Managing the multiple causes of nausea and vomiting in the patient with cancer

PURPOSE/OBJECTIVES: To review the multiple causes of nausea and vomiting in the patient with cancer. Pharmacologic and nonpharmacologic management strategies are provided to deal with each type, and selected clinical nursing research is discussed. DATA SOURCES: Scholarly and professional published articles. DATA SYNTHESIS: Nausea and vomiting may result from chemical, visceral, central nervous system, and vestibular causes at any time during the disease process of the patient with cancer. Investigation of possible causes beyond adverse chemotherapeutic effects is necessary prior to initiating antiemetic therapy. Anticipation of potential related problems and proactive pharmacologic and nursing management are advisable. Further nursing research is needed related to nonpharmacologic management methods such as aerobic exercise, guided imagery, progressive relaxation, and acupressure. CONCLUSIONS: Proper diagnosis and targeted intervention are essential to effectively manage cancer-related nausea and vomiting. IMPLICATIONS FOR NURSING PRACTICE: Healthcare providers must thoroughly assess and reassess the patient's disease status and current treatment interventions to effectively manage nausea and vomiting. Nurses can participate in this assessment and provide the appropriate drug therapies as well as continue to develop non-pharmacologic intervention methods that the patient can implement independently.     

-Anesthesia and analgesia practice patterns in French obstetrical patients-

OBJECTIVES: To review current management of individuals with metastases to the central nervous system and brachial nerve plexus, and to provide a scientific basis for nursing management of the effects of the disease and treatment. DATA SOURCES: Published articles, book chapters, clinical trial data, and experience from nursing literature. CONCLUSIONS: Central nervous system metastases are events that may create oncologic emergencies with neurologic impairment and pain. Treatment of patients with central nervous system metastases is generally palliative regardless of the type of the primary cancer. Early diagnosis and treatment improve the chances for optimal recovery of neurologic function and pain management. IMPLICATIONS FOR NURSING PRACTICE: Central nervous system metastases may develop in patients with systemic disease. Disease and treatment effects present challenges to patients, family, and care providers. Nurses have a responsibility in educating the patient/family and in providing supportive care.     

Gene expression of mouse S100A3, a cysteine-rich calcium-binding protein, in developing hair follicle

PURPOSE/OBJECTIVES: To discuss the causes, clinical manifestations, and consequences of diarrhea in the patient with cancer; to describe the oncology nurse's role in the assessment, management, and treatment of cancer-related diarrhea. DATA SOURCES: Synthesis of published peer-reviewed data, professional experience. DATA SYNTHESIS: The many causes of cancer-related diarrhea include specific types of cancer and specific anticancer treatment regimens (e.g., chemotherapy, radiotherapy). Poorly controlled diarrhea may result in a range of physiologic and psychological effects that extend beyond the patient to significant others and caregivers. Comprehensive assessment of diarrhea is the foundation for the appropriate use of pharmacologic and supportive therapies. CONCLUSIONS: Diarrhea, much like fatigue, is a symptom that only recently has become a focus of oncology nursing research and focused intervention. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can significantly influence the quality of care given to patients who develop diarrhea as a symptom of cancer or as a sequela of cancer therapy. As such, oncology nurses are challenged to maintain current knowledge of the causes and available treatment strategies for cancer-related diarrhea. Nurses need to rely on their experiential skill and a working knowledge of published research to identify patients at risk. They also must communicate effectively with patients and caregivers in every practice setting about the nature of diarrhea and its causes, as well as develop appropriate interventions for each individual.     

Hepatic cryosurgery for metastatic colorectal carcinoma

PURPOSE/OBJECTIVES: To review an innovative, potentially curative surgical approach for the treatment of select patients with colorectal cancer metastatic to the liver. DATA SOURCES: Published articles and reported and unreported research results. DATA SYNTHESIS: The liver is the primary site of recurrence in 60%-80% of patients who develop recurrent disease following resection of the colorectal primary cancer. Less than 25% of patients with liver metastases are candidates for hepatic resection because of the location or number of liver metastases. Hepatic cryosurgery provides a viable treatment option for some patients with unresectable metastatic colorectal carcinoma confined to the liver, including patients with bilobar and multiple lesions. CONCLUSIONS: Because colorectal cancer is the second most common cause of cancer mortality in the United States, interventions that improve survival rates are an important focus of care. With knowledge of patient selection criteria and implications of hepatic cryosurgery, informed oncology nurses are resources for patients contemplating this therapy. IMPLICATIONS FOR NURSING PRACTICE: Preoperative evaluation and postoperative nursing care focus on careful assessment, education, and interventions aimed at preventing and detecting complications unique to hepatic cryosurgery. Knowledge of hepatic cryosurgery as a treatment option for colorectal liver metastases, patient selection criteria, and related implications allows oncology nurses to serve as resources for patients and families considering this therapy.     

End-of-life confusion in patients with cancer

PURPOSE/OBJECTIVES: To review the literature on confusion at the end of life, provide accurate definitional and defining characteristics of confusion, and outline nursing strategies for its resolution. DATA SOURCES: Published articles, computerized databases, book chapters, reference lists from chapters and journal articles. DATA SYNTHESIS: As a major component of symptom distress in terminal care, confusion has not been defined clearly and therefore has not benefited from rigorous assessment and study as have other end-of-life symptoms. CONCLUSIONS: Increased knowledge about confusion that occurs in patients with widely metastatic cancer will assist in accurate symptom identification, early recognition, and timely management to reduce cognitive symptom distress at the end of life. Improved symptom resolution also can benefit family coping during terminal care. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can devise management protocols for confused patients that include screening criteria, pharmacologic interventions, environmental support, and prophylactic safety measures.     

An overview of bladder cancer: treatment and nursing implications

PURPOSE/OBJECTIVES: To review the incidence, pathophysiologic mechanisms, treatment options, and nursing care of patients with bladder cancer. DATA SOURCES: Published articles, book chapters, American Cancer Society materials, and a computerized data base. DATA SYNTHESIS: Nearly 53,000 cases of bladder cancer will be diagnosed this year. Recent studies link mutations on the p53 gene and abnormalities on chromosome 9 to bladder cancer. Seventy percent of patients present with local tumors within the bladder. Surgery and intravesical chemotherapy are the most common treatments for superficial bladder cancer. Deeply invasive disease sometimes can be cured by surgery, irradiation, or a combination of treatment modalities. Early stage detection has a 91% survival rate. Prevention strategies include smoking cessation and reduction of the risk of occupational exposure to toxic chemicals. CONCLUSIONS: Bladder cancer is a prevalent disease with significant morbidity. IMPLICATIONS FOR NURSING PRACTICE: Knowledge about bladder cancer will help nurses prevent and manage the disease and its treatment complications and meet patients' psychological needs.     

Cancer and chronic pain

BACKGROUND: The effective management of cancer pain is one of the greatest challenges for GPs. OBJECTIVE: Pain management can be best achieved with a knowledge of the fundamentals of cancer pain and its assessment. A systematic and holistic approach to its treatment needs to be individualised for each patient, taking into account the relevant physical, psychological and spiritual factors. DISCUSSION: GPs are part of a team including oncologists, palliative care specialists, nursing services, paramedical staff, counsellors and clergy and so should know about and make use of the ever-improving support services which are available to ensure that insoluble pain problems are a rare occurrence.     

Sexuality and the older person with cancer

PURPOSE/OBJECTIVES: To review the particular needs of older patients with cancer with respect to sexuality and to present appropriate nursing strategies to facilitate adjustment. DATA SOURCES: Books, journals, and American Cancer Society publications. DATA SYNTHESIS: Physical and emotional changes caused by diagnosis and treatment of cancer often are compounded in the older patient. Of particular concern is sexual adjustment, which already may be compromised by the effects of aging on normal sexual functioning, absence of a partner, or personal/societal prohibitions against sexuality in this population. CONCLUSIONS: Exercise, nutrition, and self-esteem intervention programs, coupled with strategies to facilitate sexual activity that take into account normal aging, can help older patients with cancer to reestablish usual sexual functioning. IMPLICATIONS FOR NURSING PRACTICE: Nurses must establish a comfort level with sexual assessment and patient intervention so that they can provide counseling and suggest appropriate interventions.     

Endometrial polyps: a comparison study of patients receiving tamoxifen with two control groups

OBJECTIVES: To provide a review of the unique features of both Hodgkin's and non-Hodgkin's lymphoma in pediatric and geriatric patient populations. Treatment approaches and nursing care interventions at the extremes of age will be discussed. DATA SOURCES: Review articles, research studies, and book chapters. CONCLUSIONS: Lymphoma is a highly heterogeneous malignancy whose classification and management have undergone significant evolution. Of particular concern has been lymphoma's prevalence and treatment at the extremes of age. Appropriate treatment by age and subtype remains controversial. IMPLICATIONS FOR NURSING PRACTICE: The nursing care of pediatric and geriatric patients with lymphoma presents numerous challenges in education, symptom management, and supportive care.     

Patient management strategies for interferon alfa-2b as adjuvant therapy of high-risk melanoma

PURPOSE/OBJECTIVES: To review results of Eastern Cooperative Oncology Group (ECOG) trial E1684 in the context of nursing issues concerning interferon alfa-2b (IFN alpha-2b) as adjuvant therapy for high-risk melanoma. DATA SOURCES: Published results of ECOG trial E1684 and additional safety data provided by the trial sponsor. Selection of material was based on information that would expand on published safety results and present patient-management strategies relevant to oncology nurses. DATA SYNTHESIS: High-dose IFN alpha-2b significantly prolonged median relapse-free survival (< 0.01) and overall survival (p = 0.047), but side effects required extensive nursing interventions. With appropriate patient management, including dose modifications, 74% of patients who did not relapse received a full course of therapy. CONCLUSIONS: Adjuvant, high-dose IFN alpha-2b can significantly prolong relapse-free and overall survival in patients with high-risk melanoma, but nursing interventions are required to ensure patient compliance. IMPLICATIONS FOR NURSING PRACTICE: Accurate nursing assessment and appropriate interventions can help patients safely complete this effective adjuvant therapy.     

Leptomeningeal metastasis: pathophysiology, treatment, and nursing management

PURPOSE/OBJECTIVES: To review the pathophysiology, diagnosis, and clinical treatment of leptomeningeal metastasis. DATA SOURCES: Published articles, abstracts, and book chapters. DATA SYNTHESIS: Leptomeningeal metastasis is an increasingly seen complication of cancer. Treatment is intensive and may increase survival from four to five weeks without treatment to an average of six months. Clinical management and treatment of these patients is complex and best accomplished by a multi-disciplinary healthcare team. CONCLUSIONS: Information regarding the anatomy, pathophysiology, treatment, and treatment complications can facilitate the care of patients with leptomeningeal metastasis. IMPLICATIONS FOR NURSING PRACTICE: Nursing interventions should focus on patient and family education about the disease process, side-effects of treatment, and early identification of disease progression.     

Small cell lung cancer: pathophysiologic mechanisms and nursing implications

PURPOSE/OBJECTIVES: To review current incidence and treatment perspectives for small cell lung cancer (SCLC). DATA SOURCES: Published articles, book chapters, American Cancer Society materials. DATA SYNTHESIS: SCLC constitutes 20%-30% of lung cancer cases and accounts for 40,000 deaths annually. Characterized by rapid cell division, SCLC is very sensitive to radiation and chemotherapy; however, long-term survival rates are very low. A number of paraneoplastic syndromes are associated with this disease, thereby increasing the medical and nursing management challenges. CONCLUSIONS: Because SCLC usually is diagnosed late in the disease process and survival rates are poor, quality of life and palliation of metastatic symptoms (e.g., pain, breathing difficulties) are important focuses of care. Smoking deterrence and cessation programs, as well as early detection of lesions, are key to reducing incidence and mortality. IMPLICATIONS FOR NURSING PRACTICE: Nursing care focuses on promoting comfort and preventing and managing disease and treatment complications. Nursing diagnoses include ineffective airway clearance, impaired gas exchange, pain, altered nutrition, activity intolerance, and ineffective coping. A patient care standard is presented.     

Acidic peptide-mediated expression of the antimicrobial peptide buforin II as tandem repeats in Escherichia coli

OBJECTIVES: To identify the causes of and discuss nursing management of those complications that are unique to the brain tumor patient population. DATA SOURCES: Published articles and books related to neurological and nonneurological complications in the neuro-oncology patient. CONCLUSIONS: Seizures, cerebral edema, thromboembolism, and endocrine dysfunction are several complications experienced by the neuro-oncology patient. These complications can be caused by the tumor or treatment of this disease. IMPLICATIONS FOR NURSING PRACTICE: Care of the neuro-oncology patient is complex. Knowledge of the potential complications that patients may experience and how to manage these problems serves to enhance their quality of life.     

The role of the clinical nurse specialist in acute pain management

The role of nursing in infusional cancer chemotherapy (ICC) may vary depending on the practice setting. Nurses in free-standing centers and office practices perform many duties that nurses in other facilities may not, because of the lack of many of the supports that benefit hospitals with their multidepartmental and hierarchical structures. Nurses function collaboratively with physicians in the planning and the implementation of patient treatment. Patient-related nursing responsibilities include patient/family education, drug preparation and administration, patient assessment for treatment toxicity, recognition and management of complications related to the catheter or infusion device, and telephone triage. Other duties more removed from patient care might include inventory management, research data collection and management, quality assurance and improvement, compliance with regulatory issues, and a myriad of other responsibilities. The transition of patient care to the outpatient setting has broadened the scope of nursing to include nonpatient care responsibilities due to financial constraints brought about by health care reform, changes in reimbursement patterns, and overhead required to maintain and deliver quality patient care. As a result of nursing responsibilities, it becomes paramount that the aforementioned constructs for program support are in place and that all nurses are consistently trained and have a template to follow for patient treatment and management. Nursing ability to perform patient-related tasks should be proven by formal written and practical competencies repeated annually and as procedural changes are implemented. The paragraphs to follow suggest nursing management of patients receiving ICC using a model developed at The Cancer Center of Boston (TCC).     

Medical risk report: improving patient management and record keeping through a problem-oriented approach

The problem-oriented record satisfies the needs of the contemporary practitioner by addressing the transition from diagnosis to treatment. The technique organizes collected data, identifies all patient problems (medical and dental), defines solutions and/or management of those problems, and documents treatment rendered. Predictably, the problem-oriented record will avoid problems associated with malpractice litigation, conform to regulations of third-party payers, and facilitate practice analyses and quality assessment, i.e., through computer-assisted tracking of patient care based on problems and not just treatment rendered. As many practices today focus on a "patient-centered" approach to practice, the problem-oriented record clearly supports such a philosophy in its completeness of managing patient care information. The dentist, in consultation with other health care providers, can and should feel confident treating patients from the growing population of patients with medical risk. By integrating the problem-oriented approach into patient management and record keeping, dentists can more easily develop a plan for the complexities that accompany patients. Whether these complexities are of a medical, dental, or combined nature, the problem-oriented record helps the practitioner organize information, plan for treatment, and document patient care in a complete and concise manner.     

Endonasal sinus surgery improves mucociliary transport in severe chronic sinusitis

OBJECTIVES: To explore the spiritual needs of the family caregiver and to provide suggestions for giving spiritual care to this caregiver. DATA SOURCES: A caregiver's personal experience and nursing texts. CONCLUSION: Providing care for a loved one with cancer can be stressful for the family caregiver; yet, it can also produce spiritual growth. By providing care for the caregiver, the oncology nurse is equipping this caregiver to address the spiritual needs of the patient. IMPLICATIONS FOR NURSING PRACTICE: Nurses can assist caregivers by offering actions that communicate love, support, acceptance, and faithfulness. Such measures can ease the pain and encourage spiritual wellness.     

Determinants of subsequent home health care nursing service use by hospitalized patients with cancer

BACKGROUND: The authors examined the extent to which specific patient characteristics and length of hospital stay were capable of independently explaining the use of home health care nursing services by hospitalized patients with cancer after discharge. METHODS: The current study represents a secondary analysis of a data set originally gathered to identify the home health care needs of patients with cancer. The sample involved 87 patients with cancer who received home health care after hospitalization and 43 patients who did not receive such services. RESULTS: A logistic regression analysis indicated that home health care use was related to patient age, length of hospital stay, and level of symptom distress. Specifically, the likelihood of home health care use was found to increase among subjects older than 50 years of age, subjects with hospital stays of more than 7 days (apparently related to surgery), and those who experienced moderate to high levels of symptom distress. CONCLUSIONS: The results indicate a need for home health care nurses to be skilled in the management of cancer symptoms and in the complex problems commonly experienced by the postsurgical patient with cancer.     

Chronic myelogenous leukemia and acute promyelocytic leukemia: new bone marrow transplantation options

PURPOSE/OBJECTIVES: To describe new bone marrow transplantation (BMT) options for chronic myelogenous leukemia (CML) and acute promyelocytic leukemia (APL), as well as their applications and prognoses, and to describe the role of the oncology nurse in caring for the BMT recipient and options for future nursing research. DATA SOURCES: Published articles, book chapters, and personal experience. DATA SYNTHESIS: Various pretransplant agents and methods are under investigation to improve the outcome and reduce the costs of allogeneic and autologous BMT and peripheral blood progenitor cell (PBPC) transplants. Preliminary results of current studies indicate that autologous BMTs and PBPC transplants have merit as a treatment option in patients with AML and require further research. For patients with APL, BMT usually is reserved for those who fail to achieve or relapse after achieving remission with chemotherapy. Preliminary data show that patients with CML and APL who receive a PBPC transplant engraft more rapidly with decreased morbidity and mortality. CONCLUSIONS: BMT options for patients with CML and APL continue to evolve as advances in pretransplant methods and symptom management become capable of improving the outcome, decreasing costs, and shifting patient care to the outpatient and homecare settings. IMPLICATIONS FOR NURSING PRACTICE: Understanding the marrow transplant options available to patients with CML and APL is essential for nurses. They must stay informed about ongoing improvements in pretransplant processes and symptom-management procedures that reduce BMT morbidity and mortality. Inpatient and outpatient nurses need to collaborate and participate in nursing research to find better ways of providing the best care possible for patients.     

What are the needs of neurology patients?

Problems and complications exhibited by neurology patients are identified so that the proper nursing care actions can be determined and appropriate treatment can be initiated. A look at the various problems that might appear include: respiratory, nutrition and hydration, urinary and intestinal elimination, musculoskeletal and circulatory, emotional, communication and security. Lastly, some little known considerations are discussed regarding the nursing implications of caring for these individuals.