Clinical decision support research

Published: 2018-08-10 11:50:06
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Chief complaint by patient

•    Chief Complaint

The chief complaint by this patient, the ten-year-old boy, is swelling in his right knee which is accompanied by pain.

•    Patient’s Medical History

According to his medical history, the boy has been experiencing pain in the right knee intermittently for about 3-4 weeks or so. However, during that time the pain in this particular knee was not as consistent as it is now and the swelling was not as severe as it is at the moment. According to the patient’s past months old records, his weight of 70lbs hasn’t changed since the previous appointment.

Family History

The boy is an African-American whose family has a history of cancer. For instance, the kid’s grandmother was diagnosed with breast cancer a couple of years ago and while at the age of 4 one of the boy’s closest relatives succumbed to Leukemia.

• Social/ Spiritual History

The ten-year-old patient is of African-American origin and comes from a family of strong Christian faith.

• Focused Review of Systems

General: The patient only complains of pain in the right knee. He, however, has no headaches, no weight loss, no fever and does not complain of general fatigue.

Skin: No rash or itching on the skin.

Cardiovascular: The patient has no chest pains or chest discomfort but has a slightly higher heartbeat.

Respiratory: He has no shortness of breath and has no cough or sputum.

Musculoskeletal: Despite the pain and the stiffness in his right knee, the patient has no other arthritic complaints, and has no back or muscle pains.

Objective data

Presented below is the objective data obtained during a thorough and a complete physical examination of the patient.

Height: 4 foot and 10 inches

Weight: 70 lbs.

BMI: The kid’s biometric index is 22.9 kg/m2

Heartbeat: Slightly higher pulse rates

Temperature: 37 degrees Celsius

First diagnostic test

For this condition, I would expect my patient, the 10-year-old kid, to have an X-ray as the very first diagnostic test. On the grounds of this X-ray, the radiologist is going to determine whether the patient should undergo a bone cancer diagnosis or not. Below is a list of tests in the diagnostic procedure that I would expect ordered for the patient: 

A CT Scan - This is a 3-D X-ray done on the body so as to examine the condition of the bones and soft organs in the patient’s body.

MRI: This is a scan that will be done on the entire femur bone using powerful magnets and radio waves to create a vivid image of the place where the swelling or the tumor is possibly located. From this test, the doctor will be able to determine the spread of the tumor to other areas of the bone.

A bone scan: This will include a sensitive imaging test that will reveal any bone abnormalities that could have possibly been omitted during the MRI scan and imaging tools. From the results of this bone scan, the doctor will be able to tell whether the Osteosarcoma cancer cells have spread to other bones in the body.

Biopsy: This test involves taking of a sample of the knee bone tissue for cancer testing.

PET scan: A full body scan done for the purposes of detecting cancer.

Urine Analysis: A qualitative and a quantitative test will be done on the patient’s urine sample. This test will be taken as a routine test so that the doctors will be in a position to determine and diagnose any kidney or urinary tract disorders as well as monitor any symptoms of diabetes (Hinguera, 2016).

My Nursing Diagnosis

During the assessment, I will try and note the patient’s knowledge and understanding of the disease, how the patient has been managing the pain as well as how the patient together with his family have been coping with the disease. Below are some of my interventions during the diagnosis.

•    Severe or acute pain: This could be due to the swelling or surgery and pathological processes related to the treatment of osteosarcoma. My primary goal for this intervention is to help my patient to reduce pain. The following will be my interventions: giving an explanation to the patient on how to cope with the pain, teaching distraction and relaxation techniques to the patient and also providing analgesics to the patient.

•    Low self-esteem issues: The patient is bound to suffer esteem since the treatment process will involve removal of the infected bone and replacing it with an artificial one. During my interventions, my goal will be to help improve the patient’s self-esteem by constantly motivating him and also encouraging his family to consistently show close affection to the patient so as to help boost his self-esteem.

•    The risk for injury: This is close tied to possible pathological fractures which result from the tumor. With this, my primary goal during my intervention will be to help the patient not to cause injury. My intervention aid will include explaining to the client various ways of coping with injury the means to avoid the occurrence of the injuries by reducing activity.

Plan of care

The very first component of my care plan is the assessment of the patient which will also include the provision of medical results and diagnostic reports. After the assessment phase, I will outline the patient’s long term and short term prognosis. The expected medical treatment for my osteosarcoma patient will include a combination of surgery, chemotherapy and radiation therapy (Ballantyne, 2016).

Chemotherapy will be administered to the patient using drugs that help to shrink and kill cancer cells around the tumor, before surgery. The period which chemotherapy will be administered will vary depending on how severe the spread of cancer cells is. Possible side effects of the drugs from the chemotherapy are nausea, vomiting, and general body weakness. Usually, surgery is the next step in treatment. During surgery, the tumor with osteosarcoma and the surrounding bone are removed along with a large part of the healthy tissue surrounding the tumor so as to ensure that the infected area is left disease free. It is during the surgery phase that the missing bone can be replaced with an artificial one. Some of the side effects of the surgery are chronic pain, loss of body parts, and, as a result, possible loss of self-esteem.

Finally, chemotherapy is administered again, this time with the intentions to kill any remaining microscopic cancer cells (Ryan & Sorens, 2012).

Interventions

i.    Make partial similarities as required and administer the maximal dose.

ii.    Provide calm activities and serene environments to the patient to reduce and prevent pain.

iii.    Encourage resting periods to prevent fatigue.

iv.    Encourage diversional activities.

v.    Provide accurate information about the treatment, medication, and the overall situation so as to keep the patient informed and knowledge equipped about the disease.

The Outcomes of the Interventions

Improved Clinical Status

From the above mentioned interventions, there are various measurable outcomes that I will expect from my patient. For instance, in regard to improved clinical status, my patient should demonstrate increased knowledge about osteosarcoma prior to the termination of their treatment process. This will be as evidenced by:

i. Identifying the steps required to reduce or kill pain

ii. Being able to list the possible causes of osteosarcoma

iii. Giving a brief description of the activities involved in osteosarcoma treatment.

Quality of Life

On the grounds of my interventions which will include encouraging the patient to take engage in diversional activities, during and a short while after treatment, the patient will walk with a cane at least for an hour each day.

Additionally, the patient will maintain adequate nutrition since I will expect that more frequent and adequate meals are administered at least three to four times a day. This will also include resolving conflicts through counseling or managing pain through adequate medication, managing pain and counseling. This will be an outcome of the intervention that will involve making partial similarities as required and administering the maximal dose as required.

Nursing care

During the process of evaluation, I will determine whether the patient’s condition improves after application of my nursing care. The following are the methods I will use to evaluate the outcome my treatment;

i.    Randomized Controlled Trial

In this method, I will use a different osteosarcoma patient of a similar age with my patient and randomly assign the relevant osteosarcoma treatment. For both patients, similar pre-treatment and post-treatment assessments will be administered. With this method of randomized controlled trials, it is possible to control most competing explanations for any improvement that followed treatment.

ii. Pre-post Design

Using this method, I will assess various patients on the same variables and use the same span of time before and after the treatment is completed. This kind of evaluation will be referred to as the time series design. Treatment results of this particular patient will be measured against those of the others (WHO, 2014).

Research Questions

1)    Based on the clinical decision-making process, what role do nurses in the nursing care practice play concerning patients suffering from osteosarcoma?

2)    What are the possible symptoms, diagnosis and the actual treatment of osteosarcoma in kids and adolescents?

3)    How can evidence-based practice be employed in the diagnosis, treatment and possible recovery of patients suffering from osteosarcoma and other related types of cancer?

From the above case study, I have learned that nurses, doctors and other professionals in health care have a critical role to play in order to ensure the well-being and recovery of patients with the help of the process of clinical decision-making. Additionally, I have learned that unlike many other types of cancer, osteosarcoma is common in children ranging from the age of 10 to adolescent age. This disease is, however, more common in boys that it is in girls.

References

Ballantyne, H. (2016). Developing Nursing Care Plans. Continuing Professional Development,30(26), 51-57. Retrieved from http://journals.rcni.com/doi/pdfplus/10.7748/ns.30.26.51.s48

Hinguera, V. (2016). Osteosarcoma: Symptoms, Tests & Treatments. Retrieved from http://www.healthline.com/health/osteosarcoma#Overview1

Ryan, S. S., & Sorens, M. (2012). Osteosarcoma Cancer: Diagnosis, Treatment, Research & Support. Retrieved from http://sarcomahelp.org/osteosarcoma.html

WHO. (2014). Outcome Evaluation. Outcome evaluation. Retrieved from http://apps.who.int/iris/bitstream/10665/66584/8/WHO_MSD_MSB_00.2h.pdf

 

sheldon

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