Summer 2016, Volume 7, Issue 3
Welcome back to EBSCO Health's free evidence-based nursing newsletter. We will periodically send news on the latest evidence in nursing. Please share this with your colleagues, students, practitioners and others who would benefit from this information.
Tim is a 10-year-old boy being treated in the Rehabilitation Unit following a car accident. The nurse caring for him is concerned regarding the risk of exposure to seasonal influenza from his visitors, so she consults Nursing Reference Center Plus, keying in the words "seasonal influenza children." She retrieves the quick lesson "Seasonal Influenza in Children and Adolescents."
The nurse reads about seasonal influenza in children and adolescents, including risk factors, signs and symptoms, potential complications, laboratory tests, treatment goals and interventions. Based on the information in the quick lesson, the nurse educates Tim's family about the signs and symptoms of seasonal influenza, as well as informs them about droplet and contact precautions, and influenza vaccines. She carefully monitors Tim for signs and symptoms of seasonal influenza.
Note: The above-referenced quick lesson is freely accessible to all readers of the EBSCO Health Nursing Newsletter.
Colon cancer is a malignant tumor that develops in the large intestine. The etiology of colon cancer is thought to be multifactorial, and both genetic and environmental factors are implicated. The development of colon cancer begins with mucosal cell hyperplasia (i.e., an abnormal increase in the number of cells), which over time forms a benign tumor (e.g., polyp). Dysplasia (i.e., abnormal cell development) subsequently develops and eventually manifests as cancer (e.g., adenocarcinoma), which has the potential to metastasize. The liver is the most frequent site of metastasis. Other common sites of metastasis are the lung, peritoneal cavity, adrenal glands, ovaries and bone.
Colon cancer is often preventable with screening and early intervention as identified polyps can be removed before progression to neoplasia; an early premalignant lesion takes approximately 10-20 years to progress to malignant cancer. Screening and early intervention are important because they greatly increase the odds of cure. Guidelines recommend that all individuals undergo a screening colonoscopy at least every 10 years starting at 50 years of age. Individuals who are at increased risk should be screened starting at a younger age and at more frequent intervals. Colonoscopy has replaced flexible sigmoidoscopy as the gold standard, recommended method of screening because the entire colon can be visualized and polyps can be removed during the test. Intervals for repeat colonoscopy vary according to the quantity of polyps found and degree of dysplasia.
Prognosis in colon cancer is correlated with TNM (tumor, node, metastasis) staging. T (T1-T4) corresponds to the depth of tumor invasion, and T4 is the most invasive. N (N0-N2) describes lymph node involvement. M indicates the presence (M1) or absence (M0) of metastasis. Patients with stage I colon cancer (i.e., T1-2N0M0) have a greater than 90% chance of surviving 5 years, and patients with stage IV colon cancer (i.e., any stage that includes M1) have only a 5-7% chance of surviving 5 years.
Treatment options include surgery (e.g., removal of the primary tumor and/or isolated liver or lung metastases), neoadjuvant chemotherapy (i.e., receiving chemotherapy prior to surgery), adjuvant chemotherapy (i.e., receiving chemotherapy after surgery), hepatic arterial infusion (HAI; i.e., regional chemotherapy to treat liver metastases), monoclonal antibody therapy (e.g., bevacizumab, cetuximab, panitumumab), and radiation therapy. For surgical resection, laparoscopy should be considered as an option depending on the experience of the surgeon. Treatment follow-up includes clinical and laboratory evaluation every 3-6 months for 5 years, annual imaging studies for 3 years, and colonoscopy at 1 year and subsequently as clinically indicated.
Please log in to your Nursing Reference Center™ or Nursing Reference Center Plus subscription to read the quick lesson on "Colon Cancer."
Recently, the evidence-based care sheet "Herpes Zoster (Shingles) in Older Adults" was revised following review under the Systematic Literature Surveillance Program. Among new information of value to nursing practice was a systematic review regarding the prevention of herpes zoster in adults.
Cochrane reviewers identified 13 randomized controlled trials including 69,916 participants and concluded that Zostavax administration results in a 51% reduction in the occurrence of shingles in patients aged ≥ 60 years at up to 3 years' follow-up.
We invite you to log in to Nursing Reference Center or Nursing Reference Center Plus to read updated content as it becomes available.