Colon cancer is the third most common type of cancer that causes mortality in the U. S. It occurs when changes in the DNA of epithelial cells anywhere in the colon cause them to undergo uncontrolled cell division and growth. It is characterized by carcinoma formation – an invasive type of cell mass. The cancer cells penetrate the intestinal wall and invade nearby organs. Cells that break away metastasize to other organs by way of lymph vessel invasion. Treatment depends on the stage of colon cancer. The only curative treatment available for colon cancer is surgery (Viale, Fung & Zitella, 2005).
Options are laparoscopic colectomy or colon resection. The nature of resection depends on which portions of the colon are diseased and if adjacent organs are involved. The objective of surgery is to remove the tumor that is partially or totally blocking the intestine to allow bowel movement. In many cases, an ostomy is created as route for the elimination of intestinal contents. Radiation therapy and chemotherapy are utilized when cancer cells have invaded the lymph nodes or have already metastasized.
Radiation reduces the size of the tumor while in chemotherapy, one goal is to eliminate cancer cells to achieve remission or the absence of cancer signs and symptoms (Lewis, Dirksen & Heitkemper, 2007). Another is to prevent relapse. Examples of chemotherapeutic agents specific for colon cancer patients are 5-fluorouracil, irinotecan and oxaliplatin (Wilkes, 2005). Nursing interventions focus mainly on alleviating the signs and symptoms of the disease itself, the side effects of radiation and chemotherapy and care throughout the different phases of the surgical operation.
A diagnosis of colon cancer may also represent a situational crisis that might devastate the patient. Thus, nursing care does not only address physiologic but also psychosocial needs. During the end-stage, interventions consist of end-of-life care. Frequently encountered nursing problems related to the disease process are diarrhea or constipation related to altered bowel elimination patterns and acute pain related to the difficulty in passing stools due to partial or total intestinal obstruction by the tumor.
Patients also manifest anxiety related to the upcoming surgery, radiation therapy, chemotherapy and potential terminal illness (Lewis et. al. , 2007). Ineffective coping related to the diagnosis of colon cancer and the multiple, often severe, side effects of treatments. During the course of radiation and chemotherapy, nausea, vomiting, diarrhea and mucositis are common problems. Another is suppression of the bone marrow wherein WBC counts become dangerously low leaving the patient prone to infection. Chemotherapy may also produce side effects specific to the drug or drug combinations used. Radiation may also induce anorexia and fatigue.
Nursing interventions should help mediate the signs and symptoms of drug toxicity particular to the chemotherapy regimen. To relieve nausea and vomiting, the patient is advised to take in small, frequent meals and to employ relaxation or distraction techniques such as music and guided imagery (Becze, 2009). Fatigue is managed by helping the patient pace his activities in accordance with energy levels. Sufficient rest and sleep must be ensured. During periods of diarrhea, a fecalysis may be ordered to rule out infection. Fluids and electrolyte balance must be ensured and personal hygiene reinforced.
I constipated, adopting a high-fiber diet, increasing fluid intake and encouraging frequent repositiong are appropriate interventions (Lewis et. al. , 2007). Antidiarrheal, antiemetic and stool softeners may also be administered as ordered. Pain is managed through pharmacologic and non-pharmacologic means. To increase food intake, food preference is considered and meals given with an ambience that stimulates appetite. To prevent further mucosal injury, soft foods should be provided and good oral hygiene maintained (Becze, 2009). Blood counts are routinely monitored.
Once immunosuppressed, the patient is placed in protective isolation. This should be referred to the physician for timely chemotherapy dose adjustments or delays in administration (Becze, 2009). Handwashing and aseptic techniques are strictly practiced when providing care. Prior to surgery, routine nursing interventions include enforcing an NPO status for at least 6 hours prior to entry into the OR, administering pre-op analgesics and other medications as ordered, performing an enema as ordered and dealing with anxiety among others. During the post-op period, pain alleviation is of paramount importance.
Additionally, interventions focus on preventing post-op complications brought about by anesthesia such as nausea, vomiting, ileus and urine retention (Lewis et. al. , 2007). Preventive interventions reduce the risks for respiratory and wound infections. Ostomy care is also necessary for patients with ostomies. Knowledge deficit of the patient and his family must be addressed to obtain cooperation, guarantee medication compliance and active participation in care. The patient must develop the capacity for self-assessment, identify and report adverse side effects for prompt action (Becze, 2009).
More importantly, the patient experiences fear, anxiety and isolation from being severely ill and having an uncertain future. Depression is a frequent mental health problem. The nurse should spare sufficient time to listen, encourage the expression of feelings, empathize, encourage and affirm the patient. The family’s capacity to cope effectively must be evaluated to ensure appropriate interventions. Colon cancer, like any cancer, requires complex nursing interventions because of the severity and range of problems encountered by the patient.
Knowledge on pathophysiology, sign and symptom management, nursing considerations in chemotherapy administration and laboratory result interpretation are necessary for effective care. Finally, nursing interventions are always patient-specific. Assessment is always a key feature in care planning. List of References Becze, E. (2009). Individualized colorectal cancer treatment in 2009: The role of the oncology nurse in the delivery of quality care. Oncology Nursing Society Connect, 4(8), 34-36 Becze, E. (2009). Managing toxicities from colorectal cancer treatment.
Oncology Nursing Society Connect, 24(7), 14-15 Lewis, S. , Heitkemper, M. and Dirksen, S. (2007). Medical-Surgical Nursing: Assessment and Management of Clinical Problems 7th Ed. Missouri, MO: Mosby Inc. Wilkes, G. S. (2005). Therapeutic options in the management of colon cancer: 2005 update. Clinical Journal of Oncology Nursing, 9(1), 31-44 Viale, P. , Fung, L. & Zitella, A. (2005). Advanced colorectal cancer: current treatment and nursing management with economic considerations. Clinical Journal of Oncology Nursing, 9(5), 541-552