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colorectal 3

colorectal 3

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Publicado porJanice MǾntañǾ

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Published by: Janice MǾntañǾ on Jul 31, 2011
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COLORECTAL CANCER

Is a disease in which normal cells in the lining of the colon or rectum begin to change, start to grow uncontrollably, and no longer die. Less formally known as bowel cancer,is a cancer characterized byneoplasia in the colon, rectum, or vermiform appendix.

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Fecal occult blood test - Used to detect blood in the feces which can indicate the presence of polyps or cancer. Colonoscopy - Allows the doctor to look inside the entire rectum and colon. - A screening test that allows the removal of polyps. Sigmoidoscopy - Is inserted into the rectum & lower colon to check for polyps, cancer and other abnormalities.

DIET: High fiber diet Low fat diet NURSING DIAGNOSIS: 1. Imbalanced nutrition, less than body requirements 2. Anxiety r/t impending surgery and the diagnosis of cancer. 3. Impaired skin integrity r/t the surgical invasions (abdominal and perianal), the formation of a stoma, and frequent feacal contamination. 4. Risk for infection r/t formation of stoma. 5. Disturbed body image r/t presence of stoma. 6. Ineffective sexuality patterns r/t changes in body image and self-concept. NURSING CONSIDERATION:

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CAUSE: Unknown. RISK FACTORS: • Increasing age (age of 40) • Family history of colon cancer/ polyp • History of inflammatory bowel disease • High-fat, high protein, low-fiber diet • Smoking • Heavy alcohol intake • Obesity SIGNS & SYMPTOMS: - Change in the bowel habits - Persistent nausea - Unexplained anemia - Unexplained anorexia - Unexplained wt. Loss - Persistent tiredness ∗ Associated with Right-sided lsions - Dull abd’l pain - Melena (black, tarry stool) Associated with Left-sided lesions (obstruction) - Abd’l pain 7 cramping - Narrowing stools - Constipation - Bright-red blood in the stool

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TNM/STAGES: The stages of colon cancer are:

Stage 0. Your cancer is in the earliest stage. It hasn't grown beyond the inner layer (mucosa) of your colon or rectum. This stage of cancer may also be called carcinoma in situ. Stage I. Your cancer has grown through the mucosa but hasn't spread beyond the colon wall or rectum. Stage II. Your cancer has grown into or through the wall of the colon or rectum but hasn't spread to nearby lymph nodes. Stage III. Your cancer has invaded nearby lymph nodes but isn't affecting other parts of your body yet Stage IV. Your cancer has spread to distant sites, such as other organs — for instance to your liver or lung.

∗ ∗ ∗ ∗ ∗

Associated with Rectal lesions - Tenesmus ( painful straining at stool) - Rectal pain - Feeling of incomplete evacuation after a bowel mov’t - Alternating constipation & diarrhea - Bloody stool TEST & PROCEDURES:

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Digital rectal exam - Effective in detecting rectal cancer, however doctors are able to detect only 7-10% of colorectal cancers since most of the colon cancer cannot be felt by the examiner’s finger.

Recurrent. This means your cancer has come back after treatment. It may recur in your colon, rectum or other part of your body. TREATMENT: MEDICAL: Aspirin Cimetidine Chemotherapy Radiation therapy

♥ SURGICAL: 1. Segmental Resection with anastomosis 2. Temporary Colostomy 3. Permanent Colostomy or Ileostomy

Providing wound care and preventing infection Examines the abdominal dressing during the first 24 hours after surgery to detect hemorrhage. Help the patient splint the abdominal incision during coughing and depp breathing to lessen tension on the edges of the incision. Monitor vs for elevation which may indicate an infectious process. Maintaining optimal nutrition and hydration The diet is individualized as long as it is nutritionally sound and does not cause diarrhea or constipation. Avoid foods that cause excessive odor and gas (cabbage, eggs) Advise to increase fluid intake at least 2-3 L per day. Supporting positive body image Encouraged to verbalize feelings and concerns about altered body image If applicable, the pt must learn colostomy care Help the pt overcome aversion to the stoma by providing care and teaching in an open and accepting manner. Show to the pt a positive supportive facial expression and other non-verbal cues. Encourage spouse/S.O to view the stoma. Discussing Sexuality issues Review, when appropiate, that an ostomy in a woman does prevent does not prevent a succesful pregnancy. Alternative sexual positions are recommended, as well as alternative

Over 2 hours. 5. Inform the patient the she/he may:  Feel quite sleepy during the test  Experience abdominal pressure. and risks of the test.  cook meat products in low temperature  take daily vitamins(folate. Place client in side-lying (sims) position. 6. NPO after midnight the day before the test Patient must bring a competent adult who responsible for signing out and must receive the discharge instructions. platelet count results should be reviewed and charted. DURING TEST: 1. Persons with known heart disease may receive prophylactic antibiotics before the test. 6.  It is a screening test for cancer of the colon and is encouraged on a regular scheduled basis for persons over the age of 40. 5. 2. • As the colonoscope advances. Advise those Diabetic persons not to take insulin before the procedure but to bring insulin with them. 7.  Foreign objects. vegetables. NURSING CARE: Before Test: 1. bleeding.methods of stimulation to satisfy sexual drives. then inyroduces the sigmoidoscope into the colon. and biopsy specimens can be removed through the colonoscope. the CBC. The sigmoidoscopy is an important tool in screening for colon cancer in clients who are at risk. 2. In the evening before the test. an ECG may be ordered to monitor the cardiac status during the procedure. Instruct client to report a rise in temperature. If the client has a history of cardiac problems. 6. Explain the procedure. Take baseline vital signs and oxygen saturation of arterial blood.  Procedure • Insert a well-lubricated colonoscope about 12cm. prothrombin time.  minimize intake of red meat and fatty foods as well as processed foods. Instruct to discontinue aspirin and aspirin products 1 week before the test. ECG and Oxygen saturation. During Test: 1. POTENTIAL COMPLICATION: ♥ Bowel perforation ♥ Hemorrhaging ♥ Peritonitis ♥ Cardiac arrhythmias CONTRAINDICATION: ♥ Diverticulitis ♥ Fistulas ♥ Third-trimester pregnancy ♥ Sedatives ♥ Bleeding disorders ♥ Acute peritonitis INDICATIONS: 1. 5. BEFORE THE TEST 1. The rigid sigmoidoscopy may require the client to be in the knee-chest position. Instruct patient on clear liquid diet for 72 hours before the test. After Test: 1. An enema is often administered in the morning before the test. 3. Locates areas of bleeding. or sustained bleeding. Evalutes irritable bowel syndrome or diverticular disease. INDICATIONS: To Diagnose: ♥ Polyps and tumors inflammation ♥ Hemorrhoids diverticulosis malformation The 1 day preparation consists of glycol (CGOLyte) bowel preparation is taken orally every 10-15mins. 2. into the bowel. Instruct to discontinue iron preparations 3-4 days before the test. Biopsies can be sent o the laboratory after being put in the preservative and properly labeled. but massively. benefits. Explain the procedure and the purpose of the test. PREVENTION Lifestyle and nutrition Exercise regularly  high intake of dietary fiber (from eating fruits. Take VS before the client is released. polyps. 2. Air may be introduced into the bowel. COLONOSCOPY  It is the most direct way to visualize the intestinal mucosa and can be done in clients who are actively. TEST PROCEDURE: 1. 2. 2. instruct client to take oral cathartics. if the client is extremely anxious. thromboplastin time. ♥ ulceration and ♥ origin of bleeding ♥ Diverticula/ ♥AV PATIENT EDUCATION procedure) GUIDELINES (Before the 1. Perform continuous monitoring of the patient’s V/S. 3. 4. The examiner performs a rectal examintaion. 2. 4. usually in the left side for the flexible sigmoid examination. 4. 3. Client may be placed on a clear liquid diet 24hrs before the test. purpose. Vitamin D) SIGMOIDOSCOPY  It involves the insertion of an instrument into the anus and up into the colon allowing the examiner to directly view the walls of the colon. . Place patient in left sided or Sim’s position and drape properly. 4. 3. the patient may need to be repositioned to aid in proper visualization of the colon. Ensure that resuscitation equipment is available. Consent form must be signed after patient has received proper instruction about the test 3. Before testing. 3. and other high fiber food products). ulceration and irritation.  Sites of active bleeding may be treated. abdominal pain. • Ask the patient to take a deep breath through the mouth. Start an IV line and use administration of sedatives and narcotics. Instruct client to report unsual discomfort. 3. Inform client that he may experience some flatulence and mild discomfort. Assess the client’s knowledge of the test. mild pain/ cramping  Pass gas(flatus) or urge to defecate 4. cereals. relieved with change of position. Mild sedatives may be given.

she should inform her healthcare provider. FECAL OCCULT BLOOD TEST For the presence of blood in the stool as an indicator of gastrointestinal bleeding. 2. 5. COLOSTOMY Pre-Operative Implementation 1. 2. blood in stool. or necrotic tissue. EQUIPMENTS Direct examination of stool: commercial kit. 14. Blood may be present in isolated areas of sample so testing more than one spot increases chance of capturing target area. if positive. Instruct client to report any color changes to their health care provider when using the direct method of testing. 6. cardiac or respiratory arrest. Irrigate perineal wound if present and if prescribed. depending on the area of the colostomy. Observe for possible complications. Client reads test and. hypotension. 10. if requested. peroxide preparation is then applied to sample spots. Advise to avoid eating and drinking dairy products. 4. Elderly clients are more at risk for interfering factors associated with constipation and hemorrhoids. Caution should be exercised in interpretation of results as the direct stool examination results may be altered by many factors related to diet. Monitor V/S and oxygen saturation. Administer analgesics and antibiotics as prescribed. Expect that store will be liquid postoperatively but will become more solid. 3. 3. The client collects a random stool specimen and feces should be tested from two separate areas. If test is being done in an institution or health care agency. Screens for diverticulitis and colitis. Instruct client not to eat foods for 2 days that interfere with results. 2. medication. CONTRAINDICATIONS 1. informs health care provider. DURING TEST 1. CLINICAL IMPLICATIONS AND INDICATIONS 1. Instruct for NPO (2 hours after the test) and encourage fluids (to prevent dehydration associated with bowel preparation. 4. 18. Instruct client to resume normal diet once testing is complete. 3. the test can be read on the unit or. red or orange colored foods/ beverages. 13. Inform client that one method of collecting the specimen is to place a loose film of plastic wrap across the toilet bowl. INDIRECT TESTING OF SPECIMEN 1. Ascending colon colostomy: expect liquid store. can be sent to the laboratory for testing. Again. NURSING CONSIDERATIONS 1. Post-Operative 1. wooden applicator stick or tongue blade Indirect testing: commercially prepared biodegradable test pad DIRECT EXAMINATION OF SPECIMEN 1.• If necessary. Monitor for color changes in the stoma. 3. Inform client that if positive results are obtained. The hydrogen peroxide agent reacts with the pseudoperoxidase activity of any hemoglobin present in sample and oxidizes out as a change in color. 17. The sample is spread over the identified testing areas of the kit. AFTER TEST: 1. 7. Aminister laxatives and enemas as prescribed. • Recent abdominal or bowel surgery. abdominal pain and distension. 2. indicating high vascularity. Note that the normal stoma color is red or pink. endoscopic surgery is performed to remove polyps on tissue in biopsied. 11. Instruct the clint to avoid foods that cause excessive gas formation and odor. 2. and a purple-black stoma indicates compromised circulation. a biodegradable test pad is thrown directly into the toilet bowl. unusual bleeding. Assess the functioning of the colostomy. A blue-green color will appear on the test pad if occult blood is present. Urine and emesis should be tested for blood with a dipstick style of testing rather than occult blood kits. 9. Empty pouch when one-third full. Screens for carcinomas (particularly colon) and polyps of GI tract. 3. To reduce risk of false negatives/positives and increase chance of identifying presence of blood. Fecal matter should not be allowed to remain on the shin. 4. 3. Place a pouch system on the stoma as soon as possible. Infants and children will need assistance in obtaining stool specimen. Consult with the enterostomal yherapist to assist in identifying optimal placement of ostomy. requiring physician notification. Following a bowel movement. Monitor the stoma for size. 2. Place a petroleum jelly gauze over the stoma to keep it moist. The test should be repeated for three consecutive stools. further testing is likely. 16. and monitor for signs of infection. Instruct the client to eat low-residue diet for a day or two prior to surgery as prescribed. followed by a dry sterile dressing if a pouch system is not in place. and other factors. Assess the client’s knowledge of the test. Monitor the pouch system for proper fit and signs of leakage. 12. 2. Transverse colon colostomy: expect looseto semiformed stove. 8. Instruct the client in stoma care and irrigation as prescribed. Barium enema in last 72 hours . Explain the test procedure and the purpose of the test. AFTER TEST 1.) 4. 2. and the hydrogen NURSING CARE: BEFORE TEST 1. 2. • Serious cardiac or respiratory problems. Note that a pale pink stoma indicates low hwmoglobin and hematocrit levels. There are two main methods of tests on the market: those that require direct examination of stool and those that provide testing material that can be thrown into the toilet bowl without direct handling of feces. Menstruation 2. Identifies GI bleeding related to upper GI bleeding (gastric ulcer). Adhere to standard precautions. and also those juices with pulp CONTRAINDICATIONS: • Massive intestinal bleeding. Descending colon colostomy: expect close to normal stool. 15. • Suspected perforation of the colon. if the client is doing home testing and gets a positive result.

Instruct the client that normal activities may be resumed when approved by the physicians. Stool is liquid. 3. Do not give suppositories through ileostomy. Postoperativedrainage will be dark given and progress to yellow as the client begins to eat.19. Risk for dehydration and electrolyte imbalance exists. a color change to dark blue or black should be reported to the physician. 2. Post-operative: ILEOSTOMY 1. Healthy stoma is red. . 5. 4.

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