University NSB 334 Integrated Practice 4 Assessment 1: Harold's Case

This assignment, completed for NSB 334 Integrated Nursing Practice 4 at a university, analyzes a case study of Harold, a 75-year-old male with stage III Non-small cell lung cancer (NSCLC). The assignment covers various aspects of cancer care, including an overview of an Australian cancer prevention program, cancer screening methods, and the clinical signs and symptoms of lung cancer. It further explores the anatomy, physiology, and implications of NSCLC, including prognosis and the impact of treatment on quality of life. The assignment also addresses challenges faced by patients in rural communities and explores nursing interventions related to chemotherapy side effects like anemia and pain. Additionally, it covers the management of hypercalcemia, goal setting, and communication strategies to reduce stigma associated with lung cancer. The student provides justifications for their answers, drawing on evidence-based resources.

Running head; NSB 334 ASSESSMENT 1
NSB 334 Assessment
Student name
University Name

NSB 334 ASSESSMENT 2
1) Some cancers have a strong relationship with certain lifestyle factors. Many
prevention programs are promoted in the media, healthcare facilities and other
cancer organizations in Australia. Using evidence, identify and discuss one (1)
cancer prevention program, you are aware of that is used in Australia. (3 marks)
Breast Screen Australia is one of the Australian programs founded with an aim to reduce
deaths and illnesses resulting from breast cancer (van Gaans et al., 2018 pp. 103-114). Its main
goal is to do breast screening regularly. It invites women aged 50 to 74 years old for free
mammogram every two years (O’Hara et al., 2018, p. 2)
This program works with the government and other agencies to help prevent complications
which come about with breast cancers. This is achieved through early detection and early
screening. They also do a follow-up on the treatment once a diagnosis and treatment plan is
made. Despite the big progress rural and remote areas remain a big challenge (Coory et al., 2013,
pp. 605-608). Treatment of pre-cancerous abnormalities can also be done. This will prevent their
progression into cancerous cells which may be complicated to treat.
2) Early detection is the key to increased survival in most cancers. Some cancers can
be screened for to facilitate early diagnosis. Identify (2) cancers that can be screened
for and discuss how screening for these cancers is performed. (4 marks)
Breast cancer screening can be done in a hospital or at home. There are three ways developed
to do the breast cancer screening; mammography, self-breast examination and clinical breast
examination (Takkar et al., 2017). One can do a self-breast examination or undergoes
mammography. A breast examination is done to detect lumps in the breast. It can be done by a
nurse or can be done by one after an education. An observation is first done for the breast to see

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if there are any changes in the breast color. Clockwise palpation of each breast and the organs
around it is then done. Any detection of lumps should be reported to the doctor. Regular breast
examination, however, has not been shown to reduce deaths from breast cancer. Mammography
can also be taken. This is an x-ray examination of the breast to detect lumps in the breast. This is
effective for tumors which are too small to feel (Welch et al. 2016, pp. 1438-1447).
Cervical cancer screening is also done for females. A Pap test is done to detect cancer of the
cervix. It is done through the collection of cells from the cervical and vaginal area. These cells
can then be viewed in a microscope to see any abnormalities. A positive Pap smear result is
followed by an HPV (Human Papilloma Virus test). This is to confirm whether the HPV is the
cause of the abnormality (Burd, 2016, pp. 291-319).
3) Harold has recently had a CT scan that indicated he had a diagnosis of lung cancer.
Identify (2) clinical signs and symptoms that would also indicate that Harold might
have lung cancer and explain the pathophysiology of these. (4 marks)
The signs and symptoms of lung cancer include;
a) Shortness of breath
b) Feeling tired
Shortness of breath is a result of the tumors in the lungs. Lung tumors sometimes can
press on the airways. This causes the constriction of these airways making it difficult for the
delivery of air into the distal organs of the respiratory system, the alveoli. Constriction causes
straining on the accessory muscles in an effort to increase the effort to push the air in through the
small tubes. The tumors can also affect the pleural areas of the respiratory system. This causes
over secretion of the pleural fluid from the pleural membrane. This causes pressure on the other

NSB 334 ASSESSMENT 4
thoracic region causes difficulty in the inspiration of air. This presents with some feeling of dull
sound on percussion of the thoracic region (Winland-Brown, & Klause, 2017, p. 239).
Fatigue is the most commonly encountered symptom throughout the course of lung
cancer (Carnio et al., 2016, p. 73). The feeling of fatigue is a result of the altered function of the
respiratory system. With the insufficient function of the lungs, there will be less oxygen to
supply the body. Less amount of oxygen will be supplied to the body's musculature; the few
available amounts will be transported to the crucial organs of the body such as the brain. (Carter,
2019).
4) Harold has been diagnosed with Non-Small Cell Lung cancer (NSCLC).
a) Describe the anatomy and physiology of NSCLC. (2 marks)
Non-small cell lung cancers are named and have characteristics depending on the different
organs of the lungs.
Adenocarcinomas are cancer which affects the glandular organs of the lungs. They are most
cancers of the mucus-producing cells. It is common in patients with a history of smoking
(Hoffmann et al., 2017, pp. 199-211)
Squamous cell carcinomas are associated with squamous cells. They are flat and mostly line
the airway. They are most common in people with a history of smoking (Dusingize et al. 2017,
pp. 1700-1708).
Large cell carcinomas are not part specific. They tend to grow in any part of the lungs, spread
easily and are therefore harder to treat. They are undifferentiated cells (Pelosi et al. 2015, pp.
226-231).

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b) Discuss the implications for Harold of having a diagnosis of NSCLC commenting on
prognosis and the impact of treatment on his quality of life. (4 marks)
The diagnosis of NSCLC will affect the life of Harold across almost all aspects of his life. The
course of the disease is unpredictable. He is likely to suffer complications which come about
with the condition (Carrier, 2015). However, he holds on some hope to live to a hundred, he is
unlikely to get there.
The quality of his life is also changing to the worse. Harold will never again enjoy his life the
way before. He will no longer work on his farm because of the complications which come about
with his condition. The distressing sign of the condition robs him his comfort. His family will
also be affected. John will have to pull resources, including the time to take care of Harold.
Cancer-related pain also affects the quality of life one lives (Rodriguez et al., 2019, pp. 116-123).
c) Discuss two (2) challenges Harold faces as a person living in a rural community
diagnosed with cancer. (2 marks)
Most people living in rural areas are dependent on agriculture (Imai, Gaiha, & Garbero, 2017
pp. 963-982). Harold will no longer be able to give a hand to John in their farms. This will affect
his productivity on the farm. He may be needed to struggle to help on the farm despite his
condition.
Harold's access to immediate care in case of a complication is difficult. Living in rural areas
with cancer is not advisable. In an event when Harold develops a complication, he is likely not to
access immediate care (Martin et al., 2018 pp. 382-383).
5) Harold is receiving chemotherapy for his lung cancer.

NSB 334 ASSESSMENT 6
a) Review National Standard 3 (Preventing and controlling healthcare-associated
infections). Describe and justify why people undergoing chemotherapy are at higher risk of
getting healthcare-associated infections. (2 marks)
Chemotherapy targets rapidly dividing cells in the body. It mostly is not likely to discriminate
between the normal cells and the immune cells. The immune cells are, therefore, a target of the
chemotherapy. The death of these cells causes immunosuppression. Immunosuppression occurs
with use of alkylating agents (Chortkoff, & Stenehjem, 2019, pp. 753-768). The patients
receiving chemotherapy are, therefore, at a higher risk of getting healthcare-associated
infections.
b) Name and justify two (2) side effects Harold might experience when receiving
chemotherapy. (2 marks)
Harold is likely to develop anemia. Chemotherapy causes the suppression of bone marrow
(Engel et al., 2019, p. 420). This causes reduced production of the red blood cells. This will
present with signs of pale moist membranes.
Harold will experience pain. Chemotherapeutic agents are cytotoxic which results in
neuropathic pain (Brandolini et al., 2019, pp. 705-713). This characteristic makes it cause a lot of
pain the body. Care should be taken when securing the line to ensure that the drug is not
administered directly into the tissues.
c) State and justify two (2) interventions (nursing or collaborative, NOT referrals to allied
health professionals) to minimize the effects of each stated side effect. (4 marks)

NSB 334 ASSESSMENT 7
The blood hemoglobin level should be monitored before and after the administration of
chemotherapy. Before a decision to start a client on chemotherapy, the hemoglobin level should
be considered. Patients with no hemoglobin should not receive chemotherapy. Regular
monitoring of the hemoglobin level should also be done. Blood transfusion should also be done
for patients with low hemoglobin (Zhou et al. 2015, p.75).
Adequate pain assessment and management should be done. Assessment can be done using the
pain ladder or observation for features such as facial expression. Cancer pain is managed
collaboratively either pharmacological or non-pharmacologically. Pharmacological use of
analgesics, mostly opioids is used after collaborative discussion to decide specific one (Wiffen et
al., 2017, pp. 7). Non-pharmacological methods are mostly not effective for cancer pain.
d) Discuss how you would evaluate that each intervention was effective (2 marks)
Evaluation of the effectiveness of the intervention lies more on observation. Early detection
of anemia and hair loss helps on the decision of the course of treatment. Regular attainment of a
normal range of hemoglobin level is a sign of the success of the intervention done (Phelps,
2019).
6) In the case study, it is identified that Harold's corrected serum calcium is high. This
is a common complication for patients with advanced cancer and can become a
medical emergency.
a) State the normal adult values (in mmol/L) for serum calcium and discuss (2) clinical
effects of high serum calcium. (3 marks)
The normal serum calcium level is 2- 2.5 mm/L (El‐Hajj Fuleihan et al. 2015, pp. 1119-
1133).

NSB 334 ASSESSMENT 8
High serum level causes cardiac arrhythmias. This is the irregularity in the cardiac
rhythm. The increased serum in the blood causes over-activity of the cardiac muscles, which
result in irregular cardiac activity (Dyson et al. 2015, pp. 1633-1641).
High calcium level causes increased urination (Singla & Gupta, 2019 p.e33- e34). The
body tries to secret excess calcium through the kidneys. This regulatory mechanism causes
frequent and more urination. This may result in symptoms of thirst (Singla & Gupta, 2019 p.e33-
e34).
b) Identify two (2) interventions to manage an increased serum calcium level and discuss
their mode of action (4 marks)
Administration of calcimimetics in medical therapy for hypercalcemia. Calcimimetics mimics
the calcium in the blood. They bind to calcium-sensing receptors, thus depressing the secretion
of parathyroid hormone (Nemeth & Goodman, 2016, pp. 341-358).
Administration of salmon calcitonin is another medical therapy. It inhibits bone resorption and
thus reduces the amount of calcium in the circulation (Naot, Musson, & Cornish, 2019, pp 781-
805).
7) Given Harold’s complex condition and care requirements. Write (2) short-term goals
for Harold in a SMART format. (2 marks)
Harold to report of reduction of pain from a grade of 8 to 5 on a scale of zero to ten within
twenty-four hours.
Harold to report reduced difficulty in breathing within twenty-four hours.

NSB 334 ASSESSMENT 9
8) Lung cancer is associated with significant stigma due to its relationship with smoking.
Discuss and justify two (2) communication strategies that you could use when interacting
with a person affected by lung cancer to reduce the potential impact of stigma. (4 marks)
Messages concerning the effectiveness of the treatment may be used. Communicating in
a way to show that the treatment they are undergoing is effective. The stigma will reduce and see
some hope of recovering from the condition. This will help them to open up about their
conditions (Walczak et al 2016, pp. 3-16).
Messages highlighting the support of the government and the public should be used. This
will make them feel appreciated and therefore reduce the feeling of being stigmatized. They will,
therefore, see how accommodating the society is, and that stigmatization is just an image they
have. The communication should be done while observing the patient’s non verbal
communication cues (Banerjee et al. 2020)
9) Harold discusses concerns about his finances. Describe how you, as a nurse, would
provide good psychosocial, patient-centred care for Harold in relation to his financial
concerns. (2 marks)
I would give psychosocial support to Harold. He should not worry much about his finances. The
matters at hand are his health and the future ought not to be worried about. He first should focus
on his health condition. I would also advise involving John in his financial decisions he is going
to take (Cagle et al., 2017 pp. 198-207).
10

NSB 334 ASSESSMENT
10
a) Define what is meant by palliative care and justify its role in caring for patients
with cancer and other life-limiting illnesses. (2 marks)
Palliative care is the approach of improving the quality of care of the patient and that of the
family facing life-threatening illnesses through prevention and relieving of suffering by early
identification and treatment of pain and other problems; psychological, psychosocial and
emotional (Swagerty, 2017 pp. 415-429).
Palliative care is important for cancer patients. They suffer from pain and other problems
which affect their quality of life. They, and their families, deserve to be cared for as they battle
life-limiting illnesses (Wasilewski-Masker et al 2017, pp.749-764).
b) Using evidence, identify two (2) interdisciplinary team members in a palliative care team
and justify their role in the context of Harold’s care and his social environment. (4 marks)
According to Bruera (2016, p. 273), the provision of palliative care is dependent on teamwork.
The teams involved include the nurses, the doctors, spiritual leaders and even the social workers.
The nurses play a role in the provision of care to Harold. They provide treatment and also may
give psychological care to him. The nurses give the management of pain; pharmacological and
non-pharmacological (Brown, et al. 2017).
The spiritual leaders give spiritual care to palliative care patients. Spiritual care should be given
to address the patient's matters spirituality (Cobb, 2018 p. 193). The spiritual leaders can be
trained health care providers on spirituality, church leaders, Imams (De la Porte, 2016, pp. 1-9).
They will provide care to Harold on his spiritual needs.

NSB 334 ASSESSMENT
11
c) Harold is experiencing ongoing thoracic pain and dyspnoea. Describe the
pathophysiological basis of these symptoms in end-stage lung cancer. (2 marks)
The lung tumors grow in the lung cavity. They need space to grow into. This space is, however,
not available. They, therefore, push on other organs exerting pressure on them. This results in
thoracic pain. The growth of the tumors can also be within the airways. This constricts the
airways causing the passage of air, in and out, of the lungs to be impaired. This causes difficulty
in breathing. Patients with difficulty in breathing needs to undergo pulmonary
rehabilitation(Polanski et al., 2016, pp.1023)
d) Discuss (2) evidence-based palliative interventions to manage pain and dyspnoea. (2
marks)
Pain is managed using pharmacological and non-pharmacological methods. The pharmacological
methods include administration of analgesics depending on the severity of the pain. Strong
opioids, for example, are used in cases of severe pain (Bennett, 2017, pp. 705-713). The non-
pharmacological methods may not be effective for cancer-related pain. It includes the distraction
of thoughts to divert attention from the pain.
Dyspnoea is also managed through pharmacological and non-pharmacological methods. Drugs
are administered to increase the dilatation of the airways. This will reduce the difficulty of
breathing. Appropriate positioning of the patient is done on patients having difficulty in
breathing (Ibrahim et al., 2017, pp. 9-14). This is to reduce the pressure exerted on the thoracic
area to reduce the effort in inhalation of air.

NSB 334 ASSESSMENT
12
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