Your Actual or Potential Heath Conditions or Needs

Dear Colon,

We have learned about everything we need to know when you and/or your buddy, rectum become cancerous.  This week, I would like to learn about what a nurse would think I need when you have cancer.

Nursing Diagnosis #1- Constipation related to obstructive lesions.  This usually happens when my bowels are obstructed in you.

Nursing Diagnosis #2- Acute pain related to tissue compression secondary to obstruction.  I may experience excruciating pain because of feeling bloated.  I might later on experience post-surgical pain.

Nursing Diagnosis #3- Fatigue related to anemia or anorexia.  Feeling tired because you are bleeding in my bowel and I lost my appetite.

Nursing Diagnosis #4- Disturbed image related to colostomy.  Possible self-loathing because of stoma and colostomy.  Feeling disgusted by managing my bowel movement on my abdomen.  

Nursing Diagnosis #5- Knowledge deficit about diagnosis, surgical procedures, and self care.  Feeling really lost and not knowing anything about your condition.  This would freak me out!  

Nursing Diagnosis:  Knowledge deficit about diagnosis, surgical procedures, and self care.  

Actual Problems:  Unaware about the onset, course, pathophysiology of colorectal cancer.  Not knowing what to expect from the surgical procedures. 

Potential Problems:  At risk of improper self care. 

Plan:  Patient will be able to use teach back technique to demonstrate knowledge of colorectal caner, his/her surgical procedures, and ways of proper self care after surgery or when discharge home.  

Outcome:  Patient and family will be knowledgeable about the diagnosis of colorectal cancer, surgical procedures (knowing what to expect and consequences), and will be able to provide proper self care after the surgery.    

Nursing Intervention:  RN will provide verbal and written education for patient and family about colorectal cancer, the surgical procedures of it, and ways of proper self care after the surgery.  

Yours sincerely,

Jumbo

What can a nurse do?

Dear Colon,

How are you?  This week, we'll learn about how the nurses can take care of me while you have cancer.  There's a lot the nurses can do to take care of us; it all depends on the treatment options I elect.  If I choose to have part of you or all of you surgically removed, the nurse would have to provide pre-operative care like the following as suggested by :
1) Preparing the patient for the surgery by offering guidelines about what an be expected from general anesthesia, intubation, and post-operative care management.
2) After surgery, the nurse will monitor my vital signs while I regain my consciousness from anesthesia.
3) The nurse will closely monitor my orientation, my post-operative pain, and my intake and output every 30 minutes.
4) The nurse would also closely monitor the lab results to ensure good blood count and possible infection (Hct, Hb, Leuk), and electrolyte balanced.
5) If there's a stoma as a result of the surgery, the nurse would use aseptic procedures to care for it to prevent infection.
6) Respiration would be closely monitored to see if I can breath on my own.
7) If the catheter is no longer necessary, the nurse would have to remove it from me as soon as possible to prevent hospital acquired infections.

These pictures illustrate how I can change the ostomy bag independently.

This video shows us what a stoma is.

This video shows how a nurse providing ostomy care.

According Pereira (2014), with the increased number of colorectal cancer survivors worldwide, nursing interventions are crucial to enable autonomy and promote independence for the patients.  Effective nursing interventions include multimedia education program, a structured telephone follow-up conducted by an experienced nurse specialist, and a 17-item patient completed continuity assessment with feedback to clinical nurse specialist and actions to address the needs identified.  More research needs to be done in this area to promote post-cancer care for the patients and their families.  I hope I will benefit from these research in the future.

Yours sincerely,

Jumbo

Reference:
Colon Cancer Care Plan. (2013, June 16). Retrieved May 13, 2015, from http://www.istudentnurse.com/care-plans/crc/
Pereira, N. (2014). Educating and empowering colorectal cancer survivors. Gastointestinal Nursing, 12(9), 33-40.

To Treat or Not to Treat?

Dear Colon,

If one day you are diagnosed with cancer, I will no doubt pursue treatment.  Treatment options varies depending on the stage of cancer that's invading you, and the location of it.  It might not be a 100% cure. I will pursue treatment aiming for remission, preventing metastasis and relapse, and hopefully a cure eventually.  Cancer treatment is not easy physically and mentally; nevertheless, with the advanced medical technology, we have hope.

I actually found some detailed staging information about your colorectal cancer on the American Cancer Society's website.  Here is the link:  http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-staged
I think I was only describing your progression in general in my last letter.  However, this website gives you extensive description of your cancer's staging.  After I learn about the stage of the cancer, I will talk to my doctor about the type of treatment I want to undergo.

According to the American Cancer Societ, there are four treatment options:  surgery, radiation therapy, chemotherapy, and targeted therapy.  The diagram on the letter head is showing one of the surgery options, colectomy (partial or complete removal of colon) for your cancer.  It can be done through open surgery, one incision in the abdomen, or a laparoscope-assisted colectomy.  A laparoscope is a thin tube with light and a camera at the end of it.  Some lymph nodes would be removed while undergoing a partial colectomy.  After the surgery, you will need two to three days of pain medication to manage the pain and you won't be able to return to your regular diet until a few days later.  We have to give you time to heal.  Side effects of colectomy are like any other surgeries.  However, if you undergo a total colectomy, you may have a temporary or permanent colostomy.  In that case, I will need to adjust my lifestyle to manage it.

Radiation is another treatment option.  People with colon cancer that has attached to an internal organ or the lining of the abdomen would need radiation for treatment (ACS, 2015).  It can also be used when the cancer has spread to the bones or brain.  If you buddy, rectum, has cancer, radiation will be needed before and after surgery to prevent the return of cancer at it.  There are four types of radiation therapy, but external beam radiation therapy is the most common kind of radiation for colorectal cancer.  Radiation is focused on the cancer given outside of the body.  Radiation therapy is usually given five days a week for several weeks depending on your stage and location.  Length of time it is given can be shorten before surgery.  Side effects of radiation include:  skin irritation, nausea, rectal irritation, bowel incontinence, bladder irritation, fatigue and sexual problems.

Chemotherapy is giving anticancer drugs to treat cancer.  It can be given systemically or regionally.  Systemic chemotherapy will be injected into a vein or given orally.  Regional chemotherapy will be injected into an artery directly leading to the part of the body containing the tumor (ACS, 2015).  For colorectal cancer, chemotherapy are usually given in multiple cycles.  Each cycle of it last for two to four weeks.  Here are some common chemotherapy drugs for you:  5-Fluorouracil (5-FU), Capecitabine (Xeloda), Irinotacan (Campotosar), and Oxaliplatin (Eloxatin).  Side effects of chemotherapy include:  hairloss (alopecia), mouth sore (mucositis), loss of appetite, nausea/vomiting, low blood counts, and low blood counts.

Type of cancer treatment will be stopped depending on the effectiveness, patients's reaction to the side effects, and whether the cancer metastasize or not.  Doctors would definitely stop your treatment if you or I have an allergic reaction to any of the treatment.  Just remember, you may not die from colorectal cancer; however, you can die from a allergic reaction if it's severe enough.  Don't take the chance.

This is a treatment pathway given by the Bowel Cancer Australia,which is an Australian national charity that educate, raise awareness, fund raise, research, and advocate for people with colorectal cancer.  Here is the link,   https://www.bowelcanceraustralia.org/

This week's research article is one of my favorite areas of cancer research, emotional resistance of family members of loved ones undergoing chemotherapy.  How would my family and friends react if I have to undergo chemotherapy?  I can imagine.  According to MacCarthy, Andrews, & Hegarty, 2015), emotional collapse was the fear for all the family members who participated in their study.  This fear would lead to the Emotional Resistance Building process, which includes "Figuring it out", "Getting on with it", and "Uncertainty adjustment".  They are basic social processes that are interrelated.  The study concludes that health care providers may use this theory to provide support for the family members of loved ones undergoing chemotherapy.  Unfortunately, their emotions are always neglected during cancer treatment for the patients.  I believe more research is needed to look into this area.  Maybe effective ways to provide emotional support?    

Reference:
Chemotherapy for colorectal cancer. (n.d.). Retrieved May 6, 2015, from
http://http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-chemotherapy

McCarthy, B., Andrews, T., & Hegarty, J. (2015). Emotional Resistance Building: How family members of loved ones undergoing chemotherapy treatment process their fear of emotional collapse. Journal of Advanced Nursing, 71(4), 837-848. doi:10.1111/jan.12549

Radiation therapy for colorectal cancer. (n.d.). Retrieved May 6, 2015, from http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-radiation-therapy

Surgery for colorectal cancer. (n.d.).  Retrieved May 6, 2015, from
http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-colon-surgery