Case Scenario

Mr W.C is a 65year old retired coalminer employee,

husband and father of three grown children. For the
past 3 months, he noticed small amounts of blood
in his stools and occasional mucus.
He has a sensation of pressure in the rectum, and
notice that his stools are smaller in diameter, about
a size of a pencil.
After palpating a mass on DRE, patient went for
colonoscopy & a large sensible lesion found,
pathology report shows the lesion to be
adenocarcinoma.
Mr. W.C is scheduled for an AP resection and
sigmoid colostomy.
13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

ASSESSMENT
A.N, RN, completes the admission assessment,
Mr. W.C states that his bowel habits have recently
changed, but denies pain or other symptoms.
Physical assessment finding include
T 36.90c, PR 82, RR 18 and BP 118/78. he is
178cm tall and weighs 84kg. Laboratory finding
are normal except for the previous pathology
report of adenocarcinoma of rectum.

Mr. W.C states, I really dont want a

colostomy, but if that is what it takes to get rid of
this, I am ready to get over with it.
13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

PRE- OPERATIVE NURSING DIAGNOSIS

Constipation related to obstruction/narrowing
of gut by the disease process and use of oral
morphine evidenced by bowel movement of
1-2 times a week
Fear-related to cancer diagnosis and outcome
of treatment evidenced by pt asking questions
on treatment regimen and reoccurrence.

13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

S/N NURSING
DATE DIAGNOSIS

EXPECTED
OUTCOME

NURSING
INTERVENTION

Patient will have Patient

soft, formed
advised to
obstruction/narr stools that are
maintain a
owing of gut by easy to pass
regular bowel
the disease
after 12- 24
pattern
process and use hours of
1.5 liters of
of oral morphine intervening.
water given
evidenced by
daily
bowel
High fiber diet
movement of 1given
2 times a week
Feed 3 times
daily
Liquid paraffin
COLORECTAL CANCER, 2013 BY UZOMA
13/10/2013
ANTHONIA RN.
10ml given

1 Constipation
14 related to
\7

EVALUATION

Patient
opened
bowel 1-2
days
nursing
interventio
n

Date NURSING DIAGNOSIS

&
S/N

EXPECTED
OUTCOME

2
15/7

Patient will
verbalize fears and
concerns in
relation to his
diagnosis and
condition

Fear-related to cancer
diagnosis and outcome of
treatment regimen and
reoccurrence

13/10/2013

NURSING
EVALUATION
INTERVENTION

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

pt. verbalized
fears and
concerns in
relation to his
diagnosis and
condition

POST-OPERATIVE NURSING DIAGNOSIS

Pain related surgical incision evidenced by
patients description, facial expression & gnashing
of teeth.
Diarrhea: related to effect of surgery evidenced
by bowel movement of 3-4 times a day.
Impaired skin integrity: related to surgical incision
evidenced by pouch and stoma.

Fatigue: related to effect of chemotherapy

evidenced by extreme weakness and inability to
perform activities of daily living
13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

POST OP NURSING DIAGNOSIS contd.

Disturbed body image :related to colostomy
evidenced by withdrawing and keeping to self
Risk for infection
Risk for sexual dysfunction related surgical
incision, radiation and chemotherapy

13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

S/n
date

1.
17/
7
4.3
0p
m

NURSING
DIAGNOSIS

EXPECTED
OUTCOME

NURSING
EVALUA
INTERVENTION TION

Pain, related to
surgical incision,
evidenced by
patient
description of
pain, facial
expression and
gnashing of
teeth.

Mr. W.C will

report pain
within an
acceptable
range that
allows ease of
movement and
ambulation
within 30mm1hr of nursing
introversions

listened to him
Patient made
comfortable
Therapeutic touch
given
Diversional therapy
done
Patient taught on
importance of drug
adherence
Inj morphine
500mg given
Pain reassed 1 hr
later.

13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

pt.
expressed
less pain
by
interactin
g with the
Nurse on
reassess
ment of
pain 1 hr
later.

S/n
date

NURSING DIAGNOSIS

2. Impaired skin
17/7 integrity: related to
5pm surgical incision,
evidenced by pouch
adhesive and stoma.

EXPECTED OUTCOME

Mr. W.C will

perform
colostomy care
using correct
technique within
1-2 days of
nursing teaching
of self care.

NURSING INTERVENTION

13/10/2013

COLORECTAL CANCER, 2013 BY UZOMAr

ANTHONIA RN.

discussed food less in

fibre
Counselled on food that
produce odour and gas
provided privacy when
teaching and discussing
concerns about ostomy
Provided a list of local
medical supply to reduce
cost.
Gave him and the wife
verbal & written
instruction on colostomy
care.
Taught to avoid rectal
temperature.
Taught patient to avoid
heavy lifting.
Told pt the importance of
follow-up care.
Referred to community
based nurse.

EVALUATION

Mr. W.C
was able
to empty
and rinse
out his
colostomy
pouch on
supervisio
n by nurse
after 2
days of
stoma
care.

3. Diarrhea, related to
18/7 effect of surgery on
8am bowel function,
evidenced by bowel
movement of 3-4
times a day.

Patient will pass

formed stool after
2-3 days of nursing
intervention

13/10/2013

Maintained
assignment of trust
patient taught the
cause of diarrhoea
Bland diet given
Stoma care given
Prescribed
antibiotics given
Maintenance of
perennial skin
integrity and relief of
perennial discomfort
Intake and output
chart maintained
Psychological care
given

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

patient
passed soft,
formed
stool after
3 days

4.
20/7
10am

13/10/2013

Disturbed body image

related to
colostomy{stoma}
evidenced by patients
not co-operative
withdrawing and
keeping to himself

Patient will
enhance physical
and emotional
self-esteem
within 2-3 days of
nursing
counseling

-encouraged to
always wear
free clothing
-kept him
kempt
-changed
colostomy bag
when soaked
-used air
fresheners by
bedside
-encouraged to
bath 2 times a
day
-attention
given

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

Patients self
image reestablished
after 5 days of
counseling

5
22\7

Risk for sexual

dysfunction.

Demonstrate
willingness to
discuss changes in
sexual function

13/10/2013

Asked consent to
involve wife
involved wife in
the discussion
explained the
impact of
surgery and
radiation
therapy on
muscle and
nerves of the
pelvis
Advised to
change
colostomy
before mating

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

7.

Patient will
demonstrate
other
methods for
sex without
anal sex.

5
23/
8

Risk for
infection

10a.
m

13/10/2013

Patient will not

exhibit signs or
symptoms of
infection throughout
hospitalization

- taught patient normal

colour of stoma barrier which
is pink-red
-changed colostomy bag by
clean procedure
-fed patient on high
protein/vitamin diet
-changed bag when necessary
-observed for signs of
infection
prescribed antibiotics given
-taught patient how to care
for colostomy on discharge

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

Stoma
showed no
signs of
infection
throughout
hospitalizatio
n

6
24\8
5.30
pm

Fatigue related to
effect of
chemotherapy
evidenced by
inability to perform
activities of daily
living and looking
weak.

Patient will
perform certain
activities of daily
living to improve
quality of life after
2-3 days of nursing
care
-

13/10/2013

built trust on
relationship with
patient
educated patient
on adverse
treatment effects
educated patient
on how to manage
those symptoms
gave patient
psychological and
emotional support
allowed support
persons to visit
gave information
on need
fed on adequate
diet as patient can
tolerate

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

Patient
managed
symptoms
conserved
energy &
performed
certain
activities.

Follow up
Nurses could run follow-up clinics and regularly
assess patients holistic care needs
Patients who have had surgery with the intention
of cure are often followed up to detect
recurrences early.
The nature, extent and frequency of follow up
vary widely.
Tests should be done every three months
Follow-up also involves co-ordinating appropriate
surveillance for patients who have curative
treatment
13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.

CONCLUSION
CRC, previously rare in Nigeria is becoming
common largely due to adoption of western
diets
Healthy lifestyle reduces its occurrence
Early detection renders the disease curable
Appropriate referral could ease patients
burden

13/10/2013

COLORECTAL CANCER, 2013 BY UZOMA

ANTHONIA RN.