Question

· Patient B is a 60-year-old male survivor of colon cancer treated with a colon resection and sigmoid colostomy, chemotherapy, and radiation therapy.

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.

Answer 1

Nursing Diagnosis and interventions

1. Risk for Impaired Bowel Elimination related to related to the possibility of an unbalanced diet.

1. Risk for Infection related to colostomy and inadequate secondary defences, malnutrition, chronic disease process and immunosuppression,

(It can be due to bone marrow suppression, occur as a side effect of both chemotherapy and radiation).

Expected Outcome

A patient will remain afebrile and timely healing will be achieved as appropriate.

Nursing interventions with rationale

Appropriate use of universal precautions including timely hand washing by staff and visitors: it can protect the patient from cross infection.

Good personal hygiene: it can limit potential sources of infection.

Identify and participate in interventions to prevent/reduce the risk of infection.

Monitor vital signs frequently: Temperature variation is the best indicator of infection.

Assess for the signs of infection frequently (skin, respiratory, urinary etc.): early identification and intervention may prevent progression to more serious situations like sepsis

Promote adequate rest and exercise: Encourages sufficient movement to prevent stasis complications and ensures rest.

Limit invasive procedures where applicable: reduces the chance of infection

Monitor blood count: to identify bone marrow suppression

Administer prescribed antibiotics: can identify infection or can be used as prophylactically.

2. Fear and anxiety related to unknown outcome of disease and perceived effect of illness evidenced by insomnia, feeling of helplessness, expression of concerns regarding change in life events

Expected Outcomes:

Express appropriate range of feelings and less fear.

Appear relaxed and tension free.

Report reduced anxiety.

Demonstration of effective coping mechanisms and active participation in treatment regimen

Interventions:

Identify the extent of fear and misconceptions regarding cancer and treatment process: helps in further planning.

Encourage the patient to express thoughts and feelings: patient will feel accepted without the feeling of judging, and promotes a sense of dignity and control.

Provide assurance: to gain the confidence of the patient.

Limit sensory deprivation: that may intensify the feeling of anxiety, fear and alienation.

Provide accurate and relevant information regarding prognosis: can improve understanding of the disease process.

Accept the perceptions of a situation as it is: can win the confidence of the patient.

Explain the recommended treatment with its purpose, and potential side effects: enables the patient to accept the treatments.

Explain procedures by giving the opportunity for questions and honest answers.: providing accurate information allows the patient to manage anxiety more effectively with the reality of the situation and thereby reducing anxiety and fear.

Stay with the patient during anxiety-producing procedures and consultations: reduces the unknown situational anxiety.

Provide calm and quiet environment: it facilitates rest and conserve energy and there by enhancing coping abilities.

Identify the stage of grief and use of defence mechanisms: psychological status can be assessed and can plan care accurately.