NRS 410 Grand Canyon Week 5 Discussion: Mr C’s functional health patterns

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The case scenario provided will be used to answer the discussion questions that follow. Discussion: Mr C’s functional health patterns

Case Scenario

Mr. C., a 32-year-old single man, is seeking information at the outpatient center regarding possible bariatric surgery for his obesity. He reports that he has always been heavy, even as a small child, but he has gained about 100 pounds in the last 2-3 years. Previous medical evaluations have not indicated any metabolic diseases, but he says he has high blood pressure, which he tries to control with sodium restriction and sleep apnea. He current works at a catalog telephone center. Discussion: Mr C’s functional health patterns

Objective Data

• Height: 68 inches; Weight 134.5 kg
• BP: 172/96, HR 88, RR 26
• Fasting Blood Glucose: 146/mg/dL
• Total Cholesterol: 250mg/dL
• Triglycerides: 312 mg/dL
• HDL: 30 mg/dL

Critical Thinking Questions

1. What health risks associated with obesity does Mr. C. have? Is bariatric surgery an appropriate intervention? Why or why not?
2. Mr. C. has been diagnosed with peptic ulcer disease and the following medications have been ordered: (a) Magnesium hydroxide/aluminum hydroxide (Mylanta) 15 mL PO 1 hour before bedtime and 3 hours after mealtime and at bedtime; (b) Ranitidine (Zantac) 300 mg PO at bedtime; and (c) Sucralfate / Carafate 1 g or 10m1 suspension (500mg / 5mL) 1 hour before meals and at bedtime.Discussion: Mr C’s functional health patterns

The patient reports eating meals at 7 a.m., noon, and 6 p.m., and a bedtime snack at 10 p.m. Plan an administration schedule that will be most therapeutic and acceptable to the patient.

1. Assess each of Mr. C.’s functional health patterns using the information given (Hint: Functional health patterns include health-perception – health management, nutritional – metabolic, elimination, activity-exercise, sleep-rest, cognitive-perceptual, self-perception – self-concept, role-relationship, sexuality – reproductive, coping – stress tolerance).
2. What actual or potential problems can you identify? Describe at least five problems and provide the rationale for each.Discussion: Mr C’s functional health patterns

Approach to Cancer Care: Pathology and Nursing Management of Client’s Health

Approach to Cancer

Cancer is a malignant neoplasm that can affect individuals of any ethnic background, age, occupation, and social economic status. Some of the common factors that contribute to the high mortality rate are consumption of alcohol, tobacco smoking, occupational exposures to asbestos and radiation among others. Genetic factors are also proven to be a contributing factor to mortality rates. Early detection of cancer can lead to good outcomes (Artherholt, 2012).

Diagnosis of Cancer

There is no proven test that is used to diagnose cancer despite having various types and forms of cancer. There are however several basic diagnostic procedures and tools that are used to assist in recognizing, determining and monitoring the treatment of cancer. The first step of diagnosing cancer is reviewing the personal history of the patient and family health history then a physical exam is obtained. The second step is laboratory testing of various specimens like stool, blood, urine or other bodily fluids that can help in recognizing any deviances in normal values. Laboratory testing is a basic tool used to help in directing more diagnostic tests that show different types of cancer. An abnormal laboratory is therefore not a certain sign of cancer (Carelle, 2002). Tumor markers are substances that are produced to show high levels of cancerous conditions. This is however not always the case as these tumor markers can also be produced by normal and non-cancerous cells of the body at beginning cancerous conditions. Tumor marker measurements are therefore used along with other tests the likes of biopsies in the treatment of cancer throughout the entire duration. Nowadays there are various technological ways of determining the presence of a tumor in the body. They include ultrasounds, magnetic resonance imaging (MRI), x-rays, positron emission tomography (PET) scans and computerized tomography (CT) scans. A biopsy is the most common and effective test used in diagnosing cancer together with the above technological techniques. A biopsy is a procedure which involves removal of a sample of organ tissue in question and then analyzed by a pathologist using a microscope to check the presence of cancerous cells. Biopsy samples are collected using endoscopic tools, aspiration needle to withdraw fluid or through surgery.

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Staging of cancer

Cancer is staged after diagnosis of cancer. Staging of cancer helps in determining the chances of survival, determining the best treatment method to be used, recognizing clinical trial options as well as understanding cancer better. Staging of cancer is determined by tumor size and extent of tumors, lymph node involvement, the location of the original tumor and presence or absence of distant metastasis.

The most common and effective method of staging cancer is the TNM classification system. This classification system should always be updated at least 6-8 months as the understanding of cancer continues to advance. Letter T, represent the size and extent of primary tumor, N represents the number of regional lymph nodes that have cancer and M refers to whether the tumor has spread to other body parts (Kroschinsky, 2017). If letter X is seen after T, N, or M, this is an indication that the category is unmeasurable. If number 0 follows T, N or M, then the category can’t be found.

Clinical staging assesses the extent of cancer through results obtained from imaging tests such as X-rays and scans, physical exams and tumor biopsies. Other results tests can also be used such as blood tests. Clinical stage helps in determining the best treatment to be used as well as comparing how treatment responds to different treatment. Another method of staging cancer is pathologic staging also known as the surgical stage of cancer. This stage depends on the results obtained from previous exams and tests mentioned above or through what is learned about cancer during surgery. The surgery is done to remove cancer or nearby lymph nodes. The surgery may also be conducted to determine the extent of cancer in the body and take out tissue samples. Pathologic stages differ from clinical staging especially when the surgery indicates that cancer has spread in the body more than it was expected. Pathologic stage helps the health care team to obtain vital information to be used in predicting treatment outcomes and response.

Complications and side effects of cancer treatment

Complications of cancer depend on the affected part of the body. Some of the common complications include fatigue, difficulty in swallowing, changes in bladder habits, weight gain or loss, persistent cough, persistent indigestion, and unexpected fevers among others.

Commonly used cancer treatment include radiation therapy, chemotherapy, and surgery. This treatment is accompanied by side effects that often affect patient’s ability to comply with treatments or make treatment less effective than they could be. Neutropenia is a common side effect after chemotherapy treatment (Ko, 2002).  Neutropenia decreases the number of white blood cells in the body which are the main defense against germs. Chemotherapy drugs kill all fast-growing cells in the body including healthy white blood cells and cancer cells. Patients who have less white blood cells to fight infection are likely to be more affected. Washing hands often is the most recommended way of lowering the chances of getting neutropenia side effects. Another way of preventing this infection is by consulting a doctor especially when one notices any other signs of infection such as fever.

Lymphedema is another side effect that occurs when lymph nodes are removed during surgery or when lymph nodes are damaged by radiation treatment thus blocking the lymph fluid from draining properly. The blocked lymph fluid then builds up in the skin thus making that part of the body to swell. Cancer patients are recommended to inform the doctor when they notice such body swellings. There is a specialist who can be able to drain the lymph nodes manually. Alternatively, the patients can be recommended to exercise or wear tight-fitting garments that will help in managing lymphedema.

The aim of chemotherapy drugs is to kill all growing cells in the body which means they are also capable of destroying hair roots. Some patients end up losing all hair in the body including eyebrows, pubic hairs, armpit hair, and eyelashes. The hair may, however, grow again after 3 to 10 months after the last treatment. Radiation can also lead to hair loss although it only affects the exposed areas. There is no proven effective treatment for hair loss however treatments such as cooling caps helps in keeping more of the hair from falling out (Mourtzakis, 2008). The cooling cap is fitted in the patients head to keep the scalp cool before, during and after chemotherapy treatment. The effectiveness of the cooling cap is determined by the kind of chemotherapy one receives. Most cancer patients prefer to shave their hair before it starts falling out. Others choose to wear hats, scarfs or wigs during chemotherapy treatment.

Some cancer patients’ experiences nausea and vomiting just from thinking about cancer treatment. Nausea can be managed byways such as taking ginger and drinking plenty of water. Others techniques include acupuncture and hypnosis. Other side effects of treatment include trouble eating, depression, decreased sex drive, tiredness, hearing loss, skin changes, and nail changes.

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Methods to lessen physical and psychological effects

Encouraging exercise program especially during radiation therapy can help in improving signs and symptoms as well as mental and physical health of the patient. During therapy, a patient is recommended to walk around to help in maintaining his or her fitness. A medical practitioner is required during the exercise to address any complication that can occur. Most patients including healthy individuals believe that no one can survive from cancer. It is therefore important for cancer patients to be taught on how to relax and deal with the situation thus lessening psychological and physical effects. This technique is referred to as a relaxation method which involves diaphragm breathing and guided imagery (Murray, 2013). The patient is encouraged to only think of the good moment in his or her life. The patients are also educated to enable them to clearly understand and accept their condition hence reducing anxiety. They are educated on what type of cancer they are having and why it is necessary for them to change their lifestyle. This relieves dilemmas concerning cancer as well as reducing psychological disturbances. Other techniques that can help in lessening physical and psychological effects include emotional and social support, medications for depression or anxiety, training in stress management and early distress screening.

References

Artherholt, S. B., & Fann, J. R. (2012). Psychosocial care in cancer. Current psychiatry reports, 14(1), 23-29.s

Carelle, N., Piotto, E., Bellanger, A., Germanaud, J., Thuillier, A., & Khayat, D. (2002). Changing patient perceptions of the side effects of cancer chemotherapy. Cancer, 95(1), 155-163.

Kroschinsky, F., Stölzel, F., von Bonin, S., Beutel, G., Kochanek, M., Kiehl, M., & Schellongowski, P. (2017). New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management. Critical care, 21(1), 89.

Ko, C., & Chaudhry, S. (2002). The need for a multidisciplinary approach to cancer care. Journal of Surgical Research, 105(1), 53-57.

Mourtzakis, M., Prado, C. M., Lieffers, J. R., Reiman, T., McCargar, L. J., & Baracos, V. E.(2008). A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Applied Physiology, Nutrition, and Metabolism, 33(5), 997-1006.

Murray, S. A., Kendall, M., Boyd, K., & Sheikh, A. (2013). Illness trajectories and palliative care. International Perspectives on Public Health and Palliative Care, 30, 2017-19.Discussion: Mr C’s functional health patterns