Prevention Strategy Before the Commencement of John's Chemotherapy - Essay Example

Case Study Essay - Individual Once an individual has been diagnosed with colorectal cancer, it is of great significance that the extent of the disease be established. Once distant or regional metastases are identified, a combination of various therapies such as surgical are applied. The initial treatment intervention for the colorectal cancer is the removal of primary tumor through surgery. Approximately 20-30% of patients with colorectal cancer get diagnosed when the disease has already advanced. In such a situation, curative intervention is nearly impossible (PHARMACY UPDATE: Treatment of Colorectal Cancer 17). As in the case study, John has undergone surgery. After surgery, he agrees to receive adjuvant chemotherapy which comprises of fluorouracil. After a few days, John returns for Chemotherapy third cycle. During this visit, he has developed some wounds in his mouth making him to experience difficulty in eating. After mouth assessment, it is noted that his oral cavity is red in color. Besides, the oral cavity has at least three ulcers (3), each five millimeter (5mm) in diameter. These side effects are as a result of fluorouracil prescription. Patients undergoing such a treatment report various side effects such as temporary hair thinning or loss, dizziness and the resurfacing of painful sores inside the mouth lining and in some cases on the lips as in the case of John. Given the side effects of this treatment, John should shun spicy or irritating foods as they can enhance further inflammation or irritation. Apart from the named side effects, fluorouracil impacts significantly on the cells around the immune system. For instance, chemotherapy drug tampers with the normal functioning of the bone marrow thereby decreasing the number of white blood cells. This increases the patient’s vulnerability to various infections. In this situation, health specialists have to take precautions in order to ensure that John is not exposed to a sick persons suffering from diseases such as flu, cold or any other contagious disease while undergoing chemotherapy (Mona 1). John’s case study aims to ease the establishment of competencies that gives an over view of the role played by health professionals in the management and treatment of colorectal cancer patients with reference to those who have been diagnosed or at risk. Prevention Strategy before the Commencement of John’s Chemotherapy The diagnosis and treatment of colorectal surgery requires adequate prior preparation. A well coordinated approach and agreement between the patient, nurses, surgeon, and radiation oncologist is exceptionally critical and necessary for a successful treatment. Prior to the surgery, the leading clinician ought to hold a thorough discussion with the colorectal cancer patient, the family and other health professionals to come to a consensus on the best treatment mechanism to employ in the treatment of the patient (Rankin 89). This open and interactive discussion with the key stakeholders will as well provide an avenue to examine the possible outcome of the treatment, the aim and the rationale of the surgery, likely positive and negative effect, the available treatment options, as well as possible psychological support to the family and the patient. In contemporary healthcare sector, practitioners have developed various strategies necessary in the commencement of any chemotherapy to prevent the occurrence of any side effect. In John’s case, the most effective strategy to prevent the prevailing side effects was the comprehensive use of primary prevention strategy (Epstein 1037). By using the primary prevention strategy, it was possible to reduce the risk of emergence sore and ulcers infections which was associated with cancer treatment. According to Epstein (1037), primary prevention strategy is relevant and effective during the pre-exposure period as well as in the initial and promotion stage of cancer treatment. This strategy was appropriate in preventing John from some specific infections that were brought about by cancer treatment, which included sore mouth, oral cavity complications and ulcers. The strategy also proposes the use of vaccination in preventing the victim from any emerging cancer related pathogenic infections. The use of prophylactic vaccines to reduce the impact of pathogenic virus has a very profound record in health sectors due to its efficiency, safety, and its capability to address the problem of economically challenged populations (Schwab 2131). After the identification of the infection, the second step in primary prevention strategy entails the elimination of the growth of pathogen in the victim’s body. The core aim of the primary prevention strategy is to contrast a mechanism that would lead to the promotion and initiation of tumors in the infected patient. The understanding of strategy responsible for the neo-plastic transformation in a patient is relevant in the advancement of protective pharmacological agents. The knowledge is as well effective in the execution of dietary chemoprevention regimens (Mercadante 1389). Primary strategy uses different mechanism both epigenetic and genetic to reduce the impact of infection related to colorectal cancer treatment. Some of the common mechanisms include the inclusion of viral oncogenes into the patient cells, introduction of chromosomal translocation and instability, host cell genes mutation, oxidative stress, alteration of genes expression, cell proliferation stimulation, chemical carcinogens interaction, and immune-suppression and apoptosis inhibition. All these mechanisms aim at reducing the impact of cancer treatment infections. Primary prevention strategy aims at reducing the spread of cancer infection agents. The strategy has identified three mechanisms in which infectious agents can maintain and promote tumor formation in the patient body. These mechanisms include chronic suppression in the immune system, virus induced configuration and chronic inflammation. To protect John from infections which are related to cancer treatment, the employment of the primary prevention strategy was extremely proficient and necessary (Brennan 787). John’s Case: Pharmacological Intervention to Manage the Side Effects The term cancer to many means death and pain. According to various studies, it is evident that approximately 30% of individuals at the time of diagnosis experience pain. Another thirty to fifty percent (30-50%) suffers from pain while receiving therapy, and seventy to ninety percent (70-90%) experiences pain as the disease (cancer) advances and triumphs over the normal body cells (Portenoy and Lesage, p.1695). According to World Health Organization’s 1996 findings, 90% of patients suffering from cancer receive adequate relief from various interventions such as use of drugs to relieve pain. For effective management of pain, care givers need to have adequate knowledge on the causes of pain and types in order to come up with effective strategies to assess and manage pain. The pain caused by cancer can result to a patient suffering from stress and anxiety. Severe symptoms either psychological or physical accompany colorectal cancer treatment. The symptoms impact on the patient’s quality of life. Symptom management and assessment are vital to a balanced approach in dealing with colorectal cancer patients (Donnelly and Declan 68). As a result of the diverse nature of the symptoms, professional management and assessment of the disease symptoms is mandatory. The interdisciplinary approach advocates for the expertise of express therapists, spiritual care providers, physicians, nursing assistants, social workers and nurses intervention. To accommodate John’s desires, the only way is to alleviate the symptoms is via non-pharmacological and pharmacological interventions. Pharmacological Intervention John has some sores in his mouth making it extremely difficult for him to eat normally. His oral cavity is red with at least three ulcers, each five millimeter in diameter. This causes a lot of pain to John. In normal circumstances, a cancer patient experiencing pain suffers from stress and pain and John is not an exception. It is only proper interventions that can help John out of this pain. According to (Bednash and Ferrel 195), cancer patients experience anxiety as the disease advances. Anxiety is characterized by either cognitive or physical symptoms such as irritability, insomnia, shortness of breath and loss of appetite. Anxiety can only be managed if pain is alleviated. Once pain has been alleviated, the patient does not need to undergo further treatment. The most efficient and effective treatment is the blending of both pharmacological management and counseling therapy. All these interventions aim at improving the patient’s self-esteem, morale and coping skills. For health care professional to effectively apply pharmacological intervention in pain management, they have to adequately assess the severity of the symptoms. This is because; managing pain may involve the actual treatment of symptoms. The principal pharmacological treatment of acute pain is Opioid analgesics. It applies to both cases, when the pain is mild or severe. However other interventions such as NSAIDS can be used to contain mild to moderate pain. In some cases it limits the opioid dose rations for pains that are more severe. Once a patient tolerates oral intake, then oral medication should be used. Administration of medications through intramuscular (IM) is not a recommended way in any pain management. As a result, John should adopt oral medication. According to Wycross (95), pain management can only be effective through medications. The commonly used medications are such as co-analgesics or adjuvant, opioid analgesics and acetaminophen, ASA and NSAIDS. In summary, cancer pains are effectively managed by utilizing oral medications (Grant 40). The Table below Details the Steps Taken To Manage Various Intensities of Pain Source: http://www.nursingceu.com/courses/324/index_nceu.html Non-Pharmacological Intervention Non-pharmacological intervention have extremely essential positive outcome in cancer diagnosis and healing process. In most cases, cancer victims encounter psychological trauma, physical pain, stress depression, loss of appetite and fatigue immediately after cancer diagnosis. Testing positive for cancer in most cases destabilizes the psychological makeup of both the patient’s family and the entire society (Brennan 787). Psychologists and health professionals have tin response developed various non- pharmacological interventions that aid in the maintenance of both the physical and mental health of cancer patients. Some of the common non-pharmacological interventions in the treatment of cancer related complication and infections include: physical based therapies, active enhancement therapy and psychological intervention. In John’s case, the most effective non-pharmacological priority intervention to managing the physical side effects brought about by pharmacological therapy entails the use of active enhancement non-pharmacological interventions. However, the decision on the best non-pharmacological therapy must be agreed upon by all players. The practitioner and family members should also consider some factors such as expenses, the nature of health condition, as well as the availability of the proposed therapy. As observed by Lalla (787), the improvement of strength and energy through frequent exercises, proper diet, community participation and restrained exercise walking programs has a very significant role in patient health transition. Active engagement therapy has proved to be very effective in the reduction of depression and anxiety, elimination of physical pain, improvement of the patient body image and increased tolerance to the patient physical activity. The development of sore mouth, oral cavity complication as well as ulcers in John’s cancer treatment can be articulate to medical complication as well as the reduction in his physical and activity performance (Brennan 787). Although other medical factors might lead to the reduction of John’s functionality, the psychological trauma and fatigue can be rated as one of the main causes of his health complication. In most cases, cancer related physical complication hampers the activities of daily living index to cancer victims. It also inflicts pain and suffering in the client’s health. However, the interference is always moderate to victims who have metastatic diseases, non-white men and women. These interferences also affect individual’s medical condition thus giving room for opportunistic diseases in the body. Health practitioners encourage patients to start non-pharmacological therapy before and during the pharmacological therapy. Non pharmacological therapy is more effective during the clinical treatment as compared to after treatment therapy (Williford 799). For John to benefit adequately from active enhancement therapy, immediate commencement is to some extent very necessary and significant. Additionally, John should be encouraged to participate in restrained level of physical and technical activities to reduce the impact of cancer treatment in his health. The current researches are yet to recommend specific physical and technical activities to reduce the impact of cancer treatment among colorectal cancer victims. To achieve the maximum benefit from active enhancement therapy, John ought to engage in at least thirty minutes moderate activity in a day. According to Larson (267), colorectal cancer patients who engage in moderate activities in at least three to five hours in a week experience significant outcome and have less side effects on pharmacological therapy. In extreme situations, some patients may require referral to a specialist exercise. In the referral, colorectal cancer patients might require specialist therapies such as rehabilitation services, exercise prescription, physical medicine as well as physical therapy. However, these specialized trained must be executed by well trained practitioners (Williford 799). Some of the special scenarios that may force John to undergo physical therapies referrals may include diagnosis with co-morbidities such as COPD and cardiovascular, substantial de-conditioning, recent major surgery, as well as specific anatomical or functional deficits which include reduced motion range brought about by neck dissection. On the other hand, as observed by Hovan 1089) active enhancement therapy ought to be executed with extra caution especially if the patient is suffering from complications such as anemia, bone metastases, active infections or fever, thrombocytopenia as well as any other chronic disease. Additionally, to get the maximum benefit from the therapy, active enhancement therapy should be individualized based on patient’s gender, age, physical fitness level as well as the type of cancer. On the other hand, the therapeutic program should commence with low level of duration and intensity. The therapy should also progress in a slow mood and be modified in accordance to the patient health condition. Conclusion With appropriate interventions in place, the severity of the symptoms experienced by individuals suffering from colorectal cancer can be adequately managed as the disease advances. When the patient’s pain, distress or anxiety is well managed, there is improvement in their quality of life. Lipman (135) writes that, the end-of-life care that encompasses various aspects of evidence-based medicine results to a considerate care. Health-care professionals, who possess inadequate knowledge in terms of end-of-life symptom assessment and management, need to review a variety of literatures for clues (Sweeder 15). Pain management plan is often developed once health care professionals assess pain. The main objective of pain management is to allow the patient to achieve maximum function and comfort. This should be accompanied with minimal analgesic therapy side effects. The plan includes pain cause treatment, optimal utilization of adjuvant and analgesic medication and use of whenever appropriate non-pharmacologic interventions. Works Cited Bednash, Gregory and Ferrell Bohm. Pain and Symptom Management in End of Life Care, Sacramento: CME, 2002. Print. Brennan, Schubert. Oral complications of cancer therapy: Pharmacology and Therapeutics for Dentistry. 6th Ed. 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Sweeder, Jack. “Educating Clinicians on Effective Pain Management.” The Pain Clinic, 4.1(2002):11–19. Print. Williford, Salisbury. The safety of surgery extractions in patients with hematologic malignancies. Journals of Clinical Oncology, 2009,7 (6): 798-802, wycross, Robert. Symptom Management in Advanced Cancer, 2nd edition. Oxon, England: Radcliffe Medical Press, 1997. Print. Read More