HEALTH TEACHING PLAN Learning Objectives Goal: After 2 days of nursing interventions, the client will report maximal

pain relief or control with minimal interference with activities of daily living Learning Content For some people, pain can be relieved without using medicine. They use relaxation, imagery, distraction, and skin stimulation. You may need the help of health professionals to learn to do these for yourself. Friends or family members can help with some of them. The techniques are also useful along with pain medicines. Information about nondrug treatments for pain also may be available at a local hospice, cancer treatment center, or hospital pain clinic. (http://www.hospicenet.org/html/without_med s.html) The nasopharynx is the upper part of the pharynx (throat) behind the nose. The pharynx is a hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes from the throat to the stomach). Air and food pass through the pharynx on the way to the trachea or the esophagus. The nostrils lead into the nasopharynx. An opening on each side of the nasopharynx leads into an ear. Nasopharyngeal cancer most commonly starts in the squamous cells that line the oropharynx (the Method Lecture Rationale Lecture will inform the patient more about the intervention that will be implemented. Time/Venue/ Resources Time: 2 10pm Evaluation After 8 hours of nursing interventions, Was the client able to report maximal pain relief or control with minimal interference with activities of daily living? YES_ NO_ Why?__

Venue: Veterans Memorial Medical Center

Resources: Pen and Paper Handouts Visual aids

Time and effort of both the nurse and patient.

part of the throat behind the mouth). As for any of the techniques described, you should use what works best for you. Heat often relieves sore muscles; cold lessens pain sensations by numbing the affected area. Many people with prolonged pain use only heat and have never given cold a try. Some people find that cold relieves pain faster, and relief may last longer. Skin stimulation is the use of pressure, friction, temperature change, or chemical substances to excite the nerve endings in the skin. Scientists believe that the same nerve pathways transmit the sensations of pain, heat, cold, and pressure to the brain. When the skin is stimulated so that pressure, warmth, or cold is felt, pain sensation is lessened or blocked. Skin stimulation also alters the flow of blood to the affected area. Sometimes skin stimulation will get rid of the pain, or the pain will be less during the stimulation and for hours after it is finished. Distraction means turning your attention to something other than the pain. Any activity that occupies your attention can be used for distraction. If you enjoy working with your hands, crafts such as needlework, model building, or painting may be useful. Losing Demonstration and Return Demonstration Return demonstration will evaluate the patients understanding about the procedures that are taught.

Demonstrate use of relaxation skills and diversion activities as indicated for individual situation.

yourself in a good book might divert your mind from the pain. Going to a movie or watching television are also good distraction methods. Slow, rhythmic breathing can be used for distraction as well as relaxation. You may find it helpful to listen to rather fast music through a headset or earphones. To help keep your attention on the music, tap out the rhythm. You can adjust the volume to match the intensity of pain, making it louder for very severe pain. This technique does not require much energy, so it may be very useful when you are tired.

Relaxation relieves pain or keeps it from getting worse by reducing tension in the muscles. It can help you fall asleep, give you more energy, make you less tired, reduce your anxiety, and make other pain relief methods work better. Some people, for instance, find that taking a pain medicine or using a cold or hot pack works faster and better when they relax at the same time. Relaxation may be done sitting up or lying

down. Choose a quiet place whenever possible. Close your eyes. Do not cross your arms and legs because that may cut off circulation and cause numbness or tingling. If you are lying down, be sure you are comfortable. Put a small pillow under your neck and under your knees or use a low stool to support your lower legs. Imagery is using your imagination to create mental pictures or situations. The way imagery relieves pain is not completely understood. Imagery can be thought of as a deliberate daydream that uses all of your senses - sight, touch, hearing, smell, and taste. Some people believe that imagery is a form of self-hypnosis. Certain images may reduce your pain both during imagery and for hours afterward. If you must stay in bed or cant go out of the house, you may find that imagery helps reduce the closed-in feeling; you can imagine and revisit favorite spots in your mind. Imagery can help you relax, relieve boredom, decrease anxiety, and help you sleep. ( http://www.hospicenet.org/html/without_meds .html)

Follow prescribed pharmacol ogical regimen.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may test the thyroid gland before and after therapy to make sure it is working properly. It is also important that a dentist check the patient's teeth, gums, and mouth, and fix any existing problems before radiation therapy begins. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

Lecture

Lecture will inform the patient more about the intervention that will be implemented.

When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Surgery Surgery is a procedure to find out whether cancer is present, to remove cancer from the body, or to repair a body part. Also called an operation. Surgery is sometimes used for nasopharyngeal cancer that does not respond to radiation therapy. If cancer has spread to the lymph nodes, the doctor may remove lymph nodes and other tissues in the neck. New types of treatment are being tested in clinical trials. These include the following: Biologic therapy Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Intensity-modulated radiation therapy Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.