Question

For this discussion, your instructor will assign you to Patient A or Patient B. Patient A is a 22-year-old female survivor of Stage II Hodgkin lymphoma treated with radiation and chemotherapy. Patient B is a 60-year-old male survivor of colon cancer treated with a colon resection and sigmoid colostomy, chemotherapy, and radiation therapy. For your assigned patient: Identify 2 interventions the nurse will include on the survivorship plan of care that will address health promotion and management of comorbid conditions. Provide a rationale for each intervention. Identify another member of the interprofessional team that could play a role in the cancer survivorship care for this patient. Explain the role of this interprofessional team member.

Answer 1

Nursing interventions for Stage II Hodgkin lymphoma treated with radiation and chemotherapy:

Description

• Is a threatening lymphoma of the reticuloendothelial framework that outcome in a gathering of broken, juvenile lymphoid-inferred cells.
• The sickness for the most part spreads by lymphatic channels, including lymph hubs, spleen, and at last (through the circulation system) to additional lymphatic destinations, for example, gastrointestinal tract, bone marrow, skin, upper air entries, and different organs.
• It is most normal in quiet ages 20 to 40 and in those more established than age 60.
• It's motivation is obscure.

Causes/Risk Factors

The reason for Hodgkin's malady is obscure. Numerous specialists have suspected an irresistible segment. A portion of the early side effects incorporate fever, chills, and leukocytosis, as though a viral contamination were available. Quality sections like those of a murine leukemia infection have been found in Hodgkin's tissue. Specifically, higher than common Epstein-Barr antibodies have been found in numerous Hodgkin's patients, and a little increment in Hodgkin's occurrence has been found in individuals who have had the Epstein-Barr– actuated illness, irresistible mononucleosis. A few people who have lessened insusceptible frameworks, for example, those with AIDS and organ transplant patients, are likewise at a higher hazard for Hodgkin's ailment.

Assessment:

• Fatigue, fever, chills, night sweats, effortless swelling of lymph hubs (by and large one-sided), pruritus, weight reduction.
• Wide assortment of manifestations may happen if there is aspiratory inclusion, predominant vena cava check, hepatic or bone contribution, and association of different structures.

Confirm diagnosis:

• Lymph hub biopsy distinguishes trademark Reed-sternberg goliath cell, affirming analysis.
• Complete blood check and bone marrow yearning and biopsy decide if there is bone marrow association.
• X-beams, CT output, and MRI recognize profound nodal association.
• Lymphangiogram distinguishes size and area of profound hubs included, including stomach hubs, which may not be promptly observed by CT examine.
• Liver work test and liver biopsy decide hepatic contribution.
• Gallium-67 identifies regions of dynamic illness; decides forcefulness of malady.
• Surgical organizing (laparotomy with splenectomy, liver biopsy, various lymph hub biopsies) might be done in chosen patients.

Essential Nursing Diagnosis

• Risk for disease identified with impeded essential and auxiliary barriers

Pharmacologic Interventions:

• Chemotherapy might be utilized as a part of blend with radiation.
• Initial treatment regularly starts with a particular four-sedate regimen known as MOPP (Mustargen, Oncovin, procarbazine, and prednisone).
• Three or four medications might be given in discontinuous or recurrent courses, with times of treatment to permit recuperation from toxicities.

Restorative Management

• Chemotherapy took after by radiation treatment is utilized as a part of beginning time ailment
• Combination chemotherapy alone is currently the standard treatment for further developed infection.
• When Hodgkin's recurs, the utilization of high measurements of chemotherapeutic medicines, trailed via autologous bone marrow or undifferentiated organism transplantation, can be extremely viable.

Surgical Interventions:

• Autologous or allogeneic bone marrows or undeveloped cell transplantation.

Nursing Interventions:

• To ensure the skin getting radiation, abstain from rubbing, powders, antiperspirants, salves, or treatments (unless endorsed) or use of warmth or icy.
• Encourage patient to keep spotless and dry, and to bathe the territory influenced by radiation delicately with lukewarm water and mellow cleanser.
• Encourage wearing baggy garments and to shield skin from introduction to sun, chlorine, and temperature extremes.
• To secure oral and gastro-intestinal tract mucous layers, empower visit, little dinners, utilizing tasteless and delicate eating regimen at gentle temperatures.
• Teach the patients to maintain a strategic distance from aggravations, for example, liquor, tobacco, flavors, and to a great degree hot or cool sustenances.
• Administer or show self-organization of torment prescription or antiemetic before eating or drinking, if necessary.
• Encourage mouth mind no less than twice every day and after suppers utilizing a delicate toothbrush or toothete and mellow mouth wash.
• Assess for ulcers, plaques, or release that might be characteristic of superimposed disease.
• For looseness of the bowels, change to low-deposit count calories and regulate hostile to diarrheals as requested.
• Teach tolerant about danger of disease. Guidance patient to screen temperature and report any fever or other indication of contamination expeditiously.
• Explain to quiet that radiation treatment may cause sterility.

Documentation Guidelines

• Response to organizing: Emotional and physical reaction to symptomatic testing, recuperating of incisions, signs of incapable coping, response to diagnosis, ability to take part in arranging treatment options, response of huge others
• Response to treatment: Effects of chemotherapy or radiation therapy, or both; reaction to treatment of symptoms, presence of intricacies (weight loss, infection, skin aggravation)
• Emotional state: Effectiveness of adapting, nearness of wretchedness, enthusiasm for assemble bolster or counseling, referrals distraught

Discharge and Home Healthcare Guidelines

Despite the fact that they are cured of the disease,patients who survive Hodgkin's sickness keep on having insusceptible deformities that endure all through life. Imperfections incorporate transitorily discouraged immune response creation, diminished polymorphonuclear chemotaxis, diminished antigen-instigated T-cell proliferation,and changes in deferred extreme touchiness. Combined with the occasionally waiting eventual outcomes of radiation and chemotherapy, the patient needs to keep up contamination watchfulness even after abatement is gotten. Educate the patient long lasting techniques to keep away from disease. Patients may have different inconveniences for up to 25 years after mantle radiation treatment, including hypothyroidism, Graves' disease, and thyroid malignancy. Light can likewise cause aspiratory and pericardial fibrosis and coronary course changes, and it might expand the hazard for the advancement of strong tumors, for example, lung cancer, breast cancer, and others. Clarify the showing side effects of the disorder, provide composed data for the patient, and urge yearly physicals to keep up development. Since fruitlessness might be a complexity of chemotherapy, men might need to consider sperm keeping money before medications, albeit numerous have sperm brokenness at diag.

Nursing interventions for colon cancer treated with a colon resection and sigmoid colostomy, chemotherapy, and radiation therapy:

Nursing Interventions: Colorectal Cancer

• Set up the patient for surgery, as demonstrated.
• Give comfort measures and consolation to patients experiencing radiation treatment.
• Set up the patient for the antagonistic impacts of chemotherapy and find a way to limit this impacts.
• Utilize strict aseptic method when watching over I.V. catheters.
• Have the patient wash his hands when suppers and in the wake of heading off to the lavatory.
• Tune in to the patient's feelings of trepidation and concerns, remain with him amid times of serious pressure and tension.
• Urge the patient to distinguish activities and care measures that will advance his solace and unwinding.
• Screen the patient's inside examples.
• Screens the patient's eating routine change, and survey the ampleness of his nourishment admission.
• Guide the patient to take after a high fiber eat less carbs.
• Alert him to take intestinal medicines or an antidiarrheal pharmaceuticals just as endorsed by the specialist.
• Advise the patient about screening and early recognition.
• Set up the patient for surgery, as demonstrated.
• Give comfort measures and consolation to patients experiencing radiation treatment.
• Set up the patient for the antagonistic impacts of chemotherapy and find a way to limit this impacts.
• Utilize strict aseptic method when administering to I.V. catheters.
• Have the patient wash his hands when dinners and subsequent to heading off to the washroom.
• Tune in to the patient's feelings of dread and concerns, remain with him amid times of extreme pressure and nervousness.
• Urge the patient to distinguish activities and care measures that will advance his solace and unwinding.
• Screen the patient's inside examples.
• Screens the patient's eating routine alteration, and survey the ampleness of his sustenance consumption.
• Guide the patient to take after a high fiber consume less calories.
• Alert him to take diuretics or an antidiarrheal medicines just as recommended by the specialist.
• Illuminate the patient about screening and early location.