SCHOLARLY ASSIGNMENT- EXPERIENCING A HEALTH CHALLENGE:

THE EFFECTS ON CLIENTS

Student: Senarath Rathnayake

Student No: 822-974-028
Date submitted: Nov 18, 2014
NURS209(360) : Experiencing a Health Challenge: The Effects on Clients
Professor: Eva Hearn
Humber College ITAL

Student# 822-974-028

SCHOLARLY ASSIGNMENT- EXPERIENCING A HEALTH CHALLENGE: THE EFFECTS

ON CLIENTS
THE DOCTOR
This movie is about a surgeon -Dr. Jack McKee -who became a Cancer patient, and sought
treatment in the same hospital where he works. Dr. McKee unexpectedly identifies a growth of
Cancer cells around his throat. Knowing that it is malignant, he became upset and shocked. He
became isolated from his family and among his colleagues. He thinks that he only will have to
deal with this incident. When his wife tries to talk about his disease, he stops her screaming
Its not a team game. He has to face many struggles in this hospital even though he is still a
surgeon in the facility. Asking him to sit on a wheel chair, neglecting him as he is a doctor,
delaying to provide forms and referral made him feel challenges to his dignity. He has to undergo
incorrect investigations, and negligence. He worries and is angry about his erasing dignity. But,
with four tumors in the brain, a beautiful bold headed lady with a smiling face breaks his
psychological conflict. He tries to be friendly with her and looks at other patients with a kind
heart. Then, he understood the mental state in patients minds. As a result, he makes his medical
students try to understand the psychological world of the patients who are struggling with
deadly diseases. At the end, the surgeon who cut bodies as a timber cutter cuts logs, understands
the soul of a patient under his goggles and the instruments tray with the sense of empathy.
Physical effects
This patient was experiencing a continuous cough. It affected badly to his day today life. This
was the first symptom he noticed related to the growing Cancer. What is cough? According to
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the Medical-Surgical Nursing in Canada (2014), Cough is a protective reflex action that clear
the airway by a high pressure, high velocity of air. Coughing is effective in removing secretions
from large or main airways. [ Lewis et al ( 2014) p. 616]. Cough is a significant symptom to be
assessed effectively. Hence, a nurse should get a thorough understanding about the cough by
asking questions such as, do you have a cough?, when did it start?, how often do you cough?,
does activity affect your cough? And what alleviates your cough?. In addition, when the patient
has a productive cough, it is crucial to get details about the amount, colour, consistency, and
odour. This patient had a continuous cough, and one evening, he noticed blood.
Haemoptysis- Coughing blood
Even though haemoptysis is the most common symptom in lung cancer, this client with a
head and neck cancer experienced this symptom. Client and his wife happened to notice it while
they were returning home from a party. He coughed blood over his wifes face and the front
screen of the car. Since, the carcinoma develops over the squamous epithelial cells of the lining
of the throat, ruptured small blood vessels might caused his haemoptysis. This is really a very
frightening symptom. In such situations, nurse is required to assess it properly asking how much,
how often, you coughed blood. And also, it is very important to know whether the client is on
medications that might cause bleeding.
Hoarseness of voice
This is a significant change in voice when something affects to the structure of the vocal
codes. Head and neck Cancer patients experience changes in their voice. when a Carcinoma
develops around the larynx, vocal cords are affected, and it makes the hoarseness of voice. It
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may grow up to late symptoms such as severe hoarseness of voice, airway obstruction,
aspiration, and pain.
Psychosocial effects
Anxiety :
According to the Core Curriculum for Oncology Nursing (2005), Anxiety is a state of feeling
uneasy and apprehensive to a vogue, nonspecific, or undesirable threat. Many signs and
symptoms are present with anxiety: flushed face, tense or worried expression, poor concentration
and memory, decreased interest in usual activities, insomnia, headaches. palpitation, elevated
blood pressure, hyperventilation, and hurt burn. It is nurses duty to minimize risk and severity of
anxiety using her skills such as getting calm, reassuring approach; listening attentively,
encouraging verbalization of feelings, and fears. In addition,assessing the level of anxiety;
providing a safe, supportive environment; assisting with self care as needed; and refraining from
asking the client to make decisions during high anxiety states, may really helpful to client to deal
with anxiety.
Psychological stress
A Cancer patient can develop psychological stress in many ways. Some are as follows: fear of
dying from the illness, painful medical procedures such as bone marrow biopsy, loss of job, and
social isolation. These stressors lead the client to have many symptoms such as depressed mood,
anxiety, insomnia, and anorexia. Further, these may lead difficulty in activities in daily living,
and recurring thoughts about an uncertain future.
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Declining closeness to the family

In the movie- the client Dr.MC Kee feels that he is alone, and only himself have to face the
upcoming obstacles. When his wife tries to talk to him he says This is not a team game. There
is an another incident in the movie that indicates a threat to their family closeness. During a
conversation at a night, when his wife says I am cold, he screams you are always cold.
Unfortunately, unexplainable emotional changes emerged due to the life threatening Cancer
declined his closeness to the family. Finally, the client was friendly with an another Cancer
patient June Ellis, a beautiful lady whose brain had been invaded by four tumors. They were
closed to each other, and they travelled to a far destination to see a native Indian show.
Area of priority for holistic nursing care
My priority area is to maintain the quality of life, during and after the treatment. Because
Cancer and its treatments are associated with both physical and psychological consequences, the
quality of life is enormously challenged. Pain, fatigue, weakness, loss of appetite, sleep
disturbances, anxiety, and altered body image make a strong impact on the quality of life. Hence,
nurses first priority should be improving the patients quality of life, by providing comfort,
introducing coping strategies, and addressing sexuality.
During the interventions of providing comfort, nurse addresses the clients pain, fatigue, and
sleep disorders. According to the Core Curriculum for Oncology Nursing (2005), pain is
unpleasant sensory and emotional experience associated with actual or potential tissue damage
(Joanne et al 2005, p. 3). There are two types of pain: nociceptive pain and neuropathic pain.
Physiology of pain is a process of four stages: transduction, transmission, perception, and

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modulation. Nurse should correctly assess and can relieve pain using pharmacologic or
nonpharmocologic methods such as distraction, music therapy, hypnosis, and massage. Fatigue is
also a major concern of a Cancer patient. This can be caused by disease or treatment related
factors, immunotherapy, radiation, surgery, and lifestyle. Further, sleep disorders are common
with Cancer patients due to a number of factors; new diagnosis, symptoms such as pain, fever,
fatigue, delirium. And also, hospitalization, personal factors such as medical illness, increased
age, depression, anxiety, naps, and excessive time in bed may inversely affect to sleep.
Therefore, nurse should address pain, fatigue, and sleep disorders to provide comfort in order to
maintain the patients quality of life.
The other big part of maintaining the quality of life is to introduce coping strategies related to
anxiety, loss of personal control, and loss and grief. By minimizing the risk and severity of
anxiety, providing safety, and enhancing adaptation and rehabilitation such as discontinuing
alcohol, caffeine, nicotine, and promoting sleep, nurse can improve the quality of life of the
client.
An another major aspect of the quality of life is sexuality. Nurse can intervene properly by
discussing potential or actual alterations of sexuality caused by disease or treatment, and
strategies the client can use. Further, nurse can facilitate to have an open communication with
partner. Eventually, nurse can maintain the clients quality of life by providing comfort,
discussing coping methods, and addressing sexuality during and after treatment.
Three nursing interventions

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One of my nursing intervention for this patient is to promote physical functioning including
activities of daily living, as it has a direct impact on the quality of life. Maintaining oral hygiene
is essential as the lining squamous epithelial cell membrane is damaged due to chemotherapy,
and radiation. And also, as they are immune-suppressed, daily bath, clean clothes, and avoiding
contact of infected individuals are needed to keep them free from infections. In addition,
performing active and passive range of motion exercises, consulting rehabilitation services for
physical and occupational therapy, are important interventions of promoting physical activities.
To support the client to deal with the emotional distress is the second intervention. Joanne
(2005) states a pattern of expected changes in thinking, feeling, and behaviours that occur in
response to the diagnosis, prognosis, treatment, and events that occur in the clinical course of
Cancer is the emotional distress ( Joanne 2005 p. 29). To provide safe, comfortable, supportive
environment, and listen attentively- allowing the client to discuss thoughts, feelings, fears may
helpful to relieve their pain in mind.
The third intervention is to maintain nutritious balanced diet. As Cancer patients experience
loss of appetite and sore mouth, it is essential to provide high protein, high calorie diet to fulfill
their nutritional needs. No added spices or salt, less acidic diets are preferred. Getting to know
about individual food preferences, keeping food out of sight in between mealtimes, providing
snacks such as graded cheese, crisps, dried fruit and nuts or yogurt may helpful to increase his
food intake.
Inter professional collaborative care

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Oncologist: Oncologist is the professional who diagnoses the disease, prescribes medications,
and follow up the progress of the patient. He plays a tremendous role in re-establishing the
clients quality of life.
Nutritionist: He is responsible for choose the most appropriate diet to gain clients nutritional
needs.
Social worker: He helps to client to find social institutes, financial assistance if needed,
Community resources
1.

Brampton Civic Hospital-Cancer Unit Bramalea Rd, Brampton Ontario

Its mission is to innovative health care delivered with compassion.

Its role is to provide inpatient oncology treatment, consults radiation and follow-up onsite,
access to Positron Emission Tomography (PET), psychosocial support, referral to other
community services, Oncology outpatient clinic, and Early Detection of Lung Cancer Program.

2. Wellspring Chinguacousy support Center for Cancer Patients and Caregivers. 5

Inspiration way, Brampton Ontario L6R 0L7

Its role is to provide emotional, psychological, and informational support, free of charge, to
individuals and families living with Cancer in Brampton. Caledon and surrounding area.

References

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Cancer Care. Retrieved Nov 10, 2014 from http//www.williamoslerhs.ca

Joanne, K. I., Karen, N.T.,(2005). Chapter1.Quality of Life. Core Curriculum for Oncology
Nursing (4th ed). Philadelphia: Elsevier Saunders
Lewis, S. L., Dirkson, S.R., Heitkemper, M., M., Bucher,L., Camera,I.,M., (2014). Chapter 17.
Cancer. Medical-Surgical Nursing in Canada (4th ed). Toronto: Elsevier Mosby
Lisa, K. S., Donna, H., Cynthia, A.,(2012). Psychosocial Concerns in Cancer Care- The Role of
the Oncology Nurse. Clinical Journal of Oncology Nu.rsing, volume 16. Retrieved November
12, 2014 from CIHNAL database