Transcript Gall Bladder Disease

Colorectal Cancer
Lewis, pp. 1035-1046
Concept 3, pp. 141-148
CSC pp. 691-696
Colorectal Cancer—statistics
Third (ACS) leading cause of death from cancer
Most are adenocarcinoma
Approximately 70-75% occur in colon; 25-30% in rectum
with ½ occurring in the rectosigmoid area
Over ¾ of cancers come from polyps that spread into
mucosal lining and into lymph system and then to
liver*,lungs, bone, brain
More common in men than women
Mortality rates highest among blacks
Colorectal Cancer—Risk Factors
>50 y.o.
PMH or FH
Hx polyps, polyposis, or inflammatory bowel disease
Obesity
Inactivity
Smoking
ETOH
Diet high in animal fat
Manifestations
Maybe none for 5-15 years
Hematochezia or melena
Abdominal pain/cramping
Weakness, anemia, weight loss
Change in bowel habits
Change in stool caliber
Fullness in lower abdomen or rectum or palpable mass
Complications
Intestinal obstruction (pain, vomiting, distention,
unusual bowel sounds, no stool)
Anemia from blood loss
Perforation with peritonitis (sudden pain,
distention, fever, sepsis)
Fistula formation
Diagnostics
Colonoscopy is gold standard—polyps or tumors may
be seen, but bx is confirmation
Hemoccult or guaiac (FOB)
CBC
Coag studies
Liver functions
CEA—initial and to monitor treatment and recurrence
CT or MRI
Collaborative Care: Surgery
Treatment depends on TNM classification
Polypectomy during colonoscopy for in-situ
Colon resection (right or left hemicolectomy) with endto-end anastomosis with lymph removal (lap procedures
increase recovery time)
Abdominal-perineal resection (rectal) with ostomy;
lower abdominal resection (rectosigmoid) without
ostomy to preserve anal sphincter
If metastasized, surgery may be palliative to control
bleeding or obstructive sx
Chemo and Radiation Therapy
Several options in pharmacology book. Treatment is
highly individualized.
Chemo for + lymph nodes using a triple combo of 5FU, leucovorin and usually one other drug
If triple is not an option, then Xeloda
Biologic and targeted therapies slow/prevent tumor
growth by stopping vessel formation or inhibiting growth
factors in tumor
Radiation as adjuvant or for metastasis to reduce tumor
size & provide symptomatic relief
Nursing Management: History
Colon, breast, ovarian cancer, familial or
hereditary polyposis, inflammatory bowel dz,
meds affecting bowel function
High-fat, low-fiber diet
Weakness, fatigue, anorexia, wt loss, N/V
Bowel changes: urgency, bleeding, mucoid,
black, gas, decrease in caliber, pain
Nursing Management: Objective
Data
Pallor, cachexia, lymphadenopathy
Abd mass, distention, ascites, hepatomegaly
Hemoccult + stools, anemia
+ DRE, + scopes, + radiography
Nursing Management: Preop Care
Preop teaching—may need ostomy teaching by
wound care or ostomy care nurse, preferably
Need info about bowel prep procedure
Bowel cleansing and or antibiotics to decrease
contamination
Postop Nursing Management
If reanastamosis is done, then postop care is
routine abdominal surgery. Incision may be
large, but closed with staples. Remember to
check incision, dressing, and drainage.
Lap procedures will only have small midline
incision and lap sites covered with Tegaderm
Pt may have NGT or TPN. May be NPO, ice
chips, or clear liqs depending on type of surgery
Surgical Nsg Care cont’d
Monitor for infection in any skin break
Provide adequate pain control and give prophylacticly
Monitor for signals of readiness to resume oral intake
If abdominal-perineal surgery is done for extensive
metastasis, care of both an abdominal and an open
perineal wound and drain management is necessary.
Ostomy care if indicated
Probs with sexual dysfunction
Patient Education
For screening:
– FOB q yr
– Patients > 50 to have routine colonoscopy; 45 in
blacks—repeat q 10 y unless + hx; flex sig q 5y
– Teaching regarding colonoscopy prep
– Teach patients how to recognize early warning signs
For postop:
– Home instruction on sitz baths, wound & ostomy care
– Don’t forget psychosocial issues & grief mgmt
Ostomies (1039)
Ileostomy—small bowel; Colostomy—colon
Sigmoid (permanent) most common; doublebarrel (temporary or permanent); transverse loop
(temporary)
Continent pouch—total colectomy with
reanastamosis at ileoanal area with formation of
an ileoanal pouch (J-pouch, Kock pouch)
Prostate Cancer
Lewis, pp. 1386-1391
Concept 3, pp. 169-175
Prostate Cancer
Most common cancer in men and
2nd leading cause of death from cancer. 2/3 are
over 65 y.o.
Almost 30,000 die each year. Interestingly, early
dx leads to cure.
5-year survival rate is 100%
Risk Factors
>50 y.o.
African American (twice as likely)
Family hx (father or brother twice as likely)
High fat diet, Vitamin A supplements, low intake
of fruits and vegs
Vasectomy (more circulating testosterone)
Manifestations of Prostate Cancer
Asymptomatic at 1st
Dysuria, urgency, frequency, hesitancy,
dribbling, nocturia, retention, interrupted stream,
inability to urinate, hematuria, oliguria
Painful ejaculation, back, hip, leg pain and
perineal or rectal discomfort and anemia,
nausea, wt loss may be sx of metastasis
Complications
Metastasis to lymph nodes, bones, bladder,
lungs, and liver
Bone mets are especially painful because of
spinal cord compression and destruction of
pelvic bone, femoral head, or lumbosacral spine.
Pain control is important aspect of care.
Diagnostics
DRE reveals hard, nodular, asymetrical gland
PSA>4 (not all elevations are cancer). For
screening and monitoring success of tx
CBC for anemia; elevated alkaline phosphatase
indicates malignancy
Transrectal US; CT, MRI, bone scan, needle bx
Medical Management of Prostate
Cancer
Depends on stage
Pharmacologic: androgen deprivation therapy or
androgen antagonist therapy (estrogen)
Proscar (for BPH) may reduce risk; also black or
cayenne pepper (capasazin)
External beam or brachytherapy (internal radiation with
seed implants)—with or without surgery
Cryotherapy—liquid nitrogen placed into prostate
Surgical Management
Surgical tx includes radical prostatectomy
(prostate, seminal vesicles, part of bladder neck
and lymphs are removed) by one of three
methods: suprapubic, retropubic, perineal—see
p. 1389, Figure 55-5
May also be done laproscopically and with
nerve-sparing procedure
Orchiectomy may also be done if late stage
Complications
Urinary incontinence
Erectile dysfunction
Hemorrhage
Urinary retention
Infection
Dehiscence
DVT and PE
Nursing Management: Health
Promotion
Teach importance of PSA and DRE beginning at
age 50 and 45 for African Americans
If risk factors are present, screening may need to
be done earlier
Teach symptoms of enlarged prostate and to
seek help when it happens
Stress high success rate with early detection
Postop Nursing Management
Monitor for return of sensation from spinal
anesthesia and protect from injury
Monitor 3-way Foley and CBI if used
Keep CBI running at rate that keeps urine pink
without clots
Watch for hemorrhage
FF, keep strict I&O (subtract CBI)
Monitor surgical incision
Postop Nursing Care cont’d
After CBI is d/c, urine will be cranberry
Monitor for clots—call MD for irrigation order
Usually go home with cath; After cath is out, urine is
racked (monitored by comparison samples)
Push fluids! Clots must be prevented
Expect bladder spasms and discomfort with first voiding
which will be small
Give analgesics and also antispasmodics (if ordered),
stool softeners
Emotional support
Patient/Family Education after
Surgery
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Catheter care and bag-switching
Kegel exercises
Wearing pad up to one year
Avoid intraabdominal pressure: Valsalva, lifting,
long trips, strenuous activity, sitting or walking
for long periods
• Caffeine restriction, FF, urine will be cloudy
• Watch for bright red bleeding, infection,
decreased UOP, incision, calf tenderness