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 previous medical history, the boy has been experiencing pain in this right knee intermittently for about 3-4 weeks or so. However, during this time the pain on 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 patients past four months records, his current weight of 70lbs was still his weight then.
The boy is an African American who has a strong family history of multiple cancer. For instance, the kid's grandmother had previously 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 an 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, and no fever and does not complain of general fatigue.
Skin: No rash or itching on the skin.
Cardiovascular: The kid 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 on his right knee, the patient has no other arthritic complaint, and has no back or muscle pains.
B. OBJECTIVE DATA
After a thorough and a complete physical exam below is the objective data which was a result of the examinations:
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
For this condition, I would expect my patient, the 10-year-old kid, to have an X-ray as the very first diagnostic test. Within this X-ray, the radiologist is going to determine whether the patient is going to undergo a bone cancer diagnosis or not. Following closely, the following 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 and including the chest so as to detect the lung metastases and also 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 whole bone using powerful magnets and soundwaves 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 by other 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 the removal 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 a routine test so that the doctors will be in a position to determine and diagnose kidney or urinary tract disorders as well as monitor whether the patient is diabetic during the entire treatment process (Hinguera, 2016).
My Nursing Diagnosis
During the assessment, I will try and note the patient's knowledge and understanding of the disease process, 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 dead and also reduce the pain. My interventions will be such as; 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 issues due to loss of various body parts. During my interventions, my goal will be to help improve the patient's self-esteem by providing motivation to the patient and also defining the role of the patient's family during the treatment process.
The risk for injury: This is close tied to possible pathological fractures that are related to pathological fractures which are as a result of 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 on the various ways of coping with injury and to avoid the occurrence of the injuries by reducing activity.
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 patients long term and short term outcomes. The expected medical treatment for my Osteosarcoma patient will include a combination of surgery, Chemotherapy and radiation therapy (Ballantyne, 2016).
Right before surgery is done, Chemotherapy will be administered to the patient using drugs that help to shrink and kill the cancer cells around the tumor. 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 chemo are nausea, vomiting, and general body weakness. After chemo is done, 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 surgery are chronic pain, loss of some body parts and possible loss of self-esteem.
Chemotherapy again, which this time, is intended to kill any remaining microscopic cancer cells may resume once again (Ryan & Sorens, 2012).
i. Administer the required analogies as required and to the maximal dose.
ii. Provide calm activities and serene environments to the patient to reduce and prevent pain.
iii. Encouraging 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.
During this process, 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 of the patient;
i. Randomized Controlled Trial
In this method, I will use another patient who will be randomly assigned to the 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 that of the others (WHO, 2014).
1) Based on the clinical decision-making process, what role do nurses in the nursing care practice, have 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 cancers?
From the above case study, I have learned that nurses and others in the health care profession have a critical role to play towards the well-being and recovery of patients through the clinical decision-making process. Additionally, I have learned that unlike many other cancers, Osteosarcoma is common in children ranging from the age of 10 to adolescent age. This disease is, however, common in boys that it is in girls.
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, January 4). Osteosarcoma: Symptoms, Tests & Treatments. Retrieved from http://www.healthline.com/health/osteosarcoma#Overview1
Ryan, S. S., & Sorens, M. (2012, October 14). 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
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