Colorectal or colon cancer occurs when polyps in the large intestine become malignant.
The risk of this type of cancer increases with age, with most cases detected in people older than 50. There is an increasing trend of colorectal cancer in people between 20 to 49 years old due to unhealthy diets, sedentary lifestyles, obesity, family history, alcohol consumption, and physical inactivity.
Complications of colorectal cancer include metastasis, obstruction, perforation, fistula formation, and peritonitis.
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Diarrhea
- Dysfunctional Gastrointestinal Motility
- Ineffective Tissue Perfusion
- Risk for Infection
Nursing Process
The management of colorectal cancer will correlate with the pathologic staging of the tumor and may include surgery, chemotherapy, and radiation therapy. Nurses play a critical role from the start of the screening process through treatment and follow-up prevention.
Nurses can help identify symptoms indicative of colorectal cancer and counsel patients regarding their risk factors. They provide support through the different treatment regimens and patient education to ensure understanding and adherence.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to colon cancer.
Review of Health History
1. Identify the patient’s general symptoms.
Colorectal cancer develops slowly, and symptoms may not appear until the disease is advanced. Colon cancer manifests these common signs and symptoms:
- Fatigue
- Weight loss
- Abdominal pain
- Blood in the stool
- Changes in bowel habits
- Bloating
- Diarrhea
- Constipation
2. Determine the patient’s bowel habits.
Stool changes in consistency, color, shape, and frequency should not be disregarded. Early indications of colon cancer might also include lethargy, blood in the stool, and unintentional weight loss.
3. Track the family history.
A thorough family history assessment is crucial to finding familial clusters and underlying patterns. Frequent screening is necessary due to the increased risk for primary colon cancer, indicated by a family history of colon cancer and advanced polyp by an immediate (first-degree) relative (parent, sibling, or child). There would be a higher risk if the affected family member had colon cancer before age 45.
4. Identify the patient’s risk factors.
Colon cancer risk is increased by the following:
- Non-modifiable risk factors
- Old age: As people age, the chance of colorectal cancer increases. Although it can occur in young individuals, it is more common in people over 50.
- Past medical history of colorectal polyps or colorectal cancer: It is more likely to get colorectal cancer if there is a history of adenomatous polyps (adenomas) exhibiting dysplasia. Having had colorectal cancer increases the risk of getting it again in other regions of the colon and rectum, even if it was entirely removed. If colorectal cancer is diagnosed at an earlier age, there is a higher chance of recurrence.
- Past or present medical history of inflammatory bowel disease: The risk of colorectal cancer is higher by having inflammatory bowel disease (IBD), including ulcerative colitis or Crohn’s disease. IBD is a disorder where the colon becomes inflamed. Individuals with IBD for a long time, especially those with uncontrolled flares, frequently develop dysplasia (abnormal-looking cells).
- History of an inherited syndrome: Familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary non-polyposis colorectal cancer, or HNPCC) are rare inherited syndromes associated with colorectal malignancies.
- Ethnicity: In the US, African American adults and American Indian and Alaska Native people have the most significant incidence of colorectal cancer.
- Diabetes: A higher risk of colorectal cancer exists in those with type 2 diabetes. Several risk factors for type 2 diabetes and colorectal cancer are similar (such as being overweight and physical inactivity).
- Modifiable risk factors
- Obesity: Obesity increases a person’s risk of developing colon and rectal cancer. The link appears to be more pronounced in males. A healthy weight may help reduce the risk.
- Physical activity: Colon cancer is likely higher if the patient is not physically active. Reduce the risk by engaging in regular, moderate-intensity physical activity.
- Diet: The risk of colorectal cancer increases if processed meats like hot dogs, deli meats, and bacon are consumed. Chemicals in salted, smoked, or cured meats may increase the chance of developing cancer. Low levels of vitamin D also increase the risk. A diet low in fruits and vegetables, low in fiber, and high in fat also contribute to colon cancer.
- Smoking: Long-term tobacco users are more likely to get colorectal cancer and pass away from it than non-smokers. Smoking is an established risk factor for lung cancer but is also connected with several other malignancies.
- Alcohol consumption: Moderate to excessive alcohol use has been associated with colorectal cancer. Even occasional or modest drinking has been linked to some risk.
5. Review the treatment history.
The risk of colon cancer is increased by radiation therapy administered to the abdomen to treat prior malignancies.
Physical Assessment
1. Perform a physical examination.
At the onset of colon cancer, physical examination results can be unclear (such as fatigue or weight loss) or normal. The following might exist in more severe cases:
- Rectal bleeding
- Palpable abdominal mass
- Liver enlargement (hepatomegaly)
- Enlarged abdominal organs
- Fluid accumulation (edema)
2. Do a digital rectal exam.
Assist the healthcare provider while inserting a lubricated, gloved finger into the rectum during a digital rectal exam (DRE) to feel for any abnormalities.
Diagnostic Procedures
1. Encourage the patient to undergo the recommended screening tests.
One of the most potent defenses against colorectal cancer is routine screening. Early detection of colorectal cancer shows smaller, localized, and easier-to-treat tumors. Colorectal cancer can be prevented with routine screening.
2. Assist with performing screenings.
Screening tests fall into two categories:
- Stool-based tests look for cancerous traces in the stool. They are less invasive and easier to perform but must be carried out more frequently.
- Fecal immunochemical test (FIT) uses antibodies to detect blood in the stool.
- Guaiac-based fecal occult blood test (gFOBT) utilizes a chemical reaction to detect occult (hidden) blood in the stool. It cannot identify the origin of the blood.
- Stool DNA test scans the sample for occult (hidden) blood and specific abnormal DNA segments from cancer or polyp cells.
- Visual (structural) examinations search for abnormalities in the colon and rectum’s structure.
- Colonoscopy uses a flexible tube with a light and tiny video camera to investigate the entire length of the colon and rectum through the anus. Specialized tools can be inserted via the colonoscope to remove or biopsy any suspicious-appearing regions, such as polyps.
- CT colonography (virtual colonoscopy) involves a sophisticated computed tomography (CT) scan of the colorectal region that can detect abnormal tissue like polyps or cancer. It creates 3-dimensional images of the interior of the colon and rectum. No instruments or scopes need to be inserted into the rectum or colon, nor is sedation necessary.
- Flexible sigmoidoscopy is similar to a colonoscopy. It does not visualize the entire colon. It is inserted from the anus, through the rectum, and finally into the lower portion of the colon with a sigmoidoscope.
3. Send blood samples for testing.
Blood tests include:
- Complete blood count can detect anemia due to the tumor’s prolonged bleeding.
- Liver enzymes may be elevated since liver enlargement (hepatomegaly) is one of the manifestations and complications of colon cancer.
- Tumor markers are detected in the blood. They are produced by colorectal cancer cells. Carcinoembryonic antigen (CEA) is the most common tumor marker for colorectal cancer.
4. Send a sample for biopsy.
Biopsy samples (from colonoscopy or surgery) are sent to the lab and closely examined. If cancer is found, further lab tests may also be performed on the biopsy samples to classify the cancer stage and guide treatment options.
5. Review the imaging findings.
- Computed tomography (CT or CAT) scan can help determine whether colorectal cancer has progressed to the liver, lungs, or other internal organs.
- CT-guided needle biopsy retrieves a tissue sample to screen for cancer. This can be useful if assessing for lung, liver, or other organ metastasis.
- Ultrasound produces images of the interior of the colorectal region using sound waves. A transducer, a tiny device resembling a microphone, emits sound waves and collects the reflections from organs. A computer transforms the echoes into an image that appears on the screen.
- Magnetic resonance imaging (MRI) scan presents detailed photos of tissues in the colon. Instead of using X-rays, MRI scans employ radiowaves and powerful magnets to visualize abnormal-looking tissues, polyps, or tumors.
- Chest x-ray can reveal the spread of colon cancer to the lungs.
- Positron emission tomography (PET) scan may be used in conjunction with CT scans to locate cancerous cells.
6. Determine the stage.
Cancer staging indicates how many cancer cells are present in the body. It aids in determining the severity of the malignancy and the most effective course of treatment. Stages are classified as 0-IV. 0 is the earliest stage of colorectal cancer, while stage IV denotes cancer metastasis.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with colon cancer.
Assist With Cancer Treatment
1. Evaluate therapies according to the stage and patient needs.
Specific therapies may be more effective for the patient depending on the location, stage, and other health issues. Typically, surgery is used to remove cancer from the colon as part of treatment. Commonly prescribed therapies include chemotherapy and radiation therapy. Nurse navigators commonly help guide patients through their cancer treatment and expectations.
2. Prepare for surgical procedures.
Surgical resection is the primary treatment option for localized, non-metastatic colon cancer. Other surgical options include:
- Laparoscopic surgery
- Temporary or permanent colostomy
- Radiofrequency ablation or cryotherapy for metastasis to the liver or lungs
3. Educate on adjuvant therapy.
Adjuvant treatment reduces the chance of recurrent cancer by destroying any remaining cancer cells following surgery.
- Neoadjuvant treatment is provided before the primary therapy (typically surgery) to shrink the tumor.
- Adjuvant therapy is recommended for patients with colon cancer stage III (node-positive) and stage II with high-risk characteristics.
Examples of adjuvant therapy are:
- Chemotherapy kills colon cancer cells and is frequently given after surgery if the cancer is more prominent or has metastasized to the lymph nodes.
- Radiation therapy uses potent energy sources like protons and X-rays to kill colon cancer cells. Before surgery, radiation can reduce the size of a large cancer tumor to make removal easier.
- Targeted therapy concentrates on particular defects that are prevalent in colon cancer cells. Targeted medication treatments can kill cancer cells by targeting specific genes, proteins, and tissue environments that contribute to cancer cell growth.
- Biological therapy employs components derived from living organisms to combat cancer. An example of this therapy is immunotherapy, where the body’s immune system aids in the defense against cancer cells.
4. Administer palliative therapy to non-surgical patients.
Palliative systemic chemotherapy is provided to non-surgical patients with unresectable locally advanced cancer or substantial metastatic burden. Palliative care concentrates on reducing pain and other symptoms of cancer to enhance the quality of life for patients and their loved ones. This therapy is available in addition to any curative or other treatments the patients might receive.
5. Manage treatment side effects.
Both cancer and its therapies may have side effects. Side effects arise when a medication or treatment affects not only the cancer cells but also the healthy tissues and organs. The most common side effects are:
- Neutropenia (low WBC)
- Lymphedema (fluid buildup in the lymph nodes)
- Alopecia (hair loss)
- Nausea and vomiting
- Chemo brain (difficulty in concentration and remembering things)
- Pain
- Blood clots
- Fatigue
- Loss of appetite (anorexia)
- Depression
- Constipation or diarrhea
Instruct on Ostomy Care
1. Teach the patient and the caregiver about ostomy care.
In some instances, surgical resections may result in an ostomy, which connects the colon to the outside of the skin through the creation of a stoma. The nurse must monitor the newly created ostomy for complications like bleeding, ischemia and necrosis, retraction, and prolapse.
2. Refer to an ostomy nurse.
Living with an ostomy is an adjustment. An ostomy nurse instructs on how to place an ostomy pouch with a proper seal to prevent peristomal skin irritation. The nurse will teach each patient the correct size for their appliance, proper cleaning, powders and pastes to protect the skin, when to change the pouch system, and how often to empty the pouch.
3. Avoid gas-forming food.
Some foods are more likely to result in gas, bloating, diarrhea, constipation, and poor digestion. Odorous foods and drinks commonly include:
- Beans
- Cabbage
- Carbonated beverages
- Coffee
- Beer
Gas-producing foods will make the ostomy pouch swell with air, and the gas will be foul-smelling. When eating something in front of others, advise the patient to try it at home if unsure how it will make them feel. They will spend less time worrying about the consequences of the meal and more time socializing if they know how a particular food affects their digestion.
4. Manage disturbances in body image.
Colostomies can affect the patient’s self-esteem and body image. Educate the patient that ostomy pouches are usually easily covered under regular clothing. Pouch covers are available to hide the plastic appliance.
5. Refrain from contact sports and heavy lifting.
Before lifting weights and engaging in contact sports after surgery, advise the patient to check with the healthcare provider. They might need to wait for the surgical incision to heal to lower the chance of complications.
Manage the Pain
1. Administer pain medications as ordered.
Treatment options for colon cancer-related pain depend on the pain severity and location. Over 70% of colorectal cancer patients experience pain. These include:
- Over-the-counter pain medications (such as acetaminophen, aspirin, and ibuprofen)
- Oral and IV opioids (hydromorphone, morphine, oxycodone)
- Antidepressants
- Anti-seizure drugs
- Steroids
- Rectal suppositories
2. Offer non-pharmacological treatments.
Acupuncture, massage, physical therapy, stress-relieving activities, meditation, and hypnosis are some useful methods to relieve pain. For some, it may be acceptable to use medical marijuana to treat cancer pain in some jurisdictions.
3. Manage treatment side effects.
Treatments used to manage pain come with their own unpleasant side effects, such as constipation, nausea, insomnia, and more. The nurse can assist with managing uncomfortable side effects through other medications, diet, aromatherapy, or changes in dosages or frequencies of pain medications.
4. Offer a sitz bath.
Patients with rectal pain may benefit from sitting in a warm water sitz bath.
Assist the Patient in Coping
1. Ask the patient about their thoughts and feelings about cancer.
It can be scary to receive a cancer diagnosis. The nurse is an important part of the healthcare team to assess the patient’s concerns and offer listening and support.
2. Present all treatment options.
Making informed decisions requires a thorough grasp of various treatment options’ advantages, disadvantages, and uncertainties along the cancer care continuum. The nurse can assist the patient in making the best decision for their health and goals by presenting all the facts.
3. Involve the family and caregivers as requested.
Family members and caregivers are valuable companions and indispensable sources of support for a patient with cancer. They offer emotional support and often influence the patient’s choices. Include loved ones as indicated by the patient.
4. Refer the patient to a counselor.
Working with a mental health professional trained in supporting patients with chronic or terminal illnesses can help patients and their loved ones deal with the difficulties of receiving a cancer diagnosis.
Educate on Risk Factors and Prevention
1. Manage modifiable risk factors.
There is no guaranteed method to prevent colorectal cancer. However, some steps may reduce the risk, such as controlling modifiable risk factors like smoking, diet, alcohol use, and physical activity.
2. Recommend regular screenings.
It typically takes 10 to 15 years from the time the initial abnormal cells begin to develop into polyps for them to turn into colorectal cancer. Most polyps can be discovered and removed with routine screening before cancer develops. Patients aged 45-75 should be screened through stool tests and diagnostic exams.
3. Assist the patient in lifestyle modification.
A diet high in fruits and vegetables, avoiding processed meats, weight management, regular exercise, drinking less alcohol, and quitting smoking are all examples of healthy lifestyle practices that can lower the chance of developing cancer.
4. Encourage supplements.
Magnesium, calcium, and vitamin D may lower the risk of colorectal cancer.
5. Consult the healthcare provider about hormone therapy.
Hormone therapy (estrogen-replacement therapy) lowers the rate of colorectal cancer in women. If a woman received hormone therapy before a colorectal cancer diagnosis, the mortality risk is significantly reduced.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for colon cancer, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for colon cancer.
Death Anxiety
Colorectal cancer patients have a higher risk of feeling death anxiety, especially those diagnosed with advanced colon cancer. This is a normal part of accepting a cancer diagnosis, but it can create unnecessary stress and depressive symptoms that require intervention.
Nursing Diagnosis: Death Anxiety
Related to:
- Anticipation of pain
- Anticipation of suffering
- Awareness of imminent death
- Depressive symptoms
- Discussions on the topic of death
- Low self-esteem
- Nonacceptance of own mortality
- Uncertainty about life after death
- Uncertainty about the existence of a higher power
- Uncertainty of prognosis
As evidenced by:
- Expresses concern about the impact of one’s death on significant other/family
- Expresses deep sadness
- Expresses fear of loneliness
- Expresses fear of pain related to dying
- Expresses fear of premature death
- Expresses fear of a prolonged dying process
- Expresses fear of separation from loved ones
- Expresses fear of suffering related to dying
- Expresses fear of the dying process
- Expresses fear of the unknown
- Expresses powerlessness
- Reports negative thoughts related to death and dying
Expected outcomes:
- Patient will be able to freely express feelings associated with dying.
- Patient will discuss realistic goals concerning their condition and prognosis.
Assessment:
1. Consider the psychosocial maturity of the patient.
Females have a higher risk of developing death anxiety compared to men. Determining psychosocial maturity will help better understand how to support and comfort the patient.
2. Assess the patient’s fear of death and the current stage of grief.
This will promote a better understanding of the patient’s current mental and emotional state and allow the provision of appropriate psychosocial support.
3. Determine cultural/religious beliefs.
Patients who have a strong sense of faith may struggle less with their prognosis and lean heavily on their culture or religion. Nurses can support patients in whatever brings them peace.
Interventions:
1. Always use therapeutic communication.
This allows the establishment of interpersonal relationships with the patient.
2. Assist the patient in life planning.
Advanced planning improves end-of-life care and promotes satisfaction for both patients and families. It also reduces stress, depression, and powerlessness.
3. Acknowledge the normality of negative feelings like fear, anger, and denial.
It is normal to feel negative emotions when faced with loss. Allowing the patient to express feelings and emotions can make the patient feel important and acknowledged.
4. Encourage patients with life review and reminiscence.
Finding an acceptable and satisfying completion in life helps relieve discomfort, reduce stress, and gain acceptance of the situation.
5. Encourage mental health or spiritual services.
Chaplains may provide emotional relief for religious patients. Nurses can also involve mental health/grief counselors to aid in supporting the patient and family.
Diarrhea
A change in bowel habits like frequent diarrhea, constipation, and a feeling of incomplete emptying are symptoms of colon cancer.
Nursing Diagnosis: Diarrhea
Related to:
- Disease process
- Colorectal tumor
- Tumor fluid leakage
As evidenced by:
- Abdominal cramping
- Abdominal pain
- Bowel urgency
- Dehydration
- Blood in the stool
- Hyperactive bowel sounds
Expected outcomes:
- Patient will maintain the perianal area free from any irritation or breakdown.
- Patient will utilize medications to control diarrhea and symptoms as prescribed.
Assessment:
1. Assess defecation patterns.
Assessment of defecation patterns and any related symptoms such as bloating, pain, or urgency can help identify appropriate interventions and treatment regimens.
2. Assess stool characteristics.
The presence of blood, foul odor, or pus may require further assessment for trauma or infection.
3. Assess abdomen.
Inspect, auscultate, palpate, and percuss the abdomen. Increased frequency of bowel sounds is expected with diarrhea.
Interventions:
1. Monitor intake and output.
Diarrhea can cause dehydration. Monitoring the patient’s intake and output can help monitor the patient’s fluid status and prevent dehydration.
2. Encourage fluid intake as indicated.
Adequate fluid intake can improve bowel consistency and promote hydration.
3. Refer the patient to a dietitian.
Colorectal cancer patients may need specialized meals to help ensure adequate dietary intake and facilitate recovery. Some foods may need to be avoided to reduce gastric irritability.
4. Encourage perianal skin care.
Diarrhea can cause altered skin integrity in the perineal/rectal area. Instruct on proper cleaning and comfort with the use of medicated or wet wipes and barrier creams.
5. Administer medications as needed.
Antidiarrheal medications are prescribed to help relieve symptoms of diarrhea.
Dysfunctional Gastrointestinal Motility
Dysfunctional gastrointestinal motility is a common problem for patients with colon cancer due to damage to the nerves and tissue in the colon from cancer cells.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Inflammatory process
- Disease process
- Malnutrition
- Sedentary lifestyle
- Stressors
- Anxiety
- Changes in eating habits
As evidenced by:
- Abdominal pain
- Abdominal cramping
- Absence of flatus
- Altered bowel sounds
- Diarrhea
- Distended abdomen
- Difficulty defecating
- Nausea
- Vomiting
Expected outcomes:
- Patient will be free from abdominal distention, cramping, and pain.
- Patient will demonstrate active bowel sounds with at least three formed stools per week.
Assessment:
1. Conduct a detailed history and physical assessment.
Signs and symptoms of colon cancer include a persistent change in bowel habits, rectal bleeding, abdominal pain, fatigue, weakness, and unexplained weight loss.
2. Assess the patient’s bowel sounds.
Bowel sounds, their characteristics, and their frequency are a vital part of the assessment for patients with colon cancer. Hypoactive or high-pitched bowel sounds in patients with colon cancer suggest gastrointestinal motility problems and obstruction.
3. Assess diagnostic studies.
Fecal occult blood tests can visualize blood in the stool, which can signal polyps or cancer. CT/PET scans visualize the internal organs for abnormalities and tumors that contribute to dysfunctional gastrointestinal motility. Colonoscopy assesses the entire length of the colon and can help diagnose colon cancer and determine its extent and location.
Interventions:
1. Encourage a high-fiber diet.
Patients with colon cancer are encouraged to eat high-fiber foods like lentils, whole grains, and fruits to aid the passage of food through the intestines and reduce problems related to dysfunctional gastrointestinal motility.
2. Encourage the patient to exercise as indicated.
Digested food moves through the gastrointestinal tract through a series of muscle contractions. Exercising promotes peristalsis and increases metabolism reducing problems with gastrointestinal motility in patients with colon cancer.
3. Encourage adequate fluid intake.
Adequate fluid intake keeps the stool soft, improves transit time, and reduces gastrointestinal motility problems. Dehydration can cause the intestinal walls to contract slower, making the bowels sluggish.
4. Prepare and assist in surgical intervention.
Depending on the stage of cancer, a colon resection may be required to remove the tumor and affected parts of the colon to promote normal gastrointestinal function.
5. Provide ostomy care and patient education and support.
Normal bowel function can be preserved through a colostomy, where the colon is reconnected to the abdominal surface by creating a stoma. The nurse educates the patient and families on how to care for their colostomy.
Ineffective Tissue Perfusion
Colon cancer affects normal cellular regulation manifested through the increasing growth of the tumor locally or its metastatic spread to the other organs, resulting in perfusion problems like bowel obstruction, perforation, peritonitis, fistula formation, and abscess formation.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Disease process
- Cancer progression
- Damage to the gastrointestinal tract
- Inflammatory process
As evidenced by:
- Abdominal pain
- Abdominal tenderness
- Abdominal distension
- Hypoactive bowel sounds
- Nausea and vomiting
- Change in bowel habits
- Diarrhea or constipation
- Bloody stool
- Absence of flatus
Expected outcomes:
- Patient will remain free from any signs of perfusion complications, such as rectal bleeding, abdominal distension, vomiting, or severe abdominal pain.
- Patient will exhibit active bowel sounds with the absence of abdominal pain and bloating.
Assessment:
1. Conduct a thorough abdominal assessment.
Colon cancer exhibits gastrointestinal symptoms, including palpable abdominal masses, distension, ascites, and in severe cases, hepatomegaly if liver metastasis has occurred.
2. Assess diagnostic studies and results.
Patients with colon cancer often exhibit anemia on serum blood tests due to intermittent intestinal bleeding associated with the tumor. Colonoscopy, sigmoidoscopy, barium enema, and CT scans will provide evidence of abdominal abnormalities.
3. Assess the patient’s bowel sounds.
Colon cancer may cause partial bowel obstruction due to the presence of the tumor, which usually manifests as a high-pitched or tinkling sound. If, upon auscultation, there is a total absence of bowel sounds, this indicates complete bowel obstruction.
Interventions:
1. Assist in radiation therapy.
Preoperative radiation therapy can help control tumor growth and metastasis to other organs, ultimately reducing tissue perfusion complications.
2. Assist and prepare the patient for surgical removal of the tumor.
Surgical resection of the tumor in the colon is considered the best method for the removal of colon cancer and for improving tissue perfusion in the gastrointestinal tract. The type of procedure performed will depend on various factors, including the size, location, extent of metastasis, integrity of the bowel, and the patient’s overall condition.
3. Administer chemotherapy as indicated.
Adjuvant chemotherapy is indicated after surgical removal of the tumor for patients with stage II or stage III colon cancer. This treatment will interrupt the DNA production of cancer cells and destroy them, preventing colon cancer recurrence and gastrointestinal complications, including perfusion problems.
4. Intervene promptly if serious complications are suspected.
If signs of peritonitis, obstruction, or perforation are suspected, the nurse and healthcare team must quickly intervene. These complications often manifest as sudden and severe abdominal pain, distension, fever, loss of flatus or bowel movements, and nausea and vomiting.
Risk for Infection
Colorectal cancer patients often get unusual infections due to the invasion of tissues close to the tumor or transient bacteremia from necrotic tumors. Patients with colorectal cancer treated with chemotherapy are at risk for infection due to immunosuppression.
Nursing Diagnosis: Risk for Infection
Related to:
- Chemotherapy
- Disease process
- Surgical interventions
- Colostomy
- Immunosuppression
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.
Expected outcomes:
- Patient will remain free from infection.
- Patient will demonstrate infection control precautions.
- Patient will demonstrate how to care for their ostomy.
Assessment:
1. Assess factors contributing to increased risk for infection.
The disease process and chemotherapy or radiation treatment can increase the patient’s risk for infection. Patients who undergo colon resection or receive a colostomy are also at an increased risk.
2. Assess vital signs and laboratory values.
Alteration in laboratory values like neutropenia or leukocytosis can indicate infection. Signs of infection include fever, shaking, chills, and hypotension.
Interventions:
1. Encourage and practice good hand washing before and after patient care.
Handwashing can help prevent the transmission of pathogens and avoid infection.
2. Isolate the patient during ongoing chemotherapy or radiation treatment.
Isolating the patient can help prevent infections easily transmitted through direct contact.
3. Avoid alcohol or smoking.
Both should be avoided completely to allow the immune system to function at its best.
4. Administer antibiotics as ordered.
Antibiotics may be given prophylactically to prevent infection in patients undergoing chemotherapy or surgery.
5. Instruct on incision and colostomy care.
Surgery of the colon/rectum is considered a clean-contaminated procedure due to the presence of fecal bacteria. Nurses must closely monitor incisions after surgery for signs of poor healing or infection. Nurses should instruct patients on caring for their incision sites and ostomies.
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