In present scenario, John happens to be the patient of colorectal cancer that has been affecting men as well as women and happens to be the most common cause of cancer related death. The patient recently underwent a surgery and agreed to receive doses of Fluorouracil as a part of his chemotherapy treatment (Swan 2006). But after a few cycles, he developed some side effects in form of feeling very tired even after sleeping for a span of 9 hours. Due to this, he has reduced the work schedule to three days, in the rest of the days he looks after his grand children. No changes have been made by him in his dietary regime which happens to be the same which was before the diagnosis. The present essay has tried to present a brief over view about the relation between Fluorouracil and the side-effects faced by John. It will also focus on priority interventions so as to manage the side effects in form of fatigue. Persuasive interventions will also be constructed so as to develop a persuasive argument for the above mentioned intervention (Espie and et al. 2008).

1. INTERVENTIONS TO TREAT THE SIDE EFFECT
DUE TO FLUOROURACIL
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OVERVIEW AND BACKGROUND INFORMATION ABOUT JOHN’S EXPERIENCE
In present scenario, John happens to be the patient of colorectal cancer that has been affecting men
as well as women and happens to be the most common cause of cancer related death. The patient recently
underwent a surgery and agreed to receive doses of Fluorouracil as a part of his chemotherapy treatment
(Swan 2006). But after a few cycles, he developed some side effects in form of feeling very tired even after
sleeping for a span of 9 hours. Due to this, he has reduced the work schedule to three days, in the rest of the
days he looks after his grand children. No changes have been made by him in his dietary regime which happens
to be the same which was before the diagnosis. The present essay has tried to present a brief over view about
the relation between Fluorouracil and the side-effects faced by John. It will also focus on priority interventions
so as to manage the side effects in form of fatigue. Persuasive interventions will also be constructed so as to
develop a persuasive argument for the above mentioned intervention (Espie and et al. 2008).
ROLE OF FLUOROURACIL AND JOHN’S SIDE EFFECT
Fluorouracil is a drug belonging to class of chemotherapy which interferes with the cells that make
DNA and RNA so as to stop the growth of cancer cells. These have long been used to treat cancer inclusive of
colon, rectum, and head. The given drug has been associated with causing many side effects among which
fatigue is also present which usually happens during and after treatment (Saltz 2007). Same has been the case
with John, where he has been facing fatigue leading to reducing his work days to a span of three per week. This
can happen due to lessening of red blood cells which is further associated with causing of anemia. Moreover,
chemotherapy treatments usually results in anemia which is clear on basis of the full blood count sheet that
has been provided for the patient (Lower and et. al. 2009). There is a high risk of developing macrolytic anemia
whose major symptom is fatigue.
INTERVENTION ONE: NURSING INTERVENTION
In the present situation it will be essential to deal with the fatigue issues faced by the patient with the
help of nursing interventions. In present situation, it would be beneficial to assess the signs and symptoms of
fatigue in the patient which is found to be inability to maintain the daily routine on account of fatigue (Swinson
and Seymour 2012). Then it will be required to assess the severity of fatigue followed by assessment of the
patterns. This may be in terms of time of the day, after certain activities. The most important step will be to
plan out activities so as to manage the fatigue.
In this regard, various actions can be performed by nurses to promote rest and conserve energy. It is
advisable to schedule several rest periods throughout the day as compared to taking a complete sleep of nine

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hours (Jacob 2012). Proper sleep measures can be promoted by encouraging relaxation activities in evening,
reducing environmental stimuli that may reduce sleep. If possible sedative-hypnotics can also be prescribed.
The patient is involved in many local charity activities which must be reduced as in present situation it is very
essential to conserve energy. Measures are also required to be taken for reducing the fear and anxiety that is
happening
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Other than this many energy saving techniques in form of using shower chair, sitting while brushing
teeth or combing hair, prioritizing activities and eliminating the ones that are optional can also be beneficial
(Chu and et.al. 2008). The patient can also be encouraged to maintain a prescribed fluid level of at least 2500
ml/ day so as to eliminate the byproducts that are happening in cancer as a result of cellular breakdown.
Routine exercises in form of pacing oneself by a moderate pace rather than rushing through the activities can
be advisable. It will also be helpful to reduce a sudden jerk or prolonged strains (Williams 2008). Walking,
swimming, cycling and a combination of aerobic and resistance training can help to reduce the fatigue. This
may involve for weekly to daily exercise regimens. Other than this, alternative sitting and standing regimes will
also be beneficial.
The nurses’ intervention can also involve the usage of coping strategies to deal with fatigue. These can
be inclusive of positive thinking approach, conservation of energy, accepting what cannot be changed, humor
as well as trusting those who can readily provide a social support. Education as well as counseling strategies
can also play a key role to help in supporting the self management of fatigue by the patients (Andrews and et.
al. 2007). The counseling sessions given by nurses can aid in understanding the reasons behind fatigue and can
help the patient in having an increased control over the feeling. Hence, it is clear that the intervention of nurses

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can play a key role to combat fatigue as a side effect due to uptake of chemotherapy drug. The promising
intervention seems to be exercises, sleep regimes, relaxation and counseling sessions (American Cancer Society
2011).

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INTERVENTION TWO: COLLABORATIVE INTERVENTION
The second intervention can be collaborative in nature where activities can be carried out by nurses in
collaboration with health care team members in form of dietitians, physical therapists, and physicians. As it is
clear from the mentioned blood count chart that the level of White count cell as well as Neutrophils is less than
the normal range clearly indicates high risk of developing infections (Fakhimi and Probert 2013). Hence, the
collaborative intervention by involving physicians can be undertaken. They may recommend a course of
antibodies to prevent the onset of any infection. They can also suggest other medications in form of growth
factors or granulocyte-colony stimulating factors for increasing the white blood cell production in the bone
marrow. In this regard it will be essential for the nurses to be aware about how the drug is to be administered,
normal dosage levels, side effects and their prevention as well as special precautions to be taken for evaluating
the effectiveness (Mayer, 2009).
Other than this, the collaborative interventions can also involve for dietitians. This will play an effective
role to promote an adequate level of nutritional status. It is essential for the nurses to help the patient to follow
a proper diet chart which can be used to maintain the red blood cell count in the body
(Ndukwe and et.al., 2012). This is essential as it seems that the patient may approach towards anemia. Hence
the collaborative treatment will involve fixing the diet that would help increasing the level of iron in blood. A
proper diet chart may also be designed and made sure by the nurses that the patient adheres to it. Here, the
decisions can be taken to decide over the nutritional supplements, time as well as amount of intake among
others (Holt and et.al. 2009). It is the responsibility of nurses to be aware about any precautionary measures
that must be followed with the patient taking care of the prevailing health status that is being faced by the
patient. It will also be essential to evaluate the effectiveness of diet after a brief span of time (Eaton and Tipton
2009). There can also be a usage of transfusion therapy and/ or administration of recombinant human
erythropoietin also known as Epoetin alpha. Hence, it is the responsibility of the nurses to make sure that the
therapy has been administrated properly (Hurter and Bush, 2007).
A collaborative intervention with a physiotherapist can also be essential. In this regard, it is the
responsibility of nurses to decide on the type of exercise to be followed, the time of day, weeks and location
of activity so as to enable the patient for carrying out a frequent regime as per the requirement for reducing
the fatigue (Gorin and McAuliffe 2009). Nurses must be responsible towards taking care of the special
precautions that must be remembered while helping the patient follow their daily exercise regime. This should
be carried out keeping in mind the general health status.

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CRITERIA USED TO EVALUATE FOR EFFECTIVENESS OF INTERVENTIONS
On the basis of above criteria it will be beneficial to evaluate the effectiveness of chosen interventions.
Both independent as well as collaborative interventions can be chosen. The nursing as well as collaborative
interventions will help in managing the patients’ problems. The nursing intervention will provide for finding
out the level of fatigue being experienced by John. They will suggest for basic measures that can be used to
reduce the level of fatigue (Somunoglu and Tatar 2012). On the other hand, the collaborative interventions will
provide for added measures to deal with the other issues. From the blood cell count it is very clear that there
has been a decrease in white blood cells, neutrophils, platelets which is a clear indicator towards chances of
developing infections and movement towards anemia.
Hence, the medications as well diet chart will help in reducing the severity of side effects. The
interventions nursing and collaborative interventions is appropriate for the patient’s health issue because
other than treating the fatigue they will also aid in the direction of dealing with chances of developing infections
and the issues faced in terms of anaemia (Segal and Saltz 2009). Moreover, they will assist in assessing the signs
and symptoms of fatigue, finding out the level of severity and assessment patterns in form of level of fatigue
in terms of time of the day and after certain activities. They will aid towards planning out activities so as to
manage the fatigue by inducing proper sleeping, energy conservation exercises, and usage of coping strategies
can aid towards decreasing the fatigue levels.
SUMMARY
The above essay aided in the direction of following the care considerations that are associated with
treating colorectal cancer. The patient has been suffering from side effects in form of fatigue after
administration of chemotherapeutic drug Fluorouracil. Hence there has been a suggestion towards nursing as
well as collaborative interventions so as to treat the side effects. It is clear that it will be beneficial to use both
kinds of interventions for treating the patient (Toth 2006). Both are effective as nursing intervention will
provide for a means to evaluate the basic condition being faced by the patient along with suggesting him
towards basic measures that must be followed. However, based on the full blood count, it is clear that patient
may develop an increased risk towards catching infections and anemia (Larkin, Lopez and Aromataris 2012).
This can result in more fatigue. Hence it will be beneficial to use the collaborative intervention as well. It will
be in collaboration with the dieticians, physicians and physiotherapist to help in provision of advanced
treatment.

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