Integrated Nursing Practice Addressing Malnutrition

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Table of Contents

Patient’s Problems
Patient’s Goals
Treatment Methods
Outcomes
Bowel Cancer
Checking the Position of the Nasogastric (NG) Tube
References

Patient’s Problems

The first problem for Mr. Dwight is related to malnutrition. According to recent research, malnutrition and the resulting weight loss, namely, the deterioration of muscle tissue, affects patients’ chances for survival (Arends et al., 2017, p. 17). In the case of Mr. Dwight, he had been diagnosed with bowel cancer, and he had not eaten for three days. It is essential for care providers to understand that starving for a long time can have adverse effects on his health. Therefore, researchers say that patients with cancer and bowel failure should be provided with artificial nutrition to prevent starvation.

The second problem for Mr. Dwight can be related to the nurses who lack training about the patient’s diet. According to Kelley and Morrison (2015), the extent of the health practitioners’ expertise on the subject matter is very low, which affects the quality of the provided assessment (p. 748). The areas refer to providing palliative care to patients with serious illnesses (e.g., cancer). Due to a lack of training, nurses often forget to take into account the patient’s diet that can negatively affect their health. Additionally, research states that dieting choices made to keep the nutrition of the patients at an appropriate level will help to increase the patients’ ability to fight cancer due to the presence of a greater number of useful nutrients (Molina-Montes et al., 2017, p. 811). Therefore, the framework for addressing the dieting options of patients has to be revisited.

Patient’s Goals

One goal for Mr. Dwight’s management is to provide him with the most exceptional palliative care service in regards to fluid and nutrition. Several things should be considered: 1) specific training programs for palliative care providers that will improve their productivity; 2) measurable tests; 3) achievable certificate programs; 4) programs relevant to palliative care setting; 5) time-based programs.

Treatment Methods

The collaborative intervention allows better decision-making processes due to the opportunity for experts from different fields to collaborate and introduce a coherent approach toward managing patients’ needs properly (Trosman, Weldon, Kircher, Gradishar, & Benson, 2019, p. 11). In the case of Mr. Dwight, collaborative intervention is essential because of his insecure feelings about fluid and nutrition. The collaborative intervention allows the prevention of bowel cancer and can be beneficial for Mr. Dwight. According to research, the application of the collaborative approach increases the probability of survival in patients with colorectal cancer (Woodall & DeLetter, 2018, p. 71).

In addition, a pharmacological intervention will be needed to prevent possible instances of nosocomial infections. For this purpose, close examination of a patient’s nostrils for possible deformities is required. In addition, a nurse will need to inform a patient about the details of the procedure prior to inserting the tube. The benefits of the specified intervention include an opportunity to reduce the extent of stress experienced by the patient and create the basis for the future patient education (Woodall & DeLetter, 2018, p. 73). Therefore, the specified intervention should also be considered along with the traditional approach toward managing the NG process.

Outcomes

Evaluating the outcomes of the intervention will also be a fundamental step toward the management of the patient’s needs. First, data is collected from the results of the training tests about the effect of the patient’s diet. Second, the collected data (comments from the trainers) are analyzed (Van Rooijen et al., 2018, p. 103). In addition, the assessment of the changes made to the patient’s current health status will be assessed by performing the tests that evaluate the pH of the NG aspirate (Van Rooijen et al., 2018, p. 103). The specified evaluation will provide the results that will help to locate the difference between the regular pH level and that one of the patient. As a result, a strategy for addressing the patient’s immediate health needs will be developed.

Bowel Cancer

According to Kontovounisios et al. (2017), the MDT for an advanced stage of bowel cancer implies the support and assistance of experts with profound and vast knowledge of the subject matter and the interventions that can be used to address the issue effectively (227). These members include surgeons, oncologists, radiologists, and clinical nurse specialists.

First, having an MDT is beneficial because it allows better decision-making. Research says that the incorporation of the MDT-based strategy and several other techniques, one will be able to produce several solutions and offer a patient a variety of options for addressing the disease (Kelley & Morrison, 2015, p. 748). Second, having an MDT allows creating a setting where a proper assessment of patients’ well-being can be performed with the following suggestion of treatment options (Kelley & Morrison, 2015, p. 748).

Checking the Position of the Nasogastric (NG) Tube

In order to ensure that the NG tube is placed correctly in a patient, a nurse will need a radiographic test or an X-ray in order to ensure that the tube is placed correctly. While the use of air auscultation, also known as the whoosh test, used to be quite frequently used for these purposes, the specified approach is no longer adopted (Kisting, Korcal, & Schutte, 2019, p. 2). Additionally, colorimetric capnography may be used to check the tube placement (Erzincanli, Zaybak, & Güler, 2017, p. 48). The specified tools can be seen as the definitive check of the tube’s position since the X-ray and the capnography-based approach will help to locate the exact location of the tube.

References

Akhtar, R., Chandel, S., Sarotra, P., & Medhi, B. (2014). Current status of pharmacological treatment of colorectal cancer. World Journal of Gastrointestinal Oncology, 6(6), 177–183. Web.

Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., & Bozzetti, F. et al. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11-48.

Erzincanli, S., Zaybak, A., & Güler, A. (2017). Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube. Intensive and Critical Care Nursing, 38, 46-52.

Kelley, A., & Morrison, R. (2015). Palliative care for the seriously ill. The New England Journal of Medicine, 373(8), 747-755.

Kisting, M. A., Korcal, L., & Schutte, D. L. (2019). Lose the whoosh: An evidence-based project to improve NG tube placement verification in infants and children in the hospital setting. Journal of Pediatric Nursing, 46, 1-5.

Kontovounisios, C., Tan, E., Pawa, N., Brown, G., Tait, D., Cunningham, D.,… Tekkis, P. (2017). The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre. Colorectal Disease, 19(4), 331-338.

Molina-Montes, E., Sánchez, M. J., Buckland, G., Weiderpass, E., Amiano, P., Wark, P. A.,… Quirós, J. R. (2017). Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort. British Journal of Cancer, 116(6), 811.

Trosman, J., Weldon, C., Kircher, S., Gradishar, W., & Benson, A. (2019). Innovating cancer care delivery: The example of the 4R oncology model for colorectal cancer patients. Current Treatment Options in Oncology, 20(2), 11.

Van Rooijen, K. L., Shi, Q., Goey, K. K. H., Meyers, J., Heinemann, V., Diaz-Rubio, E.,… Sargent, D. J. (2018). Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: individual patient data analysis of first-line randomised trials from the ARCAD database. European Journal of Cancer, 91, 99-106.

Woodall, M., & DeLetter, M. (2018). Colorectal cancer: A collaborative approach to improve education and screening in a rural population. Clinical Journal of Oncology Nursing, 22(1), 69-75.

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