Nursing Process Approach to Care of Cancer

Nursing Process Approach to Care of Cancer

A nursing process is applied to systematically identify problems and prevent and treat them to promote health and wellness. The five steps are assessment, diagnosis, planning, implementation, and evaluation. Similarly, this approach is adequately utilized in patients diagnosed with cancer, a group of more than 200 distinct diseases characterized by the uncontrolled growth of abnormal cells in the body. Therefore, the nursing process is functional in providing patient-centered care through the above nursing process steps. It is resourceful in identifying the cancer patients’ potential needs and developing goal-oriented plans to deliver nursing interventions.

Diagnosis of cancer involves a series of events based on knowledge and experience accumulated by healthcare professionals over their theoretical training and practice period. It involves several systematic methods to make a diagnosis effectively. Family and personal medical history is one way to determine cancer. Factors such as genes, environment, occupation, and lifestyle give significant clues that help determine the risk of developing cancer. It can also be ruled out through its symptoms of cancer. Although these symptoms may be similar to those of other diseases, health care professionals need to be keen not to miss the vital signs. These are the presence of a lump, abnormal bleeding, prolonged cough, unexplained weight loss, change in bowel movement, body sputum, loss of function, and many others. A practical nursing process approach makes these signs less likely to be missed.

Also, a thorough physical exam through smell, palpation, and percussion of the respective body parts helps identify lumps and other abnormalities that could be highly suggestive of cancer. Laboratory tests of blood, urine, and lymph can reveal existing abnormalities that may be cancer-related, such as a complete blood count that may indicate an elevated level of white blood cells which is related to leukemia and other cancer-related illnesses. Imaging tests allow detailed examination of internal organs, including bones (Forner et al., 2019). The imaging tests include; a computerized tomography scan that uses a computed and processed combination of a series of X-rays measures taken from distant angles. Other imaging tests are Magnetic Resonance Imaging (MRI), position emission tomography, ultrasound/sonography, and radiography.

 A cancer diagnosis can also be made by obtaining tissue to screen for the presence of cancer either through microscopy or laboratory tests. These tissues can be obtained through Fine Needle Aspiration (FNA), where primary lesions are screened to determine the involvement of lymph nodes and other secondary sites. Other methods include bone marrow biopsy, punch biopsy, core needle biopsy, incisional, and excisional biopsy. However, biopsy examination is the only definite way to diagnose cancer.

Cancer staging refers to determining the extent of cancer in the body. It describes the severity of cancer on an individual based on the size of the spread and the magnitude of the primary tissues. It also describes the distance to the surrounding tissues and organs (Forner et al., 2019). A numerical system of staging tumors is the most commonly used method. Stage 0 describes cancer in situ limited to surface cells and has not spread to nearby tissues. Stage 1 is usually a tumor with evidence of growth but is limited to the tissue of origin. Stage 2 describes cancer with the limited spread of cancer cells. Stage 3 refers to extensive local and regional distance may include involvement of lymph nodes. In contrast, stage 4 describes cancer that has spread to other body organs, advanced or metastatic tumors.

Another form is the TNM staging method used for most malignancies. The tumor (T), lymph nodes (N), and if cancer has spread (metastasis) are all described using letters (M). The letter T for tumor describes how large the primary tumor is and the location, N (lymph nodes) defines whether cancer has spread to lymph nodes, and M (Metastasis) describes if the spread has spread to other parts of the body, where and how much has it lay. Pathological staging involves microscopic examination of the tumor by a pathologist after its surgical removal to determine the extent. Clinical staging is done based on information available that may have been obtained through a detailed physical examination, biopsy, and imaging tests. Lastly, post-neoadjuvant therapy is done on some cancers on treatment other than surgery. After the first treatment intervention, this staging is done to measure cancer’s response to treatment.

Oncologic complications resulting from cancer progression occur in almost all cancer patients. They are an indication of advancing disease and are life-threatening. Therefore, nurses should be in the frontline in assessing through the nursing process to identify patients at high risk of developing these complications. Cardiac tamponade is one complication resulting from cardiac muscle compression due to fluid accumulation within the pericardial sac (Casanovas Blanco, 2019). It may constrict the pericardium’s constriction by a tumor, hence reducing blood flow to ventricles and cardiac output. With time it develops into myocardial ischemia. Increased intracranial pressure is another complication due to increased brain volume, cerebral blood volume, and cerebral spinal fluid within the skull and meninges. Approximately 20-40% of oncology patients develop brain metastases increasing the risk of brain herniation and death.

Spinal cord compression results from the epidural abscess. This complication occurs mainly in patients with cancer that spreads to the bone. Spinal cord compression eventually causes edema and ischemia that causes damage to the neural tissue. Disseminated intravascular coagulation is a bleeding disorder that results from alteration of the blood-clotting mechanism due to depletion of clotting factors. It is related to disease progression and cancer therapy. Hypercalcemia is an oncologic complication occurring due to the rise of serum calcium above the normal. It can, in turn, lead to renal failure, cardiac arrest, or coma. Pleural effusion may also result due to fluid accumulation in the pleural cavity. This directly alters the respiratory function since it restricts lung expansion and decreases lung volume, affecting gas exchange. Septic shock also occurs due to systemic inflammatory response syndrome leading to irreversible multiorgan failure that eventually causes death.

Treatment approaches to treat cancer are always prone to adverse side effects to patients that may be life-threatening and alter the normal functioning of an individual. These side effects are; neutropenia which results from chemotherapy treatment, thereby causing a reduced number of white blood cells which functions in helping the body fight against infection. Chemotherapy works by killing rapidly growing cancer cells and white blood cells. Lymphedema is another side effect resulting from radiation therapy that damages lymph nodes and vessels; hence, the lymph fluid cannot drain correctly. Alopecia (hair loss), nausea, and vomiting are caused by chemotherapy and other cancer treatment medication. Other side effects are; anemia, constipation, loss of appetite, thrombocytopenia, edema, fatigue, sleep problems, and loss of fertility.

To lessen cancer treatment’s physical and psychological effects, emotional and social support is critical to help them cope. This reduces anxiety, depression, and disease-therapy-related symptoms. This includes training on relaxation techniques, meditation, stress management, talk therapy through cancer education sessions, and exercise. Also, antidepressants and anxiolytic medications may be given to manage depression and anxiety. Advising them to spread their daily activities throughout the day, taking breaks to rest between them, and taking short naps consistently throughout the day, instead of one long nap, can help reduce the physical effects of cancer treatment.

The burden of cancer in the United States can be associated with modifiable lifestyle behaviors that increase disease risk. These factors are the significant contributors to annual incidence and mortality rates related to cancer in America. Tobacco use is responsible for over 440 000 deaths due to lung cancer every year. Other factors are lack of physical activity, overweight, poor diet, and excessive alcohol consumption. Some factors substantially contribute to cancer incidences; these include exposure to ultraviolet rays, sexual practices, and occupation factors.

The American Cancer Society provides support and education regarding cancer through various strategies. It publishes many educative brochures, pamphlets, journals, and books that are educative to patients, their families, caregivers, and health care professionals. It includes preventive and coping strategy books (Rock et al., 2020). It also offers community programs and services that aim to help over 1.4 million patients diagnosed with cancer every year and the 14million survivors of cancer and their families. Educative information and emotional support are provided to this population. The ACS also helps day-to-day support such as getting rides to treatment, lodging, mastectomy and hair loss products, breast cancer support, and sharing experiences through an online community. Some cancer patients contact ACS via phone and chat; they are helped to offset isolation feelings. However, I would recommend educative reading materials since it offers preventive education and coping strategies for cancer patients. Emotional support and community programs also help lessen cancer’s physical and psychological effects and its treatment.

A nursing process is a systematic tool that promotes evidence-based practice in the nursing process in identifying and addressing patient problems (Leslie, 2018). Assessment is the first step of the nursing process. It involves prioritizing patient issues by obtaining detailed baseline information on presenting symptoms, the patient’s family history, and medical history. Assessment should address activity, elimination, intake, pain, respiration status, and neurosensory status of the patient. Diagnosis is drawn based on the assessment data through prioritization. Although it might be impossible to address every diagnosis, nursing focus and priority diagnoses need to be addressed. Systematically reviewing those areas improves patient outcomes.

Planning in the nursing process developing a plan of action. Through assessment prioritization, measurable goals are set, and an expected beneficial outcome is to track the patient’s wellness. Implementation is done by following through on a decided plan of action that focuses on achieving the desired outcomes to promote patient health. It involves putting into action interventions such as patient education, providing chemotherapy and radiotherapy, and surgical procedures to remove the tumor. Evaluation is done once all the interventions have been implemented. It is done to determine whether the goals to promote patient wellness have been met. If the goals were not met, the nursing process begins again to ensure that cancer patients provide safe and effective care.

Undergraduates in liberal arts and studies contribute the foundation of nursing knowledge and prepare nurses to provide patient care by utilizing the nursing process. It is achieved since liberal arts and sciences encourage critical and creative thinking. Nursing practice requires one to understand quantitative data and research and a course like mathematics provides this (Kooken, 2019). Nursing process implementation involves looking at evidence and research findings that are practical and reliable. It consists of the ability to think, ask, evaluate and come up with a solution reinforced through the liberal arts and science curriculum critically.

The core role is that liberal arts and science help nursing students and practicing nurses improve their communication skills think critically, navigate diversity, make goal-oriented decisions, and make better versions of themselves. Also, it contributes to nursing practice since they are eye-opening and changes the way one approaches it. Nurses are involved in caring for different patients with diverse conditions. Therefore, one needs to be competent culturally and understand the needs of all patients and their families. The liberal arts and sciences serve as a core component in educational discipline throughout nursing practice. For a while, science has performed a central task in nursing education. 

References

Casanovas Blanco, M. (2019). A critical review of emergency department management of chemotherapy complications in cancer patients. European Journal of Cancer Care, 28(2), e12974.

Forner, A., Vidili, G., Rengo, M., Bujanda, L., Ponz‐Sarvisé, M., & Lamarca, A. (2019). Clinical presentation, diagnosis and staging of cholangiocarcinoma. Liver International, 39, 98-107.

Kooken, W. (2018). Blending the liberal arts and nursing: Creating a portrait for the 21st century. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/29406141 Blending the liberal arts and nursing: Creating a portrait for the 21st century.

Leslie, J. (2018). Employment of the Nursing Process to Facilitate Recovery from Surgery: A Case Study. OJIN: The Online Journal Of Issues In Nursing, 23(2). https://doi.org/10.3912/ojin.vol23no02ppt07.

Rock, C. L., Thomson, C., Gansler, T., Gapstur, S. M., McCullough, M. L., Patel, A. V., ... & Doyle, C. (2020). American Cancer Society guideline for diet and physical activity for cancer prevention. CA: a cancer journal for clinicians, 70(4), 245-271.