Care Needs for a Patient with Cervical Cancer - Case Study Example

Case Study Care Needs for a Patient with Cervical Cancer Scenario This is the case study of a 30-year-old female patient with stage IB squamous cellcarcinoma of cervix, for which she had been operated earlier. This case episode relates to her postoperative radiotherapy. She is a single parent with two children under age 10. In this assignment, the care needs of the patient will be analysed in order to develop a care plan for her with the aim of solving all the problems and meeting her care needs as she undergoes external beam radiotherapy. Brief Assessment She has cervical cancer stage IB, which according to FIGO classification system is confined to the cervix but invasive at the microscopic level. Although it is an early stage of cancer, due to its metastatic potential, the treatment offered to her was extirpative surgery in the form of Wertheim hysterectomy. This is a radical surgery by definition, and this involves surgical removal of uterus along with uterine tubes and ovaries, cervix, and upper part of the vagina. Since theoretically, cancer at this stage is microinvasive with potential for spread through lymphatic circulation, radiotherapy is usually offered to cover any possible lymph node involvement surrounding these organs (Jensen et al., 2003). Radiotherapy In the microinvasive stage, postoperative radiotherapy or chemotherapy or both are offered to the patient as treatment. She undergoes external beam radiotherapy, which in itself has complications, with impact on general physical wellbeing of the patient. The known complications of external beam radiation therapy are bone marrow depression, fistula formation, or bowel obstruction. Among them, bone marrow depression may lead to effects on general physical health due to its all round effects on blood cell formation, leading to anemia, increased tendency for infections, and tendency for bleeding (Christman et al., 2001). These problems may be manifested in physical examination, and the assessment must include a general physical examination (Magnan and Mood 2003). Another direct adverse effect of external beam radiotherapy is skin reaction. Some patients may have other acute side effects such as irritation at the operative area, anorexia, disfigurement of the area. All of these must be assessed in this patient (Grigsby and Herzog 2001). Psychosocial Aspect Cancer is a life-threatening illness and is associated with extreme suffering. The diagnosis and treatment of cancer many a times are intolerable to the patient. The knowledge about the diagnosis leads to trauma and anxiety. In most cases unawareness and misinformation are the reasons of fear, denial, guilt, and anxiety. Therefore assessment of the patient's knowledge about the disease, its treatment, anticipation, understanding, and responses to it would be very important so the patient may be helped to cope with this traumatic life situation. Social support groups, networks, and family supports have important roles to play in strengthening the psyche of such patients, which help them cope up with the trauma of suffering from the disease and the treatment (Flory 2005). Economic In most cases, these patients are from lower socioeconomic classes. Therefore, being itself creates a burden on the family. As anticipated, her surgery and radiotherapy have likely forced her to have long leave from the job, and such long absence is not usually reimbursed. This would lead to financial crisis for the family, leading to more stress and anxiety due to the thought about ways to support her family or children. This may be compounded further sue to the anxiety that this cancer may leave her incapacitated enough, bedridden, or may even cause her death, creating problem for financial support in raising the children (Flory 2005). Loss of Body Image Extirpation of the most vital female organ, namely, the uterus and adnexae leads to excessive stress in females undergoing this surgery. This may lead to disturbed body image which needs to be attended to. Care Requirement Physical Assessment During weekly reviews a thorough examination of the physical status will be done. This would particularly focus on assessment of adverse effects of radiotherapy. Apart from general survey, anaemia, infections, bleeding tendencies and the area of radiotherapy in the pelvic area and vulva will be looked for in order to rule out any adverse effects (Khoo 2003). Relief of Anxiety The patient will be assisted to receive and understand information on the stage of cancer and its implications in future with possible progress of the disease. The treatment done and offered to her will be explained, so she can prepare herself for eventuality. The better side of the treatment and the prognosis will be explained to her, and the fact that 79% of such patients recover completely to lead an active life without any disease for 5 years is great fact to inspire and encourage the patient to cope up and not to lose hope. If necessary, counselling on her traumatic experience of disease, diagnosis, and treatment will be arranged. Radiotherapy The patient will be placed on strict bed rest. The upper part of the body will be bathed. Appropriate perineal care will be provided, and the linen will be changed regularly. A low-residue diet will be provided, and the patient will be encouraged to have small frequent meals. To prevent bladder infections, the patient will be encouraged to drink plenty of water. The signs and symptoms of acute radiation sickness will be looked for, and symptomatic treatment for nausea, vomiting, diarrhea, and abdominal cramping will be provided (Solomon and Cherny 2006). To minimise anxiety, the patient will be frequently monitored, and sometimes to aid this, mild sedatives and pain medication will be necessary (Wells and MacBride 2003). Enhance Body Image The patient must be provided emotional support during treatment. Since she is ambulatory, she will be encouraged to be active, out of bed, and to socialize with others as much as possible (Maas and der Kulie 2003). She will also be encouraged to take pride in her appearance by dressing and putting on makeup in order to exploit what she has, rather not to bother much on what she lost. There may also be concerns due to effect on her sexual life due to hysterectomy (Mock 2003). Patient Education and Health Maintenance The care would involve explanation of the importance of life-long followup, since she had had cancer. It is to be explained that regardless of successful treatment, the healthy survival of cancer patients are facilitated by surveillance and repeated assessment of response to treatment, so possible spread of cancer is immediately detected. Since many a cases recurrences are symptomless, appropriate followup checkup is absolutely necessary (Porock 1995). Support Group The patient will be referred to a cancer support group in the community, who can provide psychosocial support to the patient. These groups not only provide psychological support, they can also guide the patient towards different resources which may help them survive financially (McGough et al., 2006). Social and Psychological Given the patient's condition of single motherhood and two less than 10 year children, there is an obvious need for making arrangements for her to see her children or to stay with her children. She can receive daily radiotherapy as an outpatient, provided she can avail free hospital transport if she meets the criteria for such. She should be recommended for getting her travel expense reimbursed, although final decision will depend on the authority's permission based on the benefits she already is getting (Poirier, 2005). However, in her case, the problem is more crucial since she is the single mother of the two of her children, both of whom are below 10 years of age. It is known that children below 10 years are not allowed into the radiotherapy department where she is currently being treated. Moreover even if possible, visit and meeting with their mother would mean appointment during school hours. In her distress, she would need talking to her children, which she is missing now. These factors further aggravate the stress and anxiety, which she already is having due to her disease and treatment (Slevin et al., 1996). Reference List Christman, NJ, Oakley, MG, and Cronin, SN, (2001). Developing and using preparatory information for women undergoing radiation therapy for cervical or uterine cancer. Oncol Nurs Forum; 28(1): 93-8. Flory N (2005) Psychosocial effects of hysterectomy - literature review. Journal of Psychosomatic Research, 59, 117-129 Grigsby P and Herzog TJ (2001) Current management of patients with invasive cervical carcinoma. Clin Obstet Gynaecol, 44 (3), Sept, 531-537 Jensen PT, Groenvold M, Klee MC, Thranov I, Petersen MA and Machin D (2003) Early stage cervical carcinoma, radical hysterectomy and sexual function. Cancer, 100 (1), 97-106 Khoo V (2003) Late toxicity: bone problems, in Faithfull S and Wells M (eds) Supportive Care in Radiotherapy. Churchill Livingstone, Edinburgh. pp. 337-347 Magnan MA and Mood DW (2003) The effects of health state, haemoglobin, global symptom distress, mood disturbance and treatment site on fatigue onset, duration and distress in patients receiving radiation therapy. Oncology Nursing Forum, 30 (2), E33-E39 Maas CP and der Kulie MM (2003) The effect of hysterectomy on sexual functioning, in Weijenborg PT (ed.) Annual Review of Sex Research, 14, 83-113 McGough C, Baldwin C, Norman A, et al. (2006) Is supplementation with elemental diet feasible in patients undergoing pelvic radiotherapy Clinical Nutrition, 25 (1), 109-116 Mock V (2003) Clinical excellence through evidence-based practice: fatigue management as a model. Oncology Nursing Forum, 30 (5), 787-796 Poirier, Patricia, (2005). Policy Implications of the Relationship of Sick Leave Benefits, Individual Characteristics, and Fatigue to Employment During Radiation Therapy for Cancer. Policy Politics Nursing Practice; 6: 305 - 318. Porock D (1995) The effect of preparatory patient education on the anxiety and satisfaction of cancer patients receiving radiotherapy. Cancer Nursing, 18 (3), 206-214 Slevin M, Nichols SE, Downer SM, et al. (1996) Emotional support for cancer patient: what do patients really want British Journal of Cancer, 74 (8), 1275-1279 Solomon R and Cherny NI (2006) Constipation and diarrhoea in patients with cancer. Palliative and Supportive Care, 12 (5), 355-36 Wells M and MacBride S (2003) Radiation Skin Reactions, in Faithfull S and Wells M (eds) Supportive Care in Radiotherapy. Churchill Livingstone, Edinburgh. pp. 135-159 Read More