portrait for the 21st century. J Prof Nurs. 34(1):60-64.

Li P, Guo Y, Tang Q & Yang L. (2018). Effectiveness of a nursing intervention for increasing hope in patients with cancer: a meta-analysis^. Rev Lat Am Enfermagem. 1(26), e2937.

Momenimovahed Z & Hamid S. (2019). Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer (Dove Med Press). 1(11), 151–164.

Rodgers, K., Funke, B., Rhodes, D., Brown, K., & Cox, C. (2017). The Role of the Liberal Arts in Preparing Health Education Specialists. Pedagogy in Health Promotion. 3(1), 9–15.

Quidde J, Pan Y, Salm M, Hendi A, Sven N, Karin O, Stein A & Nestoriuc Y. (2018). Preventing adverse events of chemotherapy by educating patients about the nocebo effect (RENNO study) – study protocol of a randomized controlled trial with gastrointestinal cancer patients. BMC Cancer. 18(916).

Wockel A, Albert U, Janni W, Anton S, Rolf K & Tanja S. (2018). The Screening, Diagnosis, Treatment, and Follow-Up of Breast Cancer. Dtsch Arztebl Int. 115(18), 316–323.  Care Approach Discussion Paper