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Running head: THE DOCTOR

The Doctor
Bindu Sharma
800-720-708
NURS 360 :Scholarly Assignment
Tuesday, November, 19, 2013

The Doctor

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Running head: THE DOCTOR

Dr. Jack Mckee is an egocentric heart surgeon. He treats his patients like names on a list not
like humans. He had a cough but was ignoring it one day he and his wife, Anne, were coming
home after a party. The doctor was coughing blood and his wife insisted him to visit a physician.
Dr. Jack visited a physician and an ear, nose and throat specialist. Dr. Jack was scheduled for
biopsy due to growth in his throat. Dr. Jack took time to share with his wife. Once his wife came
to know about the appointment she looked worried. She is caring and supportive but Dr. Jack
refused to accept the assistance from his wife at the hospital. Dr. Jack had to go through radiation
therapy for six weeks to treat the malignant tumour. Jack feared, distress and later on fatigue.
During radiation therapy Dr. Jack become friendly with terminal cancer patient June. They met
daily during treatments. Dr. Jack realised a Doctor can become a patient any day. During the
treatment he faced attitude of the hospital staff and wasted time in the waiting room. A friend
inspired him to treat others with humanity and sensitivity. Dr. Jack continued to work his own
practice. His wife wants to support him but she cannot reach him. Radiotherapy didnt reduced
mass and Dr. Jack had to undergo surgery partial laryngectomy. He apologised to surgeon Eli for
his behaviour in the past and requested surgeon Eli to do his surgery who treats patients with
empathy. Dr. Jack feared to lose his voice. His wife came to know through his secretary about the
surgery. Dr. Jack was not able to talk for few days. Anne, his wife gave him a whistle to blow on
whenever he had to communicate and he also used the writing tool. After experiencing cancer,
the arrogant and self centered heart surgeon became an empathetic and caring surgeon. He
started treating the patients with dignity.

Three significant physical effects

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Fatigue, pain and losing voice

Fatigue: Fatigue is common symptom in cancer patient. Kurtz, Kurtz, Given &Given (2008)
stated Fatigue and pain are among the most frequently occurring symptoms experienced by
patients with cancer(p.367). Kurtz et al. (2008) indicates Studies have indicated that during
the six months following diagnosis pain and fatigue seem to be the most problematic
symptoms(p.367).Cancer patients feel fatigued during the radiotherapy and sometimes unable to
complete the activities of daily life. Research indicates Pain and fatigue are prevalent
particularly during chemotherapy , some researchers suggest that their presence may add to
severity of other symptoms and increase the complexity of symptom management( Kurtz et al.
368).
Pain: Pain has major impact on activities. Alexopoulos, Koutsogiannou, Moratis, Mestousi &
Jelastopulu (2011) states pain is not only one of the most undesirable side effects of cancer but
also one of its major complications. A descriptive cross- sectional study involving the eight
larger oncology centers in Greece was conducted in 2008. Cancer patients (n=134) attending the
oncology outpatient departments were interviewed using a 35- item questionnaire regarding
pain- and treatment- related characteristics. The great majority of the patients (72%) with
advanced malignancy reported high pain intensity and 66.4% experienced the pain as continuous.
Although most patients (81%) responded to treatment , more than 30% reported side effects and
asked for treatment to change. Negative attitudes and feelings toward treatment combined with
deficits in patient education/information seem to influence both response and therapy compliance
suggesting the need for more comprehensive approach to pain management of cancer patients.

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Losing voice: Human beings depend on their voice to communicate and to do the
tasks of daily activities. Loss of voice after Laryngectomy is a great loss. It is very difficult time
for the patient, family and friends. After partial laryngectomy patient is able to talk with in week.
Speech therapist can educate different ways of communicating . After total laryngectomy patient
has to learn to speak in a different way . Before surgery a speech pathologist will talk to the
patient about the different ways one can learn to speak. Johnson &Alan (1994) states loss of
voice has become the most feared consequences of total laryngectomy for many patients .Small
cancers can be treated by radiotherapy alone or by limited surgery, with excellence voice
retention.
Three significant psychosocial effect
Depression, Anxiety, fear
Depression: Depression and normal sadness are different. National Cancer Institute (2013)
indicates it is a disorder with specific symptoms that can be diagnosed and treated. About onefourth of cancer patients become depressed . The numbers of men and women affected are about
the same. A person diagnosed with cancer faces many stressful issues. These may include: Fear
of death, changes in life plans, changes in body image and self esteem, changes in day to day
living, money and legal concerns. Miller, Kimberley, Massie& Jane ( 2006) states somatic
symptoms , such as anorexia, fatigue, insomnia, and weight loss, are of less value as diagnostic
criteria for depression in cancer patients, because they are common to both cancer and
depression. In cancer patients, the diagnosis of depression must depend on psychological ( i.e.,
dysphoric mood, feelings of helplessness and hopelessness, loss of self-esteem, feelings of
worthessness or guilt, anhedonia, and thoughts of death or suicide), not somatic symptoms.
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Anxiety: Anxiety can affect the quality of life of patients with cancer. It is fear and
uneasiness . National Cancer Society (2013) Anxiety is caused by stress . Anxiety may affect a
patients ability to cope with a cancer diagnosis or treatment. It can increase pain , affect sleep,
and cause nausea and vomiting. Anxiety can affect patients ability to cope . A condition in
which a person has extreme anxiety is an anxiety disorder. It may be because of a stressful event
like a cancer. Symptoms of anxiety disorder include fear, and dread. Miller et al.(2006) a small
percentage of cancer patients have anxiety disorders that antedate the diagnosis of cancer and are
exacerbated by the stress associated with cancer diagnosis or treatment. For most patients,
anxiety symptoms are reactions to cancer and its treatment. Although anxiety symptoms can be
either cognitive or somatic, the most salient symptoms can be either cognitive or somatic, the
most salient symptoms are usually somatic and include tachycardia, shortness of breath,
sweating.
Fear: Diagnosis of cancer causes fear in a person. White, Craig, Macleod & Una (2002)
states cancer is the most feared of disease. Unsurprisingly, it causes considerable psychological
distress in patients , families, carers, and often those health professionals who care for them.
Only minority of cancer patients develop psychiatric illness, but other psychologically and
socially determined problems are common. These include unpleasant symptoms such as pain,
nausea, and fatigue; problems . Fear of impact of cancer on the family members. Not able to
manage the responsibilities of married life.
One area of priority for holistic nursing care
Fatigue: Moderate or severe pain is present in a person with cancer. Howell , keller,Hack,
Broadfield, Biggs, Chung, Gravelle , Green, Hamel, Harth, Johnston , McLeod, Swinton, Syne
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and Olson (2013) cancer related fatigue can be experienced at all phases of the disease
trajectory. Prevalence rates for cancer related fatigue are reported to range from 70% to 100%
during active treatment and to be about 30% in post-treatment survivors. Fatigue interferes with
daily living and personal and social roles with in family and community , it has a negative effect
on quality of life. Howell et al (2013) indicates descriptions of fatigue by patients in their own
words can be helpful to reflect subjective experience, and the patient should be asked to describe
their pattern of fatigue. The pattern typical of cancer related fatigue is described as a sensation of
tiredness that is persistent. Other factors may include poor nutrition, deconditioning, and
interrelationships with other. Mitchell et al. (2006) states fatigue is a complex and multifaceted
symptom . often observed to be a component of symptom clusters in oncology, fatigue may be
directly associated with the disease or its therapy , or it may be related to anemia , depression,
chronic pain and other concurrent symtoms, sleep disturbances, cardiopulmonary, hepatic or
renal dysfunction, endocrinopathy, infection, malnutrition, deconditioning and the side effects of
drugs that act on a central nervous system.
Three nursing interventions
Alternating period of rest and activity : Level of activity and rest period should be balanced..
Mitchell , Maryland, and Berger ( 2006) stated exercise can be effective in reducing fatigue in
patients during and after cancer treatment. Energy conservation and activity management is an
intervention focused on teaching the principles of energy conservation and activity management
and providing patient with coaching to integrate these activities into their daily lifestyle. The goal
of energy conservation and activity management is to balance rest and activities so that
prioritized activities are rest and activities are more likely to be achieved( p. 381). Patient

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should follow a plan of activity . Howell et al. (2013) states exercise regimens must be tailored
to the individual, taking into account factors such as age, disease status, treatment modalities,
pre-treatment activity levels, and comorbidities. Effective /Quality sleep: Restful sleep is
necessary for cancer patient Mitchell , Maryland, and Berger ( 2006) stated studies support a
conclusion that multicomponent cognitive behavioral interventions designed to optimize sleep
quality may also improve fatigue. The intervention generally includes relaxation training , along
with sleep consolidation strategies , behavioural change and strategies to reduce cognitive
emotional arousal .Study results support the feasibility of delivering this intervention
individually or in groups. Results also suggest that cognitive behavioural interventions for
insomnia may stabilize fatigue during and after chemotherapy treatment , a time when , in the
absence of an intervention , fatigue might intensify( p. 382).
Good nutrition and adequate hydration Malnutrition is the cause of fatigue. According to
Mitchell et al. (2006, p. 381) fatigue intervention supported by expert opinion, patients
experiencing fatigue during and after cancer treatment : Encourage a balanced diet with adequate
intake of fluid, calories, protein, carbohydrates, fat, vitamins and minerals. Potter & Perry (2010,
p. 60) states many survivors become interested in learning more about dietary supplements and
nutritional complementary therapies to manage disease symptoms. Lewis, Heitkemper ,
Dirksen, OBrien, &Bucher (2014) stated maintaining good nutrition and
adequate hydration , alternating periods of rest and activity , relying on
family members for assistance with responsibilities and managing pain and
anxiety may help reduce fatigue(p.366).
Three Interprofessional collaborative care
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Dietician, Physiotherapists and Occupational therapist, Physician

Dietician : Lewis et al.(2014) states the patient with cancer often experiences protein and
calories malnutrition , characterized by depletion of fat and muscle. The nurse should suggest a
referral to a dietician as soon as a 5% weight loss is noted or if the patient has the potential for
protein and caloric malnutrition (p.377). Dietician monitors patients nutritional status and intake
and makes recommendations for changes in diet. Planning goals mutually between patient,
dietician and nurse shows the best outcome.
Physiotherapists and Occupational therapist: Individualised care plan of activities on the basis of
energy level and if there is any need of assistive device.
Physician: Physician refers the patient to specialist for effective treatment when patient has
symptoms of cancer.
Two Community resources
Speech language Pathologist and Registered Dietician
Speech language pathologist : Princess Margaret Cancer Center (2013) states patient experience
difficulty swallowing or speaking after receiving cancer treatment. Speech language pathologist
can assist patient to manage swallowing and speaking difficulty to improve communication and
functioning. Pathologist can recommend foods patient can swallow easily , give patient exercise
to improve ability to swallow, give exercises to improve ability to speak, and advice patient to
help patient to communicate non verbally.
Registered Dietician : Princess Margaret Cancer Center (2013) states registered dietician can
teach patient eating well during and after treatment. Dietician can help patient to develop a
personal nutrition therapy program. In one-on one consultation a dietician work with patient to
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plan healthy diet for patient during and after cancer treatment

References
Alexopoulos,E.,Koutsogiannou, P.,Moratis, E., Mestousi, A., & Jelastopulu,E.,
(2011). Pain in
cancer patients : The Greek experience. European Journal of Oncology
Nursing, volume
15, pages 442-446
Howell , D., Keller, S., Oliver, T.K., Hack, T.F., Broadfield, L.,Biggs,K .,Chung,
J.Gravelle,
D.,Green,E.,Hamel,M.,Harth,T.,Johnston,P.,Mcleod,D.,Swinton,N.,Syme,A.,&Ols
on,K.,
(2013). A pan- Canadian Practice guideline and algorithm :
Screening, assessment, and
Supportive Care of adults with Cancer- related fatigue. Current
Oncology, 20(3), 233-246
Retrieved September 29, 2013 from CINAHL Database
Johnson, Alan (1994). Voice restoration after laryngectomy. The Lancet, 431-2
Retrieved November 18 ,2013 from CINAHL Database
Kurtz, E.M., Kurtz, J.C., Given, C.W., & Given, B.(2008). Age and depressive
Symptomatology:
impact On the relative effectiveness of two pain and fatigue control
interventions among
cancer patients. Cancer Therapy.6,367-376
Retrieved September 29,2013 from CINAHL Database
Lewis, S.M., Heitkemper , M.M., Dirksen, S. R., OBrien, P.G., &Bucher, L.
(2014).Chapter :18
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Cancer Medical-Surgical nursing in Canada: Assessment and

management of clinical
problems (3rd ed.) Toronto: Elsevier
Mitchell, S.A., Berger, A.M.(2006). Cancer Related Fatigue: The Evidence
Base for Assessment
and Management. Cancer,12, 374-387
Retrieved September 29,2013 from CINAHL Database
Miller,Kimberely, Massie, Jane (2006). Depression And Anxiety. The Cancer
Journal ,12.5,388-97
Retrieved November 15,2013 from CINAHL Database
National Cancer Society .(2013) Anxiety. Retrieved Nov.14, 2013 from
www.cancer.gov/cancertopics
National Cancer Society .(2013) Depression. Retrieved Nov.14, 2013 from
www.cancer.gov/cancertopics
Princess Margaret Cancer Center. (2013) Head and neck cancers. Retrieved Nov.14, 2013
from https:// www.uhn.ca/PatientsFamilies/Health.../Health.../head_neck_cancers.aspx
White, Craig A; Macleod, Una (2002). Cancer. British Medical Journal, International
edition,325.7360, 377-80