Integrated Nursing Practice 4 (NSB334): Harold's Cancer Care Analysis

This assignment presents a comprehensive analysis of Harold, a 75-year-old male with stage III Non-small cell lung cancer (NSCLC), and his nursing care needs. The paper addresses various aspects of his condition, including the BreastScreen Australia program for cancer prevention, early cancer detection through screening for cervical and colon cancer, and the symptoms and pathophysiology of lung cancer. It explores the different categories of NSCLC, treatment interventions, and the impact on Harold's quality of life, considering the challenges of living in a rural community. The assignment also covers the prevention of healthcare-related infections, management of chemotherapy side effects like fatigue and nerve/muscle effects, and interventions to minimize these. Further, it discusses the management of hypercalcemia, setting SMART goals for Harold, and communication strategies to reduce stigma. It addresses the financial concerns of patients and the role of nurses in providing support. Finally, it examines palliative care interventions, including interdisciplinary team members, and strategies to manage dyspnea and pain.

Running head: INTEGRATED NURSING PRACTICE 1
Integrated Nursing Practice 4
Name of Student
Institutional Affiliation

INTEGRATED NURSING PRACTICE 2
Integrated Nursing Practice 4
Question One
BreastScreen Australia program is used to foster prevention and early diagnosis of breast
cancer risk factors in the country. The program has encouraged behavioral changes to reduce the
prevalence of breast cancer (Olver & Roder, 2017, p. 2). Under this program, women aged
between the age of 50 and 74 are invited to participate in a free mammogram every two years.
The program was tailored to support and encourage lifestyle changes among individuals at risk
of getting breast cancer. Therefore, the program is serving as a prevention blueprint focusing on
the reduction of risk factors while fostering early detection and diagnosis. The government has
collaborated with partners to implement measures such as population-based screening,
community sensitization, and support programs across the groups at risk (Olver & Roder, 2017,
p. 2).
Question Two
Practitioners recommend early diagnosis and treatment of cancer to reduce the adverse
effect of the disease (Bazargan et al., 2015, p. 756). Cervical cancer and colon cancer could be
screened to facilitate early detection.
Cervical cancer could also be detected at an early stage to pave the way for immediate
treatment. Cervical cancer screening is carried out through pap tests on tissues obtained from the
cervix. Over 450,000 women are diagnosed with cervical cancer each year across the globe
(Musa et al., 2017, p. 2). Regular pap tests enhance the chances of identifying cervical cancer at
an early stage.

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Another cancer that could be diagnosed at an early stage through regular screening
colorectal or colon cancer, which develops from the abnormal growth called precancerous polyps
within the colon. Screening of colon cancer could be carried out through sensitivity tests of the
stool or colon and rectum imaging or visual examination (Issa & Noureddine, 2017, p. 5087).
Question Three
Harold’s CT scan results indicated that he has lung cancer. However, several signs and
symptoms also indicate the possibility of a positive diagnosis. Harold and other patients with
lung cancer have chronic coughing and dyspnea (Lemjabbar et al., 2015, p. 201). Each of these
symptoms is associated with specific pathophysiology pathways. In many cases, lung cancer
occurs within the airways and cause extreme obstruction and enlargement of the lymph nodes.
These changes encourage the development of post-obstructive pneumonia, which leads to
persistent chronic coughing (Lemjabbar et al., 2015, p. 190). Additionally, as seen in Harold’s
case and among a significant number of patients with lung cancer, the development of dyspnea is
part of the causes of distressing experiences. Lung cancer is characterized by the development of
tumors within the central airways, which leads to occlusion. Lung parenchyma, complications
from the treatment interventions, and pleural effusion could also lead to dyspnea. Such pathways
explain why lung cancer patients experience continuous distressing symptoms over an extended
period.
Question Four
Non-Small Cells Lung Cancer (NSCLC) is categorized into three specific groups based
on the characteristics of the cancerous cells. Harold has been diagnosed with NSCLC, which
implies that his cancer could be among these three categories. Squamous Cell Carcinoma (SCC)
emanates from tobacco smoking, which explains why it usually develops within the central

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region of the lungs (Testa et al., p. 17). Adenocarcinoma is an NSCLC category that develops on
the outside of the lungs. The third category is the Large Cell Carcinoma (LCC), which entails
rapid and spontaneous growth of the tumor with a subsequent poor prognosis.
Since Harold has been diagnosed with NSCLC, treatment interventions and prognosis is
going to affect his quality of life. Clinical evidence ascertains that patients with NSCLC
experience distress and symptom burden, which could adversely impact the post-treatment
outcomes and symptom management (Abdel-Karim et al., 2020, p. 176). At the same time,
patients with NSCLC, as seen in Harold’s case, could achieve positive outcomes during
prognosis through social support and self-resilience. Additionally, treatment interventions will
play a key role in symptom management, which ascertains that Harold could witness reduced
symptom burden and distress as key positive indicators of quality of life among cancer patients
(Abdel-Karim et al., 2020, p. 176).
Harold lives in a rural community, which implies that as a person living with cancer, he
will face the following challenges.
i. Harold could face a challenge of access to emergency services owing to the
healthcare disparity in most rural areas. Access to emergency oncology services is
limited for cancer patients living in rural communities (Ugalde et al., 2019, p. 1).
ii. Additionally, Harold is at risk of receiving limited community-based services
such as psychosocial support from social workers.
Question Five
The prevention of healthcare-related infection is important in improving patient
outcomes. Cancer patients undergoing chemotherapy are at a high risk of infection because of

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neutropenia (Nurgali et al., 2018, p. 2). Neutropenia is a common limitation of chemotherapy,
which leads to a reduction while blood cell count. Additionally, infection risks originate from a
long hospital stay period increases the risk of healthcare-related infections.
Harold is at risk of two primary side effects of chemotherapy. Harold could experience
increased fatigue as well as nerve and muscle effects. Chemotherapy causes fatigue because the
process could denature health cells in the body. On the other hand, muscle and nerve effects
emanate from damaged nervous pathways, which could cause numbness or pain (Nurgali et al.,
2018, p. 2).
Interventions for Minimizing Fatigue
i. The fatigue side effect could be reduced through proper diet. Having a balanced diet
plan improved body immunity.
ii. Secondly, the use of pharmacological therapy is effective in reducing experienced
fatigue.
Evaluating the Interventions - The impact of a proper diet and medication as interventions
for fatigue could be evaluated by examining the nutritional responsiveness based on diet plan
and changes in fatigue patterns.
Interventions for Minimizing Nerve and Muscle Effects
i. Nerve and muscle effects could be reduced through moderate and targeted exercise
could also improve the response of the muscles and nerves within the affected area.
ii. The second intervention for muscle and nerve effects is the use of therapy (Nurgali et
al., 2018, p. 2).

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Evaluating the Interventions - The impact of exercise and therapy could be evaluated by
assessing muscle and nerve response and whether there is a reduction in pain.
Question Six
The normal serum calcium for normal adults is 8 – 10 mg/dL, which is equivalent to 2 –
2.5 mmol/L (Sidhar et al., 2016, p. 268). High serum calcium weakens the bones, interferes with
heart efficiency, and could lead to kidney stones. The occurrence of hypercalcemia is caused by
the overactivity of the parathyroid glands.
One strategy for the management of hypercalcemia is achieved through hydration and
low dose furosemide because an increase or decrease in serum calcium is asymptomatic (Body et
al., 2018, p. 3). The use of normal saline hydration intervention increases the serum volume and
enhances glomerular filtration rates leading to improved calcium excretion. Pharmacological
interventions could also be used to manage increased serum calcium. The use of appropriate
medication inhibits the reabsorption of calcium ions back into the blood through the renal tube.
For example, Body et al. (2018, p. 3) reviewed the efficacy of different medications for
hypocalcemia condition.
Question Seven
Harold’s condition is complex and requires strategic goals to achieve quality outcomes.
The first two short-term goals for Harold are controlling cancer and achieving comfort. The
goals for Harold should be SMART, which implies that they are Specific, Measurable,
Attainable, Realistic, and Trackable. SMART goals play significant roles in healthcare
interventions.

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A Goal on Control: To reduce further exacerbation of cancer through chemotherapy and
pharmacology in the next two months.
A Goal on Comfort: To achieve comfort and positive post-treatment outcome through proper
symptom management in the next two weeks.
Question Eight
The majority of patients diagnosed with lung cancer have reported a high level of stigma
because of its association with smoking. In this case, care interventions should equally focus on
measures that could be adopted to reduce the stigmatization of patients. When working with such
patients, communication strategy plays a key role in defining the outcome and impact of the
interactions between the practitioner and the affected individual (Shen et al., 2016, p. 2095). One
effective communication strategy is openness when interacting with the patient. Such a move
will allow the patient to understand the risks, implications, potential outcomes, and nature of
experiences that they will encounter in their path of treatment, prognosis, and management of the
condition. When the nurse is open during the conversation, it creates an environment that
supports trust between the two parties. At the same time, inclusion and collaboration during
conversations engagement is another essential approach of improving the interaction between
care provider and the patient to prevent stigma. The patient should be given enough time to
express their perception and experiences. Including the patient in a conversation as a partner in
care, provision reduces stigma risks as part of good provider communication practice (Shen et
al., 2015, p. 2095).

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Question Nine
Patients diagnosed with chronic diseases also express their concerns regarding financial
challenges and fears. The role of the nurse is to take the patient through a comprehensive support
program that could enhance their ability to overcome their financial concerns to prevent them
from withdrawing from treatment (Barbaret et al., 2017, p. 2). Harold expressed his financial
concerns, which could negatively affect his physical and psychological health. As a nurse, I will
first assess the degree of Harold’s financial concerns. This will determine whether he is willing
to include his family in the discussion on the way forwards. The second step will be the
development of case planning through the collaboration of other professionals in social work to
identify key resources that could effectively assist the patient in the short-term and long-term.
The decision to be referred to care support services in the community will depend on the
outcomes of the care planning and assessment of the available resources. Additionally, I will
consider how Harold could benefit from existing medication assistance programs. Over the
years, pharmaceutical companies have offered patients significant support when they have
financial burdens. However, the best patient-centered support is to offer effective treatment to
ensure that the patient regains normal life within the shortest time possible (Weis, 2015, p. 85).
Question Ten
Palliative care is a multidisciplinary care intervention that incorporates practitioners from
different disciplines who work together to optimize the quality of life for patients with chronic
illness. The purpose of palliative care is to mitigate suffering and improve symptom management
throughout the care period. Cancer palliative care includes psychosocial support interventions
(Malloy et al., 2017, p. 46). For cancer patients, palliative care is important because it focuses on
physical, psychological, and social support to enhance the quality of life. Two interdisciplinary

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team members in Harold’s palliative care team include a psychologist and a nurse. Nurses play a
central role in palliative care for cancer patients because they offer professional support during
diagnosis, treatment, and prognosis. Psychologists assist the patients to develop positive
narratives and perceptions throughout the cancer journey. Psychosocial support is important for
people diagnosed with cancer (Malloy et al., 2017, p. 46). The use of therapy is an essential
strategy that could mitigate dyspnea and pain among cancer patients as part of palliative care
interventions. The therapy improves body coordination and muscle response, which could reduce
the pain experienced by cancer patients. Additionally, the use of proper diet is another palliative
care intervention that could improve patient outcomes. Support from nutritionists could enhance
the ability of the cancer patient to manage pain and dyspnea.

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