Essay NSB334: Harold Case Study – Clinical Reasoning Cycle – Nursing Assignment Help

Assignment Task :

Harold is a 75-year-old-male who has stage III Non-small cell lung cancer (NSCLC). He lives on a farm with his son John. He is receiving treatment which includes concurrent administration of systemic chemotherapy and thoracic radiotherapy. He has been experiencing multiple physical symptoms related to his diagnosis and treatment. 

Caring for a patient with Cancer 

There were approximately 145 000 people diagnosed with cancer this year in Australia. It is estimated that 1 in 2 men and women will be diagnosed with cancer by the age of 85. It is also the leading cause of death in Australia. It is for this reason that cancer control is regarded as a national priority. All nurses will experience caring for a patient with cancer throughout their career. Understanding the important elements of cancer care and cancer control are therefore essential for all nurses. 

Your Task: (NSB334)

Use the Clinical Reasoning Cycle on the following pages to review the nursing priorities in relation to the care of Harold. 

Gain an initial impression of your patient 

1. Consider Harold’s situation, both socially and physically. What is your initial view of this patient and potential issues for him and his family? 
2. Consider Harold’s living situation and how a cancer diagnosis will be impacted by this? 
3. Consider Harold’s cancer diagnosis and what are some of the lifestyle factors that could have contributed to this? 

(a) Review current information

(b) Gather new information

(c) Recall knowledge (A&P, ethics, law, cultural safety) 

1. Consider Harold’s current admission.
2. What are the issues?
3. What may be contributing to this?
4. Ensure you understand the cancer Harold has presented with and how his diagnosis and his living situation may complicate his situation. 
5. Consider the nursing role in his care both in the hospital and when at home 

 Interpret data – what does it all mean? 

1. What are the general nursing problems for patients who experience cancer, particularly lung cancer? 
2. What do you anticipate may be discharge complications for Harold? 
3. How do you care for a patient who is receiving chemotherapy? 
4. What are some her risk factors for deterioration? 

Synthesize all information that has been collected and processed.

1. Based on your assessment of Harold and your knowledge of the pathophysiology of his presenting condition and his ongoing needs. 
2. You need to consider Harold’s priority problems and any actual or strong potential problems he may experience throughout his cancer journey. 

As a nurse, what are your desired outcomes for Harold? 

1. Now you have identified his problems, you need to identify your goals of care for each problem using the SMART acronym. 

What action/interventions will you do? 

1. The next step is to consider what you will do and ensure your nursing interventions suit the context and are evidence based. 

Assess the effectiveness of actions 

1. Now think about your interventions and how you will evaluate them. 

1: Prevention and Screening 

Question 1: Some cancers have a strong relationship with certain lifestyle factors. There are many prevention programs that are promoted in the media, healthcare facilities and other cancer organisations in Australia. Using evidence, identify and discuss one (1) cancer prevention program you are aware of that is used in Australia.

Question 2: Early detection is the key for increased survival in most cancers. Some cancers can be screened for to facilitate early diagnosis. Identify (2) cancers that can be screened for and discuss how screening for these cancers is performed.

2: Diagnosis & Treatment  (NSB334)

Question 3: Harold has recently had a CT scan that indicated he had a diagnosis of lung cancer. Identify (2) clinical signs and symptoms that would also indicate that Harold might have lung cancer and explain the pathophysiology of these. 

Question 4: Harold has been diagnosed with Non-Small Cell Lung cancer (NSCLC). a) Describe the anatomy and physiology of NSCLC. (2 marks) b) Discuss the implications for Harold of having a diagnosis of NSCLC commenting on prognosis and the impact of treatment on his quality of life. (4 marks) c) Discuss two (2) challenges Harold faces as a person living in a rural community diagnosed with cancer. 

Question 5: Harold is receiving chemotherapy for his lung cancer. 

a) Review National Standard 3 (Preventing and controlling healthcare-associated infections). Describe and justify why people undergoing chemotherapy are at higher risk of getting health care associated infections. 

b) Name and justify two (2) side effects Harold might experience when receiving chemotherapy.  

c) State and justify two (2) interventions (nursing or collaborative, NOT referrals to allied health professionals) to minimise the effects of each stated side effect.

d) Discuss how you would evaluate that each intervention was effective 

Question 6: In the case study it is identified that Harold’s corrected serum calcium is high. This is a common complication for patients with advanced cancer and can become a medical emergency. 

a) State the normal adult values (in mmol/L) for serum calcium and discuss (2) clinical effects of a high serum calcium.

b) Identify two (2) interventions to manage an increased serum calcium level and discuss their mode of action

Question 7: Given Harold’s complex condition and care requirements. Write (2) short-term goals for Harold in SMART format.

3: Providing patient centred psychosocial care 

Question 8: Lung cancer is associated with significant stigma due to its relationship with smoking. Discuss and justify two (2) communication strategies that you could use when interacting with a person affected by lung cancer to reduce the potential impact of stigma.

Question 9: Harold discusses concerns about his finances. Describe how you as a nurse would provide good psychosocial, patient centred care for Harold in relation to his financial concerns. 

4: Support for people at the end stages of life 

Question 10: 

a) Define what is meant by palliative care and justify its role in caring for patients with cancer and other life limiting illnesses. 

b) Using evidence, identify two (2) interdisciplinary team members in a palliative care team and justify their role in the context of Harold’s care and his social environment. 

c) Harold is experiencing ongoing thoracic pain and dyspnoea. Describe the pathophysiological basis of these symptoms in end stage lung cancer. 

d) Discuss (2) evidence-based palliative interventions to manage the pain and dyspnoea.