Question

Alex is a nurse who volunteers at a local medical mission for an impoverished neighborhood in his community. Mary and her husband came to the clinic and asked Nurse Alex about genetic testing for colon cancer. Mary is a 40 year-old woman who has not had any serious or chronic medical problems in her lifetime. She is interested in getting tested because her sister was diagnosed at age 31 with colon cancer and died seven months after she received that diagnosis.

Alex took a thorough family history for Mary and learned that she is the mother of two children (16 y.o. daughter and 12 yo son), that Mary's mother had endometrial cancer at age 45, and that Mary's maternal aunt is a survivor of small bowel cancer. Nurse Alex recognized that Mary is at increased risk for hereditary non-polyposis colorectal cancer (HNPCC).

Nurse Alex was able to refer Mary for genetic testing for HNPCC and scheduled her for a colonoscopy screening. The genetic tests indicated that Mary does carry a gene alteration causing HNPCC and her colonoscopy showed a healthy bowel, free of polyps. Armed with this knowledge, Mary follows her health care provider's advice and plans to have a colonoscopy every year and will be screened for endometrial cancer.

Answer the following questions about this case study:

1) What are the steps nurse Alex should do to help the family of Mary complete a family health history?

2) What are the "genetic red flags" in Mary's family histories?

3)  Now that Mary is more aware of her risk, what advice should nurse Alex provide for Mary's children?

Answer 1

1. Patient's health history is collected through the interview process.Using structured ordered for collecting data during the interview process facilitates completion of a thorough patient health history. It includes demographic data; chief complaint or present illness; allergies and sensitives; medication, vitamins, and herbal supplement; immunization; medical history; surgical history; social history; cultural and spiritual or religious traditions; ADLs; cognitive and emotional status

The steps that should be taken by the Nurse Alex to complete a family history are :-

- Preparatory Phase

Review chart, assess own feelings

- Introductory Phase

Introduce self, purpose of interview, develop goals and provide privacy and comfort

- Working Phase

Obtain objective data, validate information, work with pt to establish goals

- Closing Phase

Summarize, validate, identify nursing diagnoses, listen to the patient and allow him/her to ask questions

2. The genetic red flags in Mary's family history are :-

- Mary's sister was diagnosed at age 31 with colon cancer and died seven months after she received that diagnosis.

- Mary's mother had endometrial cancer at age 45

- Mary's maternal aunt is a survivor of small bowel cancer.

- The genetic tests indicated that Mary does carry a gene alteration causing HNPCC.

3. Advices that should be provided by the nurse are :-

- advice patient for regular follow ups

- advice patient to do yearly colposcopy

- advice patient to avoid foods that causes diarrhea and constipation

- teach patient about the signs and symptoms of colorectal cancer

- provide patient with specific directions about when to call the physician and what complications require prompt attention like bleeding , abdominal distension , rigidity , fever etc.