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Nursing patients with acute aortic dissection in emergency departments
Acute aortic dissection is an emergency condition that is often missed during initial assessment. Delay in diagnosis increases mortality, but the presentation can mimic several more common conditions. Emergency practitioners must maintain a high index of suspicion in patients who present with chest or back pain and ensure timely diagnostic testing and interpretation of results if aortic dissection is suspected.
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Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology
Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.
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Making reasonable adjustments to cancer services for people with learning disabilities
People with learning disabilities do not access or engage with proactive cancer screening in line with those without learning disabilities. As a result, they often experience delays in diagnosis and treatment for cancer, leading to suboptimal health outcomes and, in some cases, premature mortality. This article explores how the legal requirement for public bodies to make reasonable adjustments to ensure people with learning disabilities can use their services can have a positive effect on patient outcomes and experience. In cancer services this applies across the patient pathway, from access to screening, assessment, diagnosis, treatment and discharge. The authors use case studies to illustrate how reasonable adjustments can be made for individuals with learning disabilities in accessing cancer care. They also provide readers with the opportunity to reflect on their own practice and explain how to make small, achievable reasonable adjustments in their clinical areas.
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Best practice in the transition to adult services for young adults who had childhood cancer
This article discusses the importance of a successful transition from children’s to adult services for young adults who had childhood cancer. It considers the role of nurses in children’s and adult services in supporting young adults to adequately prepare for the transition to adult services. Historically, the responsibility has been with children’s services to prepare young adults to transition to adult services; however, a joint approach between children’s and adult service providers is now recommended. A well-organised, person-centred, transition plan commenced early can contribute to a young adult’s successful transition to adult services.
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Conducting holistic pain assessments in patients with cancer-related pain
The incidence of cancer is increasing and people diagnosed with cancer are living longer, with and beyond cancer, and experiencing acute and long-term effects of their disease and its treatment. One such effect is pain, which may occur at any stage, from diagnosis to survivorship or end of life. The exact incidence of cancer-related pain is challenging to determine but it is estimated to affect between 39% and 66% of patients, according to the stage of their disease trajectory. Cancer-related pain is complex, multifactorial and multidimensional, and nurses need to be equipped with the knowledge and skills to assess it in a holistic way. This article explores how nurses working in cancer settings can support people in their care by conducting holistic pain assessments.
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Prehabilitation in cancer care: preparing people for treatment physically and mentally
Prehabilitation is the process of enhancing an individual’s functional capacity by optimising their physical and mental health to prepare them for treatment. Prehabilitation is the first stage of the rehabilitation pathway and comprises pre-assessment, interventions and follow-up. It is designed to reduce the risk of the physical and psychological complications of cancer and its treatment, thereby improving patients’ ability to recover as well as their long-term outcomes.This article highlights the principles of prehabilitation in cancer care and its benefits for patients, and explores the role nurses can play in delivering prehabilitation assessments and interventions and in encouraging positive behaviour change in their patients.
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Adult primary brain tumours: presentation, diagnosis, treatment and complications
Primary malignant brain tumours are aggressive tumours with limited treatment options, and as such they remain the largest cause of cancer-related deaths in men aged under 45 years and women aged under 35 years. Benign brain tumours are frequently treated with the intention to cure them. Both malignant and benign brain tumours often cause long-term, debilitating neurological effects, and if they recur can be fatal.This article outlines the updated World Health Organization classification of adult primary brain tumours, as well as their treatment and predicted outcomes. It also identifies the role of cancer specialist nurses in supporting patients and their families.
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Protecting nurses against the risks of occupational exposure to systemic anticancer therapy agents
Many agents used for systemic anticancer therapy (SACT), which include chemotherapy drugs, monoclonal antibodies and other biological therapies, are known to be carcinogenic, teratogenic and mutagenic. Occupational exposure to SACT agents carries a proven risk of short- and long-term adverse health effects such as nausea, headaches, dizziness, hair loss, impaired fertility and cancer. The risk of contamination exists not only for staff who prepare or administer SACT agents, but also for those involved in transport, storage and waste disposal. In the UK, the handling of SACT agents is subject to a series of laws, regulations and guidelines. However, there are still inconsistencies in practice and a lack of awareness of the risks involved and need for training. The necessary preventive measures are not always in place and some staff remain exposed to cytotoxic agents. Furthermore, the risk of occupational exposure to SACT agents has intensified in recent years due to a significant increase in their use. This article prompts nurses to reflect on the health risks associated with handling SACT agents and the preventive and protective measures required.
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Abemaciclib▼ for the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer
Many patients with metastatic breast cancer develop resistance to endocrine therapy. Therefore, treatments with novel molecular targets have been developed to overcome endocrine resistance in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer, including cyclin-dependent kinase 4 and 6 (CDK4 and CDK6) inhibitors. CDK4 and CDK6 inhibitors such as abemaciclib offer a new treatment option for patients with metastatic breast cancer.Nurses have an important role in providing guidance, education and support to patients with breast cancer. Since more patients are likely to receive abemaciclib, it will become increasingly important for nurses to understand how it works, how to effectively manage potential side effects and how to support patients with adhering to treatment.This article describes the rationale for the use of CDK4 and CDK6 inhibitors in patients with breast cancer, and provides practical advice on how to manage patients with metastatic breast cancer who have been prescribed abemaciclib.
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A nurse-led review of patient experience for development of quality services
This article gives an example of a nurse-led service review and explains the process of evaluating a service that includes nurse-led clinics, patient information and patient experience. The aim of the evaluation was to engage with patients to gather information about and understand their experience, to inform the development of quality services and patient pathways.
