: Outline content

senario , the topic , aims ,the 5 session (2)-1

session 1 : introduction (3)-2

session 2-3 : : risk factor related to chemotherapy treatment &how to prevent this -3

risk factor (4-11)

session 4: : evidence related to chemotherapy and the important on educate the -4

patient. (12-13)

session 5 : method of education $ evaluation (14) -5

References -6

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Scenario 3

You are asked to design a short course (consisting of 6 one hour sessions ) to help patients understand

.the nature of their condition( chemotherapy) and hot to prevent and treat episodes of the condition

: The topic

.Educate patient under chemotherapy

:Aims

. Enables the patient to identify the chemotherapy -

- Explain the risk factor related to chemotherapy treatment

- Provide the necessary information about how to prevent and manage

side resulting from chemotherapy .

:Teaching sessions

Session 1: Introduction and explanation the reason of choice this case

.Session 2: risk factor related to chemotherapy treatment

Session 3 : how to prevent this risk factor

Session 4 : evidence related to chemotherapy and the important on educate the patient

. Session 5: the education method & the evaluating

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: Session 1

: Introduction

: Reasons for choice this topic

I choice this case because one day same one ask me about leukemia and I had been not know any think

about it , Then I tearing in IMC oncology unit the nursing manger teach us about the nursing role for

patient undergoing chemotherapy treatment including education about how to deal in life style all these

.reasons make me to choice this topic

Chemotherapy, in the most simple sense, is the treatment of an ailment by chemicals especially by killing micro-

organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the

.combination of these drugs into a cytotoxic standardized treatment regimen

Chemotherapy is the medical practice of treating a disease using chemicals. Specific examples include

the use of chemicals to reduce or eliminate cancerous cells in a patient. Chemotherapy is grueling for the

human body, so a patient undergoing chemotherapy needs significant medical and psychological

support. Chemotherapy nurses work as part of a team with nursing assistants, doctors who specialize in

cancer treatment, and the nuclear pharmacists in charge of dispensing a chemotherapy patient's

medication. Chemotherapy nurses are typically qualified to degree level in a registered nurse training

program. While training to become a nurse, an individual may choose to specialize in the administration

of chemotherapy treatment and care to patients; alternatively, this specialization may develop after

graduation from nursing education. There are a number of strategies in the administration of

chemotherapeutic drugs used today. Chemotherapy may be given with a curative intent or it may aim to

prolong life or to palliate symptoms. Combined modality chemotherapy is the use of drugs with other

cancer treatments, such as radiation therapy or surgery. Most cancers are now treated in this way.

Combination chemotherapy is a similar practice that involves treating a patient with a number of

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different drugs simultaneously. The drugs differ in their mechanism and side effects. The biggest

advantage is minimising the chances of resistance developing to any one agent.

Session 2-3 :

Before Starting Chemotherapy

Before starting chemotherapy we suggest that you take care of some of your basic health needs. If time

permits, have your teeth cleaned before rather than while you are having chemotherapy. If you need

.major dental work, try to postpone it until after chemotherapy

Emotional Support

You can have a family member, friend or support person accompany you to your chemotherapy

sessions. We recognize that cancer has an impact on you as a whole person and also on your family and

loved ones. To varying degrees, all people with cancer struggle with the challenges of coping and

adjusting to these life changes. At the Cancer Center, we have a number of programs to support you

through the process, such as the Peer Support Program, support groups and individual counseling, that

are available to all cancer patients.

Fever and Infection

Chemotherapy lowers the number of white blood cells (WBCs) your body makes. White blood cells are

made in the bone marrow and help fight against infection. Neutrophils are one type of WBC that fights

infection. Often your neutrophil count will determine whether or not you will receive chemotherapy on

schedule.

A fever of 101° Fahrenheit (38.3° Celsius), or chills with or without a fever, can be a serious sign of

infection. You must call your cancer specialist even if it's at night or on the weekend.

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An infection is most likely to occur when your neutrophil count is low. You are most susceptible to a

bacterial infection about seven to 12 days after your chemotherapy infusion. Most bacterial infections

result from your body's inability to fight off normal bacteria present in your gastrointestinal tract or skin.

Bacterial infections do not commonly result from being in a crowded place. So, if you are feeling well,

we encourage you to continue to go out to the movies or out for a meal.

However, viral infections such as colds and flu are common and are transmitted easily from other

people. To reduce your chance of infection, wash your hands frequently and avoid close contact with

anyone who is ill during this time.

Practical Hints Regarding Fever and Infection

 If you have a fever of 101° Fahrenheit (38.3° Celsius), with or without chills, call your doctor or

nurse immediately. If you cannot reach your cancer specialist, go to an emergency room.

 Keep a thermometer in your home and know how to take your temperature. Do not eat, drink or

smoke for 10 minutes before taking your temperature. Leave the thermometer under your tongue

for three minutes. If you are still unsure of how to take your temperature, ask your doctor or

nurse.

 Call your doctor or nurse as soon as possible if you develop a cough, sore throat, pain or burning

when you urinate.

 To help prevent infection, we encourage frequent hand washing with soap and water.

 Avoid rectal intercourse, tampons, douches, enemas and rectal thermometers.

 Do not eat raw food such as sushi and sashimi, Caesar salad or milk shakes made with raw eggs,

until you complete chemotherapy and your blood counts have returned to adequate levels. Raw

foods may carry bacteria that can lead to infection. Make sure to thoroughly wash any fruits and

vegetables.

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  Wash hands and cutting boards well after food preparation.

 Always tell your doctor before going to the dentist.

Practical Hints for Nausea

 Before your chemotherapy appointment, eat a small, light meal. Most people do better if they

have something in their stomach.

 Eat what sounds good to you. Generally starches such as rice, bread, potatoes, hot cereals and

puddings are well tolerated.

 Try not to skip meals. An empty stomach will worsen all symptoms. If you don't feel like sitting

down to a meal, try nibbling on something that appeals to you.

 Drink plenty of fluids. Herbal teas, water, sports drinks and diluted juices are recommended

more than soda.

 Avoid smells that are unappealing.

 Freeze meals so that you don't have to cook. Ask your family and friends to help with meals,

especially following chemotherapy when you are most likely to feel nauseous.

Fatigue

 Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated

with more cycles of chemotherapy.

 Most people have to make some adjustment in work and family responsibilities; the degree of

change is very individual. Try to balance activity and rest. As much as possible, try to maintain

your everyday activities. It can be very beneficial to both your physical and emotional recovery.

The fatigue will go away after you recover from chemotherapy.

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Practical Hints for Fatigue

 Plan your activities, such as grocery shopping, for a time when you feel the best.

 If you have children, rest when they are napping. When you feel most tired, consider hiring a

babysitter for a few hours so that you can relax or take a nap.

 Take naps early in the day so you do not disturb your sleep pattern at night.

 Consider exercising every day or several times a week. Good forms of exercise include

swimming, walking and yoga.

Hair Loss

Many people feel that hair loss is one of the most difficult aspects of chemotherapy treatment. Not all

chemotherapy drugs cause hair loss, so talk to your physician or nurse about what to expect.

Most often, hair loss begins about two to three weeks after starting chemotherapy. Some people will lose

relatively little hair, while others may lose the hair on their head, eyelashes and eyebrows, as well as

other body hair. You may want to cover your head with a wig, scarf, hat or turban, or you may not want

to cover your head at all. Do what makes you most comfortable. Many people choose different head

coverings for different situations..

Your hair will begin to grow back after you stop chemotherapy. It usually takes from two to three

months to see the change from no hair to some hair. Your new hair may be slightly different in color and

texture than your old hair. Often, the new hair will be baby soft and curly, but will generally return to its

original texture after some time.

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Appetite and Taste Changes

During chemotherapy, you may experience taste and appetite changes and a heightened sensitivity to

odors. Don't worry if you don't have an appetite the first few days or a week following chemotherapy; it

is not unusual. As you feel better, your appetite will improve.

Reflux — when food backs up into your esophagus — burping, or a burning sensation may worsen

nausea. Please report these symptoms to your physician or nurse so that they can be treated. You may

find that you can tolerate only certain foods. We encourage you to eat what appeals to you during this

time, and to drink enough fluids: eight to 10 eight-ounce glasses per day, more if you have a fever or

diarrhea.

Recommendations for healthy nutrition include a diet low in fat (less than 20 percent fat) and high in

whole grains, fruits and vegetables, and plant-based proteins. Some people want to begin dietary

changes during active therapy; others prefer to wait until chemotherapy is completed. Some people

prefer small, slow changes, while others benefit from a "major overhaul." We encourage you to become

informed and make healthy dietary and lifestyle changes.

Practical Hints for Taste and Appetite Changes

 Eat what appeals to you during this time.

 Eat foods that are warm rather than hot.

 Avoid places where food is being cooked, such as the kitchen at dinnertime.

 Avoid smells that are unappealing.

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  To try drink eight to 10 glasses of fluid a day.

Diarrhea or Constipation

Some chemotherapy drugs can cause diarrhea. If you have more than three or four watery stools in 24

hours or blood in your stool, call your doctor or nurse. Do NOT use over the counter anti-diarrhea

medications like Imodium unless advised to do so by your physician or nurse.

Some chemotherapy and anti-nausea drugs can cause constipation. Also, you may be more prone to

constipation because your activity level and diet have changed. If you experience constipation, contact

your doctor or nurse the same day.

Practical Hints for Constipation

 To help prevent constipation, drink eight to 10 glasses of fluid a day.

 Take a stool softener (not a laxative) such as ducosate sodium (DSS), also known as Colace, one

tablet once or twice a day. Senekot or Senekot-S also may be suggested. Ask your doctor or

nurse for a recommendation.

 Stay as active as you can. Consistent regular exercise can reduce constipation.

 If you can tolerate them, try high-fiber foods such as prunes, bran, fruits and vegetables.

Practical Hints for Diarrhea

 To replenish lost fluids, drink eight to 10 eight-ounce glasses of non-caffeinated fluids per day.

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  If your rectum is sore, use soft toilet paper and A&D ointment (used for diaper rash in infants) or

Anusol, which can help numb the rectum and soothe soreness.

Mouth Sores

Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth sores

occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such as those

that line your mouth and esophagus. Please call your practitioner should you develop painful mouth

sores or have difficulty swallowing. A special mouth rinse may be prescribed.

Practical Hints for Mouth Sores

 Brush your teeth with a soft toothbrush three times daily.

 Rinse your mouth with a solution of one teaspoon baking soda and one teaspoon of salt, diluted

in a glass of lukewarm water, three or four times daily.

 Most commercial mouthwashes contain alcohol. You can ask your health care provider about

mouthwashes that are not irritating to your mouth.

 Ulcer-ease is a commercial product that may provide temporary relief from sores.

Neuropathy

Neuropathy, which literally means disease or dysfunction of the nerves, can happen to some people.

Some of the most common symptoms of the type of neuropathy caused by chemotherapy include

tingling and burning, numbness or pain in the affected areas, loss of your sense of position — knowing

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where a body part is without looking at it — and loss of balance. The most commonly affected areas are

the tips of fingers and toes, although other areas are sometimes affected as well.

Tell your doctor about any symptoms that you experience. Early detection and treatment are the best

way to control your symptoms and prevent further nerve damage.

Practical Hints Regarding Neuropathy

 Tight shoes and socks can worsen pain and tingling, and may lead to sores that won't heal. Wear

soft, loose cotton socks and padded shoes.

 If you have burning pain, cool your feet or hands in cold, but not icy, water for 15 minutes twice

a day.

 Massage your hands and feet, or have someone massage them for you, to improve circulation,

stimulate nerves and temporarily relieve pain.

Menopause

For women, chemotherapy may temporarily stop your periods or result in permanent menopause. The

effects depend on the type of chemotherapy administered, your age and how close you are to naturally

occurring menopause.

With menopause, you may experience symptoms such as hot flashes, decreased libido, vaginal dryness,

mood changes and sleeping disturbances. If you experience any of these symptoms, talk to your doctor

or nurse to get information and treatment for the symptoms.

If your periods continue during treatment, they are likely to change in duration, flow and regularity. The

changes may be temporary, lasting only while on chemotherapy, or the changes may lead to menopause.

Practical Hints for Menopausal Symptoms

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  If you have breast cancer, we DON'T recommend hormone replacement therapy.

 Eat soy products or take vitamin E (400 units only) to reduce hot flashes.

 Your doctor may recommend prescription medications for hot flashes.

 Wear light cotton pajamas to help prevent overheating when sleeping.

 Use vaginal moisturizers on a regular basis or other water-based lubricants as needed, especially

during and before sexual activity. These products will help with vaginal dryness and irritation.

 Try an opened vitamin E capsule or olive oil spread on the vagina to increase lubrication.

 There are prescription medications that give a local dose of estrogen to the tissues in the vagina

to treat vaginal dryness.

Articles : (1)

The whys of patient education

The rationale for patient education is that patients and families have the right to be informed; that

professional standards describe appropriate patient education; that health care organizations and the law

require patient education; and patients, health care organizations, and that society benefit from the

process. Patients with cancer benefit in terms of knowledge acquisition, enhanced self-care, reduced

anxiety, enhanced self-concept and self-esteem, increased satisfaction with care, improved pain control,

improved oral status, and reduced disruption in daily functioning. Health care organizations benefit in

terms of quality services, reduced costs, and reduction in malpractice suits. Society benefits as patients

with knowledge and skills maintain or resume functional status and return to school, work, or service

activities.

Nurses are key professionals in the coordination and delivery of patient education programs. They too

have the opportunity to benefit from patient education through therapeutic alliances with patients and

families that foster both personal and professional satisfaction

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 Article 2 :

Evaluation of patient chemotherapy education in a gynecology oncology center

Goals of work  

To assess the level at which patient chemotherapy education needs are being met by the health-care
team in an outpatient clinic setting and to identify any unmet needs regarding patient chemotherapy
education.

Patients and methods  A questionnaire comprising 17 questions was developed to evaluate patient

preferences regarding chemotherapy education. In the clinic, patients were offered a copy of the

questionnaire with a cover letter describing the study.Main results   A total of 282 questionnaires were

completed, and 190 respondents had previously received chemotherapy. Of the 165 respondents who

were previously treated at our institution, 66.7% (110) had received some form of chemotherapy

education specifically from our clinic. The majority of all respondents (86.8%) reported that they

preferred to receive information about their chemotherapy via written materials and/or through a

conversation with a health-care professional. Regardless of the source of information, 62.6% of

respondents (119) felt they were provided with adequate information about their chemotherapy

treatment, and 42.4% reported that they would like more information about their chemotherapy.

Conclusions  

The current practice in our clinic is to provide patients with written information about their

chemotherapy that is reviewed with a health-care professional. The data revealed that our current

practice is consistent with our patients preferences. However, this survey did identify new information

that patients want to know about chemotherapy, such as how chemotherapy works, why chemotherapy

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stops working, and drug-drug as well as drug-food interactions. This information will be incorporated

into future patient education materials.

Method of teaching :

Patient educahon is defined as "a planned learning experience using a combination of methods such as

teaching, counseling and behavior modification techniques which influence patients' knowledge and

health behavior.( Emmy M)

in my study I well choice verble method for educate the patient about chemotherapy because verbal

method is The most traditional form of patient education is the one-on-one exchange of information that

occurs between physician and patient (Matthew J.2009) in a study by Hill et al, education about

rheumatoid arthritis medications resulted in improved pharmacologically measured adherence only

when receiving verbal support in addition to a pamphlet. Communicating with a patient verbally allows

the physician to adapt education based on the response of the patient. Additionally, the physician can

individualize information to be directly relevant. In the management of atopic dermatitis, patients

typically respond better when they receive individualized advice and personalized ways of

incorporating management into their lives. Brief educational messages by telephone, usually as follow

up, have also been shown to be an effective, quick use of verbal communication that increases

adherence in patients. Matthew J.2009)

and in this study for a group of people I well use presentation lecture to educate them about how to

prevent yourself during chemotherapy treatment .

Evaluating :

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in part, by educating and advising patients during their course of treatment. asked directly about health

education. To assess their level of knowledge after the verbal education I well s did they understand the

lecture .

References:

availablefrom:> }online{.\ -1
/http://www.ucsfhealth.org/education/coping_with_chemotherapy

[accessed 2011]

Emedicine.com,2009.{online}availablefrom:> -2
http://en.wikipedia.org/wiki/Chemotherapy

2009]

Emmy M SlulJs (2005),A Checklist to Assess Patient Education in Physical -3

Therapy Practice: Development and Reliability

Matthew J. Zirwas, MD; Jessica L. Holder, BS, Department of Internal Medicine, -4

Division of Dermatology, The Ohio State University College of Medicine, Columbus,

Ohio. (2009) Patient Education Strategies in Dermatology—Part 2: Methods available

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online from http://www.jcadonline.com/patient-education-strategies-in-dermatology

/%E2%80%94part-2-methods

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