1. What are the risk factors associated with the development of colorectal cance

Question

1. What are the risk factors associated with the development of colorectal cancer? 2. What preoperative teaching should be done to prepare a patient for an abdominal- perineal (AP) resection and a permanent colostomy? 3. What therapeutic interventions would be anticipated for a patient following this type of abdominal surgery? 4. Identify nursing strategies to decrease the risk of postoperative complications following an AP resection and colostom 5. Discuss the development and treatment of postoperative pneumonia (nosocomial). 6. What is the most common type of cancer to affect the colon? 7. Discuss the manner in which colorectal cancer can metastasize. 8. What is the significance of staging cancer and how does this correlate with prognosis? 9. Identify appropriate discharge teaching/planning needs for a patient recovering from this major surgery. 10. Discuss the psychosocial and emotional issues following an AP resection and a colostomy

Explanation / Answer

1. Risk factors for colorectal cancer are:
• Old age
• High saturated fat diet
• Low fibre diet
• Alcohol consumption
• Family history
• Obesity
• Smoking
• Lack of physical activity
• Irritable bowel disease, Crohn's disease, ulcerative colitis, polyps in colon and rectum.
2. The preoperative teaching includes:
• Emptying of the colon
• Oral antibiotics to be taken several days prior to the procedure.
• 2 to 3 days prior to the surgery only semi solid foods are taken.
• Before 24 hours, clear liquid diet to be taken.
• Laxatives are given before the surgery.
• Intravenous fluids are given.
• In case if the patient is taking aspirin, it should be discontinued one week before the surgery to prevent excessive bleeding.
3. The therapeutic interventions following this surgery are:
• The patient is catheterised for a day or 2.
• Patient is kept on nil per oral for 1 or 2 days.
• Intravenous fluids are given.
• Pain medications are given.
• Diet is given only after the bowel movements are assessed and is present.
• Bowel sounds are assessed.
• Stool is assessed.
• If bowel movements are present clear fluids are given to the patient.
• If the patient tolerates clear liquids, semi solids and then solid diet is given.
• Early ambulation is important.
• Colostomy is assessed for colour, discharge and signs of infection.
• Colostomy care is performed.
• Normal activity is resumed within 1 to 3 weeks.
• Avoid heavy lifting for 4 to 6 weeks.
4. Some of the complications are: high output, skin irritation, ischemia, hernia and prolapse. The nursing intervention to prevent such complications are:
• Assess for signs of infection
• Maintain hydration level because patient might go for renal failure.
• Check for electrolyte levels because patient might have hypokalaemia, hypomagnesemia, hypocalcemia.
• Check for the amount of stomal output to prevent high output by checking the number of stomal bags that are changed.
• Foods high in fat and sugar can cause high output.
• Fiver intake is increased.
• Antidiarrheal drugs are given in case of high output.
• Proper stoma care to be provided.
• Stoma is assessed frequently for infection, skin irritation, vascular supply, leakage, colour, odour.

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