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NURS 3512 - Class 1-6 > Week 5 - Colo-rectal Cancer > Flashcards

Week 5 - Colo-rectal Cancer Flashcards

1
Q

what is colorectal cancer

A
  • malignant disease of the colon, rectum, or both
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2
Q

what are risk factors for colorectal cancer (9)

A
  • age >50
  • alcohol
  • smoking
  • Hx IBD (esp. UC)
  • colorectal polyps
  • family Hx
  • obesity
  • increased red meat
  • low fruits & veggies
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3
Q

describe symptoms of colorectal cancer

A
  • usually nonspecific

- do not occur until disease is advanced

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4
Q

list symptoms of colorectal cancer (5)

A
  • rectal bleeding
  • alternating CD
  • change in stool calibre (narrow, ribbon like)
  • sensation of incomplete evacuation
  • obstruction symptoms
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5
Q

what diagnostic tests are used for colorectal cancer (8)

A
  • history & FHx
  • physical exam
  • digital rectal exam **
  • FOBT
  • colonoscopy **
  • CT colonography
  • endorectal US
  • carcinoembryonic antigen
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6
Q

what are the current recommendations for screening for colorectal cancer

A

if asymptomatic, >50, no risk factors

  • FOBT & fecal immunochemical test noce a year
  • flexible sigmoidoscopy every 5 years
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7
Q

treatment of colorectal cancer is based on?

A
  • staging of the cancer
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8
Q

what 3 things can a colonoscopy be used to do

A
  • diagnose
  • take biopsy
  • remove polyps
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9
Q

what is used to prep the bowel before a colonoscopy

A

purgatives:

ex. GoLytely, pico-salax

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10
Q

what do purgatives do? why are they imp?

A
  • used to clean out the bowel
  • by the time they go for colonoscopy, what comes out of bowel should be clear or slight yellow
  • nothing solid, otherwise cant see
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11
Q

what are 2 categories of treatment for colorectal cancer

A
  • surgery

- chemo & radiation

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12
Q

what is the only curative treatment for colorectal cancer

A
  • surgery
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13
Q

what types of surgery are done for colorectal cancer (5)

A
  • right hemicolectomy
  • left hemicolectomy
  • abdominal perineal resection
  • low anterior resection
  • sphincter sparing procedures
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14
Q

when is a right hemicolectomy performed? what is it?

A
  • when cancer in cecum, ascending colon, hepatic flexure, transverse colon
  • removes portion of terminal ileum, ileocecal valve, appendix
  • ileotransverse anastomosis performed
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15
Q

what is a L hemicolectomy

A

resection of the :

  • L transverse colon
  • splenic flexor
  • descending colon
  • sigmoid colon
  • upper portion rectum
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16
Q

what determines what surgical procedure is performed

A
  • location of the rectal lesion

- must be enough rectum left for secure anastomosis and preservation of anal sphincter function

17
Q

when is abdominal peritoneal resection performed

A
  • when cancer is within 5 cm of anus
18
Q

what is an abdominal peritoneal resection

A
  • abdominal incision made
  • distal sigmoid colon, rectum, and anus removed
  • proximal sigmoid colon brought thru abdominal wall for permanent colostomy
19
Q

what are left after an AP resection

A

2 wound and colostomy:

  • abdominal incision
  • perineal incision which is either sewn closed w drain in place, or packed and left open
  • colostomy in LLQ
20
Q

what are some potential complications of AP resection (6)

A
  • delayed wound healing &infections (d/t location, lots of bacteria)
  • hemorrhage
  • persistent perineal sinus tracts
  • UTI
  • sexual dysfunction
21
Q

what is a low anterior resection used fr

A
  • tumours of the rectosigmoid and mid-to-upper rectum
22
Q

when are sphincter sparing procedures performed (2)

A
  • if pt is poor operative risk

- if early disease

23
Q

when is chemo & radiation used as treatment for colorectal ca (2)

A
  • as an adjuvant

- if not surgical candidate

24
Q

what is postop care for a pt after AP resection (2)

A
  • wound assessment and care

- positioning

25
Q

describe wound assessment and care post AP resection (4)

A
  • keep perineum clean and dry , irrigate w NS
  • dressing changes
  • drain care –> examine, keep area around clean and dry,
  • examine wound regularly & record bleeding, drainage, or excessive odor
26
Q

describe positioning for a pt after AP resection (3)

A
  • side to side positioning –> not on rectum
  • use pressure cushion if sitting
  • no pressure on perineum
27
Q

what is an ostomy

A
  • a surgical opening to permit diversion of fecal material
28
Q

what are 2 types of ostomies

A
  • colostomy

- ileostomy

29
Q

describe stoma assessment post-op , how often to assess and what are normal findings? (3)

A

assess stoma q8h

  • mild to mod edema
  • small amt bleeding or oozing when touched
  • should be pink, rose to brick red
30
Q

describe stoma drainage postop

A
  • amt of drainage in first 24-48 h negligible

- will begin to pass flatus as peristalsis increases in ~48 h, then stool

31
Q

describe pt teaching r/t colostomy and ileostomy (9)

A
  • inspect stoma and skin for breakdown
  • empty pouch when 1/3 full or inflated w gas
  • use deodrants as needed
  • avoid certain foods
  • initially low residue diet, then increase gradually
  • increase fluid intake
  • observe for S&S of dehydration (esp. w ileostomy)
  • support groups
  • what S&S to report
  • assess stool consistency
32
Q

what foods should be avoid w an ostomy

A
  • food that causes odor: onion, egg, garlic
  • food that causes gas: onion, beans, cabbage, beer
  • food that cause obstruction: nuts, popcorn
  • food that cause diarrhea
33
Q

describe stool consistency w an ileostomy vs colostomy

A
  • ileostomy = liquid

- colostomy = formed

34
Q

what S&S should a pt report post ostomy(4)

A
  • fever
  • diarrha
  • constipation
  • stoma problems
35
Q

what are general rules to apply to all GI postop surgery

A
  • pain control
  • nausea
  • constipation
36
Q

describe pain control for all general GI postop (6)

A
  • PCA or regular anasthesia for 72 hr
  • assess type of pain
  • pain may be from incision or gas
  • ambulate to relieve gas pains
  • splint incision for DB&C w pillow
  • position for comfort
37
Q

describe care for nausea for all general GI postop (4)

A
  • give antiemetics
  • NG to low suction
  • assess BS and distension
  • eliminate unpleasant sights, smells, and stimuli
38
Q

describe care for constipation for all general GI surgeries

A
  • assess for distension & BS q shift
  • ambulate as tolerated
  • use stool softeners or antidiarrheals
  • increase fluid intake
  • I&O
  • stool counts

NURS 3512 - Class 1-6 (47 decks)

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