My OSCRI Clinical Experience

Esther Okoro

Professor Lanette Julian

NURS 2242 (OSCRI Paper)

8 March 2019

My clinical experience at the Oklahoma Specialist and Research Institute

I had the opportunity to meet and observe patients who were all presently trying to fight a different type of cancer. During the period I was there, I got to follow a nurse who truly cared about her patient even though it was a busy day. I had the pleasure to meet a patient who has been battling Acute Myelogenous Leukemia. The type of assessment I observed the nurse perform on the patient include patient identifiers, blood pressure, pain assessment, reviewing report for complete blood count.

I was also informed that prior to the time the patients meet with the physician or nurse practitioner they would have their central ports accessed and also to get blood samples for laboratory analysis.

A particular patient experience I would like to describe involve a 71 year old female receiving care for Acute Myelogenous Leukemia. She got diagnosed after the passing away of her mother who had lived with her.

She noticed constant fatigue, tiredness, pain easy bruising and bleeding that would not resolve, but she thought nothing of it, but just been exhausted from taking care of her ill mother. After going through a couple of blood test, bone marrow test, lumbar puncture test it was made known to her that she had Acute Myelogenous Leukemia.

Acute Myelogenous Leukemia is a cancer of the blood and bone marrow that affects a group of white blood cells that normally develops into various types of matured blood cells.

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The treatment approach I learned was used for this type of cancer involves chemotherapy alone or sometimes in combination with other treatment such as remission induction therapy, consolidation therapy, targeted therapy, drug therapy or bone marrow transplant which can take from months to years depending on how well the patient is responding to treatment.

 Vidaza chemotherapy drug is a set of regime that is administered through the patient’s port for about 30 minutes for 4 cycles which is about every 28 days. Due to the potential side effects of this therapy such as nausea, vomiting, anemia, low platelet count, low white blood cell count. Routine blood test are done to check for levels of white blood cell, red blood cells, and platelet in order to determine when to modify treatment or the use of other drugs to produce blood cells. Another drug included is Hyrea to help with spleen pain, anti-nausea medication, antibiotic, food supplement as a preventative measure to minimize side effect of the treatment.

According to the care plan for this patient and how long she had had this type of cancer, the goal for treatment is Palliative therapy. The expected outcome for the patient is to remain free of infection, maintain blood count within normal limit, free from pain, free from adverse effect of the therapy. And the patient stated that she is willing to get treatment for as long as can so she can witness her grandchildren graduation high school. The invasive method typically used in treatment of this type of cancer is placement of central venous access devices or port for chemotherapy, surgery while the noninvasive method include oral chemotherapy.

The different discipline that I saw as included in the plan of care for this patient are physicians, nurse practitioner, registered nurse who instructed the patient on what to expect during treatment. Some other discipline I would expect to be a part of the care team will be a hematoma-oncologist (treats leukemia), hematoma-pathologist (treats cancerous blood), pharmacist, social worker, counsellor, dietician, palliative care specialist to help manage symptoms/ supports  and also guidance with issues like insurance coverage.

Some potential risk factors associated with Acute Myelogenous Leukemia include adults older than 65 years, previous cancer treatment, exposure to radiation, dangerous chemical exposure, other blood/genetic disorders and smoking. The patient I observed is a 71 year old patient with history of Myelofibrosis which puts her at a greater risk of developing Acute Myelogenous Leukemia. Signs and symptoms associated with the patient’s diagnosis include fever, bone and spleen pain, lethargy, fatigue, shortness of breath, pale skin, and frequent infection, bleeding and bruising easily.

According to the website American Cancer Society, Acute Myelogenous Leukemia accounts for only 1% of all cancers. There is an estimate of 21,450 new cases and about 10,920 are Acute Myelogenous Leukemia in the United States in 2018. The incident rate in Oklahoma is 7.1% compared to the national rate of 10% (Cancer Facts and Figure, 2016). Oklahoma incidence rate is higher than the national occurrence which could be as a result of high smoking rate that is known to have a greater risk for developing this type of cancer.

The overall clinical experience at Oklahoma Cancer Specialist and Research Institute proved to be a great learning experience for me I learned a lot about cancer in a limited amount of time. It was quite enlightening because of the opportunity to interact with patient, family and learning about their experiences form diagnosis through the treatment and possible outcomes. I truly did not know what to expect since I have had no previous experience in this field of nursing. I believe the outpatient setting has an advantage because the patients are able to receive same day treatment which makes it convenient for themselves and families, and also in ruling out incurring hospital stay bills, nosocomial infection which cancer patients are at higher risk for due to the immuno-compromised health. Teamwork and collaboration was evident among the care team, the nurses always verified all chemotherapy drug with another nurse, the entire care team I observed was inspiring and this makes me want to consider working in such environment in the course of my career.

References

American Cancer Society: Cancer Facts and Figures (2016), Retrieved from

Key Statistics about Acute Myelogenous Leukemia, Retrieved from

Lewis, L.S., Dirksen, R.S., Heitkemper, M.M., & Bucher, L. (2014). Cancer. In

Medical-Surgical Nursing: Assessment and Management of Clinical Problems

(9th ed., pp 247-2284). Canada, Mosby Elsevier Inc.