Introduction
The problem of breast cancer becomes of great concern nowadays, as “The National Cancer Institute predicts that one in eight women born in the United States will develop the disease in their lifetime and that the probability of a diagnosis increases once a woman turns forty” (Carter, 2007, p.100). The given paper is an analytical and evaluative case that is intended to recover fully the problem of breast cancer and explain the ways of its treatment in the context of nursing.
In order to achieve the results in the given task, one may suggest using the case of thirty-five years Roberta Johnson, who is a mother of three. One may propose that Roberta is a current patient in the oncology ward, as she was diagnosed with breast cancer six months ago and had a lumpectomy followed by chemotherapy. Because the woman is on her third course of strong chemotherapy, she has bleeding gums, stomatitis, nausea, and severe diarrhea. Such problems caused her disinclination to eat. This can be explained by the two reasons: first, she does not feel like it, and second, she believes if she stops eating nausea will pass quicker.
Some suggestions to Roberta in terms of nutrition
As the patient suffers from gums and stomatitis, the nutrition she gets should be soft and easy to chew. Moreover, while picking up the nutrition, one should not forget about Roberta’s nausea and severe diarrhea, thus, the food should not consist of the purgative elements that might cause the following disorder of the bowels or upset stomach.
Nevertheless, the fact that the patient’s organism is weakened should be also counted, determine the fact that the nutrition should be reached on vitamins and minerals. That is why the following list of the nutrition (of course invalid food) might be suggested to Roberta:
- Oatmeal porridge prepared with the water (but not with milk)
- Mashed potatoes, again prepared with the water (but not with milk)
- Boiled Lenten beef meat without fat
- Chicken broth with the rice and peaces of boiled carrots in it (Ogden, 2004)
If the patient does not want to eat at all, she might be proposed to have a strong black tea, with the two tea-spoon of sugar in it, with the dried peaces of the white brad (might be prepared in the oven) (Fallowfield, Clark, 1991).
In order not to let the disease progress the following food should be excluded from the patient’s nutrition:
- Fat food
- Fast food
- Homogeneous (genetically modified) products
- Fried, roasted, broiled, or grilled food
- The food which contains a high percentage of protein: eggs, milk, silk milk, butter, curd (cottage cheese), cheese, sour cream, cream, kefir, yogurts, pork, mushrooms.
The help of the multidisciplinary team’s members
Because of the reason that Roberta has stomatitis and the gums ache, it would be relevant to apply for the orthodontist’s help. The orthodontist may prescribe her some medicine to cure her gums; he might also prescribe some special treatment to maintain the oral hygiene of the patient, so the infection defined by the stomatitis would not spread and would not lead to blood poisoning.
As the patient suffers from nausea and severe diarrhea, the gastroenterologist and the proctologist should be also involved in the process of the treatment. The former one may proscribe some anti-nausea pills or grouts, the medicine for the dyspepsia curing. The latter one might assign some constipate medicine for the bowels.
The help of the diabetologist might be also useful while designing the nutrition plan for the patient. The help of the professional psychologist may be helpful as well, as he or she can convince Roberta of the necessity of food consumption by the patient.
Administrative model of nursing care
In the case when one is with the RN in the treatment room and the RN asks one to administer Roberta’s next dose of intravenous antibiotic because she is one’s patient for this shift, one may reply to the RN that the administration of the medicine can be made only by Roberta’s doctor. And for the reason that the doctor gave the instructions concerning this earlier, one should reply to the RN that the antibiotic is already drawn up because the doctor had given the instructions earlier, and that is why one had helped the RN with this earlier as well.
The antibiotics and one’s rationale concerning this
One considers most of the anti-cancer drugs like antibiotics, as they can be generally described as a strong medicine, which cures the disease destroying the pesthole of the infection or malignant growth in the given case by annihilating the microorganisms and bacterium.
The problem of antibiotics lays in that that while destroying the detrimental bacterium they also annihilate the health-giving bacterium. For example, such a health-giving bacterium is needed for the system of the stomachical- intestinal tract, for the oral and other systems of the human’s organism to operate efficiently, so the person would feel him/ herself just fine. In Roberta’s case, the health-giving bacterium was obliterated. That is why she has various oral and stomachical- intestinal tract system problems.
One of the most effective IV anti–cancer antibiotics is Herceptin; it is “approved by the Food and Drug Administration that is part of a group of breast cancer treatments called monoclonal antibodies. Unlike chemo and radiation, reported side effects are less severe on the body – although this drug can affect the heart” (Roberts, Cox, Shannon, Wells, 1994, p.101).
The other antibiotics frequently recommended by the doctors are Amoxifen (also prescribed for women at high risk) and Raloxifene (used to cure osteoporosis as well as cancer). Nevertheless, one should point out that those pills affect the activity of estrogen and might cause heart diseases.
Taking the blood test
If one is told by the doctor that he will leave a blood test request form on Roberta’s chart to be taken that evening, but one, actually, knows that the blood collector has finished for the evening and the RN is quite busy, and Roberta is quite tired so it would save her having to wait for the RN to be available to take the blood, one can not take the patient’s blood without special permission. One may take the blood only if one is qualified to do this and after asking the doctor, getting his approval, and of course, in the presence of the doctor or the senior nurse.
One’s reaction on that the patient tells that she wants to end her life
If Roberta tells such a thing to one, one should try to assuage and cheer up her by reminding her that she had already passed a lot of difficulties, but she was strong and did not give up. And it would be a waste of all of her and her family’s efforts if she drops everything now when she is just one step from the successes. One should also remind Roberta how strong her husband and three kids love her and waiting for her to come back home. It is also possible for one to tell Roberta that she has good chances to cure and that there are a lot of patients like her, who do not quit but fight for their lives and their families happiness.
After the patient comes down, one should report to the senior nurse, the patient’s doctor, and the hospital psychologist. One may also ask Roberta’s husband to be even more kind and attentive to his wife.
The situation with Mr. Pankowich and his wife
When Roberta is safely on the toilet, another of one’s clients (Mr. Pankowich) indicates that he needs to pass the urine and his wife asks one to explain what a colostomy is. In the given situation one should help Mr. Pankowich with his need. Although the client has limited English, one should not talk about the disease with his wife in the client’s presence. One may properly and respectfully apologize before the patient’s wife and suggest she discuss the given theme, not in her husbands’ ward.
In the given case, one should try to pay more attention to Roberta and Mr. Pankowich, and their feelings, talk to them, and cheer them up sometimes, but never tell them that they are ill and doomed to not cure. Studies have shown that “social support serves an ameliorating function during times of psychological distress in medical populations…the social network is a source of support in a crisis and thus a buffer against the harmful effects of stress…” (Batt, Gross, 1999, p. 37).
The address to the statement
After practicing on the ward just for two weeks, one has become quite interested in oncology nursing and figured out that this field certainly attracts one, as one felt pretty confident when performed this work. Also, one discovered that he was capable of socializing with the staff and the patients. One thought it would be interesting for one to learn something new about colostomies and anything else related to oncology to be able better understand the patient’s problems and answer their relatives’ questions.
Conclusion
The given case enabled one to understand breast cancer’s nature, its causes, its symptoms, and its curing process. Therefore, this work discussed all of the curing process’ elements: designing the nutrition balance for the patient, the client’s education process, the members of the multidisciplinary team, the model of care applied to the patient. Various delicate situations that might happen to the EN (Med) were also analyzed in this paper; the solutions to those situations were brought up here as well. This work also reveals one’s attitude toward nursing in the sphere of cancer-curing and involves one’s personal opinion about this medical field.
References
Batt, S., & Gross, L. (1999). Cancer, Inc. Sierra, 84, 36.
Carter, K. S. (2007). Winning the Battle against Breast Cancer: New Treatments and Preventive Procedures Are Helping People Beat the Disease. Black Enterprise, 38, 100+.
Fallowfield, L., & Clark, A. (1991). Breast Cancer. New York: Tavistock Routledge.
Ogden, J. (2004). Understanding Breast Cancer. Hoboken, NJ: Wiley.
Roberts, C. S., Cox, C. E., Shannon, V. J., & Wells, N. L. (1994). A Closer Look at Social Support as a Moderator of Stress in Breast Cancer. Health and Social Work, 19(3), 157+.