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This Concept Map, created with IHMC CmapTools, has information related to: Colorectal Cancer, Colorectal Cancer Screening • Early detection beginning at age 50 with avg risk pts • Yearly fecal occult blood tests (FOBT) or stool DNA test • Any of the following: • Flexible sigmoidoscopy Q5years • Double contrast barium enema Q5years • CT colonography Q5 years • Colonoscopy Q10 years, Colorectal Cancer Diagnosis • Sigmoidoscopy • Colonoscopy • Chest xray to detect tumor metastasis to the lungs • CT • MRI • Ultrasonic exam • Lab tests • Fecal occult blood • CBC for anemia from chronic blood loss & tumor growth • Carcinoembryonic antigen (CEA) levels- tumor marker detected in blood of pts with CRC Can be used to estimate prognosis Monitor treatment Detect cancer recurrence • TNM staging, Colorectal Cancer Radiation • Used with surgical resection for treating rectal cancer • There is a high risk of regional recurrence after surgical resection especially when tumor has invaded tumor outside the bowel wall or regional lymph nodes • Pre-op and post-op radiation tx reduces recurrence of tumors, Colorectal Cancer Nursing Diagnoses & Interventions Risk for Sexual Dysfunction • Provide opportunities for pt and family to express feelings about cancer dx, ostomy, and effects of other treatments • Provide consistent colostomy care • Accepting attitudes and consistent care that provide a secure appliance and controls odor and leakage and instill a sense of confidence in the pt • Encourage expression of sexual concerns • Trust should be first established before most pts and families will express their concerns openly • Reassure the pt and significant other that the effect of physical illness and prescribed interventions on sexuality usually is temporary • Refer to social services or a family counselor for further interventions • Arrange for a visit from a member of the United Ostomy Association, Colorectal Cancer Nursing Diagnoses & Interventions Imbalanced Nutrition: Less than Body Requirements • Assess nutritional status using data such as height and weight, BMI, and lab data like serum albumin levels • Pt who is malnourished before beginning aggressive cancer tx requires more vigorous nutrition management to promote healing • Refer to dietitian or nutritionist for dietary management • Assess readiness for resumption of oral intake after surgery or procedure. Bowel sounds, passing gas, minimal ab distention • Manipulation of the bowel interrupts peristalsis of the GI • Monitor and document I&Os • Weigh daily • When oral intake resumes, help pt develop meal plan that incorporates food preferences, Colorectal Cancer Assessment Health history • Usual bowel pattern • Any recent change in bowel habits • Weight loss • Fatigue • Decreased activity tolerance • Presence of blood in the stool • Pain upon defection • Abdominal discomfort • Perineal pain • Usual diet • Family hx • Specific risk factors like inflammatory bowel disease or polyps Physical examination • General appearance • Weight • Abdominal shape, contour, bowel sounds, tenderness • Stool hemoccult or guaiac, Colorectal Cancer Surgery Colostomy • An ostomy made in the colon such as when bowel is obstructed by the tumor as a temporary measure to promote healing • A permanent ostomy for the fecal evacuation when distal colon and rectum are removed • Name of the colostomy relates to the part of the colon that they are formed in • Sigmoid colostomy-most common permanent colostomy especially for cancers of the rectum • Double barrel colostomy- two separate stomas are created • Transverse loop colostomy- emergency procedure used to relieve an intestinal obstruction or perforation • Hartmann procedure- common temporary colostomy procedure where the distal part of the colon is left in place and is overswen for closure. This is done to allow the bowel to rest and heal such as following traumatic injury to the colon like a GSW, Colorectal Cancer Complications • Bowel obstruction due to narrowing of the bowel lumen by the lesion • Perforation of the bowel wall by the tumor, allowing contamination of the peritoneal cavity by bowel contents • Direct extension of the tumor to involve adjacent organs • Recurrences after tumor removal occurs within the first 4 years • Size of the tumor does not necessarily relate to long term survival, Colorectal Cancer Nursing Diagnoses & Interventions Grieving • Work to develop a trusting relationship with pt • Increases effectiveness in helping them work through grieving process • Listen actively and encourage pt and family to express feelings. Assist with identification of strengths, past experience, and support systems • Demonstrate cultural respect and use those resources to cope with loss • Encourage discussion of potential impact of loss on individual family members and function • Refer to cancer support groups, social services, and counselors, Colorectal Cancer Surgery • Goal is to preserve anal sphincter and avoid colostomy with colon resection • Surgical resection of tumor, adjacent colon, and regional lymph nodes is treatment of choice • Usually rectal tumors are treated with abdominopherineal resection • Sigmoid colon, rectum, & anus are removed through both abdominal & perineal incisions • Permanent sigmoid colostomy is performed to provide for elimination of feces, Colorectal Cancer Chemotherapy • Fluorouracil (5-FU) • Folinic acid (leucovorin), Colorectal Cancer Nursing Diagnoses & Interventions Acute Pain • Monitor for adequate pain relief including location, intensity, and character of pain as well as nonverbal signs such as grimacing, muscle tension, apparent dozing, changes in pulse or bp, rapid, shallow resp • Ask pat to assess pain level • Monitor analgesic effectiveness 30min after admin • Assess incision for inflammation or swelling; assess drainage catheters and tubes for patency Poorly controlled pain or pain that changes may be related to organ distention from an obstructed NG tube, urinary catheter, or wound drain, or may indicate infection, Colorectal Cancer Reduce Risk Factors • Diets high in fruits and veg, • Folic acid • Calcium • Regular exercise • Daily multivitamin • Aspirin and other NSAID, Colorectal Cancer Manifestations Initial Manifestations • Rectal bleeding is often the initial manifestation • Anemia from occult bleeding • Change in bowel habits (diarrhea or constipation) Advanced Manifestations • Pain • Anorexia • Weight loss • Cramps and/or gas • Palpable mass • Vomiting • Fatigue • Abdominal distention • Abnormal bowel sounds, Colorectal Cancer Risk Factors • African Americans • Ashkenazi Jews • Women>Men • Familial adenomatous polyposis • Hereditary nonpolyposis CRC • Diet high in calories, protein, and fats • ᡪyo • Inflammatory bowel disease • Obesity • Smoking • ETOH use, Colorectal Cancer Pathophysiology • Nearly all colorectal cancers that begin as adenomatous polyps are adenocarcinomas • Tumor develops in rectum and sigmoid but any part may be affected • Usually grows undetected until manifestations are seen • By this time it has spread into deeper layers of the bowel and close organs • Spreads to involve the entire bowel circumference, submucosa, and outer bowel wall layers • Neighboring structures like liver, greater curvature of the stomach, duodenum, S.I., pancreas, spleen, GU tract, and abdominal wall may also be involved by direct extension • Most common form of tumor spread is d/t metastasis to regional lymph nodes • Cancerous cells from the primary tumor may spread by lymphatic system or circulatory system to secondary sites such as liver, brain, lungs, bone, and kidneys • “Seeding” of the tumor to other areas of the peritoneal cavity can occur when tumor extend through the serosa or during surgical resection, Colorectal Cancer Prevention • Diet high in fruits and vegetables • Low saturated fats and red meats • Regular exercise • Maintaining a healthy weight • Limiting ETOH • No smoking • Fiber supplements • Minerals like Ca, vitamins, • NSAIDS