colorectal cancer care [compatibility mode]

8/15/2019 Colorectal Cancer Care [Compatibility Mode]

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Ns. Hilman Syarif, M.Kep., Sp.Kep.MB

Learning Outcomes

At the end of this lecture, students will be able to:• Describe the incidence and trend of colorectal cancer• Identify the risk factors for the development of colorectal

cancer.• Discuss the clinical picture of colorectal cancer alongwith the assessment and diagnostic evaluation.

• Discuss the medical management of a patient withcolorectal cancer.

• Describe the nursing process as a framework for caringfor a patient with colorectal cancer.

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Source: http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal/page2

The colon and rectum

5 Key Points

1. Some 40,000 new cases of colorectal cancer aredignosed in the UK every year

2. Risk factors for colorectal cancer include a highintake of meat and fat, smoking, lack of exercise andhigh alcohol consumption

3. Most colorectal cancers develop from benign polypsor adenomas and so can be detected before theybecome malignant

4. Accurate staging of the cancer will mean anappropriate treatment plan can be put together

5. Colorectal Cancer Treatment includes surgery,radiotherapy and chemotherapy

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http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal/page2http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal/page2


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Risk Factors For Colorectal Cancer

• Increasing age (highest in people older than 85 years).• Family history.• Previous colon cancer.• High consumption of alcohol.• Cigarette smoking.• Obesity and history of gastrectomy.

• History of inflammatory bowel disease.• High fat, high protein, low fiber diet.• Genital cancer or breast cancer.

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Clinical Manifestations

• Three factors greatly determine the signs and symptomsexperienced by a patient with colorectal cancer. Theseare: – Location of tumor. – Stage of disease. – Function of the affected intestinal part.

• Most commonly, patients have change in bowel habitsand passage of stool with blood. Other clinicalmanifestations include unexplained anemia, anorexia,weight loss, and fatigue.

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Site of cancerSite of cancer SymptomsSymptoms

Right side AnaemiaDiarrhoeaPalpable right iliac fossa mass

Transverse colon There may be a mix of left and right symptoms

Left side Alteration in bowel habitSpurious diarrhoeaObstructionBlood mixed with stool

Rectal BleedingPassage of mucusTenesmus (constantly feeling the need to emptythe bowels)Change in bowel habitUrgencyPalpable rectal massRectal pain

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Clinical Manifestations (Continued…)

• Right-sided lesions are associated with: – Abdominal pain and melena.

• Left-sided lesions, causing obstruction, are associated with: – Abdominal pain and cramping. – Narrowing stools and constipation. – Distention and bright red blood in stool.

• Rectal lesions are associated with: – Ineffective, painful straining at stool. – Rectal pain. – A feeling of incomplete evacuation after a bowel movement. – Alternating constipation and diarrhea. – Bloody stools.

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Assessment and Diagnostic Findings Assessment and Diagnostic Findings

• Physical examination anorectal assessment asigmoidoscopy (if the suspected position of the cancer iswithin 60 cm of the anus so it can be visualised) andblood tests.

• Further examination a colonoscopy (or virtualcolonoscopy with a computerised tomography (CT)scanner), or more rarely, a barium enema

• Tissue biopsies are usually taken from any polyps seen.• Histological confirmation of the diagnosis is generally

sought before the patient is informed.

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Medical ManagementMedical Managementof a Patient With Colorectal Cancerof a Patient With Colorectal Cancer

• If there is intestinal obstruction, patients are treatedwith IV fluids and nasogastric suction. Blood transfusion

if there is significant blood loss.• Surgery is the primary treatment for most colorectal

cancers.• Radiotherapy is also used for unresectable tumors for

symptoms relief.• Chemotherapy (adjuvant/ neo adjuvant)


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Medical Management of a Patient With Colorectal Cancer

(Continued…)

• Colostomy: This is a surgical creation of an opening into the colon.It could be temporary or permanent.

13Permanent colostomy for rectal cancer

• Colostomy (Continued…):

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Percent Surviving5 Years

Oncology Nursing as a Profession• What does it take?

– Knowledge – Critical thinking – Technical skills – Psychosocial skills – Compassion

– Empathy – Self care – Called – Life-long learning

Assessment

• Collect subjective data about: – Presence of fatigue. – Abdominal or rectal pain. – Past and present elimination pattern.

– Characteristics of stool. – Family history and fat and fiber intake. – Alcohol intake and smoking. – Weight loss.

• Auscultate the abdomen for bowel sounds.• Palpate the abdomen for distention and solid masses.

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ReaksiReaksi PsikososiospiritualPsikososiospiritual

• Kehilangan kekuatanfisik / tidakmandiri lelah

• Kehilangan peran• Kehilanagn relasi

interpersonal

hambatankomunikasi• Kehilangan fungsi

seksual

• Loche & Gorman: – Kehilangan integritas

fisik perubahanpenampilan alopesia,gangguan fungsi tubuh

– Kehilangan harapanhidup (life expectancy)

– Kehilangan kontrol diri – Kehilangan integritas

mental emosi labil – Kehilangan kesempatan

beribadah

• Receiving a cancer diagnosis is generallydistressing and life-changing (Taylor,2001)

• It should be communicated sensitively(Department of Health, Social Servicesand Public Safety, 2003).

• Support and information are essential andshould be offered throughout the patient’s

journey.

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Nursing Management (Continued…)

Nursing Diagnoses

• Imbalanced nutrition, less than body requirements,related to nausea and anorexia.

• Risk for deficient fluid volume related to vomiting anddehydration.

• Anxiety related to cancer diagnosis and impendingsurgery.

• etc

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Planning and goals

• Attainment of optimal nutrition.• Maintenance of fluid and electrolyte balance.• Reduction of anxiety.• Expressing feelings and concern about colostomy and the

impact on self.• etc


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Nursing Interventions• Patient Preparation for Surgery.

• Build the patient’s stamina days before surgery.• Cleanse the bowel the day before surgery.• If possible, provide a diet high in calories, protein, and

carbohydrate for several days before surgery.• Provide full liquid diet if prescribed 24 to 48 hours before

surgery to reduce bulk.• Clean the bowel with laxatives and/ or enemas the evening

before and the morning of surgery.• Record intake and output to provide an accurate record of fluid

balance.

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Nursing Interventions

• Patient Preparation for Surgery (Continued…).• Insert nasogastric tube if ordered to drain accumulated fluids

and prevent abdominal distention.• Monitor the patient for increasing abdominal distention, loss of

bowel sounds, and pain or rigidity, which may indicate intestinalobstruction or perforation.

• Observe the patient for signs of hypovolemia (tachycardia,hypotension, decreased pulse volume).

• Assess hydration status.


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Nursing Interventions• Providing Emotional Support.

• Assess the patient’s level of anxiety.• Suggest methods for reducing anxiety such as deep breathing

exercises and visualising a patient who successfully recoveredfrom surgery and cancer.

• Provide factual information about the colostomy site to reducethe patient’s fear that everybody will be aware of the ostomy.

• Providing Postoperative Care.• Pain management.• Abdominal assessment for bowel sounds.• Mobilise the patient out of bed on the 1 st day postop.

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• Maintaining Optimal Nutrition.• Teach patients undergoing surgery about the health benefits of

consuming healthy diet.• Perform complete nutritional assessment to evaluate the

nutritional status of the patient.• Advise the patient on avoiding foods that cause excessive odor

and gas such as foods in cabbage family, eggs, asparagus, fish,and beans.

• Help the patient identify any foods or fluids that may causediarrhea including fruits, high fiber foods, soda, coffee, tea, orcarbonated drinks.

• Advise a fluid intake of at least 2 L/ day


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• Supporting a Positive body Image.• Encourage the patient to verbalise feelings and concerns about

altered body image, and to discuss the surgery and the stoma ifone was created.

• If applicable, teach the patient about colostomy care in an open,

accepting manner and encourage him to talk about his feelingabout the stoma.

Focus on; Preoperative teaching

• Preoperative education sessions should includethe patient and caregivers.

• The patient’s physician is responsible forexplaining the operative procedure andanswering any questions.

• Nursing staff is responsible for reinforcing theinformation that patients received from theirphysician and to review general post-operativeexpectations.

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Cont..• The number of tubes and holders. (Ed note: The

patient should be informed of the many tubesthat will be held in place by various tube holdersincluding, IV lines, foley catheters, nasogastrictube and colostomy bag.

• If indicated, the application of an abdominalbinder may be applied to hold “open wound”dressings in place, and additionally Velcro ®.straps can secure drainage lines and ostomybags

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Paska OperasiPaska Operasi

Diagnosa Keperawatan

• Risiko cedera b/d komplikasi pasca operasi,termasuk infeksi, perdarahan, disrupsi luka,tromboflebitis dan fungsi stoma tidak normal

• Resiko perubahan citra tubuh b/d kolostomi danperubahan gaya hidup

• Manajemen rejimen terapeutik efektif

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IntervensiMenurunkan risiko cedera

• Monitor TTV• Naikkan diet sesuai toleransi• Menurunkan kram

• Gunakan perban rektal• Mengurangi nyeri• Monitor drainase stoma

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• Intervensi• Meningkatkan citra tubuh

• Berikan dukungan emosional saat klien memulai prosespenyesuaian kolostomi

• Edukasi yang lengkap mengenai perawatan kolostomi• Orang terdekat klien juga harus beradaptasi dengan

kolostomi• Bantu klien mendengarkan reaksi tentang kolostomi• Solusi masalah seksualitas

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IntervensiManajemen terapeutik

• Ajarkan penanganan ostomi• Ajarkan irigasi stoma• Kurangi flatus

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colorectal cancer care [compatibility mode]

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