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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.
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:
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
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.
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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:
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
Instruct to discontinue iron preparations 3-4 days before the test. ♥ ulceration and ♥ origin of bleeding ♥ Diverticula/ ♥AV PATIENT EDUCATION procedure) GUIDELINES (Before the 1. Ensure that resuscitation equipment is available. 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. and other high fiber food products). 3. 5. but massively. cook meat products in low temperature take daily vitamins(folate. 3. Instruct patient on clear liquid diet for 72 hours before the test. • As the colonoscope advances. Foreign objects. Instruct client to report a rise in temperature. Take baseline vital signs and oxygen saturation of arterial blood. minimize intake of red meat and fatty foods as well as processed foods. During Test: 1. 5. Explain the procedure. polyps. cereals. Instruct client to report unsual discomfort. usually in the left side for the flexible sigmoid examination. • Ask the patient to take a deep breath through the mouth. Mild sedatives may be given. Procedure • Insert a well-lubricated colonoscope about 12cm.methods of stimulation to satisfy sexual drives. instruct client to take oral cathartics. or sustained bleeding. Place client in side-lying (sims) position. COLONOSCOPY It is the most direct way to visualize the intestinal mucosa and can be done in clients who are actively. platelet count results should be reviewed and charted. The sigmoidoscopy is an important tool in screening for colon cancer in clients who are at risk. if the client is extremely anxious. Take VS before the client is released. 3. 4. The examiner performs a rectal examintaion. The rigid sigmoidoscopy may require the client to be in the knee-chest position. Perform continuous monitoring of the patient’s V/S. If the client has a history of cardiac problems. 2. the CBC. 3. Advise those Diabetic persons not to take insulin before the procedure but to bring insulin with them. prothrombin time. Instruct to discontinue aspirin and aspirin products 1 week before the test. 4. into the bowel. vegetables. benefits. the patient may need to be repositioned to aid in proper visualization of the colon. Evalutes irritable bowel syndrome or diverticular disease. DURING TEST: 1. BEFORE THE TEST 1. 6. Explain the procedure and the purpose of the test. Consent form must be signed after patient has received proper instruction about the test 3. Start an IV line and use administration of sedatives and narcotics. Persons with known heart disease may receive prophylactic antibiotics before the test. NURSING CARE: Before Test: 1. mild pain/ cramping Pass gas(flatus) or urge to defecate 4. 3. 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. thromboplastin time. relieved with change of position. PREVENTION Lifestyle and nutrition Exercise regularly high intake of dietary fiber (from eating fruits. Assess the client’s knowledge of the test. . 5. and risks of the test. Locates areas of bleeding. 4. then inyroduces the sigmoidoscope into the colon. 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. 6. 2. 2. Before testing. Over 2 hours. 4. POTENTIAL COMPLICATION: ♥ Bowel perforation ♥ Hemorrhaging ♥ Peritonitis ♥ Cardiac arrhythmias CONTRAINDICATION: ♥ Diverticulitis ♥ Fistulas ♥ Third-trimester pregnancy ♥ Sedatives ♥ Bleeding disorders ♥ Acute peritonitis INDICATIONS: 1. 3. Place patient in left sided or Sim’s position and drape properly. 2. TEST PROCEDURE: 1. Inform the patient the she/he may: Feel quite sleepy during the test Experience abdominal pressure. ulceration and irritation. In the evening before the test. bleeding. An enema is often administered in the morning before the test. 2. 2. Biopsies can be sent o the laboratory after being put in the preservative and properly labeled. 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. Inform client that he may experience some flatulence and mild discomfort. 7. Air may be introduced into the bowel. ECG and Oxygen saturation. purpose. abdominal pain. and biopsy specimens can be removed through the colonoscope. 6. Sites of active bleeding may be treated. 2. After Test: 1. an ECG may be ordered to monitor the cardiac status during the procedure. Client may be placed on a clear liquid diet 24hrs before the test.
a biodegradable test pad is thrown directly into the toilet bowl. hypotension. Ascending colon colostomy: expect liquid store. Instruct for NPO (2 hours after the test) and encourage fluids (to prevent dehydration associated with bowel preparation. Note that the normal stoma color is red or pink. 2. if requested. Empty pouch when one-third full. Observe for possible complications. AFTER TEST: 1. 3. 9. Monitor V/S and oxygen saturation. Place a pouch system on the stoma as soon as possible. The test should be repeated for three consecutive stools. and other factors. and a purple-black stoma indicates compromised circulation. 17. Instruct client to resume normal diet once testing is complete. Monitor the stoma for size.) 4. Instruct client to report any color changes to their health care provider when using the direct method of testing. endoscopic surgery is performed to remove polyps on tissue in biopsied. Advise to avoid eating and drinking dairy products. Instruct the clint to avoid foods that cause excessive gas formation and odor. Transverse colon colostomy: expect looseto semiformed stove. Inform client that if positive results are obtained. Note that a pale pink stoma indicates low hwmoglobin and hematocrit levels. or necrotic tissue. 3. Infants and children will need assistance in obtaining stool specimen. 3. informs health care provider. further testing is likely. red or orange colored foods/ beverages. Blood may be present in isolated areas of sample so testing more than one spot increases chance of capturing target area. CONTRAINDICATIONS 1. Assess the functioning of the colostomy. Client reads test and. 8. Screens for diverticulitis and colitis. Irrigate perineal wound if present and if prescribed. abdominal pain and distension. cardiac or respiratory arrest. Descending colon colostomy: expect close to normal stool. Instruct client not to eat foods for 2 days that interfere with results. followed by a dry sterile dressing if a pouch system is not in place. Identifies GI bleeding related to upper GI bleeding (gastric ulcer). 2. requiring physician notification. wooden applicator stick or tongue blade Indirect testing: commercially prepared biodegradable test pad DIRECT EXAMINATION OF SPECIMEN 1. Administer analgesics and antibiotics as prescribed. depending on the area of the colostomy. 4. DURING TEST 1. 2. 4. Again. FECAL OCCULT BLOOD TEST For the presence of blood in the stool as an indicator of gastrointestinal bleeding. Assess the client’s knowledge of the test. 14. CLINICAL IMPLICATIONS AND INDICATIONS 1. indicating high vascularity. • Serious cardiac or respiratory problems. and monitor for signs of infection. 2. Place a petroleum jelly gauze over the stoma to keep it moist. 13. 4. 10. Monitor the pouch system for proper fit and signs of leakage. unusual bleeding. Inform client that one method of collecting the specimen is to place a loose film of plastic wrap across the toilet bowl. Menstruation 2. the test can be read on the unit or. 2. 12. Following a bowel movement. Adhere to standard precautions. 2. Expect that store will be liquid postoperatively but will become more solid. Instruct the client to eat low-residue diet for a day or two prior to surgery as prescribed. 3. Urine and emesis should be tested for blood with a dipstick style of testing rather than occult blood kits. EQUIPMENTS Direct examination of stool: commercial kit. 16. 3. she should inform her healthcare provider.• If necessary. Elderly clients are more at risk for interfering factors associated with constipation and hemorrhoids. Monitor for color changes in the stoma. • Suspected perforation of the colon. and also those juices with pulp CONTRAINDICATIONS: • Massive intestinal bleeding. The hydrogen peroxide agent reacts with the pseudoperoxidase activity of any hemoglobin present in sample and oxidizes out as a change in color. • Recent abdominal or bowel surgery. 7. blood in stool. 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. 3. The sample is spread over the identified testing areas of the kit. Screens for carcinomas (particularly colon) and polyps of GI tract. Post-Operative 1. INDIRECT TESTING OF SPECIMEN 1. can be sent to the laboratory for testing. 6. Instruct the client in stoma care and irrigation as prescribed. 2. 2. 5. medication. 15. 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. To reduce risk of false negatives/positives and increase chance of identifying presence of blood. Aminister laxatives and enemas as prescribed. A blue-green color will appear on the test pad if occult blood is present. and the hydrogen NURSING CARE: BEFORE TEST 1. AFTER TEST 1. Caution should be exercised in interpretation of results as the direct stool examination results may be altered by many factors related to diet. if the client is doing home testing and gets a positive result. Fecal matter should not be allowed to remain on the shin. Explain the test procedure and the purpose of the test. Consult with the enterostomal yherapist to assist in identifying optimal placement of ostomy. NURSING CONSIDERATIONS 1. peroxide preparation is then applied to sample spots. COLOSTOMY Pre-Operative Implementation 1. Barium enema in last 72 hours . 11. if positive. 2. 18.
Instruct the client that normal activities may be resumed when approved by the physicians. Postoperativedrainage will be dark given and progress to yellow as the client begins to eat. 2. Post-operative: ILEOSTOMY 1. Stool is liquid. Risk for dehydration and electrolyte imbalance exists. Do not give suppositories through ileostomy. 3. 4.19. a color change to dark blue or black should be reported to the physician. 5. . Healthy stoma is red.
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