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
WHAT TO REMEBER IN STOMAS?
A small amount of BLEEDING at the stoma is normal
The ideal stoma PROTRUDES slightly to allow stool to drain into the pouch
Stomas SHRINK w/in 6-8 WEEKS
COMPLETE HEALING of the wound may
take 6-8 months and size will no longer change
Measure the stoma once weekly for the first 6 to 8 weeks to ensure proper fit of the appliance
Swelling of the stoma is normal for 2 to 3 weeks after surgery
POSTOPERATIVE CARE
Monitor the POUCH SYSTEM for proper fit and signs of LEAKAGE
Expect the stool is LIQUID in the immediate posy operative period
Empty the pouch when it is one-third to half full
COLOSTOMY IRRIGATION
To regulate bowel movements at a regular time
To empty the colon of gas, mucus, and feces
colostomy irrigation and function
When to expect colostomy to function? Starts 3 to 6 days after surgery
When to perform colostomy irrigation? 4th or 5th post op day
BEST POSITION: sit on a toilet seat or chair near the toilet
coned shape catheter and straight catheter
CONE SHAPED CATHETER: if end is used → lubricate first → can insert all
STRAIGHT CATHETER: Lubricate the distal end → insert 2-3 inches into stoma
BEFORE INSERTING SOLUTION
Remove air by flushing it with fluid. Prevents gas formation.
How long will fluid be flowing into stoma?
Water should flow in over 5-to- 10-minute period
What will be amount of water needed to stimulate patient to evacuate?
300 cc
Can give as much as 500cc but not 1L
Most of the water, feces, and flatus will be expelled in 10 to 15 minutes
After 15 minutes no output → you can wait up to max of 45 minutes
When are you going to schedule colostomy irrigation?
That is the client’s former schedule of bowel movement before surgery
The best time for you to perform colostomy irrigation
If they say a specific time, then that is the time to perform colostomy irrigation → because the bowel is already trained to evacuate during that time.
Important things to remember when performing colostomy irrigation:
Never give more than 1 L of the solution in a day
Irrigate the colostomy NOT more than once a day
Never irrigate if the patient is having DIARRHEA
Best time to change colo bag
Best time to change: 2 to 4 hours AFTER a meal OR early in the morning if the patient is already awake and before he takes his breakfast and coffee (bowels and kidneys are east active that time)
If irrigant fails to return properly: what can you do?
Gently massage lower abdomen
Take several deep breaths
Drink some warm water.
See if there are any water or feces coming out
If there is STILL NO RETURN
Try irrigation the next day
If there is NO RETURN ON THE 2ND DAY → NOTIFY THE PHYSICIAN
COLOSTOMY CARE
Apply a barrier around the stoma → why? → lifetime, you will always have a bag attached to your skin → that plaster/tape can soften the skin → once softened/wrinkled → you can have a wound → wound can be infected → why? → feces is coming out of that stoma → feces can touch the wound → can cause infection.
Barrier is applied first → so that the plaster/tape of the bag will not come in contact with the skin.
Stoma → clean the skin around it → dry thoroughly → dry in a patting motion → not in a rubbing way as this will create friction and since the skin there is soft → you can injure it → wound
OSTOMY CARE
The peritoneal area should be cleaned well with mild soap and water
Dry the skin well before the skin barrier and a new pouch is applied
Do in a patting motion
The initial output after the operation will still be liquid and at times, bloody
how do you limit gas formation in your colo bag?
Avoid flatus-producing foods → so that bag will not balloon
Beans
Banana
Onions
Broccoli
Peas
Carrots
Cabbage
Dairy products
Teach patient to chew food thoroughly
Avoid the following to prevent swallowing of air:
chewing bubble gums
Drinking with straws
smoking
Instruct to increase fluid intake up to 2 quarts in one day
Control flatus/gas
Intestinal gas is created both by swallowed air and by bacterial action on undigested carbohydrates.
