Comprehensive Care Plan for Mr. Arthur Cancer Diagnosis - Assesment Answer

Introduction

The case study is about a patient named Mr. Arthur who is a 74-year-old man, and he has been diagnosed with cancer in the colon. The patient has worked towards medical treatment after rectal bleeding has been noticed. After studying the patient effectively, the patient has been scheduled for a colonoscopy and gastroenterologist. It has been mentioned that the patient before the surgery was at high risk, hence, it needs to be checked on. In the paper below the patient profile is being studied, and objective and subjective information about the patient is studied. In the next section, a comprehensive assessment is provided. Since in the case study the patient has been diagnosed with cancer, a comprehensive care plan must be designed. In this comprehensive assessment, one nursing diagnosis and one nursing intervention are explained. ISBAR communication framework is used to escalate the deteriorating condition of the patient. Other than this any area of concern has been targeted. The role of a nurse in the whole process is described, since cancer requires a holistic approach to treatment, hence, a multidisciplinary team needs to be present which will provide holistic care.

Patient profile 

The patient in the case study is named Mr Arthur Barrett, he is a 74-year-old man who has been diagnosed with cancer. The patient has witnessed rectal bleeding, occasional constipation, and diarrhea. After colonoscopy, it has been noticed that left-sided colon cancer is detected along with bowel resection. Upon admission, some of the vital signs are observed and these are mentioned below. The temperature is 36.7 degrees Celsius, the pulse rate was recorded at 90, and the respiratory rate is 18 breaths per minute. In addition to that, the blood pressure is recorded at 150/90 mmHg. Other than this, there are several comorbidities observed and these are: COPD, the patient has been diagnosed with COPD for 15 years. To get treated salbutamol inhaler and occasional smoking is observed. Other than this osteoarthritis has also been observed, and several non-steroidal anti-inflammatory drugs are being administered. The patient has also been diagnosed with type-2 diabetes.

On day 1 after the post-op, the vital signs are mentioned. The temperature which is recorded is 37 degrees Celsius, the pulse rate is 112 which is weak, and the respiratory rate is 22 breaths per rate. The blood pressure is 90/50 mmHg, which is much lower than the normal heart rate. The oxygen saturation level recorded is 97%. Other than this hourly urine output recorded is 26 ml/hr, and the specific gravity of urine is 1.022. The BGL recorded is 4 mmol/L. On day 2 of post-op, the temperature recorded is 37 degrees Celsius, the pulse rate recorded is 121 breaths/min, respiratory rate is 32 breaths per minute. The blood pressure recorded is 184/ 95 mm Hg. The oxygen saturation level which is recorded is 90%, and the hourly urine output recorded is 15-30 ml/hr. Other than this BGL recorded is 6.9 mmol/l. All this information that is present is analyzed in an effective manner so valuable information can be presented and interpreted. 

Cancer treatment requires a holistic approach, that is treatment is provided from several perspectives. A well-defined approach needs to be adopted, and there are several departments along which care needs to be provided.

Comprehensive Assessment: Nursing Diagnosis and Nursing Intervention 

In the cancer treatment process, a comprehensive assessment needs to be provided so all aspects of patient care are taken care of. The comprehensive assessment helps to assess the functional status, comorbid medical condition, psychological state, and nutritional status. Assessment of these conditions will ensure effective treatment and that every option for treatment is being assessed. One of the major nursing diagnoses of cancer is to treat the acute pain of the patient. Patients diagnosed with cancer often in the treatment process experience pain. Chronic pain is mainly due to the change in the neurons (Li et al., 2019). The nerve changes might be due to cancer which is pressing on the nerve or it is due to the chemical which is produced by a tumor. Chronic pain continues a long time after the injury or treatment and it can range from severe to mild. Pain in cancer can be experienced at any stage of the disease. The pain in cancer can be caused before diagnosis, and this pain might come and go. In some cases, the pain might also come and go. However, pain comes from the tumor itself like abdominal pain, and it can pass on the other regions like bones, organs, and nerves. There are certain procedures and tests which have been performed (Xu et al., 2022).

There are several nursing interventions for cancer, these are mentioned and explained below. 

Several assessment techniques are followed, and support for therapy is provided such as radiation and chemotherapy. Pain control measures need to be adopted, nutrition should be promoted and along with it, emotional support needs to be provided. The several therapy options which are present help to treat the underlying cause of the cancer and the infected cells are treated. In the case study, it has been mentioned that the patient has undergone a lot of pain, and this pain needs to be controlled. Several medications are prescribed to the patient to get relief from the pain. Other than this several treatment options need to be adopted. To manage acute pain it is important to use nonpharmacologic pain relief interventions (Zhang et al., 2022). Other than this, several other interventions are adopted such as meditation, massage, heat, and other diversional activities which will promote pain relief and relaxation. Some of the common pain relief medications which are required are NSAIDs and Opioid analgesics. In addition to it, there are several ways adopted to educate the patient about the pain management plan. The pain should be controlled and ways should be improved to get a better understanding of the nature of pain, its treatment, and its cause (Larimi et al., 2022). 

It also affects the psychological status of the person, hence, steps should be adopted to improve the psychological status of the person. Some cognitive-behavioral strategies are adopted and it helps the patient to cope with all the discomfort and other unpleasant effects of the pain. Several complementary therapies are adopted such as acupuncture, aromatherapy, yoga, and hypnotherapy. It will help to relieve pain and no adverse effects of medications are observed. In the cancer treatment diet also plays a vital role, the patient should include fruits and vegetables in the diet. Including all these things in the diet will help to enhance health and improve it (Ding, H., & Jiang, 2022). 

There is a risk of fluid volume deficit, hence, it is necessary to control the fluid volume and ensure that a fixed volume is maintained. Fatigue is a very common problem which is also encountered and this needs to be taken care of. The main problem which is encountered is due to extensive treatment options the patients get tired hence, effective steps need to be taken to control it. 

ISBAR communication 

In this scenario ISBAR communication will take place, there are several components of it, these components are mentioned below. The situation needs to be identified, the situation should be identified of the patient, assessment of the patient needs to be done. Other than this recommendation needs to be followed. All of these components need to be taken care of and it will help the patient to take care of the high-risk environment (Burgess et al., 2020).

The first component is the identification of the patient, in this, the patient's health status is being discussed. The name of the patient is Mr. Arthur who is a 74-year-old man, and who has been diagnosed with cancer in his colon. The patient has undergone a surgery for colonoscopy and gastroenterologist. The patient's condition is deteriorating and the area of concern needs to be addressed. In this scenario, the nurse has called over the phone to the doctor and has asked about the patient and how the condition will be treated. The nurse has called the doctor over the phone, however, the condition has not been treated adequately (Pun, 2023). The doctor should have provided an effective care treatment plan, work needs to be done towards it. For the doctor to provide effective care it is necessary to get a clear idea of the patient's condition. ISBAR helps in providing a standardized approach towards clinical handover, it is most suitable in several situations. For effective handover, it is important to think, write and talk, this is important as it will help in relevant, focused, and clear communication. There are five steps of the nursing process: it is essential in the diagnosis process, planning and outcome needs to be taken care of. Other than this implementation is an important process, in this step the several strategies that are designed need to be implemented effectively. After the implementation of the step, it is also necessary to evaluate the implemented steps, if it is presenting a positive impact (Müller et al., 2018).

Conclusion 

The case study which has been discussed is about a patient named Mr. Arthur who is a 74-year-old man, and who has been diagnosed with cancer in his colon. The patient has worked and put efforts toward medical treatment after rectal bleeding has been noticed. After studying the patient effectively, the patient has been scheduled for surgery for a colonoscopy and gastroenterologist. The subjective and objective data of the patient is presented, and it is studied. After a diagnosis of the patient's condition, the nursing diagnosis and treatment plan are explained. Several nursing diagnoses have been carried out and some of which are: assessments of pain, fatigue which is felt by the patient. The care plan which is developed is developed according to the needs of the patient and how it will be addressed. ISBAR communication has been used, in this communication tool several challenges are used and all of these need to be addressed. There are several components of ISABR and these are: the situation needs to be identified, the situation should be identified of the patient, and an assessment of the patient needs to be done. Other than this recommendation needs to be followed. 

References 

Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Teaching clinical handover with ISBAR. BMC Medical Education, 20(2), 459. https://doi.org/10.1186/s12909-020-02285-0

Ding, H., & Jiang, Y. (2022). Effect of high-quality nursing intervention on the quality of life and psychological state of tumor patients undergoing first chemotherapy. Evidence-Based Complementary and Alternative Medicine: eCAM, 2022, 9466665. https://doi.org/10.1155/2022/9466665

Larimi, N.A., Belash, I., Abedi, M., Bandari, P., Mousavi, G., Ekhtiari, S., Khademloo, F.H., Rahnamaei, K., Konari, M.E., Rahmdel, S., & Saripour, E. (2021). An investigation of efficient nursing interventions in early diagnosis of cancer: A systematic review and meta-analysis. Journal of Family Medicine and Primary Care, 10(8), 2964–2968. https://doi.org/10.4103/jfmpc.jfmpc_2148_20

Li,P., Guo, Y.J., Tang, Q., & Yang, L. (2018). Effectiveness of nursing intervention for increasing hope in patients with cancer: A meta-analysis. Revista latino-americana de enfermagem, 26, e2937. https://doi.org/10.1590/1518-8345.1920.2937

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W.E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202

Pun J. (2023). Nurses' perceptions of the ISBAR handover protocol and its relationship to the quality of handover: A case study of bilingual nurses. Frontiers in Psychology, 14, 1021110. https://doi.org/10.3389/fpsyg.2023.1021110

Xu, Q., Chen, Y., Shen, X., & Fang, Q. (2022). Application of nursing intervention plan based on symptom management theory among breast cancer patients. Contrast Media & Molecular Imaging, 2022, 3816768. https://doi.org/10.1155/2022/3816768

Zhang, T., Lu, J., Fan, Y., & Wang, L. (2022). Evidence-based nursing intervention can improve the treatment compliance, quality of life, and self-efficacy of patients with lung cancer undergoing radiotherapy and chemotherapy. American Journal of Translational Research, 14(1), 396–405.

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