Written Assignment 1: Response 2
Written Assignment 1: Response 2
Must Complete:Yes
Weighting (%):30
Assessment Notes:Written assignment
No. Words:750
Relates to Learning Outcomes:ULO2, ULO5, ULO6
Due Date:See below.
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)Discusstheassessmentsthe registered nurse would need to complete in regards to Betty'snausea and vomiting, include discussion on ONEassociatednausea and vomitingassessment tool that would be applicable toBetty.(approx 250 words).
2) Recommendtwohealth 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).
Marking criteria
View the rubric below.
Submission
Follow the instructions below to upload your completed assignment file and submit it for marking.
Marking Rubric assignment1 response2 Tri 2 2021.pdf19 June 2021, 4:10 PM
Betty Hill
Betty has been recently diagnosed with Colorectal cancer. We meet Betty as she presents to her GP with some uncomfortable symptoms and follow her journey as she undergoes screening, diagnosis and treatment for bowel cancer. Follow Betty's story as she deals with many issues associated with cancer including complications of treatment and cancer survivorship.
Betty's story is the first scenario that you will engage with during yourprogress through the unit. Betty's story is designed to prepare you for working with the person with a complex cancer diagnosis, and takes a focus on the pathophyisology of cancer, treatment options, assessment of symptoms associated with bowel cancer, prevention, public health and health promotion as well as the interprofessional management of the person with a complex disease.
Profile
Age:62 (DOB- 9/10/54)
Ethnicity:Caucasian
Marital status:Married to Bob for 37 years.
Occupation:
Children:1 child, Natalie aged 36.
Medical Hx:Treated for Hypertension for past 3 years. Family history- father died 20 years ago from colorectal cancer, Betty not sure of type of cancer.Non-smoker.Social Hx:Betty lives with her husband, Bob. They have one daughter who is married and lives in the US. They have 2 granddaughters (aged 9 and 11) who they Skype with regularly. Betty works part time at the local newsagency and Bob (aged 68) is retired. Betty and Bob travel overseas annually.
Week 2: Betty visits her GP
Betty visits her GP with some worrying signs
Mrs Betty Hill aged 62 presents to her GP, Dr Sharon Glasson with a history of recent bowel changes including episodes of diarrhea, bloating, and incomplete empyting of bowel and some pain on defecation. During Betty's appointment she mentions that she has had the "odd spot of blood" on her undergarments after having a bowel motion over the past few months. Unconcerned about this, she mentions that she has a haemorrhoid that she has had for many years now and brushed this off as coming from a bleeding haemorrhoid. While discussing other symptoms, Betty mentions that she is quite often fatigued but has put this down to her busy lifestylePhysical examination
Dr Glasson attends a full physical examination and finds the following-
History-hypertension, family history (father) of colorectal cancer.
Screening-Faecal Occult Blood Test (FOBT) attended 2 and a half years ago, result negative.
General appearance- no evidence of jaundice, some palor present
Physical Examination-Vital signs:BP- 145/82;P- 82; Temp- 36.9;RR- 26
Abdominal examination-inspection- evidence of abdominal distention (this is consistent with Betty's reports of bloating); palpation- reveals a small firm mass in lower left quadrant of abdomen, possibly faeces; some tenderness over lower left quadrant on deep palpation;auscultation- normal bowel sounds present in right upper and lower quadrants, but slightly diminished in left upper and lower quadrants;percussion- localised tenderness over lower left quadrant; nil evidence of hepatamegaly or splenomegaly; nil evidence of abdominal ascites.
Rectal examination-presence of formed stool in lower rectum, haemorrhoid visible on exterior peri-anal region.
Diagnostic tests
After the physical examination, Dr Glasson tells Betty that further tests are needed to determine the cause of Betty's symptoms. Dr Glasson draws blood for pathology testing. The following pathology tests are ordered and Betty is sent for a CT Scan.
Pathology-Full Blood Count- White blood cell count; Red blood cell count (including Hct and Hb); platelets;Urea and electrolytes (U & E);Liver function test (LFT);Carcinoembryonic antigen (CEA)- for baseline tumor marking.
CT Scan-CT of chest, abdomen and pelvis
Pathology tests are mostly unremarkable except for Hb- 110 g/L and CEA- 5.5mcg/L.
Reflect
What is the normal Hb level for a female?
What is the cause of Betty's Hb at level of 110g/L?
What is the normal range of CEA?
What does the CEA level of 5.5mcg/L suggest for Betty's diagnosis and prognosis?
Week 3: Betty receives a diagnosis
Followup after diagnostic tests
Betty returns to Dr Glasson accompanied by her husband Bob to receive what she expects to be bad news regarding the tests she has had done. Consulting Betty's results, Dr Glasson reveals that Betty's CT Scan shows a small lesion in her lower bowel and the descending part of her large bowel (colon), which is likely cancerous, and that her pathology results reveal mild anaemia, most likely as a result of the tumour in her colon. She also advises that the raised CEA level is also suggestive of colorectal cancer. Betty is visibly distressed by this news, clutching on to Bob for support. Dr Glasson spends some time reassuring Betty and Bob that diagnosis needs to be confirmed by Colonoscopy and biopsy of the lesion. Focusing on the positives of results that these indicate early diagnosis highlighting statistics of successful treatment in the early stages. She also reassures Betty that there is no indication at this stage that the tumour has spread. Betty is referred to a general surgeon for an urgent Colonoscopy and Flexible Sigmoidoscopy.
Reflect
Betty asks her doctor if there is anything she has done that might cause this disease. What would the response be?
What supports are available to Betty and Bob at this stage of her diagnosis and in future once Colorectal cancer has been confirmed?
Who are the interprofessional team members that might be involved in Betty's care as she undergoes diagnostic tests, cancer treatment and ongoing care?
Week 4: Betty's treatment begins as she prepares for her surgery
Day surgery: Colonoscopy and Flexible SigmoidoscopyUpon consultation with a general surgeon, Betty is booked into day surgery for a colonoscopy and flexible sigmoidoscopy. 3 days before her colonoscopy Betty very carefully follows the dietary restrictions and starts to prepare for her surgery by drinking her bowel prep (PicoPrep).
On the day of her colonosopy, Betty is very anxious about what this might show. Bob accompanys Betty to the day surgery unit. The colonoscopy, flexible sigmoidoscopy and biopsy of the lesion proceed without any complications and Betty is instructed to followup with Dr Glasson for the results.
Results of Betty's Colonosocpy confirm presence of adenomcarcinoma of the descending colon.
Reflect
What preparation is required for Betty prior to her having her colonoscopy?
What are the potential adverse events of a colonoscopy should Betty be informed about prior to her consenting to this diagnositic test?
Betty undergoes surgery
Betty returns to her GP, Dr Glasson to receive the results of her colonoscopy. Betty's worst fears are confirmed and she is told she has adenocarcinoma of the descending colon and that further consultation has been arranged with the general surgeon to undergo excision of the tumour.
Betty undergoes a Left Hemicolectomy with successful excision of lesion and re-anastomosis of the colon.
Reflect
What are the important considerations preoperatively for Betty, given her age and history?
What are some potential side effects from this surgery?
How can these side effects be prevented?
Post operative care
Betty is nursed in the hospital's High Dependency Unit overnight. A PCA of morphine manages her pain effectively, however, the side effects of this soon make her feel unwell and she suffers severe post operative nausea and vomiting (PONV). Betty remains in hospital for 5 days following her surgery. Once her nausea and vomiting settled she had an uncomplicated recovery.
Post surgery, Betty is referred to a medical oncologist for adjuvant chemotherapy.
Reflect
What are the possible causes of Betty's nausea and vomiting?
What is the best pharmacological management of Betty's PONV?
What does adjuvant chemotherapy mean?
Histopathology
Pathological examination of biopsy from Betty's colonoscopy and excsion reveal moderately differentiated Adenocarcinoma of descending colon, stage 3A (Dukes C).
Betty sees the medical oncologist and chemotherapy is scheduled to commence the following day.
Reflect
What does "moderately differentiated" mean?
What stage is her cancer using the TNM classification system?
Why is it important to know the staging of cancers?
Resources
NICE guidelines: diagnosis and management of Colorectal cancer
Bowel Cancer Australia guidelines on the prevention, early detection and management of bowel cancer
Week 5: 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 aChemotherapy Patient Informationguide 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 infectionwilldisplay 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. Retrieved fromhttp://search.proquest.com.ezproxy.une.edu.au/docview/1349382290?accountid=17227Littlewood, 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.13-2-185etty 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.
Although Betty and Bob don't travel overseas quite so often anymore, she is relieved that she has had successful treatment and that she has a good quality of life.
Read
Journal articles:
Chambers et al (2012).Survivor identity after colorectal cancerAnderson et al (2013).Lifestyle issues for colorectal cancer survivorsPrescribed text:
Yates (2014). Cancer. In E. Chang & A. Johnson (eds).Chronic Illness and Disability.Churchill Livingstone, Elsevier. pp. 531-545.
Merritt & Boogaerts (2014).In E. Chang & A. Johnson (eds).Chronic Illness and Disability.Churchill Livingstone, Elsevier. pp. 81-100.
