Colorectal (Colon) Cancer and Its Management Essay.

Colorectal Cancer (CRC) in a 45 Year-Old Female: Nursing Management in the Patient Who Has Undergone Surgery

Cancer of any type is one of the leading causes of death worldwide. Colorectal cancer (CRC) in particular is a type of cancer that causes high mortality due to the fact that it is normally discovered after it has already reached advanced stages.Colorectal (Colon) Cancer and Its Management Essay.

ORDER A PLAGIARISM-FREE PAPER HERE

The case of Madam K is exemplary as proof of this fact. Unfortunately, data and studies on colorectal cancer (which is also sometimes referred to as colon cancer) have shown that it disproportionately affects persons from minority communities with low socioeconomic status. Surgical resection is one of the ways in which colorectal carcinoma can be managed. It involves removing the section of the bowel that is affected in the hope that the malignant cells will not have already spread to the adjacent tissues or lymph nodes (Hammer & McPhee, 2018; Huether & McCance, 2017). This is what was done to Madam K. She now faces stigma from the community and is experiencing discomfort due to the temporary colostomy. This paper is a discussion of the management of Madam K, with emphasis on holistic nursing management of her condition and current situation.Colorectal (Colon) Cancer and Its Management Essay.

Colorectal (Colon) Cancer and Its Management

According to Vogel et al. (2017) of The American Society of Colon and Rectal Surgeons, colorectal cancer or colon cancer is the third most common form of cancer and cancer mortality in the United States. Colorectal cancer occurs when the cells of the rectum and colon undergo neoplasia and multiply out of control, escaping the normal control of the body’s innate immune system. Among the risk factors for colorectal cancer, dietary fat and a high intake of red meat feature prominently. Also responsible for the development of colorectal carcinoma is a lack of physical exercise, a high body mass index, alcohol consumption, and cigarette smoking. All these are what are referred to as modifiable risk factors. It has been shown by scholarly evidence that one’s risk of developing colorectal cancer can be substantially lowered by behavioral/ lifestyle modifications such as cessation of smoking and weight loss. The two nonmodifiable risk factors for colorectal cancer are heredity and age. There is a positive correlation between colorectal cancer and advancing age, with those above 60 years being at increased risk (Hammer & McPhee, 2018; Huether & McCance, 2017). As stated in the introduction, the incidence of colorectal cancer appears to have a correlation with socioeconomic status. In the United States, minority communities such as Hispanics have more cases of CRC than whites. Several studies have shown that the reasons for this relate to the affected community’s low household incomes, low educational achievement, lack of knowledge about colorectal cancer and the importance of screening, and lack of access to quality healthcare or healthcare insurance (Briant et al., 2018; Brenner et al., 2016; Cruz-Correa et al., 2016; Martinsen et al., 2016).Colorectal (Colon) Cancer and Its Management Essay.

The most effective way of controlling colorectal cancer is prevention through health education (Briant et al., 2018; Brenner et al., 2016; Cruz-Correa et al., 2016). This entails health education to vulnerable populations about what causes or predisposes to colorectal cancer and why screening should be performed. Screening is part of secondary prevention and enables the early detection of the cancer before it starts to produce symptoms. When discovered early through screening, colorectal cancer – just like all other types of cancer – can be completely cured. According to the clinical guidelines by The American Society of Colon and Rectal Surgeons, surgery is the treatment of choice for colorectal carcinoma. When used, chemotherapy is just an addition to the treatment to complement the surgery. The guidelines state that the overall survival for five years for metastatic colorectal cancer is 13%, for regional CRC is 72%, and for localized CRC is 91% (Vogel et al., 2017). These statistics show exactly why early screening for colorectal cancer is important. Colorectal (Colon) Cancer and Its Management Essay.Early screening as a secondary prevention measure ensures that the colorectal cancer is found when it is still localized and without symptoms. What follows is surgical resection which completely eradicates the cancerous tissue with a high chance of complete recovery. In the case of colorectal carcinoma, screening has been shown to be very effective in the prevention of morbidity and mortality. Colorectal (Colon) Cancer and Its Management Essay.This is because a majority of colon cancer cases develop from benign polyps and adenomas in a slow process that can be detected and the cancer treated before it becomes malignant. The screening involves an occult blood test to detect blood in stool. The rationale behind this is that polyps are known to bleed and therefore the presence of occult blood in stool may be a pointer to the presence of early colorectal cancer. The test itself is not diagnostic of colorectal cancer, but provides an indication for colonoscopy to further assess the patient. It is recommended that all persons aged between 60-75 years be screened after every two years (Vogel et al., 2017).Colorectal (Colon) Cancer and Its Management Essay.

The clinical guidelines by The American Society of Colon and Rectal Surgeons give the treatment of the primary tumor as surgical exploration and resection. A complete and thorough surgical exploration is carried out through inspection of the growth visually; as well as physical palpation of the pelvic and abdominal organs to ascertain organ involvement. The surgical exploration also helps with and facilitates assessment for metastasis and any present coexisting abdominal pathological process. The extent of the curative resection will be dependent on the site of the primary CRC lesion as well as the lymphovascular drainage of the area in which the lesion is found (Vogel et al., 2017). The accompanying nursing management in all this will be related to postoperative health education on appropriate diet, colostomy care, pain relief, and counseling/ psychoeducation for dealing with societal stigma.Colorectal (Colon) Cancer and Its Management Essay.

Staging

Proper and correct staging of the colorectal cancer is important in deciding the course of management and treatment. One of the clinical classification methods used to stage for colorectal cancer is the TNM (tumor, node, and metastasis) method (Farag et al., 2016). Madam K was diagnosed with colorectal cancer which was already at stage III. It is the TNM clinical classification method that is simplified as stages 0, 1, 2, 3, and 4. The ‘T’ refers to the degree to which the colorectal cancer has spread to adjacent tissues and the rest of the body. The ‘N’ shows the number of neighboring lymph nodes affected, while the ‘M’ stands for metastasis of the cancer. Using this method, therefore, T0 denotes that no growth can be detected. T1, T2, and T3 denote progressively larger degrees of growth of the cancer. Lastly, TX means that the cancerous growth is too large to be measured. N0 shows that there are no neighboring lymph nodes involved. N1, N2, and N3 represent different and increasing levels of involvement of neighboring lymph nodes. Lastly, NX denotes that the cancer has affected so many lymph nodes that it is not possible to estimate the number of nodes involved. M0 means that there is no demonstrable metastasis of the cancer, while M1 denotes that spread to other parts of the body can indeed be demonstrated. Lastly, MX shows that the metastasis is too widespread that it cannot be ascertained how far it has gone with certainty (Farag et al., 2016).Colorectal (Colon) Cancer and Its Management Essay.

The Nursing Management of Madam K After Surgical Resection of Her Stage III CRC

Because Madam K has a colostomy, meticulous nursing care is going to be necessary in order to prevent infection and complications from developing. A colostomy is a temporary stoma or opening that is surgically created on the anterior abdominal wall. It directs fecal matter away from the colon to the artificial opening in the abdomen. A specially made (commercially made) colostomy bag is attached to the stoma and receives the fecal contents that come out of the stoma. A new one is attached every day and discarded after use. In this case, the goals of nursing care will be:Colorectal (Colon) Cancer and Its Management Essay.

• To prevent infection of the stoma.
• To facilitate patient comfort.
• To educate the patient on colostomy care.
• To psychologically prepare the patient for several months of living with the colostomy.
• To speed up recovery by getting the patient up and about (mobilization).
• To re-establish oral nutrition and hydration early without delay
• To counsel the patient on societal stigma.

The most likely surgical procedure that Madam K may have undergone is total mesorectal excision or TME. The procedure is accompanied by the creation of a temporary stoma through which fecal matter will be directed outside the body. This takes the shape of a colostomy and has the objective of resting the bowel for several months until the time that the treatment will be over. Because Madam K has complained of discomfort due to the colostomy that has been created, the first and most important action that the nurse must take is to assess the colostomy or stoma. Colorectal (Colon) Cancer and Its Management Essay.A healthy stoma without any complication in a patient with normal hemoglobin levels is supposed to be beefy red in color and moist. The discomfort experienced by Madam K may be due to the fact that either the colostomy is not being perfused adequately, or the colostomy bag s not fitting properly. The nurse will have to be on the lookout for a colostomy that has turned black, brown, or purple. These colors are ominous and may mean that the stoma is dying. Therefore, the nurse should inform Madam K’s surgeon immediately. Within the first few weeks (about six weeks), the stoma is expected to be swollen but remain beefy red in color. This is normal. It is expected that after this period it will go down to the level at which it will remain for the rest of the treatment period (Wittenauer, n.d.). The nurse must reassure the patient about this and state that the discomfort might be due to the fact that the initial swelling makes the stoma fit too tightly to the colostomy bag. But that is only if there is no abnormality in the color as stated above.Colorectal (Colon) Cancer and Its Management Essay.

The next thing that the nurse should assess is the skin around the stoma or abdominal opening. This peristomal skin requires regular assessment to look for any skin breakages and signs of infection. Any abnormalities should be reported to Madam K’s surgeon immediately. Then the nurse should check the incision site for dehiscence and signs of bleeding. Dehiscence is the parting open of the surgical wound along the suture line, resulting in gaping of the wound. It is a common result of infection of the suture line and may be the result of lack of aseptic handling of the dressing by the nurses.Colorectal (Colon) Cancer and Its Management Essay. This may also be the origin of Madam K’s discomfort. The nurse also checks for signs of abdominal distension which may occur as a result of intestinal obstruction arising as a complication of the surgery. It is also very important for the nurse to maintain a strict input and output chart for Madam K in the immediate postoperative period at the hospital. This is because she may lose a lot of fluid through the colostomy and go into negative fluid balance because of insufficient intake (Wittenauer, n.d.). It is therefore the responsibility of the nurse to ensure that Madam K gets enough fluid replacement either intravenously as prescribed or orally if oral intake has already been re-established.Colorectal (Colon) Cancer and Its Management Essay.

Nursing Actions to Address Madam K’s Colostomy Discomfort

1. Perform thorough patient education on the expectations of colostomy and care of the same when the patent will be at home. Because the colostomy is new and it is not a normal thing to have, Madam K is bound to have some level of discomfort at the beginning and the nurse may only have to reassure her. This will however be after a thorough assessment is done by the nurse as outlined above.
2. Assess the colostomy for signs of chemical breakdown, prolapse of the colostomy, mechanical breakdown, or stenosis (narrowing) of the colostomy.

• Assess the health of the colostomy. Make sure that it is not black, brown, or purple but beefy red in color.

1. Check that the colostomy only slightly protrudes from the skin. An overprotruding stoma may cause discomfort since a greater surface area is exposed to external elements.
2. Ascertain that the colostomy output per day is between 500 ml and 1500 ml. Any amount above that may mean that the bowel contents are leaking from the sides of the colostomy bag thereby irritating the peristomal skin and causing the discomfort.
3. Check the peristomal skin for signs of inflammation (warmth, tenderness, oozing, redness and so on) (Wittenauer, n.d.).

What to Do In Case of Specific Problems Causing the Discomfort

Chemical Irritation

Chemical irritation of the peristomal skin is a common problem that causes discomfort in patients who have stoma. It is caused by irritation from leaked fecal content coming out of the colostomy. It may also be caused by the adhesive chemical used to attach the colostomy bag to the skin surrounding the colostomy. First and foremost, the nurse assesses the colostomy bag to see if it fits properly and if there is any leakage of fecal contents at the area of connection to the body. Next, the nurse removes any adhesive remnants stuck to the peristomal skin using adhesive solvents. She then follows this with washing the peristomal skin with soap and water. Special stoma powder may then be used to keep the peristomal skin dry and comfortable. A thin wafer and stoma paste can also be used to fill peristomal skin folds, thereby preventing leakage and affording Madam K protection of the irritated peristomal skin and some comfort (Wittenauer, n.d.).Colorectal (Colon) Cancer and Its Management Essay.

Mechanical Breakdown

Mechanical breakdown is the other possible reason why Madam K is having discomfort with her colostomy. It affects the peristomal skin and is the result of frequent removal of the colostomy bag, the protective wafer, or the tape used to attach the colostomy bag to the peristomal skin. These mechanical actions result in the inadvertent removal of the epidermis of the peristomal skin causing it to be raw and painful. The most important nursing action to solve this is patient education. The nurse has to let them know that they do not have to change the colostomy bag after getting every bowel movement. The nurse then would assist Madam K with cleaning the peristomal skin and keeping it dry by using stoma powder (which is absorbent of the moisture on the peristomal skin). A skin sealant may also be used by the nurse as additional protection of the peristomal skin (Wittenauer, n.d.).Colorectal (Colon) Cancer and Its Management Essay.

Stoma Prolapse

In case the nurse notes that Madam K’s stoma is prolapsed, it would mean that she either has weak abdominal muscles or is overweight/ obese. If this were the case, the discomfort would be as a result of the trauma caused to the stoma during the attachment of the colostomy bag (pouching). The solution would be using a flexible colostomy bag. The nurse should also consult the surgeon so that ways of preventing the stoma from protruding further can be implemented (Wittenauer, n.d.). Colorectal (Colon) Cancer and Its Management Essay.

Peristomal Rash

The nurse assesses the peristomal skin for any signs of a rash. If present, it could be the result of an allergic reaction to some of the ingredients of the adhesive used to attach the colostomy bag to the skin. However, it may also be the result of an infection. The nurse will ascertain the cause of the rash and remove the precipitating factor. If it is infection, the appropriate treatment is given through interprofessional consultation. If it is allergy, an alternative type of colostomy bag is then tried. Prescription of a steroid cream in the case of allergy and keeping the skin dry and clean at all times go a long way in ensuring comfort (Wittenauer, n.d.).

Additional Nursing Measures and Patient Education to Guarantee Comfort

The discomfort that Madam K is having is most likely related to the peristomal skin. That is the reason why most nursing attention is focused on the area. There is no reason why the peristomal skin should look different from the rest of the body skin. To ensure protection of the peristomal skin and comfort of Madam K:Colorectal (Colon) Cancer and Its Management Essay.

• The right size of colostomy bag should be used. It should just fit exactly and not be either loose or tight.
• The colostomy bag should be changed if any leakage is noted.
• The colostomy bag should be changed only once a day unless there is a leakage. This minimizes irritation and trauma to the peristomal skin.
• Care should be taken when removing the bag to avoid injuring the skin.
• The peristomal skin should be cleaned with water and dried before attaching the colostomy bag.
• The nurse and the patient (Madam K) must always watch out for signs of allergic reaction on the peristomal skin.

Counselling Madam K for the Community Stigma

Madam K has also complained about her community’s perception towards her condition. The nurse as the patient advocate has the responsibility to counsel her and her family on the fact that the colostomy is just temporary and will be removed after several months. She will be told that the condition does not represent any disability and that she can continue doing her routine duties without appearing to be handicapped. This will change the perception of her community as they will see that she can still function just like a normal person. The acceptance of her family first is crucial to having the wider community accept her.

Conclusion

Colorectal cancer is a leading cause of cancer mortality. It appears to disproportionately affect populations of low socioeconomic status due to unfavorable social determinants of health such as access to healthcare and low household income. The treatment of choice according to clinical guidelines is surgical resection which involves the creation of a temporary colostomy. Madam K has gone through this treatment and is having some discomfort around the colostomy. She is also facing stigma from her community concerning her condition. Both these problems can be solved using evidence-based nursing interventions as thoroughly discussed in the paper.Colorectal (Colon) Cancer and Its Management Essay.

SPECIFIC INSTRUCTION / ARAHAN KHUSUS

1. Answer in MALAY or ENGLISH.

Jawab dalam BAHASA MELAYU atau BAHASA INGGERIS.

2. Number of words : 2500 – 3000 words excluding references.

Jumlah patah perkataan : 2500 – 3000 patah perkataan tidak termasuk rujukan.

3. Submit your assignment ONCE only in a SINGLE file.

Hantar tugasan SEKALI sahaja dalam SATU fail.

4. Submit your assignment

Tugasan ini dihantar secara ATAS TALIAN.

5. Submission date : 15 NOVEMBER 2020.

Tarikh penghantaran : 15 NOVEMBER 2020.

6. This assignment accounts for 50% of the total marks for the course.

Tugasan ini menyumbang sebanyak 50% dari jumlah markah kursus.

ASSIGNMENT QUESTION

Objective:

The purpose of this assignment is to evaluate learners’ critical thinking skills in managing a cancer patient after surgery.Colorectal (Colon) Cancer and Its Management Essay.

Synopsis:

Madam K, a 45-year-old teacher with diagnosis of colorectal cancer stage 3 has undergone a surgery. She complained of discomfort due to temporary colostomy and perception of community towards her condition.Colorectal (Colon) Cancer and Its Management Essay.

Requirement:

Critically discuss the nursing management for Madam K.

[Total: 50 marks]

SOALAN TUGASAN

Objektif:

Tujuan tugasan ini adalah untuk menilai kemahiran pemikiran kritis pelajar dalam membincangkan pengurusan pesakit selepas pembedahan.

Sinopsis:

Puan K, seorang guru berusia 45 tahun dengan diagnosa kanser kolon  peringat 3 telah menjalani pembedahan. Beliau mengadu tidak selesa dengan kolostomi sementara serta persepsi komuniti terhadap keadaan beliau.

Keperluan:

Bincangkan secara kritis pengurusan kejururawatan untuk Puan K.

[Jumlah: 50 markah]

ATTACHMENT

ASSIGNMENT RUBRICS

NBNS2904 ONCOLOGY NURSING  /SEPTEMBER SEMESTER 2020

*QN = Question Number / *NS = Nombor Soalan