NS4340 Clinical Management

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NS4340 Clinical Management

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NS4340 Clinical Management

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Course Code: NS4340
University: James Cook University

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Country: Australia

The Time of My Life: Trajectory/Clinical Management Matrix with Associated Bibliography This assessment requires you to produce a timeline trajectory and clinical management matrix (a large table) on an A3 landscaped page, with an associated bibliography.
You can again choose any chronic disease/condition (which can be either the same or a different condition than the one used in Assessment 2 above, but the intention was for you to continue with the same disease). A very basic, EXAMPLE template has been provided, (see below), but you will need to heavily adapt it to suit the disease you have chosen.
Use the column headings of your table to identify the stages/trajectory of the chronic condition, including the different settings of care that may eventually be required as the disease progresses through the lifespan and eventually into a palliative care phase and to death.
Use the row headings to indicate all the individuals involved in the clinical management of the client across their disease trajectory, including the patient themselves as a key member of the care team. Once you have set up your matrix with column headings across the top, and row headings down the left side, you can begin to fill in the content in each box, to describe what that team member would be doing, at that point in time in the disease trajectory, in that setting, in order to optimise the patient’s quality of life.
Describe the appropriate clinical management across the lifespan and across the disease trajectory, including across the continuum of care, in a variety of relevant settings/contexts. Comprehensively synthesise the necessary clinical management to achieve optimal wellness outcomes, minimise secondary complications, control symptoms, promote quality use of medicines where relevant, maximise functional ability, extend longevity where possible, and then facilitate a respectful and comfortable palliativephase and death.
Identify and describe the contributions to meeting the above goals of optimising wellness across the disease trajectory, for each of these individuals/roles, as they are relevant for the chosen chronic disease/condition: of the RN, of any other relevant members of the Multidisciplinary Team (MDT), of the patient themselves (Chronic Disease Self-Management), of the primary caregiver(s), of the family members and of the community.
You only need to insert short phrases in the boxes of your Clinical Management Matrix, not full sentences.Some boxes may have not tasks in them, if there is no function for that team member (e.g. a pharmacist) to perform at that point in the disease trajectory (e.g. pre-diagnosis).














· The client should opt for an early inspection of the cancer by consulting the GP

· Fixing doctor appointment
· Discussion of concerns with the healthcare professional
· Assessing the risk factors related to obesity or menstrual age

· Reading articles and health portals about the different signs and symptoms
· Taking self-care management efforts such as, aerobic exercise, and dietary modifications

· Consulting the doctor and undergoing a mammogram
· Other diagnostic procedures are breast ultrasound, breast examination and removing sample of the breast to perform biopsy.

· Seek help from the healthcare professionals regarding the best possible treatment option among chemotherapy, lumpectomy, mastectomy, or radiation therapy
· Adhering to medication management strategies like hormone blocking therapy, and monoclonal antibodies.
· Peer support

· Shows compliance to different schedules of hormonal therapy
· Receives education about the different side effects of hormonal therapy
· Consuming proper doses of tamoxifen and/or aromatase inhibitors

· Joining rehabilitation programs
· Learning different coping strategies
· Performing physical therapy
· Learning different strategies of self-management

· Performing physical therapy at least thrice a week
· Going for follow-up to  the clinics

· Seeking immediate help from the GP for sudden adverse reactions or deterioration in health conditions

· Planning a living will
· Formulation of a power of attorney after consultation with the lawyer

Family/ Primary Caregiver

· Providing necessary support and helping the patient through the course of screening and treatment

· So compassion and adopt an empathetic approach towards the conditionon

· Provides physical, emotional, psychosocial, spiritual and financial assistance
· Encourage activities of daily living

· Provides physical, emotional, psychosocial, spiritual and financial assistance

· Provide the much needed fiscal support for conduction of different diagnostic tests
· Engage in a discussion with interdisciplinary team members for the different concerns related to the patient during his/her stay in the hospital
· Keep a check on health status

· Induce all forms of emotional, physical, and financial assistance
· Take into account all possible adverse effects of issues that might arise in the patient during the course of the treatment

· Provide necessary physical, fiscal, spiritual, and emotional support
· Hold meetings and consultations with members of the rehabilitative team regarding progress of the patient health

· Motivate and boost the patient on different ways by which a meaningful and purposeful life can be lead
· Provide ongoing support in the form of emotional and psychological support in leading a normal life and carrying out the activities of daily living

· Immediately reports any sudden symptoms or side effects to the concerned GP and oncologist

· Adequate monetary, emotional, spiritual, and psychological support is provided

· Establishes contact with different support groups for relating the story of the patient


· Motivates the person to adhere to healthy community lifestyle activities that are beneficial for preventing cancer progression

· Provide assistance to the patient in dealing with the diagnosis of the condition
· Adopt an empathetic approach

· Provides help and much needed support to the family members of the patient at times of their distress



· Encourage the patient in all ways during their stay at rehabilitation units

· Provide encouragement for performing BSE at regular intervals with the help of the support groups

· Play an important role in providing the necessary social, emotional, and psychological assistance

· Create provision for pastoral care services and spiritual counselling

Breast Care Nurse

· Ensuring care continuity and enhancing the services that are provided

· Educate the patients for achieving best health outcome
· Provide psychological and emotional all through the course of diagnosis and cancer treatment

· Hold counselling sessions to explain about the wide range of coping mechanism
· Address the patient concerns
· Provide valuable information that will facilitate assessment of the selected treatment strategy
· Take efforts to inform patient and family members about different referrals and team members

· Conduct exhaustive and comprehensive physical examination and note down necessary information regarding the cancer sign & symptoms
· Suggest referral to other professionals for staging the breast cancer and performing breast reconstruction

· Thoroughly checks the wounds of the patient at the site of cancer
· Helps in administration of medication
· Provides assistance in conducting activities of daily living

· Provides much needed help and support to the patient upon being diagnosed with breast cancer reaction to the diagnosis and how to cope with cancer

· Provide health teaching on self-care strategies
· Medication administration
· Pain and symptom management

· Encouraging patient to perform breast self-examination on a monthly basis using assistance from the support groups

· Provide emotional, physical, and psychological support
· Provide assistance to the GP and the patient while holding consultation sessions

· Address the emotional, physical, and psychological needs of the patient
· Efficiently manage the cancer and co-morbid symptoms

· Advocate for the rights of the family

 Oncology Nurse

· Fulfil the role of caring for the cancer patient
· Provide exhaustive information on the projection and the pathophysiology of the disease
· Administering pain management medications such as, NSAID  (aspirin) and acetaminophen (Tylenol)

· Responsible for educating the patient on cancer and its symptoms
· Managing the pain related symptoms assessment

· Gaining a deeper understanding of the results obtained following conduction of biopsy, breast ultrasound and mammogram
· Coordinate the care services that are delivered to the patient
· Suggest patient referrals to members of the multidisciplinary team

· Comprehend the laboratory results gain a deeper understanding of the consequences of breast cancer

· Provide education to the patient on the benefits of the treatment provisions that are available to the patient
· Evaluation of the proposed care plan
· Management of pain by analgesics
· Coordinating care services by a collaborative approach

· Educating the patient on the potential advantages and the contraindications of the treatment
· Safely administering certain chemotherapy  and hormone blocker drugs

· Maintaining the medical records and history of the patient up to date
· Suggesting the patient to seek referralservices from multidisciplinary healthcare professionals

· Promote patient centred care services for addressing the needs
· Reducing adverse medical complications
· Making referral to other staff
·  Coordinating delivery of care services

· Provide referrals to the GP

· Advocate for patient rights
· Educate the patient
· Offer psychological and emotional support

· Provide psychological and spiritual support


· Providing assistance in medication adherence
· Effectively controlling the symptom management
· Administering analgesics such as, Tylenol and ibuprofen for treating the pain felt in the breasts

· Assesses the patient condition
· Evaluates the suggested treatment options
· Detects and screens breast cancer
· Stages it

· Provide help to the patients on the different referral recommendations
· Deliver quick conclusive diagnosis on the cancer

· Evaluates and suggests referral
· Refers to breast reconstructive surgeons
· Offers education to the patient and family on  the diagnosis results

· Recommends medications
· Suggests treatment strategies
· Manages the cancer symptoms
· Refers to other staff
· Promotes consultation for second opinion

· Collaborates with breast reconstructive surgeon
· Conducts regular assessments
· Addresses cancer symptoms

· Coordinates care to the breast care specialist team
· Ongoing assessment
· Symptom management

· Supports the family
· Provides information on the effects of a positive diagnosis

· Discusses different treatment options
· Forms collaboration withend-of-life healthcare staff

· Promotes shared decision making

· Supports the family

Breast oncology/Plastic reconstructive surgeon



· Will help in suggesting the steps for the primary treatment
· Will conduct assessment necessary for the reconstruction surgery
·  Adopt a collaborative care approach  

· Will suggest the type of reconstruction surgery that is required depending on the severity of the cancer
· Educate the patient and different coping skills

· Refer the patient to other forms of occupational therapy for allowing participation in different physical activities and improving the health status

· Ongoing assessment
· Management of complications from reconstructive surgery



· Deliver ongoing care
· Co-ordinate between the care services
· Take assistance from a palliative healthcare team

· Provide support to the family

Physiotherapist/Occupational Therapist

· Provide comprehensive interventions or improving the ability of the client to conduct activities of daily living and enhance the quality of life




· Provide education on post-operative physiotherapy strategies for breast cancer


· Conduct counselling sessions
· Conduct baseline assessment
· Train on range-of-motion exercises

· Educate on modification or elimination of different habits such as, wearing tight clothes, sun bathing routines, and heavy work




Dietician Educator

· Provide encouragement to the client for adhering to lifestyle tips
· Conduct  an exhaustive nutritional assessment

· Assess the nutritional requirements

· Optimise the nutritional status of the patient
· Suggest dietary alterations


· Dietary management
· Collaborative care
· Liaison with nurses, doctors and other professionals

· Monitor patient progress
· Arrange nutritional support
· Educate carers and patient

· Advocate healthy lifestyle
· Suggest recommendations

· Conduct follow-up assessments









· Advocate for the patient
· Provide psychological support

· Deliver counselling services
· Assesses the psychological and mental state of family and patient

· Provide mental and emotional assistance

· Hold status to empower the patients and carers


· Provide emotional support

· Provide counselling and bereavement support






· Educate patient and family on different medicines

· Collaborate with the GP
· Talk about the adverse impacts of the interventions


· Help patient to show medication compliance


· Provide help during end of life


Social Worker (Renal)

· Provide support and resources related to the disease




· Advocate for the patient
· Refer to different community support groups that are accessible

· Address the patient’s psycho-social issues

· Provide psychosocial support

· Create provisions for counselling sessions for the patient and family members
· Provide emotional support


· Hold discussions on power of attorney or living will
· Advocate for the patient

· Refer to spiritual leaders and pastoral care


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Faller, H., Weis, J., Koch, U., Brähler, E., Härter, M., Keller, M., … & Reuter, K. (2016). Perceived need for psychosocial support depending on emotional distress and mental comorbidity in men and women with cancer. Journal of psychosomatic research, 81, 24-30. https://doi.org/10.1016/j.jpsychores.2015.12.004 
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Kami?ska, M., Ciszewski, T., ?opacka-Szatan, K., Miot?a, P., & Staros?awska, E. (2015). Breast cancer risk factors. Przeglad menopauzalny= Menopause review, 14(3), 196. doi:  10.5114/pm.2015.54346
Kapoor, A., Harris, S. T., & Baker, E. A. (2018). Fear vs. faith: how a 46 year old woman beat breast cancer. Spiritual Care, 7(2), 191-196. https://doi.org/10.1515/spircare-2017-0037
Kenison, T. C., Silverman, P., Sustin, M., & Thompson, C. L. (2015). Differences between nurse practitioner and physician care providers on rates of secondary cancer screening and discussion of lifestyle changes among breast cancer survivors. Journal of Cancer Survivorship, 9(2), 223-229. https://doi.org/10.1007/s11764-014-0405-z 
McCarroll, M. L., Armbruster, S., Pohle-Krauza, R. J., Lyzen, A. M., Min, S., Nash, D. W., … & von Gruenigen, V. E. (2015). Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application. Gynecologic oncology, 137(3), 508-515. https://doi.org/10.1016/j.ygyno.2014.12.025
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