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Nursing 172 > Week 12: Chp 58: Colorectal Cancer > Flashcards

Week 12: Chp 58: Colorectal Cancer Flashcards

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1
Q

Colorectal cancer involves cancer of what?

A

cancer of the rectum and large intestine

-mostly found in the distal portion of the large intestine

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2
Q

Risk Factors

A

personal or family history of colorectal cancer (first-degree relative), history of adenomatous polyps, inflammatory bowel disease (IBD) for 10 years or more, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer (HNPCC) or lynch syndrome, physical inactivity, obesity, high-fat diets and consumption of red meat (> 7 servings per week), and processed meats, cigarette use, and alcohol intake (> four drinks per week)

  • inadequate intake of fruits and vegetables
  • diabetes type 2
  • industrialized countries
  • increases with age
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3
Q

What type of cancer is colorectal cancer?

A

adenocarcinomas

-type of cancer that originates in glandular cells of internal organs

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4
Q

Where can colorectal cancer metastasize to?

A

liver

-lungs, brain, bones, and adrenal glands

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5
Q

Seeding

A

may also occur during resection when the cancer cells break off from the tumor into the peritoneal cavity

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6
Q

Diagnostic Studies for Colorectal Cancer

A

Fecal occult blood test (FOBT), or fecal immunochemical test (FIT) and digital rectal examination (DRE)

  • Lower GI series
  • double-contrast barium enema
  • sigmoidoscopy
  • colonoscopy
  • virtual colonoscopy
  • fecal DNA testing
  • wireless capsule endoscopy
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7
Q

Fecal Occult Blood Test (FOBT), or Fecal immunochemical Test (FIT), and digital rectal examination (DRE)

A

stool sample is collected and placed on a special slide and tested for hidden blood
-a DRE is performed by the provider

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8
Q

Lower GI series

A

a tube is inserted into the rectum, and the large intestine is filled with barium

  • the patient is asked to change positions several times in order to evenly distribute the barium
  • x-ray pictures and/or video are taken
  • the barium is constipating, so care should be taken to advise the patient to take appropriate measures to prevent constipation
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9
Q

Double-contrast barium enema

A

takes place after the patient has expelled most of the barium from the intestine
-the remaining barium clings to the intestinal wall; the intestine is then inflated with air, and additional x-ray images are taken

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10
Q

Sigmoidoscopy

A

a flexible tube with a light and camera at the end is inserted into the rectum and colon up to the transverse colon

  • the camera transmits images to the computer screen
  • biopsies can be taken from the rectum and sigmoid colon for further examination
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11
Q

Colonoscopy

A

a long, flexible tube with a light and camera on the end is inserted into the full length of the colon

  • the provider has the ability to view the entire colon as well as to remove polyps and take biopsies as deemed necessary
  • the patient receives sedation for the procedure
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12
Q

Virtual Colonoscopy

A

performed in either the CT scanning department or MRI
-a tube is inserted into the rectum
-for CT, carbon dioxide is administered to enlarge the colon for better viewing
for MRI, a contrast medium is given through the rectum to expand the large intestine
-cross-sectional images are produced and processed to create three-dimensional, computer-generated images of the large intestine
-sedation is not required

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13
Q

Fecal DNA testing

A

colorectal cancers contain abnormal DNA that is shed in the stool
-if this test is positive, it should be followed with a colonoscopy

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14
Q

Wireless Capsule endoscopy

A

“pill camera”

  • a pill approximately the size of a vitamin; patient swallows the pill with the camera within the pill, and the camera captures videos through the GI tract
  • takes 8 hours to pass through the GI tract while images are recorded on a portable device
  • images transported from device to computer
  • technique most useful with cancers of the small bowel that are difficult to detect through traditional endoscopy
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15
Q

Clinical Manifestations

A

early stage, symptoms are insidious and go ignored by patient

  • vary according to where the cancer is located in the intestine
  • first signs: unexplained weight loss and fatigue
  • change in bowel regularity and/ or appearance of stool, blood in the stool (red or black depending on location), abdominal pain and/or distension, and a sensation of pressure as with incomplete evacuation after a bowel movement, along with clinical manifestations of anemia
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16
Q

Clinical Manifestations regarding ascending colon

A

vague abdominal pain and/or cramping, change in bowel habits, anemia (not enough healthy red blood cells), and fatigue

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17
Q

Clinical manifestations regarding transverse colon

A

pain, clinical manifestations of obstruction, change in bowel habits, anemia, fatigue

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18
Q

Clinical manifestations regarding descending colon

A

pain, change in bowel habits, bright red blood in stool, and clinical manifestations of intestinal obstruction

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19
Q

Clinical manifestations regarding cancer in rectum

A

blood in stool, change in bowel habits, rectal discomfort, and feeling of incomplete evacuation

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20
Q

Gold Standard for diagnosing Colorectal Cancer

A

colonoscopy

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21
Q

Use of Colonoscopy

A

biopsies can be taken, and polyps removed during the procedure

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22
Q

Colonoscopy and what other diagnostic studies may be evaluated with colorectal cancer?

A
  • serum carcinoembryonic antigen (CEA)
  • CBC
  • CT
  • MRI
  • abdominal x-rays
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23
Q

an elevated serum carcinoembryonic antigen (CEA) indicates what?

A

overexpression of an oncofetal glycoprotein that is normally expressed by mucosal cells

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24
Q

CBC results may demonstrate what?

A

anemia due to blood loss and an elevated WBC secondary to inflammation and infection

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25
Q

CT, MRI, and abdominal x-rays may indicate what?

A

information about abdominal obstruction

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26
Q

Common method for staging colorectal cancer

A

TNM (tumor-node-metastasis) classification system

  • stages I through IV
  • prognosis worsens with larger size and depth of tumor, lymph node involvement, and metastasis
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27
Q

Treatment

A
  • chemotherapy

- radiation therapy

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28
Q

Treatment: Chemotherapy

A

used as an adjunct to improve survival rates for patients whose tumors cannot be completely removed

  • adjuvant chemotherapy for stage II and III
  • chemotherapy interrupts DNA production of cells
  • cannot distinguish between healthy cells and cancer cells
  • intra-arterial chemotherapy may be given into the liver if metastasis has occurred
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29
Q

Side effects of chemotherapy

A
  • diarrhea
  • mucositis
  • leukopenia
  • mouth ulcers
  • alopecia
  • peripheral neuropathies
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30
Q

Treatment: Radiation Therapy

A

can be used preoperatively to reduce the size of a tumor, making it easier to remove all or most of the tumor

  • used as a palliative measure to control pain, hemorrhage, bowel obstruction, or metastasis to the lung in advanced disease
  • effective for rectal cancer
  • may be used preoperatively, intraoperatively, and postoperatively
31
Q

Surgical Management

A

usually involves surgery to remove the affected portion of the colon

  • type and extent of surgery depends on the size of tumor, its location, and its stage
  • adjacent lymph nodes are also removed
  • depending on location of the tumor, a temporary or permanent colostomy may be performed; a temporary colostomy is performed, and at a later time after healing has taken place, an anastomosis (attachment of one end to the other) is performed to reconnect the the colon to the rectum to allow for normal defecation
32
Q

Goal of surgery

A

remove the tumor and affected portion of the colon with proximal and distal margins of the normal bowel

33
Q

Common Surgical Procedures

A
  • Colectomy: excision or part of or all of the colon
  • Hemicolectomy: excision of half or less of the colon (ay be right or left)
  • Abdominoperineal resection: the affected colon and affected rectum are removed, and the anus is closed; the colon is removed through an abdominal incision, and the rectum is removed through a perineal incision; the ileostomy is permanent
34
Q

Complications

A

Radiation enteritis may develop and lead to diarrhea, blood in stool, and weight loss

35
Q

Postoperative complications

A

blood loss, anastomoses, infection, and incisional dehiscence
-metastasis

36
Q

Nursing Management: Preoperative patient

A
  • undergoes a variety of emotions
  • include family members with assessment and teaching
  • teaching, preparation for treatments, and emotional support
37
Q

Assessment and Analysis for preoperative

A
  • assess patients current knowledge of disease and treatment
  • understanding of location, type, severity, and classification of the cancer is key to providing holistic nursing care
  • correlate the clinical manifestations and diagnostic study results with the definitive diagnosis
  • clinical presentation is closely associated with the location of the tumor, and includes unexplained weight loss, fatigue, blood in stool, and clinical manifestations of anemia
  • assess any support systems
38
Q

Nursing Diagnosis for preoperative

A
  • knowledge deficit r/t surgery for colorectal cancer

- fear r/t the potential outcome of surgery for colorectal cancer

39
Q

Nursing Assessments for preoperative

A
  • vital signs
  • serum electrolytes and CBC values
  • current knowledge of disease and pre/postoperative care
40
Q

Nursing Assessments for preoperative: Vital Signs

A

measure physiological function and provide a baseline for after surgery

41
Q

Nursing Assessments for preoperative: Serum electrolyte and CBC

A

important electrolytes are within normal limits prior to surgery
-the CBC provides baseline data about hemoglobin and hematocrit, as well as the WBC that may be elevated due to inflammation or infection

42
Q

Nursing Assessments for preoperative: Current knowledge of disease and pre/postoperative care

A

nurse should reinforce any teachings given by the surgeon, such as the incision and any drains that may be present after surgery
-the knowledge of what to expect postoperatively helps to alleviate concerns ad fears associated with the surgery

43
Q

Nursing Actions for preoperative patient

A
  • bowel prep (if ordered)
  • therapeutic relationship
  • surgical consent form is signed
44
Q

Actions: bowel prep (if ordered)

A

patient will likely receive a thorough “bowel prep” prior to surgery to minimize bacterial growth and prevent contamination with feces during surgery

  • most common method of bowel prep or cleansing is polyethylene glycol solution (GoLYTELY)
  • an antibiotic may also be given prior to the incision, also to reduce the risk of infection
45
Q

Most common method of bowel prep

A

polyethylene glycol solution (GoLYTELY)

46
Q

Nursing Teaching for preoperative patient

A
  • preoperative teaching related to ostomy care

- pain

47
Q

Commonly used Chemotherapy Medications

A
  • 5-fluorouracil (5-FU) with leucovorin (LV)
  • Capecitabine (Xeloda)
  • Oxaliplatin (Eloxatin)
  • Bevacizumab (Avastin)
  • Irinotecan (Camptosar)
  • Cetuximab (Erbitux)
48
Q

Assessment and Analysis for post-op patient

A
  • vital signs measure physiological functions and should be within the range of preoperative levels
  • after anesthesia it is important to note patients ability to arouse and orientation to surroundings
  • change in level of consciousness is first sign of other complications
  • postop pain in the surgical area is expected
  • bowel sounds will be severely diminished or absent, which is expected due to surgical manipulation
  • CBC may demonstrate mild anemia
  • WBC elevated due to inflammation, and is monitored for infection
  • assessment of stoma in case of an ostomy
49
Q

Nursing Diagnosis for Post op

A
  • acute pain r/t surgical incision
  • potential for infection r/t interruption of primary defenses (skin) and indwelling tubes and drains
  • risk for imbalanced fluid volume r/t the response to abdominal surgery
  • knowledge deficit r/t postoperative care
  • disturbed body image r/t the ostomy
50
Q

Nursing Assessments for Post-op

A
  • vital signs at least every 4 hours
  • hemoglobin and hematocrit
  • WBC
  • nausea and vomiting
  • intake and output
  • stoma
  • ostomy drainage
  • abdominal/peritoneal dressing/ incision
  • pain
51
Q

Post op Assessment: Vital signs at least every 4 hours

A

a mild elevation in temperature may be expected in the first 48 hours because of the inflammatory response to surgery

  • a marked elevation in the first 48 hours is usually related to atelectasis
  • after the first 48 hours, the patient should continue to be assessed for infection
  • elevations in HR and decrease in BP are indicative of decreased fluid volume status
52
Q

Post Op assessment: hemoglobin and hematocrit

A

monitor hemoglobin and hematocrit daily while patient is hospitalized because this may indicate bleeding and/or nutritional deficits
-compare preoperative levels to postoperative levels while noting the estimated blood loss in surgery

53
Q

Post op assessment: WBC

A

WBC is monitored everyday for the first few days

  • a mild elevation can be expected in the first 48 hours because of the inflammatory response
  • later an elevation may indicate infection or other complications
54
Q

Post op assessment: Nausea and Vomiting

A

anesthesia and manipulation of the bowel decreases peristalsis, and bowel sounds may be absent for 1 to 3 days after surgery

  • the patient will be NPO after surgery, with IV fluids and electrolyte replacements given as needed
  • may have an NG tube for stomach decompression postoperatively, and it must be frequently assessed for patency; the NG tube stays in place until bowel function returns
  • patient then begins with a clear liquid diet, advancing diet as tolerated
55
Q

Post op assessment: Intake and output

A

fluid losses from surgery result in decreased renal perfusion, leading to fluid retention

  • the lower output is caused by increased aldosterone and antidiuretic hormone secretion because of the surgery and associated stress associated
  • the patient should maintain 30 mL/hr of urine output
  • patient may have an indwelling urinary catheter in place after surgery, with standard measures taken to prevent UTI
  • low urine output compared with intake in the first 24 hours is normal as long as 30 mL/hr is maintained
  • by the third postoperative day, urine output normalizes
56
Q

Post op Assessment: Stoma

A

(opening of the ostomy) determines the health of stoma
-should be reddish pink and moist
-there may be some edema noted initially which will subside in a few days
may also be slight bleeding or serosanguineous drainage
-any discolorations could be a sign of necrosis and should be reported

57
Q

Post op Assessment: Ostomy drainage

A

the type, amount, appearance, and consistency of drainage will differ as to where the ostomy is placed

  • the closer to the small intestine, the more liquid the stool
  • in patient with ileostomy it is important to monitor fluid and electrolyte balance due to potential losses of potassium
58
Q

Post op Assessment: Abdominal/perineal dressings/incisions

A

incisions and dressings should not have excessive drainage noted because this could indicate complications such as bleeding

59
Q

Post-op Assessment: Pain

A

adequate pain management is necessary for the patient to return to an optimal level of functioning and to prevent postoperative complications

60
Q

Nursing Actions for Post op

A
  • administer IV fluids
  • maintain NPO/advance diet as tolerated
  • nasogastric tube care
  • implement pain management strategies
  • drain management
  • turning, coughing, deep breathing, and incentive spirometry 10 times every hour while awake
  • implement early ambulation
  • perianal care
  • make appropriate referrals
61
Q

Nursing Actions Post-OP: administer IV fluids

A

IV fluids are maintained postoperatively to replace fluid losses in surgery and to assist in maintaining proper fluid balance

62
Q

Nursing Actions Post-OP: maintain NPO/advance diet as tolerated

A

prevention of nausea and vomiting until bowel function returns
-return of bowel sounds is required prior to advancing the diet to minimize nausea and vomiting

63
Q

Nursing Actions Post-OP: Nasogastric Tube Care

A

patient may have a NG tube for stomach decompression, and measurement of this output is also necessary

  • NG tubes that allow for decompression remain in place until bowel function returns, preventing nausea and vomiting from occurring
  • important to ensure that there is consistent drainage, as lack of output from the drain may indicate an obstruction
  • without adequate decompression and drainage, there may be pressure on the surgical site
64
Q

Nursing Actions Post OP: implement pain management strategies

A

patient may have a PCA pump or epidural analgesia for the first few days postoperatively
-if pain is adequately controlled, the patient will return to an optimal level of activity sooner and prevent postoperative complications

65
Q

Nursing Actions Post OP: Drain Management

A

the placement of drains prevents fluid accumulation near the site of surgery

  • there may be drains placed within the perineal and/or abdominal incision such as Penrose drain, Jackson-Pratt, or Hemovac
  • the nurse notes the appearance and amount of drainage frequently, and drainage is usually serosanguineous
  • drains are monitored for decreasing amount of drainage and are usually left in place approximately 3 to 5 days
  • when the dressing of a Penrose drain is changed, care must be taken to make sure it is not accidentally dislodged
  • make note of amount, color, and odor of the drainage
66
Q

Nursing Actions post OP: Turning, coughing, deep breathing, and incentive spirometer 10 times every hour while awake

A

promotes lung expansion, prevents atelectasis, and helps mobilize secretions to be expectorated

67
Q

Nursing Actions Post OP: implement early ambulation

A

promotes circulation and prevention of postoperative complications such as venous thromboembolism (VTE)
-the patient may also be receiving anticoagulation therapy with heparin or Lovenox for VTE prophylaxis

68
Q

Nursing Actions Post OP: Perianal Care

A

for the patient who has undergone an abdominoperineal resection, it is important to note that the perineal incision is much more sensitive and a greater source of pain for the patient than the abdominal incision

  • patient often complains of phantom rectal sensation due to the fact that sympathetic nerves responsible for rectal control are not severed during surgery
  • the area should be inspected frequently for drainage and abscess (localized collection of pus) formation
  • sitz baths may be ordered for comfort and gentle cleansing of the perineal area
69
Q

Abscess

A

localized collection of pus

70
Q

Nursing Teachings for Post-Op

A
  • methods to prevent postoperative complications (teach preoperatively)
  • ostomy teaching
71
Q

Evaluation of Care for Post Op

A

stable vital signs, adequate hematocrit and hemoglobin, no signs of infection, positive bowel sounds, ability to care for surgical incision site and ostomy, and pain management strategies

72
Q 
The nurse is caring for a patient with colorectal cancer who just had a total colectomy with placement of a permanent ileostomy. Which nursing diagnosis is a priority for the immediate postoperative period?
A. Disturbed Body Image
B. Acute Pain
C. Potential for Infection
D. Knowledge Deficit
A

B. Acute Pain

73
Q

What does it looks like when a stoma shows signs of ischemia?

A

dark red, purplish, or black in color

-this is a sign that there is little or no blood flow to the stoma

Nursing 172 (120 decks)

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