Nursing care of patients under chemotherapy and/or radiotherapy for CRC - PowerPoint Presentation

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Nursing care of patients under chemotherapy and/or radiotherapy for CRC

Souliou KaterinaRN, MSc

chemotherapy Side effects

PainOral symptoms (stomatitis, xerostomia, abnormal taste)

Nausea and vomiting

Colorectal symptoms

(constipation, diarrhea)Urinary symptoms (bladder spasm) Respiratory symptoms Skin problems Necrotic, malodorous tumor masses Fever Venous access problemsNutritional support

So

urce:

Casciato

et al. 2000

radiation Side effects

AnorexiaNauseaLassitudeDiarrheaSkin reactions (erythema, desquamation)Mucosal reactionsEpilationHematopoietic suppression

So

urce:

Casciato

et al. 2000

nursing care plan:

AssessmentDiagnosisExpected outcomesInterventionsRationaleEvaluation

Nursing care plan

organizes, analyzes, compiles and summarizes the information they have collected recognizes their problems, their characteristics and their rationaleprioritizing needsdetermines nursing activitiescontinuous and repetitive

adjusted for each treatment

supports the patient physically, mentally and emotionally

Assessment tools

Fatigue assessment tool

Multidimensional Assessment of Fatigue (MAF) ScaleConsists of 16 itemsThe MAF is a self‐administered questionnaire to measure 4 dimensions of self‐reported fatigue:

degree and severity

amount of distress

duration degree to which fatigue interferes with activities of daily living.Completed in 5 min and scored in 5 minRespondents are asked to reflect on their experience of fatigue for the past week.

Pain assessment tool

Memorial Pain Assessment CardValid & usefulReliable for repeated assessments

Nausea & vomiting assessment tool

MASCC Antiemesis

Tool (MAT)

8 items

Assesses acute and delayed nausea & vomitingCompleted in 5 minsThe MAT is a reliable, valid, clear, and easy-to-use clinical tool

Nutritional assessment tool

Mini Nutritional Assessment Short Form (MNI-SF)Simple and highly sensitive tool6 items grouped in 4 rubricsanthropometry

general status

dietary habits

self-perceived health and nutrition statesCompleted in 5 minsSpecial training neededIn case of low score (malnutrition), do the full MNI

how patients are affected by radio-chemotherapy?

PhysicallyMentallyPsychologically

Evaluation of the side-effects of chemotherapy in patients with cancer

Polikandrioti et alPublished 2010Jan 2007- Jan 2008

Private hospital

Sample 151 patients

49% men/51% femaleAttending on One Day Clinic

Side

Effects

n

%

Fatigue

70

45.8

Xerostomia

51

33.4

Nausea

48

31.4

Suppression

48

31.4

Constipation

48

31.4

Anorexia

46

30.1

Anxiety

41

26.8

Pain

32

20.9

Vomiting

32

20.9

Numbness

31

2

0.3

Respiratory symptoms

20

13.1

Diarrhea

25

16.3

Memory symptoms

16

10.5

According to ‘Macmillan cancer support’:

49% of patients were depressed75% of patients had anxiety 19% of patients felt abandoness 

45% of patients suffered more emotional consequences than physical impairment

In general, cancer patients had high levels of depression, anxiety and problems in their relationships, including divorce and separation. Similar problems were also experienced by their environment, relatives or friends who had taken care of them

problems that arise in relationships

32% cancer causes enormous pressure and tension in relationships   26% of patients have very serious difficulties with their partner or husband because of the cancer that challenged them   7% of patients’ relationship with their partner or husband was interrupted (divorce, separation) due to their cancer  

43% of patients’ sex lives suffered from cancer

Source: MacMillan Cancer Support

How cancer patients experience the support that they receive

58% of cancer patients declare that they feel that their emotional needs do not have an equivalent level of care, such as physical health problems   24% of cancer patients feel they have none to talk   49% of cancer patients want or need more information. But 41% cannot find this information

.

75% of cancer patients say they have anxiety due to their cancer  Fewer than 44% receive any information, advice, support or treatment for the psychological consequences of their condition. Due to lack of support, the proportion of patients with depression increased from 49% to 60%

Source:

MacMillan Cancer Support

Patient needs

Physical, mental and psychological supportAn holistic and individual care planInformationAcquaintance with cancer illnessPositive aspect for life

Source:

Polikandrioti

et al,2010

Nursing care of patients under chemotherapy and/or radiotherapy for CRC

Chemotherapy administration – venous line insertionApplication of radiotherapy Cope with side effects

– nausea, vomiting, pain

Physical changes from cancer

– anorexia, diarrheaGeneral health disorders due to treatment - diabetes deregulation

Psychological support

-

patient’s and his environment

Training

- colostomy treatment,

appropriate nutrition, doing Sc injections

Briefing of his therapy

- resolving questions

Prepare of discharge plan

- removing the portable pump and gripper

An oncology nurse…

Multidimensional responseSpecial knowledge and skills on oncology nursingEffective communication and co-operation skillsAbility to adapt to the stressful oncological environmentHolistic assessment of patient and familyPatient and family training

Psychological support

Physical care

Management of symptoms and side effectsManagement of cancer healthcare team

Nurse – patient relationship

Careful thinkingSensitivenessEnergyTime

Thank you!