GI Colorectal Cancer & Ostomies

What are some side effects of chemotherapy drugs?

- Anemia - Neutropenia - fatigue - diarrhea - palmar-plantar erythrodysesthesia

What are some complications to monitor for post op from surgery? Think tx and prevention.

- Bleeding - Atelectasis (Teach deep breathing and coughing) - DVT/PE (Get ambulation gif possible, compressions) - Paralytic ileus - N/V from anesthetics (Antiemetics) - UR - Pain (Pain meds as prescribed) - Wound Dehiscence/Evisceration (Monitor for) - Hematoma

What are the two common complications that someone with an ostomy might have that they can fix at home?

- Blockage - Too much output

What are some complications of colorectal cancer or colorectal tx?

- Bowel obstruction - Perforation - Hemorrhage - Paralytic ileus - Peritonitis - Abscess - Mesenteric ischemia - Infection - Wound dehiscence/evisceration - Fistulas

What are some important labs you might need for colorectal cancer?

- CBC - BMP - Liver function tests - CEA (Tumor marker)

What are some reasons for a ostomy?

- Crohn - UC - Infection - Cancer - Diruticulitis - Obstruction - Trauma - Volvulus

How should someone with a new ostomy diet look like the first 1-6 weeks?

- Low finer diet - Small meals - Chew food thoroughly - Hydration - Low fat and no dairy (Oat meal, bananas, mashed potatoes, rice.

What are the risk factors of a jejunostomy?

- Malnutrition - Dehydration - Electrolyte imbalances - Skin breakdown d/t irritating chyme

What does the post-op assessment consist of for a pt that underwent surgery to get a stoma?

- Monitor electrolytes and s/s of dehydration - Decreased urine output - Stoma color - Drainage

What are some nursing priorities or things you would see on the care plan for colorectal cancer or colorectal tx?

- Optimal nutrition - Prevent infection (Prophylactic antibiotics) - Maintain fluid volume - Pre-op ed - Post-op ed - Providing wound care - Ed of stoma care - Monitor for complications - Encourage moving - Splint and cough ed

What does care look like for a pt that is getting a new stoma?

- Pre-op care - Post-op care - Complicaitons monitoring - Pt education - Psychosocial and holistic care concerns

How full should the ostomy bag be when emptying it?

1/3 or 2/3 full

What consist of the pre-op education for a pt about to undergo surgery for a stoma?

24 hr before clear liquid, day of NPO with cleansing solution

What is acute mesenteric ischemia?

Acute onset of intestinal ischemia

What age is colorectal cancer most common?

Ages 65-74.

What does the drainage look like after a ileostomy?

At first dark green stool and then yellow after starting to eat.

What could possibly be wrong if stoma is dull?

Blood flow problem

What is the 2nd most common sign of colorectal cancer?

Blood in stool

A patient is scheduled for a fiberoptic colonoscopy. What does the nurse know that fiberoptic colonoscopy is most frequently used to diagnose? Bowel disease of unknown origin Cancer Inflammatory bowel disease Occult bleeding

Cancer

What is the first symptom you see with colorectal cancer?

Chance in bowel habits.

The nurse is irrigating a client's colostomy when the client begins to report cramping. What is the appropriate action by the nurse? Increase the rate of administration. Discontinue the irrigation immediately. Clamp the tubing and allow client to rest. Change irrigation fluid to normal saline.

Clamp the tubing and allow client to rest.

What color will stool be when the colon is clean?

Clear or clear and yellow liquid

What is the prevention of colorectal cancer?

Decreasing modifiable risk factors and doing routine diagnostics for early detection.

How does a patient fix too much output with an ostomy at home?

Eat bulk forming food (oatmeal, banana, and marshmallows.)

Which of the following is the most plausible nursing diagnosis for a client whose treatment for colon cancer has necessitated a colostomy? Risk for unstable blood glucose due to changes in digestion and absorption Unilateral neglect related to decreased physical mobility Risk for excess fluid volume related to dietary changes and changes in absorption Ineffective sexuality patterns related to changes in self-concept

Ineffective sexuality patterns related to changes in self-concept

Where is a jejunostomy?

LUQ

Where is the stoma for a transverse colostomy? And what does the stool look like?

Middle of the abdomen, semiformed stool

What does the drainage look like after a colostomy?

Mucoid, normal for no production until day 2

What are common manifestations that you may see with left side lesions for colorectal cancer?

Obstruction with pain, cramping, narrowing stools, constipation, distention, and red blood in stool

What should a healthy post-op stoma look like?

Pink and red/large and swollen (Should not be sensitive)

What does pre-op care look like for a patient about to undergo surgery for a stoma?

Pre-op assessment - Pre-op checklist - Pre-op education - Pre-op psychosocial and holistic care

A nurse is caring for a client who had an ileal conduit 3 days earlier. The nurse examines the stoma site and determines that she should consult with the ostomy nurse. Which assessment finding indicates the need for further consultation? Beefy red stoma site Stoma site not sensitive to touch Red, sensitive skin around the stoma site Clear mucus mixed with yellow urine drained from the appliance bag

Red, sensitive skin around the stoma site

What is a colon resection with stoma formation?

Remove part of bowel and form a stoma.

During a colonoscopy, a polyp was found what might the doctor do?

Remove the polyp and test it for cancer.

Where is the stoma for a ascending colostomy? And what does the stool look like?

Right side, liquid stool

What is a colon resection with anastomosis?

Section of bowel is removed and the healthy ends are sewn together.

Where is the stoma for a sigmoid colostomy? And what does the stool look like?

Stool is formed (Able to control their BM though irrigation)

A client who has undergone colostomy surgery is experiencing constipation. Which intervention should a nurse consider for such a client? Suggest fluid intake of at least 2 L/day Instruct the client to avoid prune or apple juice Assist the client regarding the correct diet or to minimize food intake Instruct the client to keep a record of food intake

Suggest fluid intake of at least 2 L/day

What are some common manifestations that you may see with rectal lesions for colorectal cancer?

Tenesmus, rectal pain, feeling of incomplete evacuation, altering constipation and diarrhea, and blood stools.

What is a common description in stool from colorectal cancer?

Thin and ribbon like.

What are some overall manifestations you might see for colorectal cancer?

Unexplained anemia, anorexia, wt loss, and melena

How do you gently take off a ostomy bag?

Wash cloth and warm water

How does a patient fix a small blockage with an ostomy at home?

gently message, warm shower or tea, and ambulating.

What could possible be wrong if a post op stoma is light pink>

low Hct or Hgb

What should someone with an ostomy not eat?

- Corn, peas, coleslaw, pineapple, skin of fruit - Beans, onions, eggs, cabbage, fish (High fiber foods)

What are the three risks for ileostomys?

- Dehydration - Electrolyte Imbalances - Skin breakdown d/t digestive enzymes (Chyme)

What are are the steps of Bowel prep for colonoscopy

- Drink cleansing solution evening before. - Clear liquids day before - 1-2 days no red foods - Second dose of cleansing solution should begin 4-6 hours before the procedure.

What is part of your priority assessment when assessing for colorectal cancer?

- Family hx - Hx of IBD or polyps - Dietary hx (EHOH, smoking) - S/S (Wt loss, stool, BM changes) - Auscultate bowel sounds and palpate

A nurse is applying an ostomy appliance to the ileostomy of a client with ulcerative colitis. Which action is appropriate? Cutting the faceplate opening no more than 2 inches larger than the stoma Gently washing the area surrounding the stoma using a facecloth and mild soap Scrubbing fecal material from the skin surrounding the stoma Maintaining wrinkles in the faceplate so it doesn't irritate the skin

Gently washing the area surrounding the stoma using a facecloth and mild soap

What are the signs of peritonitis?

Nausea, hiccups, chills, increased temp, Tachycardia, "board like abd".

If someone has an ileostomy what is a medication concern?

No exteric coated or extended release meds.

Where is a ileostomy located? What quadrant?

Small intestine (RLQ)

The nurse is caring for a client with an ileostomy because of inflammatory bowel disease. Which assessment findings indicate to the nurse that the ileostomy is functioning as expected? Select all that apply. Stoma is pink and shiny Stoma is edematous and bleeding Formed stool in collection pouch Continuous liquid flows from the stoma Slight skin excoriation around the stoma

Stoma is pink and shiny Continuous liquid flows from the stoma

what are some types of medications someone with colorectal cancer may have?

- Immunotherapy - Chemotherapy drugs - Antiemetics

Which is the most common presenting symptom of colon cancer? Fatigue Change in bowel habits Anorexia Weight loss

Change in bowel habits

When caring for a patient with an established stoma what does nursing care look like and what does it depend on?

Depends on how sick they are and if they are able to carry out their care to themselves like normal. Nursing care look like assisting them with care, supplies, and dietary advocacy.

What are common manifestations that you may see with right side lesions for colorectal cancer?

Dull abdominal pain and melena

What are some risk factors of colorectal cancer?

Smoking, Family history, Alcohol, high fat and protein with low fiber intake, hx of inflammatory bowel disease

What are some complicaitons specific to ostomies?

- Fluid imbalance - Electrolyte imbalance - Skin irriation - Blood supply to stoma - Paralytic ileus - Mechanical Obstruction - Acute mesenteric ischemia - Peritonitis

A client's colorectal cancer has necessitated a hemicolectomy with the creation of a colostomy. In the 4 days since the surgery, the client has been unwilling to look at the ostomy or participate in any aspects of ostomy care. What is the nurse's most appropriate response to this observation? Ensure that the client knows that he or she will be responsible for care after discharge. Reassure the client that many people are fearful after the creation of an ostomy. Acknowledge the client's reluctance and initiate discussion of the factors underlying it. Arrange for the client to be seen by a social worker or spiritual advisor.

Acknowledge the client's reluctance and initiate discussion of the factors underlying it.

Whats the most common type of rectal cancer?

Adenocarcinoma (From the epithelial lining of the intestine)

A nurse is talking with a client who is scheduled to have a hemicolectomy with the creation of a colostomy. The client admits to being anxious, and has many questions concerning the surgery, the care of a stoma, and necessary lifestyle changes. What nursing action is most appropriate? Reassure the client that the procedure is relatively low risk and that clients are usually successful in adjusting to an ostomy. Provide the client with educational materials that match the client's learning style. Encourage the client to write down these concerns and questions to bring forward to the surgeon. Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.

Maintain an open dialogue with the client and facilitate a referral to the wound-ostomy-continence (WOC) nurse.