Nursing Process – Approach to Care
Cancer is a malignant neoplasm or tumor characterized by abnormal cell proliferation. Characteristics of cancerous cells include uncontrolled proliferation, invasiveness, metastasis, de-differentiation, and loss of function. Acquired or inherited mutations in a cell’s DNA transform it into a cancer cell. Activation of proto-oncogenes to oncogenes and inactivation of tumor suppressor genes promotes the formation of cancerous cells. Other etiological factors include pathogens such as Human papillomavirus, ionizing radiation, and chemicals such as asbestos.
Physical examination and a patient’s medication history are important in cancer diagnosis. The first technique used in diagnosis is conducting laboratory tests. It involves the examination of urine, blood, tissues, and other body fluids. Examples of laboratory tests used in the diagnosis include blood chemistry tests, complete blood count, and cancer gene mutation testing (Munir et al., 2019). Immunophenotyping, sputum cytology, urinalysis, tumor maker tests, and cytogenetic analysis are the other lab tests that are used. These tests do not provide a definitive diagnosis of cancer. Other tests and examinations should be considered along with the lab tests to make a definitive diagnosis.
The other technique used in cancer diagnosis is Imaging tests. Examples of these tests include computed tomography (CT) scans, nuclear scans, X-rays, bone scans, and magnetic resonance imaging (MRI) (Munir et al., 2019). Ultrasound and positron emission tomography (PET) scans are the other imaging tests used. MRI utilizes powerful magnetic and radio waves to take pictures of the body in slices. The slices create detailed images that can be used to identify cancerous cells or tissues. CT and PET scans create detailed 3-D images that can identify cancerous cells and tissues (Munir et al., 2019). In PET scans, radioactive glucose is used as the tracer. Cancerous cells take up more glucose than healthy cells; hence, they are easily detected.
The diagnosis of cancer is also achieved through biopsies. It involves the removal of a sample tissue from the body, followed by its examination. Biopsy samples can be obtained using a needle, with endoscopy, or surgically (Munir et al., 2019). In endoscopy, an endoscope is used on internal organs or tissues. Colonoscopy and bronchoscopy are examples of endoscopy examinations. Some biopsies may require the use of anesthesia and sedatives because they are painful. Biopsies are used to provide the definitive cancer diagnosis and identify the type of cancer.
Staging helps to identify the extent of the metastasis of cancer. The stage at which cancer is diagnosed is used to identify it, even if the cancer worsens. Numerous staging systems exist. The TNM staging system is commonly used. However, it is not used to stage brain, spinal cord tumors and blood cancers. T represents the size and extent of the primary tumor (Tuttle et al., 2017). N represents the number of adjacent lymph nodes that have cancer. M represents the nature of cancer’s metastasis. Based on the primary tumor (T), TX means that the primary tumor cannot be measured. T0 means that the primary tumor cannot be found. T1, T2, T3, and T4 refer to the extent or size of the primary tumor (Tuttle et al., 2017). The larger the number after T, the greater the extent of metastasis.
Regarding regional lymph nodes (N), NX means that cancer in the nearby lymph nodes cannot be measured. N0 means that there is no cancer in the nearby lymph nodes. N1, N2, and N3 refer to the location and number of cancerous lymph nodes (Tuttle et al., 2017). The higher the number after N, the more the cancerous lymph nodes. Based on distant metastasis, MX means that metastasis cannot be measured. M0 means that cancer has not spread to other body parts. M1 means that cancer has spread to other body parts.
The TNM combinations can be classified into five less-detailed stages. Stage 0 means that cancerous cells are present but have not spread to other tissues. It is also called carcinoma in situ. Stage I, II, and III mean cancer is present. The higher the number, the larger the tumor size and the greater the metastasis (Tuttle et al., 2017). Stage IV means that cancer has spread to distant body parts.
Another staging system commonly used by cancer registries involves five main categories. The categories are In situ, localized, regional, distant, and unknown (Tuttle et al., 2017). In situ means that abnormal cells are present but have not metastasized. Localized means that cancerous cells are limited to the place they started, without any spread. Regional means that cancer has spread to the nearby tissues, organs, and lymph nodes. Distant means that cancer has spread to distant body parts. Unknown means that the information is insufficient to figure out the stage.
Cancer patients usually experience adverse events that result from cancer itself, the treatment process, or both. The first complication is spinal cord compression. It is caused by a neoplasm in the epidural space (Boussios et al., 2018). Metastatic disease accounts for the largest percentage of the cases. Compression of the spinal cord causes edema of the cord and ischemia. It is characterized by pain, sensory loss, and back motor weakness. This is common in lung, prostate, and breast cancer. Superior vena cava syndrome is the other complication. It results from the compression of the superior vena cava by a tumor or by thrombosis of the vessel (Friedman et al., 2017). It is mostly characterized by dyspnea, facial swelling, cough, and chest pain. It progresses to respiratory obstruction, upper extremities cyanosis, seizures, and death.
The third complication is disseminated intravascular coagulation (DIC). It is common in acute promyelocytic leukemia (APML), stomach, breast, pancreatic, prostate, and lung cancer (Levi, 2019). Granules present in APML contain activators of the clotting cascade that trigger DIC. Petechiae, hematomas, purpura and ecchymoses are common. Intracerebral bleeding manifests as changes in mental status, headaches, stroke, and visual changes. Its cardinal sign is thrombocytopenia. The fourth complication is cardiac tamponade. Cancer can metastasize to the pericardium through hematogenous spread or lymphatic invasion (Friedman et al., 2017). This leads to pericardial constriction of the tumor and fluid accumulation within the pericardial sac. The fluid compresses the cardiac muscle, causing cardiac tamponade. It is characterized by dyspnea, tachycardia, nonproductive cough, and retrosternal chest pain.
The first side effect of treatment is chemotherapy-induced nausea and vomiting. It can be acute, delayed, anticipatory, or breakthrough nausea and vomiting. Mucositis refers to the degradation of the mucosal lining of the oral cavity gastrointestinal tract (Madmoli, 2018). It is caused by chemotherapy or radiotherapy. Febrile neutropenia is common after the administration of cytotoxic chemotherapy. Bacteria, yeasts, and molds are the pathogens implicated in febrile neutropenia. Tumor lysis syndrome occurs when there is a rapid lysis of malignant cells. This leads to the release of intracellular electrolytes, which causes hyperkalemia and hyperphosphatemia. Purines are also released and metabolized to uric acid.
Hemorrhagic cystitis occurs due to chemotherapy. Presents with hematuria, suprapubic pain, dysuria, cramping, and urinary frequency. Hypercalcemia is the other side effect. Patients treated with estrogens or antiestrogens may have hypercalcemia (Madmoli, 2018). This is caused by the hormonal stimulation of the tumor. It is common in breast cancer, renal cancer, and squamous cell carcinoma of the head, neck, and lung. Hypersensitivity reactions can also occur. High-risk hypersensitivity agents are Paclitaxel and L-asparaginase.
Nausea and vomiting are managed by antiemetics such as Ondansetron and Aprepitant. Mucositis is managed by Amifostine, topical anesthetics, and corticosteroids. Febrile neutropenia is managed by broad-spectrum antibacterial agents. Tumor lysis syndrome is managed by Allopurinol, Rasburicase, urine alkalinization, and vigorous intravenous hydration (Madmoli, 2018). Hemorrhagic cystitis is managed by hyperhydration, bladder irrigation, and administering Mesna. Hypercalcemia is managed by administering Furosemide, Calcitonin, Corticosteroids, and Denosumab (Madmoli, 2018). Psychological effects can be lessened by establishing social support groups and behavioral therapy. Behavioral therapies include guided imagery, relaxation, and music therapy.
Various factors contribute to the yearly incidences and cancer mortalities in Americans. Smoking and secondhand smoke cause approximately 90% of lung cancer deaths in the United States (Sung et al., 2019). It can also cause mouth, throat, larynx, and esophagus cancer. Exposure to ultraviolet light from the sun and tanning beds is the leading cause of melanoma, a type of skin cancer. Overweight and obesity are risk factors for at least 13 types of cancers, such as uterine and colorectal cancer. 40% of American adults are obese, and 72% are overweight (Sung et al., 2019). Excessive alcohol use is associated with liver, breast, colon, rectum, and pharynx cancer. Infectious diseases such as the Human papillomavirus are the leading cause of cervical cancer. It also causes vaginal, anal, rectal, and oropharynx cancer. Hepatitis B and C are the leading causes of liver cancer.
The American Cancer Society (ACS) can provide education and support through various methods. The first method is through health advertising campaigns. These campaigns should educate the public on cancer risk factors and how to mitigate them. The campaign should also emphasize the importance of cancer screening for the most vulnerable population. In addition to the campaigns, the ACS should provide cancer information and resources that the public can access. It can be supported by funding specific research focusing on the fight against cancer. Services of ACS that I would recommend are patient-centered services, transportation services, and accommodation services. Accommodation services will help cancer patients who receive treatment away from home. Transportation services ensure that patients reach their clinics and hospitals for treatment. Patient-centered services provide social support to cancer patients. It also provides education on how to deal with specific types of cancers.
The nursing process acts as a systematic guide to patient-focused care. It has five sequential steps: assessment, diagnosis, planning, implementation, and evaluation (Stonehouse, 2017). During the assessment, key information about the patient is gathered. It involves critical thinking and the collection of both objective and subjective data. The pain score, vital signs, and consciousness of the patient are an example of the information gathered. The next step, diagnosis, is done based on the assessment and the nurse’s clinical judgment. During this stage, the nurse will make a diagnosis of cancer. Laboratory tests, imaging tests, and biopsies can be performed to determine the definitive diagnosis.
The third step is planning. Goals and outcomes that impact the patient directly are formulated. Care plans that provide personalized care to individual patients are utilized. The plan should involve pharmacological and nonpharmacological interventions. Patients and families can be involved in making the plan. The fourth step is implementation. It involves carrying out the nursing interventions outlined in the care plan (Stonehouse, 2017). This can be chemotherapy, radiotherapy, or surgical interventions based on the plan. The last step is evaluation. This step is important for the positive outcome of the patient. It involves reassessment and evaluation to ensure the desired outcome is achieved. Lab tests, imaging, and biopsies can be done during the evaluation to determine the patient’s response to the specific intervention.
Liberal arts and science studies equip nurses with different skills. The skills include critical thinking, innovative research, communication, and decision-making (Baldwin et al., 2017). They also enable them to be reflective and navigate diversity. The nursing process requires critical thinking and decision-making. This is particularly useful during the assessment, diagnosis, and planning. Communication skills are important during the nursing process because feedback should be given to the patient. It also facilitates communication with other healthcare providers. Navigation of diversity is important because nurses deal with patients from different backgrounds. Therefore, undergraduate education in liberal arts and science studies is essential to nurses.
References
Baldwin, D. R., Towler, K., Oliver, M. D., & Datta, S. (2017). An examination of college student wellness: A research and liberal arts perspective. Health Psychology Open, 4(2). https://doi.org/10.1177/2055102917719563
Boussios, S., Cooke, D., Hayward, C., Kanellos, F. S., Tsiouris, A. K., Chatziantoniou, A. A., Zakynthinakis-Kyriakou, N., & Karathanasi, A. (2018). Metastatic spinal cord compression: Unraveling the diagnostic and therapeutic challenges. Anticancer Research, 38(9), 4987–4997. https://doi.org/10.21873/anticanres.12817
Friedman, T., Quencer, K. B., Kishore, S. A., Winokur, R. S., & Madoff, D. C. (2017). Malignant Venous Obstruction: Superior Vena Cava Syndrome and beyond. Seminars in Interventional Radiology, 34(4), 398–408. https://doi.org/10.1055/s-0037-1608863
Levi, M. (2019). Disseminated intravascular coagulation in cancer: An update. Seminars in Thrombosis and Hemostasis, 45(4), 342–347. https://doi.org/10.1055/s-0039-1687890
Madmoli, M. (2018). Evaluation of Chemotherapy Complications in Patients with Cancer: A Systematic Review. International Journal of Research Studies in Science …, 5(12), 58–63. http://www.ijrsset.org/pdfs/v5-i12/5.pdf
Munir, K., Elahi, H., Ayub, A., Frezza, F., & Rizzi, A. (2019). Cancer diagnosis using deep learning: A bibliographic review. Cancers, 11(9), 1–36. https://doi.org/10.3390/cancers11091235
Stonehouse, D. (2017). Understanding the nursing process. British Journal of Healthcare Assistants, 11(8), 388–391. https://doi.org/10.12968/bjha.2017.11.8.388
Sung, H., Siegel, R. L., Rosenberg, P. S., & Jemal, A. (2019). Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. The Lancet Public Health, 4(3), e137–e147. https://doi.org/10.1016/S2468-2667(18)30267-6
Tuttle, R. M., Haugen, B., & Perrier, N. D. (2017). Updated American joint committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (Eighth Edition): What changed and why? Thyroid, 27(6), 751–756. https://doi.org/10.1089/thy.2017.0102
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Question 
Benchmark – Nursing Process: Approach to Care
The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the health care needs of an individual and provide personalized care.
Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:
- Describe the diagnosis and staging of cancer.
- Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
- Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.
Nursing Process – Approach to Care
- Explain how the American Cancer Society (ACS) might provide education and support. What ACS services would you recommend and why?
- Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the life span. Your explanation should include each of the five phases and demonstrate the delivery of holistic and patient-focused care.
- Discuss how undergraduate education in liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process. Consider mathematics, social and physical sciences, and science studies as an interdisciplinary research area.
You are required to cite to a minimum of four sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
- RN-BSN
- 2.1: Incorporate liberal arts and science studies into nursing knowledge.
- 3.1 Utilize the nursing process to provide safe and effective care for patients across the life span.