A premalignant lesion (adenoma) progressesto invasive adenocarcinoma via a complex unknown mechanism
that most often involves genetic alterations. Most
... [Show More] lesions of the large bowel are moderately differentiated
adenocarcinomas. Tumors tend to grow slowly and remain asymptomatic for a long time. Tumors in the
sigmoid and descending colon undergo circumferential growth and constrict the intestinal lumen. Tumors in
the ascending colon are usually large at diagnosis and are palpable on physical examination.
DIAGNOSTIC TESTS
(REASON FOR TEST AND RESULTS)
PATIENT INFORMATION ANTICIPATED PHYSICAL FINDINGS
ANTICIPATED NURSING INTERVENTIONS
• Provide support and encourage verbalization of fears and concerns; assist in providing the patient and
family with information related to the treatment plan; allow the patient and family time for questions;
answer questions honestly.
• Assist with developing positive coping strategies. Arrange for the patient to speak with someone who has
had a similar experience, if appropriate, to reduce fears and to mitigate feelings of being alone.
• Give prescribed drugs. Provide information to the patient about prescribed chemotherapy, including
possible adverse effects. Premedicate with antiemetics about 30 minutes before administration, as
ordered.
• Prepare the patient physically and psychologically for surgery.
• Administer laxatives, enemas, and antibiotics preoperatively, as ordered.
• Arrange for a preoperative visit by a wound, ostomy, and continence nurse if an ostomy is planned.
• Apply antiembolism stockings or sequential compression stockings to prevent VTE.
• Provide postoperative care. Assess cardiopulmonary status. Encourage coughing and diaphragmatic
breathing exercises, and incentive spirometry. Advise the patient to splint the incisional area to decrease
pain and facilitate coughing. Encourage early ambulation.
• Assess the surgical site and perform site care, as ordered; auscultate bowel sounds; inspect the ostomy, if
present; note the integrity of the surrounding skin and check for passage of stool, noting amount, color,
and consistency.
Imaging: computed tomography scanning
determines stage. Transrectal
ultrasonography determines extent of
rectal lesions.
Diagnostic procedures: Proctoscopy or
sigmoidoscopy permits visualization of
the lower GI tract and can detect up to
66% of colorectal cancers. Colonoscopy
permits visual inspection and
photography of the colon up to the
ileocecal valve and provides access for
polypectomies and biopsies ofsuspected
lesions.
Marvin Hayesis a 43-yearold white male who
underwent a laparoscopic
abdominal perineal
resection with a
permanent sigmoid
colostomy 3 days ago for
rectal cancer. He has lost
weight, experiencing
fatigue and narrowing
stools with blood.
Abdominal distention or visible mass,
enlarged abdominal veins, enlarged
inguinal and supraclavicular nodes,
abnormal bowel sounds, abdominal
mass, generalized abdominal
tenderness, right color cancerstend to
be asymptomatic until palpable mass
in LRQ and blood mixed with stool
becomes visible, and left colon tumors
produce pencil-shaped stool. [Show Less]