Colorectal Cancer Nursing Care Plan and Management

Notes

Description of Colorectal Cancer
  • Adenocarcinoma is the most common type of colon cancer and may spread by direct extension through the walls of the intestine or through the lymphatic or circulatory system. Metastasis is most often to the liver.Colorectal Cancer
Duke’s Classification of Colorectal Cancer
  • Stage A: confined to bowel mucosa, 80-90 % 5 years survival rate
  • Stage B: invading muscle wall
  • Stage C; Lymph node involvement
  • Stage D: Metastases or locally unresectable tumor, less than 5% , 5 years survival rate.
Causes/ Risk Factors

Modifiable
  • Diet: Whether diet plays a role in developing colon cancer remains under debate. The belief that a high-fiber, low-fat diet could help prevent colon cancer has been questioned. Studies do indicate that exercise and a diet rich in fruits and vegetables can help prevent colon cancer.
  • Obesity: Obesity has been identified as a risk factor for colon cancer.
  • Smoking: Cigarette smoking has been definitely linked to a higher risk for colon cancer.
  • Drug effects: Recent studies have suggested that estrogen replacement therapy and nonsteroidal anti-inflammatory drugs such as aspirin may reduce colorectal cancer risk.
Non-Modifiable

Most colorectal cancers arise from adenomatous polyps-clusters of abnormal cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.

People with any of several conditions known as adenomatous polyposis syndromes have a greater-than-normal risk of     colorectal cancer.

  • In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.
  • The cancer usually occurs before age 40 years.
  • Adenomatous polyposis syndromes tend to run in families. Such cases are referred to as familial adenomatous polyposis (FAP). Celecoxib (Celebrex) has been FDA approved for FAP. After 6 months, celecoxib reduced the mean number of rectal and colon polyps by 28% compared to placebo (sugar pill) 5%.

Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer (HNPCC) syndromes, also run in families. In these syndromes, colon cancer develops without the precursor polyps.

  • HNPCC syndromes are associated with a genetic abnormality. This abnormality has been identified, and a test is available. People at risk can be identified through genetic screening.
  • Once identified as carriers of the abnormal gene, these people require counseling and regular screening to detect precancerous and cancerous tumors.
  • HNPCC syndromes are sometimes linked to tumors in other parts of the body.

Also at high risk for developing colon cancers are people with any of the following:

  • Ulcerative colitis or Crohn colitis (Crohn disease)
  • Breast, uterine, or ovarian cancer now or in the past
  • A family history of colon cancer
  • The risk of colon cancer increases 2-3 times for people with a first-degree relative (parent or sibling) with colon cancer. The risk increases more if you have more than one affected family member, especially if the cancer was diagnosed at a young age.
Assessment
Ascending (Right) Colon Cancer
  • Occult blood blood in stool
  • Anemia
  • Anorexia and weight loss
  • Abdominal pain above umbilicus
  • Palpable mass
Distal Colon/ Rectal Cancer
  • Rectal bleeding
  • Change bowel habits
  • Constipation or diarrhea
  • Pencil or ribbon shaped stool
  • Tenesmus
  • Sensation of incomplete
Diagnostic Evaluation
  • Fecal occult blood test (FOBT) – checks for hidden blood in the stool. Sometimes cancers or polyps can bleed and this test is used to pick up small amounts of bleeding. Have this test every year.
  • Flexible sigmoidoscopy – an exam where a health care provider looks at the rectum and the lower part of the colon using a sigmoidoscope, a tube with a light on the end. Have this test every 5 years.
  • Colonoscopy – an exam when a health care provider looks at the rectum and the entire colon using a colonoscope, an instrument with a light on the end. If polyps are found, they can be removed. Have this test every 5 to 10 years.
  • Double contrast barium enema (DCBE) – a series of x-rays of the colon and rectum. You are first given an enema with barium in it, which outlines the colon and rectum on the x-rays. Have this test every 5 to 10 years (only if not having a colonoscopy every 10 years).
  • Digital rectal exam – a health care provider inserts a lubricated, gloved finger into the rectum to feel for any problem areas. Have this test every 5 to 10 years at the time of other screening tests (flexible sigmoidoscopy, colonoscopy, or DCBE).
Primary Nursing Diagnosis
  • Pain related to tissue injury from tumor invasion and the surgical incision
Therapeutic Intervention / Medical Management

Treatment of cancer depends on stage of disease and related complications. Obstruction is treated with intravenous  fluids and nasogastric suction and with blood therapy if bleeding is significant. Supportive therapy and adjuvant therapy (e.g., chemotherapy, radiation therapy, immuno therapy) are included.

Surgical Management
  • Surgery is the primary treatment for most colon and rectal cancers ; the type of surgery depends on the location and size of tumor, and it may be curative or palliative.
  • Cancers limited to one site can be removed to a colonoscope
  • Laparoscopy colostomy with polypectomy.
  • Neodymium-yttrium-aluminum-garnet (Nd:YAG) laser is effective in some lesions
  • Bowel resection with anastomosis and possible temporary or permanent colostomy or illeostomy ( less than 1/3 of patients) or coloanal resevoir (colonic J pouch).
Pharmacologic Intervention
  • Narcotic analgesic is often administered as patient-controlled anesthesia to manages surgical pain or pain from metastasis
Nursing Intervention
  • Administer chemotherapy agents as ordered, provide care for the client receiving chemotherapy.
  • Provide care for the client receiving radiation therapy.
  • Provide care for the client with bowel surgery.
Documentation Guidelines
  • Response to diagnosis of colorectal cancer,diagnostic tests,and treatment regimen
  • Description of all dressings, wounds, and drainage collection devices: Location of drains; color and amount of drainage; appearance of the incision; color of the ostomy stoma; presence, amount,and consistency of ostomy effluent
Discharge and Home Healthcare Guidelines

PATIENT TEACHING

  • Teach the patient the care related to the abdominal incision and any perineal wounds. Give instructions about when to notify the physician (if the wound separates or if any redness, bleeding, purulent drainage, unusual odor, or excessive pain is present).
  • Advise the patient not to perform any heavy lifting (􏰀10 lbs),pushing,or pulling for 6 weeks after surgery.
  • If the patient has a perineal incision, instruct her or him not to sit for long periods of time and to use a soft or “waffle”pillow rather than a rubber ring whenever in the sitting position.
  • Teach the patient colostomy care and colostomy irrigation.
  • Give the following instructions for care of skin in the external radiation field:Tell the patient to wash the skin gently with mild soap,rinse with warm water,and pat the skin dry each day; not to wash off the dark ink marking that outlines the radiation field; to avoid applying any lotions, perfumes,deodorants,and powder to the treatment area; to wear nonrestrictive soft cotton cloth- ing directly over the treatment area; and to protect skin from sunlight and extreme cold.
  • Explain the purpose, action,dosage,and side effects of all medications prescribed by the physician.

FOLLOW-UP

  • Stress the need to maintain a schedule for follow-up visits recommended by the physician. Encourage patients with early-stage disease and complete healing of the bowel to eat a diet consisting of a low-fat and high-fiber content with cruciferous vegetables (Brussels sprouts,cauliflower,broccoli,cabbage). Most colorectal tumors grow undetected as symptoms slowly develop. Survival rates are best when the disease is discovered in the early stages and when the patient is asymptomatic. Unfortunately,50% of patients have positive lymph node involvement at the time of diagnosis. Participation in procedures for the early detection of colorectal cancer needs to be encouraged. Suggest follow-up involvement with community resources such as the United Ostomy Association and the American Cancer Society.

 

 


Sources:

Marilyn Sawyer Sommers, RN, PhD, FAAN , Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , DISEASES AND DISORDERS A Nursing Therapeutics Manual, 2007 3rd ed
NSNA NCLEX-RN Review 2000 Ed
Mastering Medical Surgical Nursing , UDAN

Exam

Welcome to your MSN Exam for Colorectal Cancer! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 14 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
  2. Instant Feedback: After each question, the correct answer along with an explanation will be revealed. This is to help you understand the reasoning behind the correct answer, helping to reinforce your learning.
  3. Time Limit: There is no time limit for this exam. Take your time to understand each question and the corresponding choices.

Tips For Success

  • Read each question carefully. Take your time and don't rush.
  • Understand the rationale behind each answer. This will not only help you during this exam, but also assist in reinforcing your learning.
  • Don't be discouraged by incorrect answers. Use them as an opportunity to learn and improve.
  • Take breaks if you need them. It's not a race, and your understanding is what's most important.
  • Keep a positive attitude and believe in your ability to succeed.

Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

Click 'Start Exam' when you're ready to begin. Best of luck!

💡 Hint

Consider the preparations necessary to ensure a clear view of the colon for this diagnostic test, focusing on bowel cleanliness.

1 / 14

1. Nurse Lee is preparing Mr. Anderson, a patient scheduled for a barium enema as part of an evaluation for colon cancer. To ensure the accuracy of the test, Nurse Lee needs to provide specific instructions regarding bowel preparation. What should Nurse Lee advise Mr. Anderson to do prior to the procedure?

💡 Hint

Reflect on the prevalence and commonality of different types of internal cancers within the United States.

2 / 14

2. In a seminar about colorectal cancer, Nurse Thompson provides accurate information to her audience about the prevalence and risk factors of colon and rectal cancer. Which of the following statements made by Nurse Thompson is correct?

💡 Hint

Focus on the symptom that directly relates to the primary function of the colon and rectum and can indicate a disturbance in this area.

3 / 14

3. In an educational session about colorectal cancer, Nurse Trish is emphasizing the importance of early detection and awareness of symptoms. She informs a client about the most common complaint or symptom that individuals with colorectal cancer experience. What is this primary symptom?

💡 Hint

Reflect on the common side effects of chemotherapy and how they can impact a patient's physical well-being and cognitive function.

4 / 14

4. During a follow-up appointment, a patient who has recently completed surgery and chemotherapy for colon cancer and is now in remission, reports experiencing fatigue following activity and difficulty concentrating during her weekly bridge games. Nurse Thompson considers various explanations for these symptoms to provide the most accurate assessment. What should she consider as a likely cause?

💡 Hint

Think about the risk factors that are directly related to the development of colorectal cancer, including genetic predispositions and certain medical conditions.

5 / 14

5. In a workshop on colorectal cancer, Nurse Davis is discussing various risk factors for the disease with a group of healthcare professionals. She presents a list of factors and asks the group to identify which ones are associated with an increased risk of developing colorectal cancer. What should be their selection?

💡 Hint

Consider which dietary choices are generally associated with a lower risk of developing colon cancer.

6 / 14

6. Nurse Reynolds has been educating her patient about lifestyle changes that can help reduce the risk of colon cancer. At the end of the session, she asks him to summarize the key points they discussed. The patient demonstrates a correct understanding of these preventive measures when he says:

💡 Hint

Consider the compatibility of patients based on the contagiousness and severity of their conditions, and the similarity in their care requirements.

7 / 14

7. Nurse Johnson is tasked with rearranging room assignments for several patients in the hospital. To ensure optimal patient safety and compatibility, she needs to determine which two patients are best suited to share a room. After considering their conditions, she decides that:

💡 Hint

Think about the potential complications directly related to the invasive nature of a colonoscopy, especially those that would cause acute symptoms.

8 / 14

8. In the emergency department, Nurse Martin assesses a patient who had a fiberoptic colonoscopy 18 hours earlier and is now presenting with symptoms of increasing abdominal pain, fever, and chills. Considering the recent medical procedure and the current symptoms, Nurse Martin needs to determine the most pressing concern to address. Which condition should she consider as the most immediate concern?

💡 Hint

Consider which type of cancer has a high mortality rate, often due to late detection and the aggressive nature of the disease.

9 / 14

9. During a consultation, a 37-year-old client with uterine cancer is inquiring about cancer statistics in women. She is particularly interested in knowing which type of cancer is the leading cause of cancer-related deaths in women. How should the nurse respond to her question?

💡 Hint

Focus on the symptom that would most likely indicate a change in the gastrointestinal system, often prompting individuals to seek medical advice.

10 / 14

10. During an educational session, Nurse Trish discusses the signs of colorectal cancer with her patient, emphasizing the importance of early detection. She highlights the most common symptom reported by individuals with this type of cancer. Which symptom does Nurse Trish identify as the most frequently experienced by patients with colorectal cancer?

💡 Hint

Consider which type of diet is often linked to a higher risk of various cancers, focusing on the quality of fats and carbohydrates.

11 / 14

11. Nurse Patel is conducting a workshop on nutrition and cancer prevention, focusing on colorectal cancer. She explains the types of diets that are associated with a higher risk of developing this type of cancer. Which diet does she mention as potentially increasing the risk of colorectal cancer?

💡 Hint

Think about the comprehensive approach to post-operative care that addresses both physical and psychological aspects of recovery, aiming for a return to normalcy as much as possible.

12 / 14

12. Before discharging a client who underwent a colostomy for colorectal cancer, Nurse Mitchell prepares to provide comprehensive discharge instructions regarding resuming daily activities. She aims to ensure the client has a realistic and positive understanding of post-operative life adjustments. What key message should Nurse Mitchell convey to the client?

💡 Hint

Focus on the scenario where the patient might encounter a potential complication or barrier in the routine care of his colostomy, necessitating medical advice or intervention.

13 / 14

13. Nurse Hernandez is providing discharge instructions to Mr. Davis, who has undergone surgery for colorectal cancer and now has a colostomy. She teaches him how to irrigate his colostomy and explains when to contact the doctor. The nurse knows her teaching has been effective when Mr. Davis mentions he will call the doctor if:

💡 Hint

Consider which condition is a known precursor or risk factor for the development of colorectal cancer, often requiring regular monitoring and potentially removal.

14 / 14

14. In reviewing the medical history of a male client, Nurse Johnson identifies certain conditions that could indicate a heightened risk for colorectal cancer. Among these, she notes:

Nursing Care Plan

Nursing Diagnosis

Diarrhea related to inflammation, irritation, intestinal malabsorption or partial narrowing of the intestinal lumen, secondary to the process of intestinal malignancy.

Characterized by:

  • Increased bowel sounds / peristaltic
  • Improved liquid defecation
  • Stool color changes
  • Pain / cramping abdominal

Imbalanced Nutrition Less Than Body Requirements related to impaired absorption of nutrients, hypermetabolic state, secondary to the process of intestinal malignancy.

Characterized by:

  • Weight loss, decreased subcutaneous fat / muscle mass, poor muscle tone
  • Increased bowel sounds
  • Pale conjunctiva and mucous membranes
  • Nausea, vomiting, diarrhea

Anxiety (describe level) related to psychological factors (the threat of changes in health status, socio-economic status, functions, roles, interaction patterns) and sympathetic stimulation (neoplastic process)

Characterized by:

  • Acute phase of disease exacerbation
  • Increased tension, distress, fear
  • iritabel
  • Narrows the focus of attention

Ineffective individual coping related to the intensity and repetition stesor adaptive threshold exceeded (chronic illness, death threats, the vulnerability of individuals, severe pain, no adequate support system)

Characterized by:

  • Declare an inability to face problems, hopelessness, anxiety
  • Declared worthless
  • Depression and dependence

Knowledge Deficit: about condition, prognosis and treatment needs related to less exposure and or misinterpretation of information.

Characterized by:

  • Ask questions, request information or a statement of the concept of fault
  • Does not accurately follow the instructions
  • Complications / exacerbations can be prevented.