Follow up diagnosis and assessments are an important aspect of cancer care treatment. In this case study, Jack (63) had undergone surgery for his left-sided colon cancer and admitted to healthcare facility where I am assigned with the care responsibility of the patient. Upon receiving the handover I witnessed the high blood glucose level and dropped blood pressure for the patient. However, the patient also reported pain in his abdomen and fatigue. Therefore, I would conduct several physical assessments and would ask the patient few questions related to his diet, lifestyle and addictions so that I could connect them to assess the chances of cancer recurrence, as Steeleet al. (2015, p. 721-722) mentions that colon cancers has higher rate of recurrence after 3 to 5 years of surgery. I will conduct physical examination by feeling his lymph nodes, in his chest, pelvis and abdomen, assessing his lungs, feeling his abdomen and conducting the digital rectal examination (Van Cutsem, et al., 2016, p. 1395). Further, with the permission of medical officer, I would conduct CT scan to locate the cancer in the lymph nodes of chest and abdomen, lungs and liver of the patient. Further, I would also conduct carcinoembryonic antigen (CEA) and would propose it to be done every 6 months so that recurrence of cancer could be located (Van Cutsem, et al., 2014, p. 1390).
The immediate problems of jack have already been observed through his dropped blood pressure and his elevated blood sugar level. However as per Stellee al. (2015, p. 720), the immediate complication of colon cancer surgery could be diarrhea and constipation due to which patients could feel fatigue and nausea. However, it was also seen that due to removal of the left side of the colon, perforation of the colon occurs due to which excessive bleeding occurs. Further, through the research of Schafer et al. (2015), it was seen that due to colon cancer surgery, body extensively decreases the absorption of calcium and Vitamin D and hence, it could exert short term complication in the patient’s body by making him prone to arthritis and osteoporosis, due to which in next few days, he could develop pain in his joints. Further, these would be the potential problem for which I would implement holistic care for the patient (Holmboe, Durning & Hawkins, 2016, p 122).
As per the Levett Jones clinical reasoning cycle (2018), while caring for the patient I applied three steps of this widely used method to direct my diagnosis, to collect information, process information, and identifying the problems and issues so that jack’s follow up diagnosis and identification of further problems could be obtained (Thomas, Kern, Hughes & Chen, 2016, p. 121). As per the clinical reasoning cycle, I reviewed, gathered and recalled evidences from recent literature and research studies and then depending on the second step of processing information I interpreted the patient’s vital signs, pain state and fluid volume to understand the signs and symptoms of further complication and match with current researches to predict the possible complication the patient could develop (Levett-Jones et al., 2018). Therefore, depending on the conductive reasoning process, I assessed the valid and true complication which is based on accurate diagnosis, and valid premises. I used this reasoning cycle as Bailin and Battersby (2015) determines this process as ‘top down approach’ which diagnoses aspects from general perspective and then specifies the ailments in the patient.
Bailin, S., & Battersby, M. (2015). Conductive argumentation, degrees of confidence, and the communication of uncertainty. In Reflections on theoretical issues in argumentation theory(pp. 71-82). Springer, Cham. DOI: https://doi.org/10.1007/978-3-319-21103-9_5
Holmboe, E. S., Durning, S. J., & Hawkins, R. E. (2017). Practical guide to the evaluation of clinical competence. Elsevier Health Sciences.
Levett-Jones, T. (2018). Chapter 3: Caring for the person with fluid and electrolyte imbalance. In, T. Levett-Jones. Clinical Reasoning: Learning to think like a nurse, (pp28-48). (2nd Ed.). Sydney: Pearson.
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Steele, S. R., Chang, G. J., Hendren, S., Weiser, M., Irani, J., Buie, W. D., & Rafferty, J. F. (2015). Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. Diseases of the Colon & Rectum, 58(8), 713-725.doi:10.1001/jama.2013.285718
Thomas, P. A., Kern, D. E., Hughes, M. T., & Chen, B. Y. (Eds.). (2016). Curriculum development for medical education: a six-step approach. JHU Press.
Van Cutsem, E., Cervantes, A., Adam, R., Sobrero, A., Van Krieken, J. H., Aderka, D., ...&Ciardiello, F. (2016). ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Annals of Oncology, 27(8), 1386-1422. DOI: https://doi.org/10.1093/annonc/mdw235