Prioritisation and Competent Nursing Practice

The management of patient life has become a concern for today’s health care professionals. This is because of the increasing complexity of cases that rely on their association with other complications. As such, careful evaluation of the patient’s life would become the important aspect and commences from the past history, the symptomology at the time of admission and other relevant factors.

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However, in certain circumstances priorities would also emerge with regard to the severity of the problem. So, the present description is concerned with the selection of nursing diagnoses based on priority and providing a rationale keeping in view of the ANMC National Competency Standards for the Registered Nurse. The cases are weight loss related to loss of appetite, nausea and vomiting related to chemotherapy, and left leg pain related to bone cancer.

The priorities were given keeping in view of the research literature. Among these, weight loss would appear to draw the prior clinical attention due to its connection with various etiologies believed to be most prevalent in the population. It was reported that high rates of weight loss is a significant predictor of all-cause mortality in elderly men and women, independent of age, incident fracture, and concomitant diseases. This may also occur independent of high rates of BMD and weight fluctuation (Nguyen et al., 2008).Here, it may indicate that weight loss is associated with mortality. Hence, patients with weight loss may need urgent nurse care. Weight loss may originate from dysphagia which is commonly known as swallowing disorder (Easterling & Robbins, 2008).

It was reported that the prevalence of dysphagia would increase to 50% in older individuals who reside in long-term care facilities and might also contribute to malnutrition (Easterling & Robbins, 2008). So, the decreased appetite or malnutrition induced weight loss observed in patients may also be due to dysphagia.

This assumption could be further strengthened by another report that emphasized on weight loss in esophagectomy patients. According to this report, patients with esophageal cancer undergo esophagectomy and are frequently encountered with dysphagia, decreased appetite, and weight loss. It has further described that nutrition would offer a better remedy for the esophagectomy patient. Therefore, it may also indicate that weight loss is associated with cancer which is the major life threatening complication.

Hence, this report would support the validation, “Weight loss in cancer patients is imminent despite normal or increased food intake”. As such, the problem of weight loss should be given prior importance in patients presented with the above known complaints previously documented. However, it is the effective nurse care that needs to be streamlined in view of these issues. Dewey and Dean (2008) described that there was poor assessment of weight loss and nutritional status in patients with advanced cancer. This was revealed from a 14 semi-structured interviews conducted with nurses from both hospital and community settings.

Jatoi (2008) further highlighted that there is a need for continued laboratory and clinical investigation due to the limited availability of palliative options to patients with cancer-associated weight loss. In view of the above information, weight loss appears to be an important pathological sign.

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Therefore, it is reasonable to mention that the research findings may enhance the clinical awareness of weight loss. Nurses should carefully evaluate the clinical profile of patients with esophageal cancer as it is reported to contribute to weight loss by increasing the susceptibility to dysphagia. Hence, the problems concerned with swallowing may possibly give a direct indication of malnutrition or eating problems, cancer and weight loss.

Since these problems appear to occur commonly, weight loss was given prior importance and the description mentioned here is in strong agreement with cues mentioned. Next, the second important issue to consider is nausea and vomiting related to chemotherapy. In the earlier section, we have noted a significant relationship between cancer and weight loss. This could definitely enable us to concentrate on malignant disorders. It is widely believed that the efficient management of cancer often relies on treatment or chemotherapy. Although it has potential to lessen the adverse effects of cancer, it has certain drawbacks.

It was recently described that chemotherapy induces nausea and vomiting in many cancer patients through the action of neurotransmitters serotonin, neurokinin-1 and dopamine receptors (Lohr, 2008). Here, the patient’s gender and age, past history of Chemotherapy-induced nausea and vomiting (CINV), plus the emetogenicity and administration schedule of chemotherapy were considered as risk factors (Lohr, 2008).

Cancer patients undergoing chemotherapy may be in need of strong nursing intervention at an earlier stage. This is because these problems could serve as interfering factors while diagnosing the already ill patients and further aggravate the clinical condition.

This could at least enable the cancer patients who have lost hope on their lives, to stay better and happy. It is imperative for the nursing professionals to avoid patient distress or dissatisfaction during their stay which would only possible through careful monitoring and follow up. Molassiotis et al. (2007) employed a strategy of assessing nausea and vomiting. They have taken the assistance of MAT (Multinational Association of Supportive Care in Cancer Antiemesis Tool) an eight-item scale. They reported that MAT is a reliable and easy-to-use clinical tool that could facilitate discussion between clinicians and patients about their nausea and vomiting experience, thereby potentially aiding treatment decisions.

This research report may address the earlier communication problems concerned with the chemotherapy that has increased the remoteness in the delivery of clinical tools (Molassiotis et al., 2007). Hence, it appears important in the present scenario.

Further, while considering the care there is a need to develop evidence-based standards which may improve the quality of life of cancer patients presented with chemotherapy induced problems. To this end, recent workers described certain strategies that include screening of patients at the initial outpatient and inpatient visit, prophylaxis for acute and delayed emesis in patients receiving moderate to highly emetic chemotherapy, and follow-up after treatment for nausea and vomiting symptoms (Naeim et al., 2008).This approach may play very beneficial role because large number of cancer patients would be assessed for treatment induced adverse affects. The data generated would cater the needs of nursing professionals concerned with oncology departments. Nausea and vomiting are also commonly experienced by general population for every alternate reason. The strategies aimed at cancer patients may also serve the society if expanded and implemented. There is also a need to develop awareness regarding the therapeutic tools.

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Jordan, Sippel and Schmoll (2007) described that the appropriate use of antiemetics could minimize the incidence of chemotherapy induced nausea and vomiting in almost 70% to up to 80% of patients. They have further emphasized on the need of treatment guidelines that would enable physicians to integrate the latest clinical research into their practices. Here, it was revealed that the information gathered from the large volume of rapidly evolving clinical data need to be summarized and incorporated into treatment recommendations by well-known and reliable institutions (Jordan, Sippel & Schmoll, 2007).Hence, it seems that the problem of nausea and vomiting in cancer patients has received good research support that made apparent the major pitfalls in the nurse practice.

Since, this aspect of nurse care has better implications for providing a therapeutic efficacy to patients, it deserves importance secondary to weight loss. The other aspect to focus on is the leg pain related with bone cancer. Pain management may also appear to present a problem if it is not detected in the earlier stages. It is unknown whether pain would commence with the initial stages of cancer or it would manifest after its development. Although, pain can be assumed as less important after weigh loss, and nausea and vomiting, its severity could become unbearable condition in bone cancer patients. Hence, there is need to consider different treatment options that provide pain relief in cancer patients with bone metastases (Thanos et al., 2008). They have reported that CT-guided radiofrequency (RF) ablation would serve as the effective treatment for painful bone metastases in terms of its instant, safe, effective and tolerable activity.

André Bonneau (2008) highlighted that bone metastases occur upto 70% in advanced breast and prostate cancer, 15% to 30% in lung, colon, stomach, bladder, uterus, rectum, or kidney cancer, and also contributes to neurological impairment secondary to compression of nerves in the spine or base of the skull. They described the utility of other pain relievers like nonsteroidal anti-inflammatory drugs, steroids, bihosphonates and cannabinoids.

Sandra Ward et al. (2008) conducted a large study of representational intervention to decrease cancer pain in 176 adults. They described that the approach was efficient in decreasing the pain severity. Here, although these research reports have not targeted their attention on leg pain, they may appear beneficial for providing remedy in pains related bone cancer in general.

Therefore, these strategies may have the potential to influence the nurse practice and suggest an in depth evaluation of health complaints that manifest in association with other complications.

Finally, it is essential to determine whether the research findings that provided a key assistance to the nurse diagnoses are in agreement with the ANMC (Australian Nursing and Midwifery Counil) National Competency Standards for the Registered Nurse. We have seen in the earlier part of this description that has emphasized on the nursing practice aimed at providing appropriate medication for patients suffering from chemotherapy induced adverse effects. This is in accordance with the law, 1.1, that describes and adheres to legal requirements for medications, and identifies and explains the effects of legislation on the care of individuals/groups. Hence, such options may demonstrate competent nursing practice. Next, the strategy to manage patient care through interventions such as MASCC antiemesis tool and RID cancer Pain may appear suitable to the standards 1.2, 1.3 and 2.1 that emphasize on performance based on nursing interventions and assessments in accordance with recognized standards of practice. The guidelines proposed by Jordan and his associates for antiemetic treatment of chemotherapy-induced nausea and vomiting are worth fitting in the context of competency standard 2.2 that relies on the maintenance of current knowledge and incorporation into practice through organizational policies and guidelines.

The recommendations proposed by Naeim and his group for cancer induced nausea and vomiting are in agreement with the evidence-based framework of competency standards 3 and 5.The rest of the research findings are in compliance with the competency standards 6,7,8,9 and 10 that aim at nursing care in consultation with individuals/groups, providing safe and effective evidence–based nursing care, evaluating progress towards expected individual/group health outcomes in consultation with individuals/groups, establishing therapeutic relationships (especially ideal for chemotherapy induced nausea and vomiting), and collaborating with the interdisciplinary health care team depending on an individual’s/group’s needs. Hence, all the previously mentioned research strategies appear to demonstrate enough competence and could be further modified with better nursing interventions.

References

André Bonneau. (2008). Management of bone metastases. Can Fam Physician, 54, 524–527.

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Easterling, C.S., & Robbins, E. (2008). Dementia and dysphagia. Geriatr Nurs, 29, 275-85.

Dewey, A., & Dean, T. (2008). Nurses’ management of patients with advanced cancer and weight loss: part 2. Int J Palliat Nurs, 14,132-8.

Jatoi A. Weight loss in patients with advanced cancer: effects, causes, and potential management. Curr Opin Support Palliat Care, 2, 45-8.

Jordan, K., Sippel, C., Schmoll, H.J. (2007). Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations. Oncologist, 12, 1143-50.

Kight, C.E. (2008). Nutrition considerations in esophagectomy patients. Nutr Clin Pract, 23,521-8.

Lohr, L. (2008). Chemotherapy-induced nausea and vomiting. Cancer J, 14, 85-93.

Molassiotis, A., Coventry, P.A., Stricker, C.T., Clements, C., Eaby, B., Velders, L., Rittenberg, C., Gralla, R.J. (2007). Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC antiemesis tool. J Pain Symptom Manage, 34, 148-59.

Naeim, A, Dy SM, Lorenz, KA, Sanati, H, Walling, A, Asch, S.M. (2008). Evidence-based recommendations for cancer nausea and vomiting. J Clin Oncol, 26, 3903-10.

Nguyen, N.D., Center, J.R., Eisman, J.A., Nguyen, T.V. (2007) Bone loss, weight loss, and weight fluctuation predict mortality risk in elderly men and women. J Bone Miner Res, 22, 1147-54.

Sandra Ward, Heidi Donovan, Sigridur Gunnarsdottir, Ronald C. Serlin, Gary R. Shapiro, Susan Hughes. (2008). A Randomized Trial of a Representational Intervention to Decrease Cancer Pain (RIDcancerPain). Health Psychol, 27, 59–67.

Thanos, L., Mylona, S., Galani, P., Tzavoulis, D., Kalioras, V., Tanteles, S., Pomoni, M. (2008). Radiofrequency ablation of osseous metastases for the palliation of pain. Skeletal Radiol, 37, 189–194.

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