Final Flashcards
(44 cards)
What are some the psychosocial services provided for oncology patients by social workers?
- physical, psychological, social, emotional, spiritual, and financial support needs to ensure best possible outcome.
- provided to patients and their caregivers.
What does the Oncology Social Work Role include
- meet with patients and their families to assess needs, discuss adjustment and arrange practical referrals.
- to provide psychosocial support/counseling
make community referrals and provide resource information: i.e. Cancer Care, Private Pay Home Care agencies, Continuum resources.
What are some recommendations for cancer care that are stated in The Institute of Medicine report entitled “Cancer Care for the Whole Patient Meeting Psychosocial Health Needs”
- all cancer patients and their families should receive cancer care that ensures the provision of appropriate psychosocial health services.
- designing a plan that: links patients with needed psychosocial services, coordinates biomedical and psychosocial care, engages and supports patients in managing their illness and health.
What are common emotional and practical concerns of cancer patients?
- fear of dying, anxiety, depression, and anger
- physical, emotional, and intimacy issues are also common.
- social, financial, and physical issues include costs of cancer, employment, discrimination, insurance, & negotiating health care system, disfigurement, side-effects.
oncology patients’ key stress periods
- time of diagnosis and pre-treatment
- treatment period
- end of treatment/remission
- recurrence/relapse
- terminal phase: pivotal visits- should trigger a referral.
The American College of Surgeons made a new requirement in 2012. What is it?
- the cancer committee will need to develop and implement a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care as standard for cancer patients
- universal screening.
factors affecting a patient’s adjustment to the cancer diagnosis
- severity of illness (prognosis) & treatment plan
- psychological stability
- social supports
- age
- socioeconomic status
- coping styles
- family functioning style
- cultural & religious & spiritual identity
- personal & social values of cancer patients & society
the important unmet needs of cancer patients
help dealing with emotional problems
the barriers to effective communication between providers and patients
- patients may be functionally illiterate
- treatment plans are very complex
- multiple providers and spread out locations (different physical locations and providers for chemotherapy, radiation, radiology, etc.) can present communication challenges.
- patients and families are often reluctant to ask questions and afraid to discuss the dying process
cultural barriers between providers and patients
- many ethnic minority and medically underserved populations face cultural, socioeconomic, and institutionalized barriers to cancer prevention and treatment, and experience poorer cancer survival rates than whites.
- other barriers: fatalism regarding diagnosis, lack of social support, and mistrust of medical & scientific establishment, beliefs/understanding about cancer and treatments
- language barrier can affect treatment options
- Many Chinese seek alternative therapies and fear telling their oncologist
- Chinese & Mexican cultures value importance of family members taking care of the elderly. Families felt that they should be informed of the cancer diagnosis/prognosis instead of the patient. In the Chinese culture, disclosing poor prognosis is often considered unethical.
How does nurses’ understanding of patients’ spirituality or religion affect patients’ care?
- it impacts the quality of life for chronically and terminally ill patients. Addressing spiritual issues has a positive impact on the patient’s psychological well-being.
- understanding a patient’s spirituality is important to understanding the patient as how he/she deals with illness, death and bereavement.
- take care not to impose your culture, values, and beliefs on the patient and family.
properties of stem cells
have capacity for unlimited self renewal
have ability to differentiate into all types of mature blood cells
- myeloid cells can further differentiate to RBC, platelets, and neutrophils
- lymphoid cells: provide the foundation for adaptive immune system.
purpose of a bone marrow transplant
- supportive measure: restore patient’s own bone marrow after intense myelotoxic therapies used in an attempt to eradicate the cancerous process
- potentially curative: eliminate and replace malignant cells with healthy donor stem cells capable of regenerating the recipient’s hematopoietic system.
methods used to extract hematopoietic stem cells
bone marrow harvest: sterile surgical procedure with large-bore needles repeatedly inserted into the posterior iliac crests after the patient has received general anesthesia.
apheresis: use growth factors to expand and increase hematopoietic stem cells into vasculature 4-5 days. cycles through machine which separates the components, then the WBCs are extracted (where the stem cells are).
description of bone marrow
soft, spongy matter stored in the bones that is a rich source of hematopoietic stem cells
the purpose of the CD34+ test
test that cell numbers are adequate for transplantation.
the difference between autologous and allogeneic transplants
autologous: infusion of one’s own stem cells (previously collected and frozen)
allogeneic: infusion of related donor stem cells, infusion of unrelated volunteer donor stem cells, umbilical cord.
diseases treated with stem cell transplants
non-Hodgkins lymphoma
Hodgkins lymphoma
multiple myeloma
benefits and risks of autologous transplants versus allogeneic transplants
autologous benefits: - no risk of graft vs. host or rejection - does not require immunosuppressive treatment - less toxicity than allogeneic autologous risks: - number of collected stem cells returned to the patient may not be enough for full engraftment. - there is a possibility that the cancer cells may contaminate an autograft, even when obtained during a remission. allogenic benefits - avoids contamination of cancer cells - graft vs disease effect allogenic risks - graft failure - infection - graft vs. host
important nursing actions in the peritransplant period and during stem cell infusions
peritransplant -clean room -prophylactic antibacterials, antivirals, antifungals -immunosuppressant therapy -platelet and RBC transfusions -dietary precautions -nutritional support during infusion -vital signs including o2 sat -cardiac monitoring -monitor for chest pain, bradycardia, tachycardia, SOB, agitation, restlessness, diaphoresis, fever/chills, flushing, urticaria, hypo/hypertension.
cytoreduction chemotherapy
- very high dose chemo and/or radiotherapy
- destroys bone marrow as a consequence of trying to kill residual cancer cells
- minimal to no chance host bone marrow will recover without stem cell support
Graft versus Host Disease
- an immunologic response of donor lymphocytes contained in the graft against the recipient/patient’s tissues which are identified as foreign.
- causes varying degrees of injury to the host’s tissues
- acute and chronic.
survival statistics associated with lung cancer and stage the majority of lung cancer patients present
overall 5 year survival: 15%
most diagnoses in advanced stage
reason for the decrease in death rates seen in lung cancer patients over the last decade
reduction in tobacco exposure
