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Presented to A. Chusri Manokarn

By: Sai Yee Lone

I.D. 5015332
28 September 2008
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 It consists of 6 parts;
G Cecum
G ^he large intestine
that runs from the G Ascending colon

cecum to the rectum. G ^ransverse colon

G Descending colon

G Sigmoid colon, and

G Rectum
 J   

G Approximately 500 ml of food pass through
the colon daily.
G Absorb and remove water
G May also absorb harmful materials
G ^o keep the body alkalized, and
G Accommodate the colonization of billions of
beneficial microorganisms to aid us in
breaking down waste matter.
 Vhat is Rectal Cancer?
G `ectum is the large bowel that lies in the
pelvis, terminating at the anus.

G Cancer of the rectum is the disease

characterized by the development of malignant
cells of the rectum.
 Vhat is colon & rectal cancer?

G Cancer that begins in the colon is called colon

cancer.
G Cancer that begins in the rectum is called
rectal cancer.
G Cancers affecting either of these organs may
also be called colorectal cancer.
J
  
Staging for Colon Cancer
G Stage 0. - very early. It is found only in the
innermost lining of the colon or rectum.

G Stage I. w involves more of the inner wall of

the colon or rectum.

G Stage II. w spread outside the colon or rectum

to nearby tissue, but not to the lymph nodes.
G Stage III. - spread to nearby lymph nodes, but
not to other parts of the body.

G Stage IV. - spread to other parts of the body.

Colorectal cancer tends to spread to the liver
and/or lungs.

G Recurrent cancer. - means the cancer has

come back after treatment. The disease may
recur in the colon or rectum or in another part
of the body.
 
    
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G Jatient has partial gut obstruction regarding to cancer rectum
(adenocarcinoma).
G TNM staging; can be considered as Stage III. The cancer has
spread to nearby lymph nodes, but not to other parts of the
body.
G Stage III, T4
T4, N1
N1, and MM00; and the characteristic of the cancer
that extends to regional lymph nodes. (T4
(T4, N1
N1, and MM0 0).
G He was performed colostomy.
G He was on colostomy bag and waiting for the plan of
chemotherapy.

(T= Tumors, N= Lymp Nodes, M= Metastasis)

 Signs & Symptoms
G a change in bowel habits
G Diarrhea, constipation, or
feeling that the bowel does
not empty completely
G Blood (either bright red or
very dark) in the stool
G Stools that are narrower
than usual
G General abdominal
discomfort (frequent gas
pains, bloating, fullness,
and/or cramps)
G Weight loss with no known
reason
G Constant tiredness
G Vomiting
 Risk factors
G -amily history of colorectal cancer
G -amily history of colonic polyps
G History of Ulcerative Colitis
G Jersonal history of cancer
G Over age 50
 |

 



G The patient has general abdominal discomfort
(frequent gas pains, and/or cramps),
G He has a change in bowel habits. He is also
feeling that the bowel does not empty
completely.
G Tiredness
G Over age 50,
50, but his family doesn¶t have
history of colorectal cancer.

 

G wrays of the large intestine
G a sigmoidoscopy for examination under a
microscope.
G a colonoscopy w to see inside the rectum
G a polypectomy is the removal of a polyp during a
sigmoidoscopy or colonoscopy.
G a biopsy is the removal of a tissue sample for
examination under a microscope by a pathologist
to make a diagnosis.
 |

 




G He was ordered several diagnostic tests to

identify his problems:
G Colonoscopy
G Sigmoidoscopy
G wrays of the large intestine
G w rays of the lungs for pneumonia
 ^



 
 
G Most patients with rectal cancer required
permanent colostomies (an opening at the
drainage).
skin with a bag for stool drainage).
G Radiation, and
G Chemotherapy
G ^he only chance for cure of a rectal cancer is
to remove it surgically.
G `emoval of the part of the rectum involved with
tumor as well as:
G a) the lymph glands that can potentially be involved
with tumor spread.
G b) the blood vessels supplying that portion of the
rectum.

G The decisionw
decisionwmaking process can be extremely
complicated. This process is tailored to the
individual patient. It is important to consult a board
certified colon and rectal surgeon who is familiar
with the current treatment strategies for rectal
cancer.
Removal part of the rectum
 Complications of rectal cancer
G lower GI bleeding, G intestinal lymphomas, or
Kaposi sarcoma involving the
G the differential gut.
diagnosis includes G Causes of intestinal
colorectal cancer, obstruction other than
G inflammatory bowel cancer include adhesions,
disease (ulcerative peritonitis, inflammatory
bowel disease, fecal
colitis or Crohn impaction, strangulated
disease)., bowels, and ileus.
G Uremia
G foreign bodies, G Obstruction is less common
for right-sided lesions
G polyps, because the ascending colon
G metastatic disease, is wider than the distal colon
and the fecal content is
fluid.
 0



åven though we don't know exactly what causes colorectal cancer, there are
some steps you can take to reduce your risk.
G Screening tests:
G the best way to help prevent
G Can found and remove , to be cured
G Diet: It is important to eat plenty of fruits, vegetables, and whole grain foods
and to limit intake of highw
highwfat foods, but not to eat the foods contain a lot gases;
for example, beans.

G åxercise: activity may be performed as tolerated.

G Vitamins: suggest that taking a daily multivitamin containing folic acid or folate
can lower colorectal cancer risk. Other studies suggest that getting more calcium
and vitamin D can help.

G Aspirins & other drugs: aspirin and drugs such as ibuprofen (Motrin, advil)
or naproxen (aleve) appear to prevent the growth of polyps.
 §






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G " # ale
G # Î yrs.
G 
# August 200
G  
# CA Lower Rectum
G [

#
G 0
# 160 Cms
G V
# ×2 Kgs
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G VBC 11 x 10
10^^3/ul (normal 4.5 ± 10)
10) (High)

G RBC 3.38 x 10
10^^6/ul (normal 4.5 ± 6.5) (Low)

G Hemoglobin 9.4 g/dl (normal 13 ± 18

18)) (Low)

G Hematocrit 27.
27.7 % (normal 39 - 54 %) (Low)

G Lymphocyte 15 x 10
10^^3/ul (normal 150-
150-400
400)) (Low)

G P^ 19.
19.7 sec (normal 10.
10.5 ± 12
12..5) (High)

G INR 9.6 sec (normal 11.

11.3 ± 11
11..8) (Low)
 Medical Order
G Vit-K
Vit- 10 mg vein OD (06:
06:00
00))
G Ativan (0.5 mg) x 1 hs. (20
20::00
00))
G Folic acid 1 x 1 Oral Pc (08:
08:00
00))
G M^V 1 x 2 Oral Pc (08:
08:00
00))
G Lasix 40mg
40 mg 0.5 x 1 Feeding pc
G Fluimucil 100mg
100 mg 1 sac Oral tid. pc.
G Air-- X
Air 1 x 3 Oral pc bid.
G Paracetamol 500 x 2 tab prn. q 4-6 hr
’ 
  
a) Simbicort - 1 Puff x 2 vein at 6:00,
00, 18
18::00 hr.
b) Ventolin - 2 puff vein prn.
 §
 

(1) a 
      
   
 

  
G Jatient said that his abdominal discomfort was
getting better. He passed stool one time this
morning. He can not sleep well last night because he
always feels thirty.
G He said that he wants to go home, and he wants to
eat by mouth.
G He told me that he drank a cup of Milo at 6 am.
[
  
G Jatient was on NG tube for receiving medication.

G Jatient has tender abdomen

G On NJO (but the doctor let him drink water)

G On bed rest, supine position.

G Has colostomy bag at LLQ.

  -   
   

 [ 

G Jatient will be able to pass stool by colostomy bag.

G abdominal distension will be absent.

 §






G (1) a


G
a 

   

G 

  
 


G a  

  



G a) Air-
Air- X (180
(180 mg) 1 sac by NG tube oral pc.,
G b) provide IV drip Acetar-
Acetar-5 1000
1000cc
cc rate 80cc/hr
80cc/hr
continuously
G c) Vit-
Vit- K 10 mg vein OD
G d) Ativan (0
(0.5 mg) 1x1 hs.,
 §
 

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G Patient said that he can¶t sleep well, and coughs very often in
order to remove sputum of secretion.

[
  
G On NG tube
G On Oxygen canula 6 Lpm
G cough with bubble sputum of secretion
G VBC = 11.
11.00 x 10^
10^3/uL (High, mild infection)
G inadequate sleeping pattern
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 Nursing Interventsion
(1)Assess for V/S

(2) Assess for O

O22 canula saturation

(3) Arrange fowler¶s position

(4) Administer medication as doctor¶s ordered:

G a) Fluimucil (100
(100 mg) 1 sac + 1 glass of
water
G b) Ativan (0
(0.5 mg) 1x1 hs.,
 §
 

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G Subjective data:
G He said that he felt itchy in the head.
G He didn¶t take a shower for 2 months.

G Objective data:
G He had dandruffs on the head.
G NG tube
G colostomy bag
G condom catheter
G JT = 19.
19.7 sec (High)
G  
G ^o promote hygiene care and to prevent
injuries

G    

G Jatient will feel fresh and show good mood.
G no dandruffs
G no s/s of infection
G no rupture skin
 §






G (1) assess patient¶s v/s in q 4 hr.

G (2) Jrovide hair shampoo at bed
G (3) Jrovide NG tube care
G (4) Jrovide Catheter care and perineum care
G (5) Colostomy bag care
G (6) Jrovide bed bathing
G Patient Action

G åvaluation
G Patient has a lot of secretion and clear
G Patient can sleep at night; even can take a nap in day
time.
G Abdominal distention was absent.
G patient can receive BD well by NG tube.
G Patient¶s stool can drainage, but contains a lot of
gases.
G Vhether the patient¶s condition is better.
G Observe general s/s by performing physical
education.
 Conclusion
G Jatient is Thai male, age 78.
78. He is well conscious.
G He was underlying Cancer Lower `ectum (adenocarcinoma
well differentiate).
G He was readmitted on 8 august 2008.
2008. Two days before
admission, he had difficult breathing, edema at both arms and
legs, and he could not eat.
G Now he is waiting for the plan of chemotherapy.
G He can¶t perform selfw
selfwcare by himself properly.
G He is on NG tube for feeding, on oxygen canula 6 lpm, on IV-
acetar 1000cc
1000cc vein 80cc
80cc per hour to maintain body electrolyte
balance.
G In addition, he has colostomy bag at Left Lower Quadrant to
collect stools drainage.
G He was also on condom catheter to collect his output.
G He was still admitted to receive his healthcare services.
However, his vital signs are normal.
 

G adult Health Nursing., Christensen Kockrow.
(2006
2006))
G http://www.colonrectalcare.com/
G http://www.colonrectal.net/cancermanagement.htm
G http://www.thefreedictionary.com/
G http://www.google.co.th/
G http://www.wikipedia.org/
G http://www.nlm.nih.gov/medlineplus/