HSNS364 Professional Practice: Application of Integrated Care
Written Assignment 1: Response 2
Must Complete: Yes
Length: 750 words
Due Date: Is displayed at the bottom of this page
This assessment relates to:
Learning Outcomes: 2, 5, 6
This assessment will allow the student to demonstrate competence in the following unit learning outcomes
2. critically analyse and utilise a range of assessment techniques and apply evidence based clinical reasoning in theory, clinical and simulated environments;
5. critique the history of prevention, public health and the evolution of health promotion in local, national and international contexts; and
6. demonstrate respectful and skillful interprofessional teamwork that values the contributions of each member of the health care team, to the management of chronic health problems.
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)
Learning outcomes 2
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 lifestyle
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.
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/
Learning outcome 5
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 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.
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.
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?
Bullock & Hales- Chapter 5
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 from http://search.proquest.
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.
Learning outcome 6
Betty 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.
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.
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.
Chambers et al (2012). Survivor identity after colorectal cancer
Anderson et al (2013). Lifestyle issues for colorectal cancer survivors
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.