Care of Patients with Noninflammatory Intestinal D/O

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Chapter 59

CARE OF PATIENTS WITH

NONINFLAMMATORY

INTESTINAL D/O


Lower GI Bleed


Colorectal Cancer


Colorectal Cancer (cont’d)Colorectal – refers to colon and rectum,

which together make up large intestineMost CRCs are adenocarcinomasEtiology:

◦Age >50 yr◦Genetic predisposition◦Personal/family history of cancer◦Familial adenomatous polyposis


Staging

American Joint Committee on Cancer ◦Stage I—tumor invades up to muscle layer◦Stage II—tumor invades up to other organs

or perforates peritoneum◦Stage III—any level of tumor invasion, up to

4 regional lymph nodes◦Stage IV—any level of tumor invasion; many

lymph nodes affected with distant metastasis


Colostomies


Colostomy CareNormal appearance of stomaSigns and symptoms of complicationsMeasurement of stomaChoice, use, care, application of

appropriate appliance to cover stomaMeasures to protect skinDietary measures to control gas and

odorResumption of normal activities


Mechanical Obstruction


Common Abdominal Hernias


Polyps


The patient is a 57-year-old male with a family history (sister, father) of colorectal cancer (CRC). His diet includes lots of red meat and fried foods. He was diagnosed with ulcerative colitis 3 years ago and treated for prostate cancer 2 years ago.

What risk factors suggest a diagnosis of colorectal cancer for this patient?


At the oncologist’s office, the patient tells the nurse that he has been experiencing vomiting and diarrhea. He states that he is tired all the time and has lost about 15 pounds over the past month.

What diagnostic test would take priority at this time?A. Stool for fecal occult bloodB. Serum electrolytesC. ColonoscopyD. EGD

(cont’d)


The patient’s stool is positive for occult blood and he is admitted to the inpatient oncology unit 3 hours later. Two hours after admission, the patient is passing bright red blood from his rectum.

Which location does this suggest for the patient’s tumor?A. Transverse colonB. Descending colonC. Ascending colonD. Rectosigmoid colon

(cont’d)


The next morning the patient is scheduled for surgery to remove the tumor and place a sigmoid colostomy. He returns to the unit with a clear ostomy pouch system in place. The stoma appears healthy.

1. How would the nurse document this finding?

2. How soon postoperatively would the nurse expect the colostomy to begin functioning?

(cont’d)


Three days later the stoma is functioning.

What assessment of stool would the nurse expect?A. Very little stool and mostly gasB. Diarrhea liquid stoolC. Pasty stoolD. More solid stool

(cont’d)


The patient is discharged and home health services are arranged.

What are the home health nurse’s assessment priorities? (Select all that apply.)A. Gastrointestinal statusB. Condition of the stomaC. Peristomal skin conditionD. Patient and family’s coping skillsE. Results of daily laxative prescription

(cont’d)


Chapter 59

Audience Response System Questions

17


Question 1What symptom does the nurse expect the patient with intussusception to exhibit?

A. Decrease in pulseB. Extremely elevated body temperatureC. Singultus (hiccups)D. Frequent bloody stools


Question 2True or False: Emotional stress is a risk factor for irritable bowel syndrome (IBS).

A. TrueB. False


Question 3Which ethnic group has a higher incidence of colorectal cancer?

A. Hispanic/LatinoB. AsianC. CaucasianD. African-American

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Care of Patients with Noninflammatory Intestinal D/O