Systemic Therapy Unit: It is also known as oncology unit. It treats patients for post-operative care for chemotherapy or cancer.par Meet Shah
1. Unit 7 - Admission, Transfer and Discharge
1.1. • In this, the admission could be either elective or direct depending upon the situation. If the primary doctor refers to the systemic care unit, then it is a direct admission. • The average LOS in systemic care unit for patients is 6 to 9 days. However, it may varies depending upon the recovery and symptoms of patient. • The possible supports needed by patient could include chemotherapy, testing, prescriptions, and follow-up procedures. It is understood that patient might be needing chemotherapy for their treatment of cancer, also prescription of discharge medications could contain numerous medications, and after some times they might need follow-up and testing for their growth and status of tumor.
2. Unit 6 - Patient Records
2.1. • Radiology/Imaging reports: It is used for diagnosing any dysfunctionality due to cancer in bodies by MRI, CT scan and X-ray. • Consultation reports: These reports are providing care recommended by doctor and is prepared by the specialist doctors consulted for the medical problem in patient. • Progress notes: It contains the progress in the patient’s body during their whole stay in the hospital. It also contains vital signs, medications of patient.
3. Unit 5 - Staffing
3.1. • The nursing model used in systemic care unit is primary nursing care. It is because this unit is a high acuity unit as there are patients with more severe symptoms in this. • The staffing ratio in this unit is 1:4. • The coverage required in this unit is 24/7 as the in systemic unit, there may be emergencies at overnight which might require nursing staff at overnight.
4. Unit 4 - Risk Management
4.1. Risks associated with clinic: • Infection – It is the most dangerous risk for the people because of their low immunity which makes them more viable to infectious pathogens in hospital setting. • Cognitive decline – It happens because of their ongoing medications and illness and to remove this factor sometimes doctors need to see patients for cognitive impairment.
4.2. Code Blue - it is for cardiac arrest. Sometimes patients might get cardiac arrest with ongoing treatment. Code White – it is for violent patient, patients with mental distress in this unit might become violent. Code Yellow- it is for missing patient, this is also because of patient’s mental disability they ran away from hospital.
5. Unit 3 - Communication
5.1. Challenges faced by patients: • Elderly patients could face some challenges because of hearing & vision impairment and cognitive decline. • When communicating with mentally ill patients, it is a challenge as they have anxiety and depression as their mental capabilities of understanding doctor’s terminology is hard
5.2. • Communication devices used are call-bells and communication board. These are common devices used. • Call bells are used by patients for calling nurses and doctors on the floor.
6. Unit 2 - Organization of Hospital/Care Units
6.1. This is typically an inpatient unit.
6.2. • Mainly, their purpose is providing systemic therapy to cancer patients. Goal is providing nice and safe surrounding for patients, improve quality of life, monitoring side effects. • Procedures typically performed are: chemotherapy – it is drug used for cancer patients for killing cancer cells, blood transfusion – it is for patients with anemia and cancer to replace blood cells lost or damaged.
6.3. Typically, this unit comes under oncology department services because it mainly deals with patients who have cancer.
7. Unit 1 - Health Care Professionals
7.1. Some of the consultants for this department are palliative care physician, medical oncologists, GP, radiation oncologists. • Medical oncologists – they are specialized in treating through types of therapies and psychological care for improving ability. • General Practitioners (GP) – they assess and treat patient issues affecting them in their work.
7.2. • Registered Nurse (RN) and Nurse Practitioner (NP) are nursing staff in this department. • They conduct clinical procedures, and prescribe medications for patient.
7.3. Health workers of unit are clinical psychologist, occupational therapist, etc., treats patient mental health, works on developing patient skills.
8. Unit 4 (HUA 2) : Pharmacology
8.1. 1) Anthracyclines: Type of chemotherapy drug, cancer cells are killed by anthracyclines by damaging their DNA. • Doxorubicin HCL 10mg/5mL injection IV daily prn. 2) Warfarin: Type of anticoagulant and blood clots in your blood and blood arteries are prevented from forming or expanding. • Coumadin 10 mg OD PC daily. 3) Tyrosine kinase inhibitors (TKIs): Type of targeted therapy drugs and used to kill abnormalities in cancer cells by targeting it. • Dasatinib (Sprycel)140 mg PO daily. 4) Aromatase inhibitors: Type of hormone therapy medication used to inhibit growth of cancer in body. • Arimidex 1 mg PO daily x 5 years 5) Cytokines: Type of immunotherapy agents used to attack the recognized cancer cells by stimulated immunity of body. • Aldesleukin 0.03mg/kg IV q8h
9. Unit 3 (HUA 2) - Direction of Care
9.1. Common food restrictions: 1) Sodium restriction: It is needed because more intake of sodium can also increase the chances of hypertension, disturbing balance of electrolytes which is not ideal who is on systemic therapy. 2) Low-fiber diet: It is recommended because these therapies might affect GI tract which could cause diarrhea and in that case this diet is necessary for patient.
9.2. Common Activity orders: 1) Walking or ambulation: In the systemic therapy unit, encouraging early ambulation and walking is frequently given emphasis. This increases strength and circulation in body. 2) Energy conservation: Systemic treatments may make you feel drained and less energetic. Patients could receive advice on setting priorities for the day and conserving energy to manage fatigue and avoid overexertion.
9.3. Common nursing interventions: 1) Vitals check and assessment: Doctors advise nurses to regularly check vitals and assess patient’s condition to find on any adverse reaction of systemic therapies. 2) Psychosocial support: Nurses are ordered to help patient support their psychological and emotional needs who are undergoing systemic therapies.
9.4. Common IV/oxygenation interventions: 1) IV Insertion and maintenance: To help in the administration of systemic therapy and other drugs, nurses deftly place peripheral IV catheters or central venous access devices. 2) Oxygen therapy: Patients who need additional oxygen to maintain optimal oxygenation may get oxygen treatment from nurses.
9.5. Common GI or GU interventions: 1) Diarrhea Management: The prevalent adverse effect of systemic medication, stools, is managed by nurses using strategies. This can entail dietary changes. 2) Oral Care: In addition to advising patients who are receiving systemic medication on good dental hygiene practises, they also offer education on the subject. They also help in regular mouth cleaning, brushing teeth.
9.6. Consult order: Consultation to oncologist: For a patient receiving systemic therapy, a primary care physician may ask for an oncology consult in order to receive specialised knowledge in the management of cancer-related treatment and side effects.
10. Unit 2 (HUA 2) - Investigations
10.1. Common lab tests: 1) Complete Blood Count (CBC) test: It is used to evaluate patient’s RBC, WBC, and platelets count which could be helpful in diagnosing anemia, finding the fatalness of cancer in patient. 2) Circulating Tumor Cell (CTC) test: Helpful in counting, identifying, & capturing tumor cells from sample of patient’s blood. 3) Renal Function Tests: It helps in determining side effects of systemic therapy on kidney.
10.2. Common diagnostic tests: 1) Biopsy: It is done in microbiology unit and helps in determining and confirming the stage of cancer and its treatments. 2) Positron Emission Tomography (PET) scans: It is done with radiology unit and is used to diagnose the size & location of tumors, and response of treatments to tumors. 3) Cytogenic analysis: It is carried out in the microbiology lab and involves looking for genetic anomalies by analyzing chromosomes, which is used to identify leukemia. 4) Molecular pathology: It is used to diagnose any genetic mutations in cells of tumor and carried out in pathology unit. 5) Magnetic Resonance Imaging (MRI): It is done in radiology unit and is used to determine the tumor in brain.
