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CARING is the essence of NURSING. -Jean Watson
Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee
Treat the patient as a whole, not just the hole in the patient.
Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill
A problem is a chance for you to do your best. -Duke Ellington
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Description of Colorectal Cancer
Most colorectal cancers arise from adenomatous polyps-clusters of abnormal cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.
People with any of several conditions known as adenomatous polyposis syndromes have a greater-than-normal risk of colorectal cancer.
Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer (HNPCC) syndromes, also run in families. In these syndromes, colon cancer develops without the precursor polyps.
Also at high risk for developing colon cancers are people with any of the following:
Treatment of cancer depends on stage of disease and related complications. Obstruction is treated with intravenous fluids and nasogastric suction and with blood therapy if bleeding is significant. Supportive therapy and adjuvant therapy (e.g., chemotherapy, radiation therapy, immuno therapy) are included.
PATIENT TEACHING
FOLLOW-UP
Diarrhea related to inflammation, irritation, intestinal malabsorption or partial narrowing of the intestinal lumen, secondary to the process of intestinal malignancy.
Characterized by:
Imbalanced Nutrition Less Than Body Requirements related to impaired absorption of nutrients, hypermetabolic state, secondary to the process of intestinal malignancy.
Characterized by:
Anxiety (describe level) related to psychological factors (the threat of changes in health status, socio-economic status, functions, roles, interaction patterns) and sympathetic stimulation (neoplastic process)
Characterized by:
Ineffective individual coping related to the intensity and repetition stesor adaptive threshold exceeded (chronic illness, death threats, the vulnerability of individuals, severe pain, no adequate support system)
Characterized by:
Knowledge Deficit: about condition, prognosis and treatment needs related to less exposure and or misinterpretation of information.
Characterized by:
Q. 1. A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?A. The patient may be immunosuppressed.B. The patient may be dehydrated.C. The patient may be depressed.D. The symptoms may be the result of anemia caused by chemotherapy.
Correct Answer: D.
Explanation:
Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression. There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression. The information given does not indicate that depression or dehydration is a cause of her symptoms.
Q.2. Which of the follow statements provides accurate information regarding cancer of the colon and rectum?
A. Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
B. Rectal cancer affects more than twice as many people as colon cancer.
C. There is no hereditary component to colon cancer.
D. The incidence of colon and rectal cancer decreases with age.
Correct Answer: A
Explanation: Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
Q. 3. Before discharge, the nurse scheduled the client who had a colostomy for colorectal cancer for discharge instruction about resuming activities. The nurse should plan to help the client understands that:
A. With counseling and medical guidance, a near normal lifestyle, including complete sexual function is possible.
B. Activities of daily living should be resumed as quickly as possible to avoid depression and further dependency.
C. Most sports activities, except for swimming, can be resumed based on the client’s overall physical condition.
D. After surgery, changes in activities must be made to accommodate for the physiologic changes caused by the operation.
Correct Answer: AExplanation: There are few physical restraints on activity postoperatively, but the client may have emotional problems resulting from the body image changes.
Q. 4.A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy:A. Is the opening on the client’s left sideB. Is the opening on the distal right sideC. Is the opening on the distal end on the client’s left sideD. Is the opening on the client’s right sideCorrect Answer: DExplanation: The proximal end of the double-barrel colostomy is the end toward the small intestines. This end is on the client’s right side.
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Forensic Nursing
It is a newly emerging field that forms an alliance between nursing, law enforcement and the forensic means anything belonging to or pertaining to, the law.
An Emerging Discipline
Forensic nursing as defined by the International Association of Forensic Nurses (IAFN). is "the application of nursing science to public or legal proceedings, the application of the forensic aspects of healthcare combined with bio psycho social education of the registered nurse in the scientific investigation and treatment of trauma and death of victim and perpetrators of abuse, violence, criminal activity and traumatic accidents". Nurses, particularly emergency room nurses, have long provided care to victims of domestic violence, rape and other injuries resulting from criminal acts. They have collected, preserved and documented legal evidence without any formal training. It was not until 1992 that the term forensic nursing was coined. IAFN group includes legal nurse consultants, forensic nurse death investigators, forensic psychiatric nurses, as well as forensic correctional nurses. Forensic nurses specializes in several diverse roles and are beginning to find employment in variety of setting, these roles include the Sexual Assault Nurse Examiner (SANE), the forensic nurse death investigator, the forensic correctional nurse, and the legal nurse consultant.
Legal Nurse Consultant
The legal nurse consultant is a licensed registered nurse who critically evaluates and analyzes health care issues in medically related law suits. They work in collaboration with attorneys and other legal and health care professional. They may have independent practices, work in the hospital setting in risk management or be employed by law firms or health insurance companies.
Medical Examiner Nurse
Death Investigator
The roles of the death investigator is to advocate for the deceased. A death investigator is a professional with experiential and scientific knowledge who can accurately determine the cause of death. At the death scene, the forensic nurse death examiner examines the body, pronounces death, and takes tissue and blood samples. They take picture of the body and evidence at the scene. They are responsible for record keeping and arrange for the transport of the body to the morgue for autopsy of further examination. She works with the forensic pathologist to collect evidence in the lab during the autopsy.
Forensic Psychiatric Nurse
They work with individual who have mental health needs and who have entered the legal system. These nurses generally practice in state psychiatric institutions, jails and prisons.
Forensic Correctional Nurse
The nurses provide health care for inmates in correctional facilities such as juvenile centers, jails and prisons. They manage acute and chronic illness, develop health care plans, dispense medications, perform health screenings and health education.
Nurse Entrepreneur
A nurse entrepreneur starts a business by combining nursing experience and knowledge with business knowledge. They can include nurse attorneys, nurse case managers, nurse educators, nurse death investigator, nurse midwives, psychiatric nurses and sexual assault nurses.
Case Management
A Care Co-ordinator
Nurse case managers act as advocates for clients and their families by coordinating care and linking the client with the physician, other members of health care team, resources and the payer. The goal of the nurse is to help the client obtain high quality, cost effective care while decreasing the duplication and fragmentation of care.
Bioterrorism
An Acute Health Issue
Bioterrorism is the use of microorganism with the deliberate intent of causing infection to achieve political goals. The use of microorganisms is particularly effective because their release can go undetected for an extended period of time because their effects are not immediate. This allows for person to person spread before they are detected.
Early Recognition
The key to an effective response is training in the early recognition of a bioterrorist attack.
Clinical Presentation
One of the first indications of a biological attack will be an increase in the number of individuals seeking care from primary care providers and emergency rooms. Hospitals, doctors, nurses and public health professionals will be on the front lines of any attack.
Biological Agents
The centers for disease control (CDC) developed a list of biological agents that are considered the most likely to be used in a bioterrorist attack. Ineffective agents were included based on their ability to produce widely disseminated infections, high mortality rates, potential for major health impact, ability to cause panic and social disruption.
Effect Response
Identification and management
Once appropriate notifications have been made, nurses will use their skills of clinical evaluation and history taking to identify the infective organism, mode of transmission, and source of exposure. In addition, nurses play a critical role in managing post exposure prophylaxis and its complications, as well as psychological and mental health problems brought on by event.
Response Training
Included was the recommendation that all basic nurse education programs include information on how to respond to mass casualty events. The task force includes self study modules and other specialty programs developed for ER nurses on detection and management of bioterrorism.
Activation and Development
In the event that the president declares a bioterrorism state of disaster, the National Nurses Response Team (NNRT) will be activated to respond by providing mass immunization or chemoprophylaxis to a population at risk. The NNRT under the auspices of the Department of Health and Human Services, will be quickly deployed in response to a major national event.
Disaster Nursing
A disaster is a catastrophic event that leads to major loss. The American Red Cross defines a disaster as "an occurrence such as hurricane, tornado, storm, flood, high water, wind driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, commercial transportation wreck, or other situation that cause human suffering or create human needs that the victims cannot alleviate without substantial assistance". The disaster nurses have various short term and long term goals ranging from providing emergency medical assistance as well as mobilisation of necessary resource such as food, water, shelter, medication and water till providing assistance with resettlement programs and psychological, economic and legal needs.
Conclusion
Florence Nightingale wrote in 1859 that "no man", not even a doctor, ever gives any other definition of what a nurse should be than this "devoted and obedient". This definition would do just as well for a porter. It might even do for a horsel!" nursing is constantly evolving and defining itself as it strives to include expanded roles of practice. Of the many new and exciting roles for nurses forensic, bioterrorism, disaster, entrepreneur, case management, and legal consultant have developed in response to the needs of the society.
Although nurses have practices in these areas for many years, they are only now beginning to be recognized for the unique skills and qualities they bring to these roles. As more nurses seek the specialised training that is now available for many of these roles and obtain nationally recognized certification as a demonstration of their knowledge, they will gain acceptance as highly qualified and valuable members of these specialized health care teams.
There are, however, many other ways to reduce the infection rate in surgical patients. In human surgery, such practices have enabled a 25% reduction in nosocomial infections, also called hospital-acquired infections.
Beyond antibiotics, there are a number of ways to prevent infections.
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