Recent studies and health researches emphasize the fact that the impact of lung cancer and other cancer diseases extend from an individual level to family level. Doctors and health professionals have often documented that gradual destruction of the system of checks and balances on cell growth, in human body fallouts and unrestrained growth or division of cells pave the way for cancer. Generally, people have the tendency to fear cancer and they often end up fearing the disease and its treatment. Medical practitioners and health professionals underline the need of proper understanding of this disease. Regardless the improvements in treatment over the past few centuries, continued existence of patients with lung cancer remain underprivileged. Mrs. Clare is identified as a lung cancer patient and feels various crises such as physical, social, financial, personal and mental. The role of Palliative treatment in cancer treatment is vital and it ensures quality, effectiveness and maximum care. Manifestation and management of the symptoms, assessment of the symptoms and the special needs of the client are very important in providing a holistic nursing care. Management of symptoms includes oxygen therapy and meditation and it is more useful in the context of a palliative treatment. At present various palliative client assessment methods are used in cancer treatment. Analysis of nursing care, biological status and spiritual status of the client are important.
Identification of the problem
Clare is a sixty five year old woman who is identified as a patient with lung cancer. She lives with her husband. She suffers sleeping problems, fatigue, and breathing problems. She considers her illness as a challenge and thinks about the effective use of symptoms management and palliative treatment.”Palliative care seeks to help patients achieve and maintain their maximum potential physically, psychologically, socially and spiritually, however limited these have become as a result of disease progression” (Twycross, 2003, p. 4).
Overview of lung cancer
Doctors and health professionals often documented the fact that Lung cancer is one of the convoluted diseases in the current world and becomes a significant cause of cancer deaths in both male and female. Frank V. Fossella et al state that; “In the United States, lung cancer is currently the most common cancer among both men and women and is the leading cause of cancer- related deaths” (Fossella, et al, 2003, p.2).
Analyzing lung cancer among the women one can see that lung cancer has surpassed severe form of cancer like breast cancer and has turned out to be the vital cause of death. Lung cancer is known to spread to other parts of the body and patients who have been diagnosed with the same after five years are also there. The survival rates for lung cancer diagnosed at the initial stage are higher. The disease cancer occurs in cells that undertake the excessive growth or division. The uncontrolled spread of cancer cells to other sites of the body is characteristic of this disease.
Some of the cancer cells get detached from the main mass or site of origin and travel by blood and lymph channels to sites distant from the original tumour and from fresh colonies […] in other organs at the cost of the normal cells (Jaggi, 2005, p. 14).
Doctors have identified the fact that normal cells that make an alteration and structures a mass or tumor is dissimilar from the contiguous tissues from which it happens. Doctors and researchers have identified different types of dangerous tumors in human body. Their studies have explained that it obtains oxygen nutrients and space from cells that have in good physical shape. These tumors often turned to be harmful for other cells and it destroys and trims down the ability and capacity of the normal tissues to function. Cancer patients, especially lung cancer patients, suffer with breathing problems, sleeplessness, fatigue and other types of bodily discomfort. Lung cancer is dangerous and many have the belief that it creates further physical and mental problems. Claudette G. Varricchio “Because cancer cells do not bind tightly together and have many enzymes on their cell surfaces that can digest the molecules of the extra cellular matrix, they are able to break off from the main tumor, move through blood vessels and tissues, and spread to other body sites” (Varricchio, 2004, pp.16-17).
Systematic treatment like surgery, radiation, therapy and chemotherapy can promote improvement in the survival of patients affected with lung cancer. Palliative treatment and related interventions often play a significant role in providing relief and quality life for patients who suffer with cancer. Concentration and spiritual support of nurse can reduce the severity of the disease. Doctor’s visit, diagnosis, testing, and management of symptoms need the assistance of a nurse. Being the main caregivers in most cases, close relatives can influence the patient’s attitude to the process of treatment significantly. On the other hand, this physical and emotional overload may result in disruption of family relationships. “The appearance of patients’ symptoms, such as fatigue, nausea and pain, underlies the severity of the disease and its potential mortality, adding significantly to the burden of family members who may feel unable to help the patient get relief” (Foley & Gelband, p. 240). For this reason, it is important to implement the family-focused approach to palliative care of lung cancer.
Palliative client assessment
Palliative client often faces various kinds of symptoms of physical distress. An effective care plan must deal with an organized assessment of these symptoms. Marianne Matzo and Deborah Witt Sherman remark; “Clients near the end of life should be assessed comprehensively for any sign or symptom that could potentially cause distress” (Matzo & Sherman, 2006, p.320).
Addressing these physical and non physical symptoms of distress should be one of the major nursing care objectives. This will help the palliative client to access a qualitative and holistic health.
The Edmonton Symptom Assessment System (ESAS)
This is designed to help the nurse to find various symptoms such as pain, tiredness, nausea, anxiety, drowsiness, depression, appetite, wellbeing and shortness of breath “A uniform approach to symptom assessment will maximize the chances of appropriate diagnosis and treatment” (DeLisa, Gans & Walsh, 2005, p.532). It will use a ten scale index which shows the intensity of various symptoms. Among the main assessment criteria included into the scale are depression, anxiety, fatigue, appetite, feeling of well-being, breathlessness and others. A model of the representation symptom is given below. Here, the suitable value is rounded and analyzed.
|No shortness||Worst possible tiredness|
|in breath||in breath|
|other problem||no other problem|
The advantages of palliative client assessment
There are many advantages for conducting palliative client assessment.
Major advantages are analyzed below.
Palliative performance scale
The palliative performance scale is the overall measurement of the activities of the client. It will improve the efficacy and quality of the nursing care. Here, the progress of the illness can be analyzed precisely. Ambulation, Activity, evidence of the disease, self care, food intake and conscious are the important factors deciding the palliative performance scale. Based on these factors, the PPS scale is recorded from 100% to 0% and when it reaches 0%, death will occur. Derek Doyle et al comment: “In palliative care, the quality of remaining life, regardless of its length, for the patient is primary and is a product of optimal relief of suffering and excellent symptom control” (Doyle, et al, 2005, p.829).
The met need
Different clients may have different medical needs. Palliative client assessment is essential to find out the special needs of the client.
Formulating effective Care plan
Each palliative client requires a unique care plan. It will help to formulate the needed care plan for the client. The assessment includes the listing out of present problems, available intervention, other possible options, etc. The goal setting is an important process in the care plan. It is formulated from the available options.
Evaluating the nursing care
Evaluation is an important aspect in the nursing care. It will be used to know the need of any change or continuation of the nursing care. The better palliative care must ensure that the health needs of Mr. Herbert’s and his family have met completely. Hence it is very significant to have an overall evaluation of the efficiency of the multidisciplinary team in the process of palliative care and treatment. The assessment will help in the evaluation process as well.
Family role and employment
Family plays a vital role of the treatment of a lung cancer patient. The family members can give spiritual support, confidence and hopeful life. They make good environment on their house so it helps in encouraging patients to return to their life fully. Yarbro et al underline; “The health care environment places considerable responsibility on the family to become active participants in the care of the person with cancer” (Yarbro, et al, 2005, p.1697).
In the case of Clare, her husband Andrew gives all kinds of personal and spiritual support to her and a nurse makes their family relations better and effective. Fear of cancer, especially cancer of the lungs and treatment results, may be a significant reason that many people with the symptoms do not search for proper treatment, until the syndrome gets highly developed. Abby S. Bloch’s view support this idea “Those patients with family support tend to adjust better and to be more willing to comply with nutrition treatment than those without such support” (Bloch, 1990, p.55).
Family members try to understand patients’ mind and spent leisure time with patients. Family members make an effort to reduce emotional stress of patient. All members are preserving the good relationship. Kathie Culhane-Pera states that, “As a decision making unit families value their traditional knowledge about illness and their abilities to heal many ailments” (Culhane-Pera, 2003, p.50). Her husband’s readiness to do domestic activities is a positive approach in palliative treatment and it provides positive results. A nurse can give enough awareness to her children and other family members about the relevance of such relations. Marilyn Haas comments that “Nurses who provide care to patients and families prior to the end during the dying trajectory need knowledge and skills in palliative care” (Haas, 2010, p.150).
The biological profile is essential in the treatment of Mrs. Clare. It will help to trace out all the medical test reports and the patients’ data. The case history will help the counselors and physicians to use the effective medication. The biological profile of the cancer will help very much in selecting the appropriate medication.
Pathophysiology of lung cancer
Health professionals and doctors have mentioned that lung cancer most frequently results from the repeated tissue trauma because of the grasp of irritants. The main substances of this problem are air pollution, arsenic, asbestos, nickel, radon, and tobacco smoking. Epithelium of lungs is the main starting point of lung cancer. In the case of normal lungs, the epithelium lines and protects the tissues and cells, but in the disease affected epithelium line does not protect tissues and cells. “Insight into the molecular mechanisms that regulate the pathogenesis of cancer metastasis as well as a better understanding of the interaction between metastatic cells and the host microenvironment should provide a foundation for the design of new therapeutic approaches” (Oldham and Dillman, 2009, p. 17).
Physicians have found that there are two types of lung cancer in the world. The first one is Small Cell Lung Cancer (SCLC) and the second one is Non-Small Cell Lung Cancer (NSCLC). Many people are affected with NSCLC. There are diverse types of NSCLC, and large cell carcinoma histologies, squamous cell carcinoma and adenocarcinoma are among them.“There are both common and distinct genetic pathways in the pathogenesis of the major types of lung cancer that are consistent with their markedly different biologic and clinical features” (El-Deiry, 2003, p. 109). It means that a comprehensive understanding of molecular abnormalities and analysis of genotypic and phenotypic characteristics of tumors is important for choosing the appropriate methods for curing them.
Tobacco smoking is one of the most important causes of lung cancer. Today, smoking is on the rise. Both males and females use tobacco to smoke. Though lung cancer is predetermined with a complex of factors, tobacco smoking is one of the central causes. “Lung cancer may be causally related to cigarette smoking in 90 % of cases in men and 79 % in women. Conversely, 85 % of all cases of lung cancer would be preventable if cigarette smoking were to be given up” (Haustein & Groneberg, 2010, p. 88). Prevention of smoking substance helps to reduce lung cancer. So the public education for smoking termination programs, getting rid of carcinogens in the work place etc help to reduce the impact of the future occurrence of new lung cancer belongings.
In Clares’ case medical care is as important as spiritual care also. The issues of spirituality become especially important for individuals facing the life-threatening diseases. “Although the need for spiritual care has been recognized within palliative care policy, in practice it is largely overlooked, avoided or there is some uncertainty as to with whom the responsibility of addressing spiritual needs lies” (Stiefel, 2006, p. 56). The importance of spiritual needs of the clients, especially the cancer patients, has got recognition for the past 30 years. It has showed some relationship with the evidence based on the research utilization of spirituality in healthcare. Professional spiritual care has been introduced in palliative care before 50 years. The study conducted on the topic of core elements of oncology spiritual care programs has given the result that spiritual care services are included into the palliative care programs as their integral elements. “The spiritual needs of the patient are incorporated into nursing care as a way to assist the dying person and family in finding meaning and resolution through exploration of life experiences or inner connection to a higher reality” (Chernecky & Murphy-Ende, 2008, p. 154). The motivation of the clients is very important for the better out-put of the health care. It is also essential to improve the motivation of the client by providing the spiritual support. Further more, the spiritual need is an import need of the clients during the palliative care.
Manifestation of symptoms
Lung cancer patients generally suffer many health and psychological problems related with symptoms in their body. As a lung cancer patient, Clare suffers from many symptoms. There are different causes of the varied symptoms related with the origin of lung caner. So symptoms are varying in different patients. In the case of Clare, her lung cancer makes a major problem which is breathlessness. It troubles Clare not only with her health but also with her confidence level. This symptom is quite natural because, it affects the breathing organ of the human body. According to medical experts, the strain due to the cancer comes out in the form of breathlessness. Smoking is an important reason for lung cancer, so there is the chance of smoking habit in the case of Clare. Generally, elderly lung cancer patients are chain cigarette smokers or ex-smokers “Most patients with lung cancer have been or continue to be cigarette smokers and so cough and sputum production are common symptoms” (Macbeth, et al, 1996, p.8). This reveals the chance of regular smoking before the occurrence of disease in Clare’s case. Another manifestation comes in the form of sleeplessness. “Anxiety and depression co-exist with breathlessness in lung cancer patients” (Haas, 2010, p.201).
Breathlessness and the presence of cough make Clare’s health weak. The physical tiredness to get breath is the major reason of her trouble related with sleeping. Continuation of the breathlessness is increasing the level of anxiety and depression.
Management of symptoms
Palliative care or management of symptoms is important according to any cancer patient because of their troubles. In the case of Clare, she has the problems of breathlessness, cough and fatigue. Moreover, sleeplessness is her problem due to the symptoms. Special approach needs to maintain the normal life; otherwise there is the chance to acquiring the disease will become grave. Breath helping and counting materials are necessary in home and hospital. Oxygen therapy is considered as a medical advice for the patients with breathing problems. It is helpful to limit Clare’s strain for breathing, which is arranged at her house. Meditation is another means to manage her anxiety and depression which also ensure the amount of oxygen. “If you have a lung cancer or condition, meditation help ease anxiety, which in turn can help ease bronchial constriction” (Budilovsky & Adamson, 2003, p.315). Thus meditation helps to develop the amount of oxygen by the definite access of air and thus limits the anxiety. This positive condition naturally avoids sleeplessness in night. Tiredness needs maximum rest according for the body and mind. A psycho-social attitude is helpful to provide rest to her mind; so the family members and friends have the role to keep up with Clare’s situation. “The focus of palliative care is on relief of pain and other symptoms and psychological support of both the patient and the family” (Yarbro, et al, 2005, p.656). This situation is not with Clare, she misses seeing her children for the improvement or her survival. So, personal and special relations are needed to the survival of Clare from the symptoms of lung cancer. However, she is surprised by the visitors to see her that it provides a joyful situation.
Critical discussion of one symptom
According to Clare, her life is a challenge because of the impact of lung cancer symptoms. Clare suffers from breathlessness, cough and fatigue. These symptoms make her depressed. Breathlessness is the major problem of Clare and it is the important symptom of lung cancer. “This uncontrolled breathlessness can cause intense distress in patients, parents and relatives” (Regnard & Dean, 2010, p.198).
Really, depression is not a direct result of lung cancer; it is an indirect result of this disease. The stress Clare has for breathing is the main reason of anxiety and sleeplessness she has the trouble sleeping at night and is frequently sleepy during the day; that is the evidence of her depression. Breathing problem generally increases during the night time because of the chance of more tension at night. On the opinion of medical professionals, depression and anxiety are common among lung cancer patients. Breathing problem decreases the amount of oxygen, which has an effect on the energy levels of a person. In short, breathing trouble is the reason of all other problems of Clare, apart from cough. Breathlessness, cough and fatigue are the reasons of Clare’s trouble in sleeping, which also caused tiredness of the lung cancer patients.
Palliative Treatments Objectives
The palliative treatment will be effective only when the multidisciplinary approach is used in the nursing care. The assessment of the symptoms and the special needs of the client are very important in providing a holistic nursing care. The treatment or the care plan objectives are essential to set the goal and improving the motivation of the patients. The palliative treatment objectives are to be set under three classifications. Such as the medical services, the psychosocial services and the vocational services. In Clares’ case, it is essential to set the treatment objective in accordance with the special needs and symptoms of the clients.
Holistic nursing care
The life-limiting condition of Mrs. Clare brings unusual impacts on all aspects of her life. The better coordination of the nursing care and the family support only will bring a best and qualitative outcome. The holistic nursing care is nothing but the multidisciplinary approach. Helping both the patient and the family by managing their health problem is an important aspect of health care. Mrs. Clare suffers from breathlessness, cough and fatigue. All these are important health problems in palliative care. “The therapy combines problem resolution using cognitive and behavioral techniques with empathic focus on the client’s feelings” (Dossey & Keegan, 2009, p. 605). The holistic nursing care includes nutritional care, environmental care, medication, physical exercise, music therapy etc.
Environmental care is the removal of hyper active smell and sound which will help to manage the problem of breathlessness. It is because the environment in which Mrs. Clare lives, such as unclean, dust polluted and sound polluted atmosphere, may cause further increase of the distress.
In Clares’ case, the most distressing symptom is breathlessness. Researches exploring the effects of Opioids on the patients’ breathlessness have demonstrated their positive impact on relief of the symptoms. “Most palliative care physicians agree that low-dose systemic opioids have a place in the symptomatic management of breathlessness in patients” (Ahmedzai & Muers, 2005, p. 151). Fatigue is another major problem in Mrs. Clare’s case. It is so common with cancer patients. Drug therapy researchers managed to prove that particular types of medications can be helpful for handling the Cancer-Related Fatigue (CRF) problem of cancer patients. “Management of CRF can be directed towards addressing contributing factors on using both non-pharmacological and pharmacologic based approaches” (Hong, 2009, p. 858). It is important to raise the awareness of the patients and their relatives concerning the nature of fatigue and its possible consequences. Non-pharmacological approach presupposes the appropriate plan of daily activities, considering the fatigue patterns or doing the physical exercises for improvement the Cancer Related Fatigue (CRF). Pharmacologic based method presupposes the use of psychostimulants and/or corticosteroids. The cough is also possible to manage effectively by the help of medication.
Only an integrated approach, besides a physician and a nurse, can produce a better out put. The family members are also an active partner or change agents of the desired nursing care. It is a proven fact that the presence of family members will increase the effectiveness of care Plan. A retrospective study of the impacts of multidisciplinary symptom control and palliative care has given the resulted the effective health care. In the research study 83 f the total 138 referred to the Multidisciplinary care has shown excellent rates of satisfaction.
Treatment and care of patients who suffers with cancer diseases, especially cancer diseases, require extreme practical knowledge and support. Lung cancer is comparatively a serious one among the people in the world. Excessive growth or division of cells paved the way for cancer. Diagnosis of the disease makes both physiological and psychological problems for patients. In the given case study, lung cancer affects Mrs. Clare’s personal, social, professional, family and financial life. Common people often fear all kinds of cancer diseases and effective support of family members is essential in the process of cancer treatment. Palliative treatment and care play a vital role in the process of curing lung cancer and other cancer diseases. On the other hand, “health promotion in palliative care is obviously not designed to prevent death, but rather the associated physical, social, psychological and spiritual problems associated with death and dying” (Mitchell, 2008, p. 142). A trained nurse can help a lung cancer patient to prevent excessive pain and earn a better life. In Holistic nursing care, one can conduct manifestation and management of symptoms. Established methods of treatment like oxygen therapy, musical therapy, nutritional care, environmental care, and meditation can provide structured progress in Clare’s life. In Palliative treatment, a trained nurse can smoothly organize various processes in the treatment such as analysis of nursing care, manifestation and management of symptoms, modification of spiritual status of the client, coordination of various methods of client assessment, family support and acquire the aim of better life for the patients.
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