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.

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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:

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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

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

Instruct for NPO (2 hours after the test) and encourage fluids (to prevent dehydration associated with bowel preparation. hypotension. 2. 4. Client reads test and. 5. 2. • Recent abdominal or bowel surgery. can be sent to the laboratory for testing. 16. and also those juices with pulp CONTRAINDICATIONS: • Massive intestinal bleeding. Empty pouch when one-third full. Monitor for color changes in the stoma. 2. Irrigate perineal wound if present and if prescribed. Instruct client to report any color changes to their health care provider when using the direct method of testing. 3. or necrotic tissue. 3. Again. AFTER TEST 1. Monitor the pouch system for proper fit and signs of leakage. peroxide preparation is then applied to sample spots. 7. 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. Assess the functioning of the colostomy. Instruct the client to eat low-residue diet for a day or two prior to surgery as prescribed. Expect that store will be liquid postoperatively but will become more solid. To reduce risk of false negatives/positives and increase chance of identifying presence of blood. 2. Observe for possible complications. 10. Identifies GI bleeding related to upper GI bleeding (gastric ulcer). a biodegradable test pad is thrown directly into the toilet bowl. Blood may be present in isolated areas of sample so testing more than one spot increases chance of capturing target area. 11. Barium enema in last 72 hours . Urine and emesis should be tested for blood with a dipstick style of testing rather than occult blood kits. requiring physician notification. 18. AFTER TEST: 1. Post-Operative 1. she should inform her healthcare provider. CLINICAL IMPLICATIONS AND INDICATIONS 1. If test is being done in an institution or health care agency. Screens for diverticulitis and colitis. Note that the normal stoma color is red or pink. Assess the client’s knowledge of the test. DURING TEST 1. 13. Monitor V/S and oxygen saturation. unusual bleeding. Place a pouch system on the stoma as soon as possible. 2. depending on the area of the colostomy. wooden applicator stick or tongue blade Indirect testing: commercially prepared biodegradable test pad DIRECT EXAMINATION OF SPECIMEN 1. CONTRAINDICATIONS 1. Instruct client to resume normal diet once testing is complete. 6. Caution should be exercised in interpretation of results as the direct stool examination results may be altered by many factors related to diet. Transverse colon colostomy: expect looseto semiformed stove. Advise to avoid eating and drinking dairy products. Instruct client not to eat foods for 2 days that interfere with results. 2. Ascending colon colostomy: expect liquid store. medication. followed by a dry sterile dressing if a pouch system is not in place. indicating high vascularity. EQUIPMENTS Direct examination of stool: commercial kit. FECAL OCCULT BLOOD TEST For the presence of blood in the stool as an indicator of gastrointestinal bleeding. if requested. Screens for carcinomas (particularly colon) and polyps of GI tract. INDIRECT TESTING OF SPECIMEN 1. Place a petroleum jelly gauze over the stoma to keep it moist. 3. Elderly clients are more at risk for interfering factors associated with constipation and hemorrhoids. Descending colon colostomy: expect close to normal stool. COLOSTOMY Pre-Operative Implementation 1. Note that a pale pink stoma indicates low hwmoglobin and hematocrit levels. 2. Menstruation 2. A blue-green color will appear on the test pad if occult blood is present. Monitor the stoma for size. if positive. 4. 17. 3. Instruct the client in stoma care and irrigation as prescribed. Following a bowel movement.) 4. • Suspected perforation of the colon. Explain the test procedure and the purpose of the test. 12. endoscopic surgery is performed to remove polyps on tissue in biopsied. The test should be repeated for three consecutive stools. Infants and children will need assistance in obtaining stool specimen. abdominal pain and distension. Fecal matter should not be allowed to remain on the shin. 2. NURSING CONSIDERATIONS 1. red or orange colored foods/ beverages. further testing is likely. Inform client that if positive results are obtained. and other factors. 15. blood in stool. and monitor for signs of infection. Adhere to standard precautions. The client collects a random stool specimen and feces should be tested from two separate areas. if the client is doing home testing and gets a positive result. The sample is spread over the identified testing areas of the kit. Administer analgesics and antibiotics as prescribed. Aminister laxatives and enemas as prescribed.• If necessary. 2. The hydrogen peroxide agent reacts with the pseudoperoxidase activity of any hemoglobin present in sample and oxidizes out as a change in color. and the hydrogen NURSING CARE: BEFORE TEST 1. 14. 8. 3. the test can be read on the unit or. 3. cardiac or respiratory arrest. informs health care provider. 4. Instruct the clint to avoid foods that cause excessive gas formation and odor. 9. and a purple-black stoma indicates compromised circulation. Consult with the enterostomal yherapist to assist in identifying optimal placement of ostomy. Inform client that one method of collecting the specimen is to place a loose film of plastic wrap across the toilet bowl. • Serious cardiac or respiratory problems.

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

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