Symptom Management in Children with Cancer - Essay Example

Topic:' Pain Management in Pediatric Oncology Introduction Cancer cells starts in the basic building blocks of the body known as cells. Sometimes, the process during cell regeneration will go wrong, and will eventually lead to tumor formation, specifically; benign and malignant. Malignant cells invade nearby tissues in the cells, break away, and spread to other parts of the human body. Like the adults, children also acquire cancer in the same body parts. Cancers in the childhood has sudden occurrence, with no early symptoms but with high cure rate. The symptoms and treatment of a cancer would depend on its classification and its complexity. Treatment includes surgery, radiation, and chemotherapy (MedlinePlus database, 2008). Untreated pain is the major source of fear and distress in children. Oftentimes produce physiologic stress, altering body systems function (Saskatoon Health Region, 2006). Literature Review Cantrell (2007) noted in her study entitled "Health - Related Quality of Life in Childhood Cancer: State of the Science" that psychological nursing care interventions are needed to influence positively the determinants of health - related quality of life (HNQOL) for children and adolescents having cancer. Research suggests that psychosocial well - being perception influences physical functioning and outcomes of the treatment amongst the children and adolescents with cancer. Their experiences during their treatment and individual responses to treatment have an effect on HRQOL in survivorship. Multiple opportunities exists for facilitating ongoing psychological development and functioning and a fostering a positive sense of well - being because of the fact that during treatment, health care professionals have frequent contact with children and adolescents during treatment. The aforementioned fact has positive implications for the overall treatment outcome of the patient and quality of life in survivorship. In conclusion, the research findings reviewed in this article provide information for intervention development in HRQOL enhancement, assessment in clinical setting, and future HRQOL research in children and adolescents receiving treatment as well for childhood cancer survivors. The level of development in physical health status assessment and functioning must reflect realistic norms for individuals in HRQOL research in childhood cancer survivors and treatment. Another study by Rheingans (2007) on "A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer," noted that in pediatric oncology, symptom management remains a problem. This remains to be the most troublesome aspect in cancer treatment despite of remarkable pharmacologic and surgical advances. Research have shown that nonpharmacologic adjunctive therapies such as acupuncture and guided imagery are the potential source of assistance in children with unrelenting pain, nausea, and other symptoms that is brought about by cancer treatment. In conclusion, this study noted that when standard pharmacologic and medical care has been exhausted, limitless potential solutions are still available for management of symptoms in cancer. Lastly, in "Managing Children's Cancer Pain in Morocco," McCarthy, Chammas, and Wilimas (2004) indicated that a study to identify issues of pain management of children with cancer was done in two oncology units in Morocco. In this study, it was found out that children's cancer pain was an overwhelming concern to the physicians and nurses in Morocco. Training and resources for pain management of children with cancer are lacking, impediments to relief of pain were verbalized such as stoic approach to suffering and limited drug use, and a critical need for comprehensive pain approach for children with cancer in Morocco. In conclusion, this study elucidated issues in the management of children's cancer pain issues in Morocco and increased knowledge of issues in current practice. Nursing Process Assessment According to Saroyan and Schechter (2005), proper pain assessment is the proper pain treatment cornerstone. The goal of pain assessment is to gain an objective understanding of a subjective experience. The history of pain and observation of the behavioral and physiologic responses of the client is necessary in the assessment of pain. In pediatric patients, physiologic measures of pain such as heart rate and blood pressure are non - specific in measuring pain level of the patient. Instead, Faces Pain Scale - Revised (FPS-R)'is recommended in the measurement of pain. In assessing a patient, it must be observed that if a child is lying still, pain may be present. Children who are in pain are not always willing or able to communicate. Besides pain, other discomfort causing the patient must be considered. A fact to consider in pain assessment is that in the usual manner, children may not report pain due to fear of painful analgesic administration or fear of returning to the hospital. Children with chronic pain may not be conscious that they are going through pain (as cited by Favaloro and Touzel, 1990). Saroyan and Schechter added that Pediatric Pain assessment should be appropriate to the level development of a patient. All pediatric patients with cancer should be assessed for pain, which can be communicated by words, expressions, and behavior (crying, guarding a body part, grimacing). The American Pain Society suggests that pain should be thought of as the 5th vital sign. In conclusion, nursing management should include assessment of pain according to its location, intensity, duration of pain, aggravating and relieving factors, effects on the patient's activities of daily living, sleep patterns and psychosocial aspects of the life of the patient, and its effectiveness of present strategies. Lastly, assessment of pain should include the pain screen rating (Haller and Rosenstein, 2001). Planning Planning is dependent on the outcome of the diagnosis. When planning, nurses should select measures based on date assessment and input that is appropriate for the client. Planning for pain management in pediatric cancer patients should be acceptable to the client and includes pharmacologic and nonpharmacologic intervention. The goal of pediatric pain planning should include the maintenance of pain rating to 2/10 or better. Goals should also be related to function, activity, and the quality of life of the patient. Part of planning is to list all the medications to be given to the patient by name, dosage, and schedule of administration (Haller and Rosenstein, 2001). Implementation Implementation of nursing pain management should follow hospital policy for medications and treatments prescription and administration. Minor analgesics such as paracetamol (acetaminophen) can be started for mild pain. In some cases, a combination of paracetamol or codeine can be administered, and in severe cases of pain, parenteral morphine can be injected (McCarthy, et al, 2004). Nonpharmacologic management of pain should include heat or cold, massage and vibration, distraction technique such as music, relaxation technique such as imagery, acupuncture, self-hypnosis, and TENS (Haller and Rosenstein, 2001). Patient and family education is also an important tool in pain management in childhood cancer care. Evaluation A nurse should be responsible in the evaluation of pain status of the patient, vital status, amount and frequency of the medication that is used, and the possible side effects brought about by pain medication. Goals of planning phase are evaluated according to the specific desired outcome. To assist in the process of evaluation, flow sheet records or a client diary may be helpful. Conclusion In conclusion, Rheingans (2007) indicated that patients, families, and health care professionals deserve to have a chance to continue to offer the hope of relief of symptoms above and beyond the standard care. Nevertheless, clinicians and researchers must be willing to go beyond their comfort zone and further investigate evidence - based nontraditional approaches in pediatric pain management. Haller and Rosenstein (2001) stated that at the end of life, the goal of pain management is to relieve pain and suffering as well as to prolong life. End of life pain management should be the framework of patient's goals, preferences, and ethical and legal judgment. References Cantrell, M. (2007). Health - Related Quality of Life in Childhood Cancer: State of the Science. Oncology Nursing Forum, 34 (1), 103 - 109. Haller, K. and Rosenstein, B. (2001). Pain Assessment and Management. Retrieved March 1, 2008, from the Johns Hopkins Interdisciplinary Clinical Practice Manual McCarthy, P., Chammas, G., & Wilimas, J. (2004). Managing Children's Cancer Pain in Morocco. Journal of Nursing Scholarship, 36(1), 11 - 15. Rheingans, J. (2007). A systematic review of nonpharmacologic adjunctive therapies for symptoms management in children with cancer. Journal of Pediatric Oncology Nursing, 24(2), 81 - 94. Saroyan, J. and Schechter, W. (2005). Pediatric Pain Assessment. Retrieved March 1, 2008, from National Hospice and Palliative Care Organization database. (2006). Pediatric Pain Management. Retrieved March 01, 2008 from Saskatoon Health Region database. (2008). Cancer in Children. Retrieved February 29, 2008, from MedlinePlus database. Read More