This paper discusses the importance of discharge planning for colorectal cancer patients, including survivorship issues and prevention strategies. It also explores collaborative approaches to education and self-management.
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Running head: NURSING ASSIGNMENT NURSING ASSIGNMENT Name of the Student Name of the university Authorâs note
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1NURSING ASSIGNMENT Introduction The case study is about John, a 62 years old patient, who had been under treatment for the several days till he had made a successful recovery. However, a proper discharge planning is required to be made in order to ensure an ideal recovery planning suitable to the physical and the emotional grievances of the people. This paper would provide with a discharge planning mentioning about the survivorship issues that the patient might be facing across physical, emotional, social and spiritual spheres of health.It will also propose a strategy that can be made for the prevention of the identified issues. Discharge planning John who had been suffering from colorectal cancer is currently getting his last round of chemotherapy and is now ready for the discharge. Colorectal cancer is the second most common type of cancer in Australia that affects both the men and women. In addition to physical examination, the diagnosis of colorectal cancer includes a biopsy. Some of the other types of tests that are required to diagnose the colorectal cancer is colonoscopy, where a doctor looks inside the rectum and the colon (Anderson, Steele & Coyle, 2013). Finally a biopsy is used to understand the occurrence of colorectal cancer. A molecular testing of the tumour can also be done by using a laboratory test on a tumour sample for identifying the specific proteins and genes unique to the tumour (D'Souza,Daudt & Kazanjian, 2016). Colorectal cancers are tested for the problems in the mismatch repair proteins, known as the mismatch repair. Initially it is used for understanding the Lynch syndrome, next the results would be used for determining if the immunotherapy can be considered for the patients suffering for the metastatic breast cancer. A complete blood count test can also be used for the assessing the levels of the proteins CEA.
2NURSING ASSIGNMENT John might have been subjected to neo-adjuvant therapy for the rectal cancer using the preoperative chemoradiation therapy. This indicates towards the fact that John might have been suffering from stage II or III disease. Preoperative chemoradiation therapy has been proven to be a standard of treatment options for the patients with stage II and stage II cancer. The follow care for John would include regular physical examinations and some other medical tests for monitoring the recovery (Primrose et al., 2014). Apart from a regular visit to the doctor, some of the tests included a CEA test for detecting the level of CEA proteins that indicates, whether the cancer has spread to different parts of the body. Again a pelvic CT scan has to be dome after six or 12 months (Primrose et al., 2014) Collaborative approaches to education and planning for self-management Cancer survivorship starts at the diagnosis and continues till the entire life span. The important care incudes inhibition of the recurrent symptoms, surveillance for the recurrence and medical or psychosomatic effects of cancer, interventions for the concerns of treatment of cancer and promotion of health (McCabe et al., 2013). There are several physical challenged, that the cancer survivors have to face with. Some of the major physical problems involved stomach ache, cramping, Incontinence, Constipation and diarrhoea (Duijts et al., 2017). Some of the physical problems involves urinary incontinence, male sexual dysfunction as well as female sexual dysfunctions (Averyt & Nishimoto, 2014). The cancer survivors are subjected to face with several psychological issues like anxiety, depression. They are also likely to suffer from post traumatic disorder (PTSD). The prevalence of anxiety and depression symptoms appears to be closely related to physical functioning of the patients, the economic contraints, cognitive functioning, lack of social support and concerns
3NURSING ASSIGNMENT regarding the relapse of cancer (Duineveld et al., 2016). It has been found that approximately two-third of the cancer survivors could get back to work within 1.5 years after the analysis of cancer (Averyt & Nishimoto, 2014). Hence, those who can return to the work have sown less chances of psychological disorders among the patients (Averyt & Nishimoto, 2014). Again, some of the patients might be concerned about the treatment effects of the colorectal cancer. Again,patientsmightreportadeclineinthementalfunctioningatthejobincluding concentration impairment, memory difficulties and decrease ability to multitask. A colonoscopy can also be done in order to look for secondary cancers or polyps (Averyt & Nishimoto, 2014). It is again necessary for the patients in relation to the cancer remittance. Sometimes patients suffering from colorectal cancer suffer from same symptoms as that of the symptoms of the occurrence for the first time.Recurrent symptoms generally presents as metastasis in the lungs or liver or as a locoregional recurrence in peritoneum or pelvis (Duineveld et al., 2016). Recurrent disease can be addressed with a curative intent, depending upon the location and the number of metastases and on the condition of the patients. Intensive follow up programs and frequent diagnosis testing can be helpful for the follow up. Any kind of cancer affects the social and the emotional wellbeing cancer survivors. It can lead to decreased quality of life. Negative body image might lead to social isolation. Many of the cancer survivors feel that life takes on a new meaning after the cancer and many wants to renew their commitments to spiritual practices or organized religion (Clay,Talley & Young,2012). Most of the survivors of the colorectal cancer loses their functionality to so their own task and probably have to rely on some formal or informal care givers, which makes them unsecured in their life. The long term adult survivors of colorectal cancer suffers from more physical limitations and chronic diseases. In many cases, the patient might become incompetent and
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4NURSING ASSIGNMENT might refuse to get back to the normal pace of social life (Denlinger & Barsevick, 2019). Spiritualty can be considered as an important constituent for evaluating the quality of life and wellbeing in cancer survivors. Intrinsic spirituality gives a sense of the purpose and meaning in life and the relationship between meaning in life and spirituality in coping up with stressful conditions. In an observational study, it has been found that there are people who found feelings of divine existence or peace reported feelingsof least physical problems. Higher spiritual wellbeing has been reported with better physical health. Many authors of the opinion, that spirituality and religion can help the cancer patients find meaning in their illness and provide comfort in the face of fear. Denlinger and Barsevick, (2019) have again argued that while diagnosis of cancer can encourage some of the people for renewing their faith, it can also have some negative impact on others. A diagnosis might challenge their feelings and make the patients doubt their religious or spiritual values. This kind of feeling might again make it difficult for the patients to survive with cancer. The nurses play an import ant role in addressing the physical, social, emotional and psychological needs of patients who had survived cancers. Even after the therapeutic treatment of cancer, patients should maintain strict follow up with increasing the visits to the primary care physician and decreasing visits to the oncologists (Duijts et al., 2017). A shared model of care is necessary for developing asurvivorship care whichcan be facilitated by a survivorship care plan. Meditation and the relaxation therapy can reduce the fear in the cancer survivors. Relaxation techniques like muscle relaxation, meditative relaxation and visualization can be helpful to reduce the fear of the cancer recurrence.Black et al., (2017) have found that mindfulness meditation conducted with the patients suffering from CRC at the beginning and
5NURSING ASSIGNMENT after the chemotherapy decreases the blunting of the cortisol level. Cortisol blunting has been associated with the progression of the disease a shorter span of survival. It is the maker if hypothalamic-pituitary-adrenal (HPA) axis dysregulation (Black et al., 2017). This s caused due to the emotional and the physical stresses experienced by the patients. The study byCarlson, (2016)had randomly assigned 57 patients receiving adjuvant chemotherapy for conducting a 20 minute audio-video guided mindfulness based meditation for about 40 minutes. Both the groups had been watched for the results (Carlson, 2016). The amount of the cortisol has been collected from the saliva sample that was collected at the baseline. Patient who had received mindfulness based therapy has been found to be an increased level of cortisol activity in comparison to the control group. Mindfulness based therapy has been found to be inversely associated to fatigue, thus, psychological issues can be solved by relaxation techniques and it also tends to increase the spirituality of the patients (Carlson, 2016). Meditation and yoga can also increase the physical strength of the muscles. These health education to the patients can be given during the follow up services. An occupational therapist in collaboration with a primary care nurse to go for a home visit for educating the about the self-management of the condition, starting from physical exercises, to suitable diet and environmental modifications. In case Mr. John is alone and does not have any informal caregivers, the hospital arrange for nurses or caregivers who would assist the patient in the household chores and the activities. In case the home visits are not possible, telephonic follow ups can also be conducted by the nurses to educate the patients.
6NURSING ASSIGNMENT Conclusion Survivorship is considered as a distinct phase of colorectal cancer treatment. The goals of care would include surveillance for the remittance, managing the long term and the late toxicities related to multimodality treatment, encouraging a healthy diet and life style behaviours can be helpful to the patient for leading a healthy life in this survival period.
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7NURSING ASSIGNMENT References Anderson, A. S., Steele, R., & Coyle, J. (2013). Lifestyle issues for colorectal cancer survivorsâ perceived needs, beliefs and opportunities.Supportive Care in Cancer,21(1), 35-42. Averyt, J. C., & Nishimoto, P. W. (2014). Addressing sexual dysfunction in colorectal cancer survivorship care.Journal of gastrointestinal oncology,5(5), 388. Averyt, J. C., & Nishimoto, P. W. (2014). Psychosocial issues in colorectal cancer survivorship: the top ten questions patients may not be asking.Journal of gastrointestinal oncology, 5(5), 395â400. doi:10.3978/j.issn.2078-6891.2014.058 Black, D. S., Peng, C., Sleight, A. G., Nguyen, N., Lenz, H. J., & Figueiredo, J. C. (2017). Mindfulness practice reduces cortisol blunting during chemotherapy: A randomized controlled study of colorectal cancer patients.Cancer,123(16), 3088-3096. Carlson, L. E. (2016). Mindfulnessâbased interventions for coping with cancer.Annals of the New York Academy of Sciences,1373(1), 5-12. Clay, K. S., Talley, C., & Young, K. B. (2012). EXPLORING SPIRITUAL WELL-BEING AMONG SURVIVORS OF COLORECTAL AND LUNG CANCER.Journal of religion & spirituality in social work,29(1), 14â32. Denlinger, C. S., & Barsevick, A. M. (2019). The challenges of colorectal cancer survivorship. Journal of the National Comprehensive Cancer Network : JNCCN,7(8), 883â894.
8NURSING ASSIGNMENT D'Souza, V., Daudt, H., & Kazanjian, A. (2016). Survivorship care plans for people with colorectal cancer: do they reflect the research evidence?.Current oncology (Toronto, Ont.),23(5), e488âe498. doi:10.3747/co.23.3114 Duijts, S. F., van Egmond, M. P., Spelten, E., van Muijen, P., Anema, J. R., & van der Beek, A. J. (2014). Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review.PsychoâOncology,23(5), 481-492. Duineveld, L. A., van Asselt, K. M., Bemelman, W. A., Smits, A. B., Tanis, P. J., van Weert, H. C., & Wind, J. (2016). Symptomatic and Asymptomatic Colon Cancer Recurrence: A MulticenterCohortStudy.Annalsoffamilymedicine,14(3),215â220. doi:10.1370/afm.1919 McCabe, M. S., Bhatia, S., Oeffinger, K. C., Reaman, G. H., Tyne, C., Wollins, D. S., & Hudson, M. M. (2013). American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care.Journal of Clinical Oncology,31(5), 631. Primrose, J. N., Perera, R., Gray, A., Rose, P., Fuller, A., Corkhill, A., ... & Mant, D. (2014). Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial.Jama,311(3), 263-270.