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Colorectal Cancer—statistics Second leading cause of death from cancer Most are adenocarcinoma Half occur in rectosigmoid area Over ¾ of cancers come from polyps that spread into mucosal lining and into lymph system and then to liver or lungs More common in men than women Mortality rates highest among blacks Colorectal Cancer—Risk Factors Age—most are over 50 PMH or FH Hx polyps or inflammatory bowel disease Obesity Smoking ETOH High red meat ingestion Manifestations Hematochezia or melena Weakness, anemia, wt loss Change in bowel habits Change in stool caliber Fullness in lower abdomen or rectum Abdominal pain/cramping Diagnostics Colonoscopy is gold standard—polyps or tumors may be seen, but bx is confirmation Hemoccult or guaiac H&H Coag studies Liver functions CEA CT Medical Management Treatment depends on TNM classification Polypectomy during colonoscopy Colon resection with end-to-end anastomosis— lymphs are usually removed If metastasized, surgery may be palliative Chemo for + lymph nodes with 5-FU and one other drug Radiation as adjuvant or for metastasis to reduce tumor size & provide symptomatic relief Nursing Management Preop teaching—may need ostomy teaching If reanastamosis is done, then postop care is routine abdominal surgery. Incision may be large, but closed with staples. Pt may have NGT or TPN. If abdominal-perineal surgery is done for extensive metastasis, care of open perineal wound and drain management is necessary Patient Education For prevention: – Hemoccult q yr – Patients > 50 to have routine colonoscopy—repeat q 10y unless + hx – Teaching regarding colonoscopy prep For postop: – Home instruction on sitz baths, wound & ostomy care – Don’t forget psychosocial issues & grief mgmt Ostomies (1069) Ileostomy—small bowel; Colostomy—colon Continent pouch—total colectomy with reanastamosis at ileoanal area with formation of an ileoanal pouch. Indications: cancer, inflammatory bowel disease, perforated diverticula, intestinal obstruction Preop Nursing Management Fluid replacement IV antibiotics Bowel cleansing NG tube Antiemetics I&O Education Postop Nursing Management Assessment of stoma and effluent I&O Labs NPO, IVF and TPN, NGT Incisional care and peristomal skin care Diet progression Ambulation Meds Emotional support Team approach to care Patient Education Self-care of ostomy including assessment, skin care, and changing the appliance Management of diet Management of odors If continent pouch is made, patient must gain bowel control Gall Bladder Disease Chapter 44, p. 1126 Definitions Cholecystitis—acute infection Cholelithiasis—calculi (stones), usually from concentrated cholesterol May have either one alone or both Pathophysiology Impaired drainage leads to bacterial growth, irritation, and inflammation Empyema (pus) develops followed by areas of necrosis and gangene Wall becomes thick and edematous Abscess can develop Assessment S&S: – Epigastric distress – NV – RUQ colicky pain – Referred to shoulder – +Murphy’s sign – Fever – Fat intolerance Dx tests: – WBC – Liver enzymes – Bilirubin – Abd xray – US – Cholecystograph – ERCP – Transhepatic choleangiography Complications If duct becomes blocked: – – – – – – – – Abd distention Jaundice Pruritis Clay-colored stools Dark urine (like Coke) Perforation Fistula development Sepsis Treatment—Nonsurgical Analgesics IVF NPO—possible NGT Low fat diet progression if improved Ursodiol Lithotripsy Treatment—Surgical Laparoscopic: – 24h stay with 2 wk recovery – CO2 complications Open: – – – – – 3-5 day stay with 6-8 wk recovery IVF NGT Foley JP, T-tube Postop Nursing Care Prevent respiratory complications (both) Splint incision (both) IVF, IV pain meds and antibiotics (open) I&O (includes what?) (both) Dressing & incision (open) Antiembolism interventions (both) Patient Education Dietary Dressing and drain management S&S infection Meds and pain management S&S to report (think outside the box) Medications for GI Unit Antacid: Mylanta Antiflatulent: Mylicon Antiemetic: Phenergan Antidiarrheal: Lomotil Laxative: MOM Cytoprotective agent: Carafate H2 Receptor Antagonist: Pepcid Anticholingergic: Probanthine Meds cont’d Proton pump inibitor: Prilosec Prostaglandin analog: Cytotec Appetite suppressant: Fastin GI stimulant: Reglan Antibiotics: Biaxin, Flagyl Antiviral: interferon Herbal: ginger
