Thursday, September 5, 2019
Responses to Cancer: Behavioural, Emotional and Physical
Responses to Cancer: Behavioural, Emotional and Physical Behavioural, Emotional, Physical and Cognitive Responses Cancer is a deadly disease cause by uncontrolled division of abnormal cells and as a group, accounts for more than 14% of all deaths each year (Ahmedin, et al., 2008) and once, the individual finds out about his diagnosis with this deadly disease, the individual is likely to experience severe emotional, cognitive, physical and behavioural response since, everyone knows that untreated and even treated cancer in some cases tend to be life threatening. The severity of these responses varies individually and is dependent on several factors such as whether the event was surprisingly recognized or whether earlier complaints were present, plays a major role (Verwoerdt, 1973). Furthermore, it depends on personal experience with the disease, for example, if previous generations of the family had been diagnosed with cancer (Verwoerdt, 1973). Behaviour is one of many responses which plays a huge role throughout the individualÃ¢â¬â¢s diagnosis and is most probable to change thoroughly. These Behavioural responses generally result from the genetic makeup, past experience and the IndividualÃ¢â¬â¢s perception of the current situation (Snyder, 2011). The individual is likely to experience several behavioural change with certain steps and are likely to prompt restlessness, stress, searching for several answers, anxiety or even disbelief. The first step during the behavioural response usually involve Pre-contemplative/unawareness stage (Miller Rollnick, 2002). In this stage the individual is not interested in his diagnosis nor does he plan to do anything about it. The individual is completely in state of denial, unmotivated and resistant regarding his diagnosis. The individual is also likely to defend his current behaviour if others such as his doctor or family memberÃ¢â¬â¢s try to intervene. The second behavioural response stage involves contemplative phase where the individual starts to think about his life and his family which ultimately leads him to think about his diagnosis and treatment seriously (Miller Rollnick, 2002). Most individuals tend to accept their problem at this phase and eventually start to plan about their future strategies to improve his and familyÃ¢â¬â¢s life. The third behavioural phase involves preparation where the individual tend to realise that a change is inevitable (Miller Rollnick, 2002). The individuals also incline to realise the severity and seriousness of his cancer and usually makes several decisions and commitments to change the outcome of his diagnosis. This stage usually tend to be a period of transition and therefore, tend to be quite short. In the fourth behavioural phase, the individual tries to implement several strategies to start a Ã¢â¬Å"newÃ¢â¬ life (Miller Rollnick, 2002). The individuals going through this phase also tend to be realistic and open minded in terms of receiving help and support. This step normally is the Ã¢â¬Å"willpowerÃ¢â¬ stage for most individuals going through hardship and often tend to reward themselves to enhance motivation and self-confidence which often help them to deal with personal and external pressures. The fifth and last behavioural phase include maintenance where many individuals try to consolidate changes in their behaviour, to maintain the Ã¢â¬ËnewÃ¢â¬â¢ status quo and to prevent relapse or temptation (Miller Rollnick, 2002). The individual normally tend to see any previous behavioural change undesirable, unnecessary and customarily tries to implement new working strategies by the means of seeking help, usually a doctor. Whilst the individualÃ¢â¬â¢s behaviour is fluctuating, emotion is likely to build up the moment the individual finds out about his cancer. These emotions often trigger responses such as feelings of fear, anger, rage, sadness and dejection.Such mood swings are tend to be normal andmost individual incline to live through this cold baths of feelings for a long time until the individual finds his way for himself to accept the disease. In most individuals, the diagnosis of Cancer triggers shock as the first emotional response (Tsao, 2010) which usually last from hours to days. Many individuals feel alienated, frozen and cannot think clearly. In this stage the patient is unable to conduct basic necessities of his life, requires help and constantly shows his emotions. The second response of emotion involves denial where the individual attempts to shut out the authenticity and magnitude of his situation by developing a fabricated, desirable reality (Tsao, 2010). Once the individual accepts his fate with the diagnosis and overcomes the denial, the third phase of emotion includes wrath and anger. During this phase the individual constantly thinks about his diagnosis to be unfair and ask questions such Ã¢â¬Å"Why is it always me? Its not fair!; How can this transpire to me?Ã¢â¬ (Tsao, 2010). The next phase usually involve bargaining (Tsao, 2010) where many individuals try to negotiate with their fate by constantly making statements such as Ã¢â¬Å"Ill do anything to live for few more yearsÃ¢â¬ therefore creating a sense of hope. In this stage, the individuals also tend to isolate themselves from others and even prevent any human interactions. After the individual realises that his fate cannot be bargained depression starts to take place as a fifth emotional phase (Tsao, 2010). In this phase, the patient is dealing with his diagnosis and the intensive life of contradictory feelings which might lead the individual to the utmost limit of his mental capacity. The individualÃ¢â¬â¢s psychological immune system is also likely to be flooded with stimuli, which might often results in fatigue, hopelessness and resignation. Once, the depression is overwhelmed acceptance, is likely to take place as a last step of emotional response (Tsao, 2010). In this phase the individual usually accepts his fate and makes statement such as Ã¢â¬Å"I have cancer and I will live with itÃ¢â¬ as a motivation. Once the individual stabilises himself on this setting, he stands on a firm foundation for a self-determined life and inclines to makes new plans and to actively solve his problems. Cognitive is another major part the individualÃ¢â¬â¢s response once the diagnosis has been revealed. In this phase, several negative thoughts tend to arise whilst the individual is interacting such as communicating, reading, watching television, listening to radio etc. (Park, 2013). cognitive changes in patients suffering from cancer may possibly be caused by disease, cancer treatment, complications of the treatment, comorbid conditions, side effects of drugs, other physiological responses to diagnosis of cancer (Park, 2013). In this response, the individual rarely thinks positively and normally tends to thinks rationally and therefore several suicidal and self-harm thoughts tend to arise. This response takes place whilst emotional and behavioural response is developing and usually ends once the individualÃ¢â¬â¢s treatment has been completed. Several physical response such as hair/weight loss, inability to speak about the cancer without experiencing grief, overreacting to minor events, loss of appetite, fatigue etc. are likely to arise throughout the whole process of cancer and its treatment. These physical changes are likely to make the individual feel shameful, guilty, paranoia and even Intellectualization. These types of physical changes are usually seen once the emotional, behavioural and cognitive responses takes place (Moos Schaefer, 1984). In conclusion, the onset of any illness gives rise to a wide range of different responses such as emotional, cognitive, physical and behavioural which varies greatly from individual to individual, even in those with the same condition. However, from above information regarding various responses, it is clear that the above responses stated are likely to arise at various point of any illness. References Ahmedin, J. D., Siegel, R., Ward, E. D., Hao, Y. D., Xu, J. D., Murray, T., Thun, M. D. (2008). A Cancer Journal for Clinicals. Cancer Statistics, 72. doi:10.3322/CA.2007.0010 Miller, W. R., Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change. Behavioural change. Moos, R., Schaefer, J. (1984). Coping with Physical Illness. Springer US. doi:10.1007/978-1-4684-4772-9_1 Park, H.-J. (2013). Structural and Functional Brain Networks: From Connections to Cognition. Cognition responses, 342(6158), 1238411 -1238411. doi:10.1126/science.1238411 Snyder, J. (2011). Adult hippocampal neurogenesis buffers stress responses and depressive behaviour. Behaviour, 476(7361), 458-461. Tsao, C. (2010). Kubler-Ross. Stages of Grief, 34(1), 38. Verwoerdt, A. (1973). Psychopharmacology and Aging. Springer US. doi:10.1007/978-1-4684-7770-2_16 Pneumonia: Causes and Treatments Pneumonia: Causes and Treatments Pneumonia is an inflammatory condition of the lung which can result from infection with particular bacteria, viruses or other organisms. It is characterised by lung parenchyma inflammation and the filling of the air-filled sacs of the lung (alveoli) with fluid resulting in a decrease in elasticity which leads to inefficient gas exchange. In excess of 5 million cases of infectious pneumonia are estimated to occur annually in the US resulting in more than 1 million hospitalizations. The onset of this condition is usually prompted following the weakening of an individuals immune system, such as by a viral upper respiratory tract infection or following an incidence of influenza. It is a condition of particular concern in those over sixty five years of age, those with chronic immune disorders or young infants, all of whom have a reduced ability to combat infections. Retrieved from [http://www.nhlbi.nih.gov/health/dci/Diseases/pnu/pnu_all.html] Almost half of all pneumonia cases originate bacterially. Some incidences of pneumonia are acquired by the inhalation of small droplets containing the organism or bacteria and these germs enter the air when the infected individual sneezes or coughs. In other circumstances the condition precipitates when bacteria or viruses that are present in the nose or mouth under normal conditions enter the lungs. However, if a person is weakened by an existing condition, severe pneumonia can develop. Along with classification based on the symptoms experienced, pneumonia can be categorized based on where or how the disease is contracted and can usually be divided into several subgroups which comprise hospital acquired pneumonia, community acquired pneumonia and aspiration pneumonia. CAP can develop as a result of the attack unleashed by pathogenic microorganisms on the lung and the response of the immune system to the infection that ensues. S. pneumonia, H. influenza, C. pneumonia and M. pneumonia are the prevalent bacterial origins of the condition with S.pneumoniae presenting as the most frequent pathogen responsible following epidemiological studies (Luna et al., 2000). A relatively inoffensive form of pneumonia results that rarely involves hospitalization. In accordance with the guidelines developed by the American Thoracic Society for the management of CAP patients should be treated for the possibility of an atypical pathogen infection (Niederman et al., 2001). Organism-specific therapy may be possible in some patients depending on culture results. CAP is characterized by the presentation of a high fever, shaking chills and a cough with yellowish sputum which may be accompanied by chest pain. It can also cause shortness of breath which considerably impacts those with chronic lung conditions such as asthma and emphysema. Hospital-acquired pneumonia (HAP) tends to be more severe than pneumonia acquired in the community mostly due to the fact that the organisms involved tend to be more aggressive and difficult to treat. Also, individuals in hospitals or care homes who contract this condition may often already have compromised immune systems and may not be able to fight off the infection. It remains the most frequent and severe nosocomial infection encountered in the ICU and the mortality incidence of patients with HAP is high (33% of unventilated patients) (Smith-Sims, 2001). The symptoms of HAP are usually the same as CAP in general. Early and suitable antibiotic therapy has been discovered to result in a decline in patient mortality rates in clinical studies due to this type of pneumonia. Patients diagnosed with nosocomial pneumonia are twice as likely to survive if in receipt of suitable antibiotic therapy, with the timing and adequacy of treatment being of crucial importance (Celis et al., 1988). D ue to the fact that the timing of antibiotic therapy with respect to suspicion of pneumonia is an imperative factor affecting mortality and that HAP diagnosis remains elusive, initial empiric therapy appears to be best practice (Fiel, 2001). An example of an additional type of pneumonia is aspiration pneumonia which is often described as the inhalation of foreign substances such as gastric matter into the lungs. This can lead toconditions such aspiration pneumonia and aspiration pneumonitis. Aspiration pneumonitis results from chemical injury due to the inhalation of sterile gastric materials whereas aspiration pneumonia is an infectious process resulting from inhalation of saliva which has been previously colonised by pathogenic bacteria (Marik, 2001). Factors that predispose an individual to aspiration pneumonia include a decreased level of consciousness, neurologic disorders, dysphagia and the aspiration of material in association with a tracheostomy (Finegold, 1991). Antimicrobial agents are the keystone of treatment and prolonged therapy is important in the prevention of relapse. Viral pneumonia on the other hand can be caused by the influenza virus along with herpes or varicella, including those responsible for the outbreak of the common cold (adenoviruses). The two types of influenza virus, A and B, are characterised by respiratory complaints in conjunction with headaches, fever and muscle aches. Contracting herpes or varicella pneumonia is usually rare unless infection with the varicella zoster virus (chicken pox) occurs. Adenovirus originating pneumonia is frequently accompanied by common cold symptoms such as a runny nose and conjunctivitis. Viral pneumonia symptoms include muscle aches, tiredness, low grade fever and the presence of a cough with very little mucus It is rarely serious and usually does not require admittance to hospital. Medicines such as analgesics (to relieve chest pain) and acetaminophen (to reduce fever) may be given to alleviate symptoms however this particular type of pneumonia is resistant to treatment with antibiotics unlike its b acterial counterpart. A vast range of diagnostic strategies are available to identify the presence of pneumonia in individuals. These include laboratory tests such as sputum examination, blood cultures or urinary antigen tests for the suspected bacterium involved. Chest X-rays are common diagnostic tools utilized and are helpful in the detection of complications of the condition also. The treatment for pneumonia can vary depending on the gravity of the symptoms and the category of pneumonia the patient has. Bacterial pneumonia requires the administration of an antibiotic, the choice of which is influenced by the age of the patient, chronic medical conditions they may have and the microorganism responsible for the infection. Macrolides are the most popular choice of antibiotic and are usually recommended in the treatment of CAP as they are effective against most microorganisms involved in this particular class of pneumonia. Trimethoprim and sulfamethoxazole may be administered if the patient has a history of COPD or smoking. These antibiotics are usually accompanied by anti-fever medications such as ibuprofen and occasionally a cough suppressant may be suggested. There are fewer options in the treatment of viral pneumonia however as very few antiviral agents are available on the market. Acyclovir is efficacious in children with lung infections involving herpes simplex, herpes zoster or varicella varieties (Feldman, 1994). Ganciclovir has been successfully demonstrated in immunocompromised patients with conditions such as AIDS or transplant patients with CMV (cytomegalovirus) pneumonia (Reed et al., 1988). The prognosis of pneumonia is quite good in patients without complications. To aid in the prevention of this condition, rigorous hygiene procedures should be followed in settings such as hospitals and nursing homes where there are individuals present with compromised immune systems. Also, smoking cessation should be encouraged in patients. Current research is underway to establish a more efficient treatment for this condition which will still eradicate the infectious microorganism and promote early defense but without the inflammatory tissue injury associated with sepsis (Cazzola et al., 2005). Bibliography CAZZOLA, M., MATERA, M. PEZZUTO, G. 2005. Inflammation-a new therapeutic target in pneumonia. Respiration, 72, 117-126. CELIS, R., TORRES, A., GATELL, J., ALMELA, M., RODRIGUEZ-ROISIN, R. AGUSTI-VIDAL, A. 1988. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest, 93, 318. FELDMAN, S. 1994. Varicella-zoster virus pneumonitis. CHEST-CHICAGO-, 106, 22-22. FIEL, S. 2001. Guidelines and Critical Pathways for Severe Hospital-Acquired Pneumonia*. Chest, 119, 412S. FINEGOLD, S. 1991. Aspiration pneumonia. Reviews of infectious diseases, 737-742. LUNA, C., FAMIGLIETTI, A., ABSI, R., VIDELA, A., NOGUEIRA, F., FUENZALIDA, A. GENÃâ°, R. 2000. Community-Acquired Pneumonia*. Chest, 118, 1344. MARIK, P. 2001. Aspiration pneumonitis and aspiration pneumonia. New England Journal of Medicine, 344, 665. NIEDERMAN, M., MANDELL, L., ANZUETO, A., BASS, J., BROUGHTON, W., CAMPBELL, G., DEAN, N., FILE, T., FINE, M. GROSS, P. 2001. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. American Journal of Respiratory and Critical Care Medicine, 163, 1730. REED, E., BOWDEN, R., DANDLIKER, P., LILLEBY, K. MEYERS, J. 1988. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Annals of internal medicine, 109, 783. SMITH-SIMS, K. 2001. Hospital-Acquired Pneumonia. The American Journal of Nursing, 101, 24-24.