COLON CANCER Flashcards
What is the number 1 most affected part in colon cancer?
RECTUM → why? → where the feces are found → what is in the feces? → TOXINS → so if that mucosa is always exposed to the toxins in your feces you are not moving your feces regularly → leads to cancer.
The most common presenting symptom
change in bowel habits.
The passage of blood in or on the stools is the second most common symptom
DIFFERENT SIGN AND SYMPTOMS FOR EACH AFFECTED AREA
Right-sided lesions
dull abdominal pain
melena (i.e., black, tarry stools).
Patients with right-sided tumors tend to have poorer outcomes than those with left-sided tumors.
Left-sided lesions
change in bowel habits or those associated with obstruction (i.e., abdominal pain and cramp-ing, narrowing stools, constipation, distention)
hematochezia (i.e., bright red blood in the stool).
Rectal lesions
Tenesmus
rectal pain
the feeling of incomplete evacuation after a bowel movement
alternating constipation and diarrhea
and bloody stool
HOW TO PREPARE FOR COLONOSCOPY? (CLEANSING OF COLONOSCOPY)
primary provider may prescribe a laxative for two nights before the examination and a Fleet or saline enema until the return is clear the morning of the test.
The use of lavage solutions is
contraindicated in patients with intestinal obstruction or inflammatory bowel disease.
Current preparations include either the nonsplit dose regimen, in which the entire solution is ingested the night before the procedure, or the split-dose regimen, in which half of the dose is ingested the night before and half is ingested the morning of the procedure, 3 hours prior to the scheduled test.
HOW TO PREPARE FOR COLONOSCOPY? (PT HEALTH HISTORY AND COMORBIDITIES)
diabetes, chronic constipation, or history of opioid use, or problematic colonoscopies influence patient preparation.
HOW TO PREPARE FOR COLONOSCOPY? (PREPROCEDURE DIET INSTRUCTION)
clear liquid or a low residue diet starting the day before the procedure
Diet type has not been shown to affect bowel preparation in patients ingesting the split preparations
If necessary, the nurse can give the solution through a feeding tube if the patient Cannot swallow. Patients with a colostomy can receive this same bowel preparation.
HOW TO PREPARE FOR COLONOSCOPY? (SODIUM PHOSPATE TABLET)
Dosing consists of 32 tablets: 20 tablets (4 tablets every 15 minutes) with 8 oz of any clear liquid (water, any clear carbonated bever-age, or juice) on the evening prior to the examination, and 12 tablets (taken in the same manner) on the morning of the examination
The side effects are especially problematic for older adults, and sometimes they have difficulty ingesting the required volume of solution.
Monitoring older patients after a bowel preparation is especially important because their physiologic ability to compensate for fluid loss is diminished.
CONSISTENCY OF STOOL IF OSTOMY IS PLACED IN:
Ascending colon: watery; liquid; stool is looser
Transverse colon: very soft stool; pasty or mushy
Descending colon - semi-solid stool; solid stool; well formed stool
PREOPERATIVE CARE
DIET: LOW -RESIDUE = LOW -FIBER DIET
Reduce frequency and volume of fecal output
Reduce peristalsis
Avoid the ff foods (may increase peristalsis):
Fruits and vegetables
Breads made with whole-grain
Tough meats, nuts, peanut butter
Colon should be free of feces Why? and what will the doctor order?
If they cut your large colon and it contains feces → contaminates peritoneal cavity→ cause peritonitis
Oral administration of CATHARTICS / Laxatives (Dulcolax, Laxoberal) → night before surgery or Fleet enema (morning: 4am or 5am to totally remove feces from colon) started at least 12-24 hours before surgery
ANTIBIOTICS: Sulfonamides, Neomycin or Cephalexin 12 to 48 hours prior to surgery to decrease bowel bacteria and postoperative wound infection
Done as prophylaxis because doctors is to cut patient’s skin → open wound → high risk to develop infection
POSTOPERATIVE CARE
Monitoring of vital signs for manifestations of INFECTIONS AND SHOCK
All major surgery can cause bleeding → hemorrhage → shock
purpose of NGT tube
An NGT tube is usually in place until peristalsis returns; removed if peristalsis returns (2nd or 3rd postoperative day)
Reason for insertion after colostomy:
Stomach contains gastric juices → adverse effect of anesthesia: atelectasis → no good gas exchange → due to temp collapse of alveoli
Another adverse effect of Anesthesia → decrease of persitalsis → accumulation of gastric secretions and acid → with severe post op pain → nausea and vomiting → possible to enter lungs → aspiration pneumonia → to prevent this → NGT is inserted to drain out accumulated gastric secretions → due to paralytic ileus (no peristalsis)
rectal tube
Insertion of RECTAL TUBE for 20 - 30 minutes per physician’s order if the rectum contains gas or flatus
No peristalsis → talking after surgery → swallowed a lot of air → flatus → abdominal discomfort → removed via rectal tube or NGT
PETROLATUM GAUZE
over the stoma to keep it moist followed by a dry sterile dressing
Patient will have stoma → large intestine pulled out in abdomen → cover with sterile petrolatum gauze → over it is sterile dressing
NURSING RESPONSIBILITY (stoma)
Monitor for color changes in the stoma
NORMAL color of stoma: REDDISH → good blood supply to stoma
PALE OR LIGHT PINK: less blood to stoma
PURPLE-BLACK STOMA: obstruction → less blood to stoma; NOTIFY PHYSICIAN
