Assignment Task
Task
Betty has recently been diagnosed with Colorectal cancer and undergone a series of treatments for her disease. Following surgery and chemotherapy, Betty experiences severe nausea and vomiting. Throughout Betty’s diagnosis and treatment for bowel cancer, she will have a number of health professionals involved in her care. Betty is but one of many people each year diagnosed with bowel cancer, and these statistics are expected to increase with cancer diagnoses on the increase worldwide. Considering these issues answer the following questions:
1) Discuss the assessments the registered nurse would need to complete in regards to Betty’s nausea and vomiting, include discussion on ONE associated nausea and vomiting assessment tool that would be applicable to Betty. (approx 250 words).
2) Recommend two health care team members (other than nurses and doctors) to be involved in Betty’s care in the community and discuss their primary role in the management of Betty’s condition. (approx 250 words).
3) Briefly outline the incidence of skin and bowel cancer within Australia and identify the key health promotion and prevention strategies that are in place to address skin and bowel cancer as public health issues. (approx 250 words).
Use academic references within 5 years only. It is very strict now
The website only used below
.org
.gov
.edu
.net
Don’t use .com please
Topic discussion.
Complications of treatment for Betty
Oncology Treatment Begins for Betty
After consultation with the medical oncologist, a treatment regime is put into place for Betty.
Her treatment includes FOLFOX6: Oxaliplatin, Leucovorin (in oncology over 4 hours), and Fluorouracil (over 2 days via a pump at home). Her cycle of treatment is every 14 days and 12 cycles of treatment recommended. Betty is given a Chemotherapy Patient Information guide that outlines her treatment and what to do if she has side effects of her treatment.
Following each treatment, Betty experiences severe nausea and vomiting, sore mouth, fatigue and episodes of diarrhea.
Reflect
How does chemotherapy work?
What are some common side effects of this particular treatment regime?
What non-pharmacological methods are available to manage nausea?
What is the best evidenced based pharmacological management of nausea and vomiting for someone experiencing chemotherapy induced nausea and vomiting? Why is this the drug of choice in this instance?
An Oncological Emergency
Betty has been following the protocol of taking her temperature each day in order to monitor for infection. She has been advised that during chemotherapy the usual signs and symptoms of infection could often be often absent because the treatment commonly affects the immune system, which therefore does not display the normal signs of infection such as redness, pus, pain, etc. However the presence of infection will display as an increase in temperature.
On day 9 post cycle three of her chemotherapy Betty’s temperature has risen to 38.6oC. As she has been instructed, she waits 20 minutes and takes her temperature again. The reading has increased to 38.9oC. Betty’s husband Bob, calls the chemotherapy unit. Bob is advised to take Betty straight to their local hospital.
On arrival, Betty identifies herself as a chemotherapy patient. She is admitted and a series of tests is undertaken to identify the source of infection. Betty is found to have a urinary tract infection. A course of the appropriate antibiotics is begun, together with close monitoring.
Reflect
Explain how the immune system is affected during chemotherapy. What is the significance of a raised temperature on day 9 of the chemotherapy cycle? What is the period of time where Betty’s immune system is most vulnerable known as?
What are possible outcomes had Betty not been monitoring her temperature or had ignored the temperature rise she experienced post-chemotherapy?
What is neutropenic sepsis?
What can be done to prevent a neutropenic sepsis?
How does neulasta work?
Read
Prescribed text:
Bullock & Hales- Chapter 5
Journal articles:
Clarke, R. T., Jenyon, T., Parsons, V. v. H., & King, A. J. (2013). Neutropenic sepsis: Management and complications. Clinical Medicine, 13(2), 185-187.
Littlewood, T. J., Clarke, R. T., Jenyon, T., van, H. P., & King, A. J. (2013). Neutropenic sepsis: Management and complications. Clinical Medicine (London, England), 13(2), 185-187. doi: http://dx.doi.org/10.7861/clinmedicine.13-2-185Betty adjusts to life after surgery and treatment
Recovering from chemotherapy side effects
Betty recovered from her episode of neutropaenic sepsis and suffered no other oncological emergencies, however, her side effects of nausea and intermittent vomiting persisted. Other side effects of treatment included some peripheral neuropathy (in hands and feet), mucositis, intermittent diarrhoea and fatigue.
Reflect
What is the recommended management of mucositis for the person undergoing chemotherapy?
What are some strategies (non-pharmacological) that are useful for managing diarrhea?
What advise would you give to Betty for managing her fatigue?
Betty completes her chemotherapy cycles
6 months have passed since Betty commenced her chemotherapy treatment. Although she continued to have some unpleasant side effects of treatment she managed to complete all 12 cycles of treatment, with the ongoing support of her husband Bob and regular support visits by Dr Glasson.
2 months after completing her chemotherapy treatments, Betty still experiences fatigue and residual peripheral neuropathy, especially in her hands. Although this is not painful she does have some lingering loss of sensation in both hands and feet as a result of one of the chemotherapeutic agents.
Reflect
What are some strategies (both pharmacological and non-pharmacological) that may be useful for Betty to help manage this side effect of her treatment?
Betty asks you which of the chemotherapy drugs caused this symptom, and how long this symptom will last, what is your response to her questions?
Time continues to pass as Betty learns to live with her residual symptoms
Betty now takes tricylic antidepressants to help manage residual peripheral neuropathy which she feels makes this symptom manageable and she has now come to terms with the fact that this symptom may not go away completely.
Betty and Bob are slowly adjusting to their lifestyle changes following recovery from surgery and chemotherapy. Although she has fully recovered from her treatment she feels that she is not as strong as you was before her diagnosis and still worries that the cancer may recur. Betty is compliant with her regular GP check ups, every 3 months and additionally as needed. Betty also is aware that she needs to have annual colonoscopies to monitor for recurrence, but she is hopeful that this is unlikely. As part of her ongoing management, Betty attends a regular support group for colorectal cancer survivors in a town nearby. She has made several friends from this group and has also started to volunteer some of her time to visiting the local hospital to meet and support other people who have been newly diagnosed with colorectal cancer.
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