Colorectal Cancer

Question 1

A newly placed colostomy takes approximately ________ days for fecal drainage to begin

Answer 1

2-3 days

Question 2

Fluorouracil is what class of drug

Answer 2

Antineoplastics

Question 3

During the Health HX assessment what are the four (4) areas that you should be asking about?

Answer 3

1) Changes in bowel pattern?
2) Family HX of Colorectal CA
3) Pain
4) HX of inflammatory Bowel DIsease and/or Polyps

Question 4

Risk factors (6) of colorectal cancer

Answer 4

1. ) >50 yrs of age
   2) Polyps of colon/rectum
   3) family hx
   4) Inflammatory bowel disease
   5) Exposure to radiation
   6) Diet high in fats, calories and meat proteins

Question 5

what type of bowel sounds will you most likely hear with an obstruction?

Answer 5

-high pitched at first, then goes silent

Question 6

TRUE or FALSE?

Colorectal CA is a rapidly growing cancer

Answer 6

False-

it is a slow growing cancer that takes typically 5-15 years before it starts causing problems

Question 7

Four (4) areas where you can assist your patient with Colorectal CA

Answer 7

1) Pain Management
2) Balanced Nutrition
3) Colostomy Care
4) Healthy Coping

Question 8

Late Manifestations of colorectal CA

Answer 8

• anorexia
• pain
• weight loss
• bowel obstruction
• palpable abdominal mass (VERY LATE SIGN)

Question 9

Risks (3) of TPN

Answer 9

1) Risk of infection
- central line dressing
- bag/tubing change

2) Risk of Hyperglycemia
- High glucose content of TPN given to a hyperglycemic pt =DEHYDRATION

3) Fluid Overload
- Hypertonic solution may causes fluid shift into vascular space

Question 10

A Healthy stoma should be what color?

Answer 10

pink/ bright red & Moist

Question 11

list four (4) very important nursing interventions when administering TPN

Answer 11

1) Daily Weight
2) Daily Labs
3) I & O
4) Bedside glucose checks Q 4-6 hours

Question 12

how often do you change colostomy appliances?

Answer 12

PRN; early AM (or) 2-4 hours after a meal when bowel is least active

Question 13

most common type of colostomy

Answer 13

Sigmoid Colostomy

Question 14

Four (4) things that can cause mechanical bowel obstruction:

Answer 14

1) Pressure from tumors
2) adhesions
3) stenosis
4) volvulus

Question 15

With Colorectal CA, what is the most common symptom that brings patients to the hospital?

Answer 15

Rectal bleeding

Question 16

what age should you begin fecal occult blood tests?

Answer 16

50 years old

Question 17

Tx (3) for Large bowel obstruction

Answer 17

1) Decompress bowel—Gtube
2) Correct fluid imbalance–IV FLUIDS
3) Surgery to resect bowel, remove tumor, release adhesions

Question 18

NOT the primary tx for colorectal cancer

Answer 18

Radiation Therapy

Question 19

Bowel obstruction typically seen after surgeries

Answer 19

non-mechanical bowel obstruction (AKA: Paralytic Ileus)

Question 20

How often should a fecal occult blood test be performed?

Answer 20

yearly

Question 21

a dry stoma that is purple/black in color indicates________________.

Answer 21

ischemia

Question 22

Bowel obstructions cause (increase/decrease) in secretions with abdominal distention

Answer 22

increase in secretions

Question 23

what diagnostic labs would be ordered for colorectal cancer? rationale for each?

Answer 23

1) Fecal occult blood- tumor may cause rectal bleeding
2) CBC- to detect anemia r/t chronic blood loss/tumor growth
3) CEA- Carcinoembryonic Antigen…tumor marker

Question 24

How is TPN administered?

Answer 24

• Through central line only!

- always via infusion pump

Question 25

(TRUE) or (FALSE)

ALL tubing an solution is discarded every 14 hours (TPN)

Answer 25

False

every 24 hours

Question 26

(TRUE) or (FALSE)…

TPN is administered over a 12 hour period?

Answer 26

False

-it is administered over a 24 hour period (2-3 Liters)

Question 27

Type of bowel obstruction caused by colorectal CA

Answer 27

Mechanical bowel obstruction

Question 28

Primary tx for colorectal cancer

Answer 28

Surgical resection of colon with anastomosis of remaining bowel and regional lymph nodes

Question 29

PREVENTION of colorectal cancer should include yearly fecal occult blood tests and one (1) of the following tests:

Answer 29

1) Sigmoidoscopy every 5 years
2) Double Contrast barium enema every 5 years
3) CT colonography every 5 years
4) colonoscopy every 10 years

Question 30

Early Manifestations of Colorectal CA

Answer 30

*changes in bowel habits (diarrhea, constipation)

Question 31

what are your concerns for the patient that has loss of K+ and chloride and emesis/

Answer 31

Hypokalemia
Hypovolemia
Metabolic alkalosis

Question 32

What type of bowel obstruction do you have if….motility is working, but there is something blocking the GI…

Answer 32

Mechanical bowel obstruction

Question 33

Most cases of colorectal cancer begin as _________.

Answer 33

Polyps

Question 34

Most clients that get colorectal cancer are in what age group?

Answer 34

Over the age of 50

Question 35

Explain the fluid shift that occurs with a bowel obstruction

Answer 35

Fluid shifts from the vascular space into the abdominal cavity leading to hypovolemia and abdominal distension

Question 36

Fluorouracil is typically used in conjunction with _____ therapy

Answer 36

radiation

Question 37

This diagnostic test called ________examines the most distal part of the colon

Answer 37

sigmoidoscopy

Question 38

Diagnostic studies (4) for Bowel obstruction

Answer 38

1) Abdominal Xray
2) CT
3) Electrolyte levels
4) CBC

Question 39

True or False?

Patient with Bowel obstruction is at Risk for fluid overload

Answer 39

FALSE

*Pt is at risk for hypovolemia r/t fluid shifting from the vascular spaces into the abdominal cavity

Question 40

Common side effects of 5-FU (fluorouracil)

Answer 40

Alopecia
Stomatitis
Nausea
Diarrhea
Loss of appetite
Increased risk of infection(r/t leukopenia)
Increased risk of bruising/bleeding (thrombocytopenia)
Fatigue (anemia)

Question 41

(True or False)

Radiation therapy is only used postoperatively

Answer 41

False-It can be used preoperatively and postoperatively

Question 42

Does TPN require special tubing for administration? If so, what size?

Answer 42

_YES

_Tubing with 1.2 micron filter

Question 43

most commonly, colorectal cancer metastasizes to the _________.

Answer 43

liver