Nursing Diagnosis

 

Today we are going to talk about nursing diagnosis for individuals with cervical cancer. I nursing diagnosis is part of the nursing process and is clinical judgment about a patient and the experiences/responses to actual or potential health problems.

Some examples of nursing diagnosis for those with cervical cancer include

• Chronic and acute pain r/t metastasis and surgery
• Risk for impaired skin integrity r/t radiation
• Fear r/t cancer diagnosis
• Anticipatory grieving r/t potential loss of life
• Decisional conflict r/t treatment options
• r/t = related to

I am going to expand a little further on the diagnosis regarding pain...

Diagnosis & definition:	Acute and chronic pain Pain is defined as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage
Actual or Potential?	Actual
Related to:	Metastasis of cancer to other areas of the body and/or possible surgeries and treatment methods (chemotherapy, radiation, etc.) to remove tumors
Plan & outcome:	Assess pain and treat pain as needed Patient will be pain free or have pain managed to where they are able to function
Nursing intervention:	Provide pain medication as ordered, provide distractions, provide heat or cool, use alternative techniques such as guided imagery,

Works:
http://wps.prenhall.com/wps/media/objects/737/755395/cervical_cancer.pdf

Nursing & Cervical Cancer

Cancer can be a very scary and emotionally turbulent event for patients. Cancer can cause pain, side effects from treatment and fear of the unknown. I am going to describe a possible nursing care plan for an individual with cervical cancer.

Nursing Diagnosis:

• Chronic and acute pain r/t surgery and metastasis
• Impaired skin integrity r/t radiation 
• Risk for fear r/t diagnosis
• Risk for decisional conflict r/t treatment options
• Risk for anticipatory grieving r/t potential loss of life

Outcomes:

• Develop strategies for pain control
• Maintain skin integrity
• Gain knowledge regarding treatment options
• Express feelings about cancer and possible fears of death

Planning & Implementing:

• Discuss treatments types and prognosis
• Asminister pain medications PRN 
• Inspect skin often
• Refer to cancer support groups
• Refer to social worker
• Provide emotional support 

Support for nurses:

A great tool for creating nursing care plans is nurselab: http://nurseslabs.com/6-hysterectomy-tahbso-nursing-care-plans/

Treatments

Today we are going to focus on treatment of cervical cancer. The national cancer institute is a great resource when looking to find more information on the treatment of cervical cancer

Several factors affect prognosis (chance of recovery). These include...

• Your age and general health
• The type of human papillomavirus (HPV) you have
• The stage of the cancer (I, II, III, IV)
• Whether or not your have HIV or other STIs (sexually transmitted infections)
• The type of cervical cancer
• Wether or not this is your first diagnosis or if the cancer is recurrent 

Treatment options differ depending on several factors as well, for example, treatment for an individual who still wants to have kids might differ from someone who doesn't. Other factors include age, stage of cancer and type of cancer. 

Cancer in situ, refers to the cancer being confined to the tissue it arose from. When a cancer is in situ, it means that it hasn't metastasized (spread to other areas of the body). The four stages of cervical cancer are as follows....

• Carcinoma in situ: abnormal cells are found confined to the innermost lining of the cervix
• Stage I: cancer is found in the cervix only
• Stage II: cancer has spread beyond the cervix but not to the pelvic wall or the lower third of the vagina 
• Stage III: cancer has spread to the lower third of the vagina, and/or pelvic wall, and/or is causing kidney problems 
• Stage IV: cancer has spread to the bladder, rectum or other areas in the body
• 
  

Treatment plans differ from patient to patient. Treatment can include surgery, radiation, chemotherapy and/or targeted therapy. 

• Surgery: cancer can be removed surgically. A total hysterectomy (removing the uterus) may be an option for those or no longer want children. 
• Radiation: this type of uses high energy x-rays to kill cancer cells
• Chemotherapy: when drugs are used to stop growth of cancer cells by either limiting division or killing the cells
• Target therapy: this is a type of treatment that uses drugs or other substances to directly harm the cancer cells without harming nearby cells. 

Works:

http://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq#section/all

Signs & Symptoms

It can sometimes be difficult to diagnose cervical cancer, due to the fact that many cancers go unnoticed. It is not unusual for a woman to have very few to no signs or symptoms in the early stages of the disease.

 

More advanced stages of cancer may produce signs and symptoms including the following...

• Vaginal bleeding after intercourse
• Vaginal bleeding outside of one's period or after menopause
• Vaginal discharge that may be bloody, watery and foul smelling
• Pelvic pain during vaginal intercourse

These symptoms can be a sign of things other than cancer, like infection, so it is important to be seen by a provider if they occur. For more information about cervical cancer, you can visit reliable websites such as the CDC, Mayo Clinic or American Cancer Society.

Works:
http://www.mayoclinic.org/diseases-conditions/cervical-cancer/basics/symptoms/

Diagnosis

Today we are going to talk about the diagnosis of cervical cancer. I have found that the American Cancer Society is a great resource for information on cervical cancer, so I will be referring to it in this post.

The first step in diagnosing cervical cancer is usually an abnormal Pap test result. A gynecologist usually performs this minimally invasive procedure, which includes scraping cells from the cervix to analyze. The procedure may be a little uncomfortable, but should not cause a lot of pain.

Cervical cancer may also be detected if a woman is having symptoms including abnormal vaginal bleeding or pain during intercourse.

Abnormal Pap test results do not always indicate cancer.

However...if you do have abnormal results, further testing needs to occur. The next step would be to have a test called a colposcopy.

A colposcopy is an exam performed by a provider to examine the cervix. Your provider will uses a colposcope, which has magnifying lenses, to see the cervix closely and clearly. A weak solution of acetic acid will be applied to make an abnormal areas easier to see. If an abnormal area is seen on the cervix, your provider will biopsy (take a small piece of tissue) from the area. This biopsy may cause some cramping, bleeding and minimal pain which are all normal side effects.

If cancerous cells are detected, your provider will order more tests to determine if the cancer has spread. Other screening tests include...

• Pelvic Exam
• Chest X-Ray 
• Computed Tomogrpahy (CT scan) 
• MRI

All of these additional screening tests are precautions to determine if the cervical cancer has metastasized (spread to other organs or areas of the body). Pelvic exams are useful to determine if spread has occurred isolated to the cervix. Chest X-rays are useful to examine any lesions in the lungs. CT scans can help the provider detect any spread to lymph nodes in the abdomen and pelvis. MRI images are particularly useful to examine the pevlvis for tumors and can also detect cancer that has spread to the brain or spinal cord. 

Early detection is essential to prevent pre-cancer from turning into cancer, so it is crucial to follow the current Pap tests guidelines. 

Works:

http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-diagnosis

Cervical Cancer Etiology

Like we discussed in the previous posts, cervical cancer begins when healthy cells undergo a change (mutation) that causes the healthy cells to become abnormal, cancerous cells. Cancerous cells grow out of control and don't die. These cells can also invade nearby tissues and spread to other areas, which is called metastasis.

It's not clear what exactly causes cervical cancer, but what we do know is that the human papilloma virus (HPV) plays a role. HPV is a very common sexually transmitted disease. As I stressed in previous blog posts, having HPV does not guarantee that that it will turn into cancer. However, HPV does increase one's cervical cancer risk.

Risk Factors for Cervical Cancer:

• Many sexual partners
• Early sexual activity
• STIs
• A weakened immune system
• Smoking

Works:
http://www.mayoclinic.org/diseases-conditions/cervical-cancer/

Cervical Cancer Epidemiology

Facts at a Glance:

• Nearly 500,000 women are diagnosed with invasive cervical cancer every year.
• 275,000 women die every year of cervical cancer.
• 80% to 85% of deaths occur in developing countries.
• The highest incidence and mortality rates are in sub-Saharan Africa, Latin America, and South/Southeast Asia
• Most cervical cancer in developing countries occurs in women who take care of children, provide income for families, and work in their communities.
• Safe and effective vaccines have been developed against the HPV types responsible for most of the cancers.
These vaccines are now available for girls and young women; HPV vaccine has also been approved for boys in some countries
Screening adult women for cancer or precancer continues to be a vital strategy.

Incidence:

Incidence is the amount of new cases that develop each year. Cervical cancer represents nearly 10% of all new cancers in women yearly. It is ranked third among women in frequency (after breast and colorectal cancer). Each year, nearly 500,000 new cases of cervical cancer are diagnosed world wide. The world health organization (WHO) reports that the highest risk areas for cervical cancer are in Central and South America, southern and eastern Africa and the Caribbean.

 

Mortality:

The mortality of a disease is the amount of people who have the disease that die from it. Africa has a disproportionately high mortality, North America has a disproportionately low mortality and Canada has the lowest mortality among all the regions. This is most likely due to the medical care and screening available in developing countries compared to developed ones.

 

Incidence and mortality have declined in North America during the last 50 years because of increased availability pap smear screening programs.

 

Risk Factors:

• Cervical cancer risk is strongly influenced by the number of sexual partners a woman may have, the age when she first had sexual intercourse and the sexual behavior of the woman's partners
• Smoking has been shown to increase a woman's risk of cervical cancer
• There is a risk of cervical cancer associated with long term use of oral contraceptives (12 yrs+)
• Diets rich in vitamin C, beta carotene and Vitamin A may reduce the risk of cervical cancer

HPV & Cervical Cancer:

HPV infection are the most common STD, and most all cervical cancers derive from the virus. HPV is the central factor for cervical cancer. Women who test positive for HPV will continue their screenings to ensure early detection of the disease if it should progress to such. Continued screenings and use of HPV vaccines may decrease cervical cancer incidence over time.

 

Treatment:

Cervical cancer treatment ranges from observation (where treatment is delayed to watch if the disease progresses) to excisional therapies (surgical removal of the cancer including hysterectomies). Radiation and chemotherapy have also proven effective in the treatment of cervical cancer.

 

Works:

Franco, E. L., Duarte-Franco, E., & Ferenczy, A. (2001). Cervical cancer: epidemiology, prevention and the role of human papillomavirus infection. CMAJ: Canadian Medical Association Journal, 164(7), 1017–1025.

http://www.rho.org/about-cervical-cancer.htm