Nursing Case Study for Colon Cancer
Watch More! Unlock the full videos with a FREE trial
Included In This Lesson
Study Tools For Nursing Case Study for Colon Cancer
Outline
Enrique Hernandez is a 55-year-old male patient scheduled for his first colonoscopy in a hospital’s outpatient gastrointestinal (GI) center. He has a recent history of alternating diarrhea and constipation and unexplained weight loss. He vaguely remembers some relatives having the same symptoms and passing away from “something to do with their colon.” He saw his primary care provider who referred him to a GI specialist for further evaluation.
During the GI center screening, he mentions that he talked with the family further and his older brother recently had this procedure and was diagnosed with polyps. He asks, “What does that mean for me? Am I too late? Could I have done something differently?”
He then complains about the prep he had to complete prior to this procedure. He says, “That was awful. I may never get this done again because of that! What the heck are they going to do anyway?”
What assessment findings in this patient are consistent with the need for colorectal cancer screening?
- Change in bowel habits. Unexplained weight loss (ask, “have you recently lost weight without trying?” to best screen) Possible family history mentioned and then confirmation of 1st-degree relative having polyps.
How can the nurse best answer the question about the polyps?
- A family history of colorectal cancer (CRC) can increase the risk that an individual will develop CRC over a lifetime. Familial CRC is a result of interactions among genetic and lifestyle factors; the amount of increased risk varies widely depending on the specifics of the family history. For a small proportion of people, genetic predisposition is the dominant risk factor. For most people, lifestyle factors (eg, diet, exercise, smoking, and obesity) are stronger risk factors”. Also, explain that having this test now is better than putting it off even longer. Early screening is shown to help improve outcomes.
How can the nurse best explain the prep he completed? The procedure?
- Prep – Before a colonoscopy, your colon must be completely cleaned out so that the doctor can see any abnormal areas. This is vitally important to increase the chances that your doctor will identify abnormalities in your colon. If your colon is not completely cleaned out, the chances your doctor will miss abnormalities increases.” Also, the patient can discuss future screenings with his Gi specialist, but they may also be able to adjust the prep. Things like not ingesting solid food for a longer time frame and different prep medications may be something to discuss with GI.
- Procedure – A colonoscopy is an exam of the lower part of the gastrointestinal tract, which is called the colon or large intestine (bowel). Colonoscopy is a safe procedure that provides information other tests may not be able to give (they may see polyps or inflammation and/or take a tissue sample). The procedure is performed by inserting a device called a colonoscope into the anus and advancing through the entire colon and generally takes between 20 minutes and one hour.
Mr. Hernandez is screened and assessed by nursing and anesthesia staff and then taken to the colonoscopy suite. The GI doctor sees not only polyps but also a tumor during the procedure and advises the nurse to come to get him when the patient wakes up fully. He says, “He will have to explain he needs to stay in the hospital because general surgery is consulted and needs to operate.
What does the nurse anticipate as the next step in this patient’s course of treatment?
- Colon resection surgery or colectomy with exploration/evaluation of tumor plus tumor being sent off for pathology. “Approximately 80 percent of cancers are localized to the colon wall and/or regional nodes. Surgery is the only curative modality for localized colon cancer.” After surgery, other therapies may be initiated depending on the pathology and metastasis.
Once the patient is fully recovered from anesthesia, the GI specialist explains his findings to Mr. Hernandez who agrees with a surgical consult ASAP. He agrees to stay in the hospital for surgery. The patient asks the nurse, “What if I have to have one of those bags? What am I supposed to do now?
How can the nurse therapeutically address the patient’s concern?
- Bowel surgery does not always result in the need for a colostomy (“the bag”). However, sometimes it does require it (either temporary or permanent). Ask the patient to be specific about his concerns with having an ostomy. Then, take those things individually and discuss further (asking questions along the way to best customize teaching).
- Getting a certified ostomy/wound care nurse to further explain may be best, but if one is not readily available the nurse should get info about/provide contact info for this specialty nurse.
What should the nurse discuss in regard to treatments?
- At this stage, it is best to await surgery results before providing specific education. Also, this patient has just had anesthesia and may not be able to fully comprehend complex medical discussions. Addressing his immediate concerns/issues as well as (simply) explaining what is going on is the best course of action. Also, it is not within a nurse’s scope to prescribe treatments for cancer (education based on providers’ orders is fine, though.)
Mr. Hernandez denies the need for further teaching. He says that is enough information for now. He says this is all very overwhelming, but he is committed to his plan of care.
What other specialist(s) does the nurse think may be added to this patient’s case? Why?
- Wound care/ostomy specialist – if he needs an ostomy (either temp or perm)
- Oncology – to prescribe a plan of care including possible chemotherapy or immunotherapy (radiation oncology may work within the team for radiation if indicated as well)
- Nurse case management – to help facilitate the patient’s expanding healthcare needs
What should the nurse do before referring Mr. Hernandez for education at a later time?
- Determine the patient’s education level and preferred learning style (some patients may not read well for example – or at all; some may like discussion or visual aids)
- Consider the patient’s individual needs (do they have visual or hearing impairment for example)
- Find out what APPROVED education resources are available from your facility to aid in patient teaching
- Make sure the patient understands what is being done and why along with the relevance and importance
- Include family members in health care management whenever possible
View the FULL Outline
When you start a FREE trial you gain access to the full outline as well as:
- SIMCLEX (NCLEX Simulator)
- 6,500+ Practice NCLEX Questions
- 2,000+ HD Videos
- 300+ Nursing Cheatsheets
Transcript
Hey everyone. My name is Abby. We’re going to go through a case study for colon cancer together. Let’s get started. In this scenario, Enrique Hernandez is a 55 year old male scheduled for his first colonoscopy in a hospital’s outpatient gastrointestinal (GI) center. He has a recent history of alternating between experiencing diarrhea and constipation, and he also has a recent unexplained weight loss. He vaguely remembers some relatives having the same symptoms and passing away from, “something to do with their colon.” He saw his PCP or primary care provider who referred him to a GI specialist for further evaluation. During the GI center screening, he mentions that he talked with the family further and his older brother recently had this procedure and was diagnosed with polyps. He asks, “what does that mean for me?” Am I too late? Could I have done something differently? He then complains about the prep he had to do prior to the procedure he says was awful. “I may never get this done again because of that. What the heck are they going to do anyway?” With all of this in mind, let’s take a look at our critical thinking checks for our patient. They’re numbers one, two, and three below.
Great job! Mr. Hernandez is screened and assessed by nursing and the anesthesia staff, and then taken to the colonoscopy suite. The GI doctor sees not only polyps, but also a tumor during the procedure and he advises the nurse to come and get him when the patient wakes up fully. He says, “he will have to explain, and that he needs to stay in the hospital because general surgery is consulted and needs to operate.” Now that we have more information about Mr Hernandez’s case, let’s take a look at critical thinking check number four below.
Excellent. Once the patient is fully recovered from anesthesia, the GI specialist explains his findings to Mr. Hernandez, who agrees with a surgical consult as soon as possible. He agrees to stay in this hospital for surgery and the patient asks the nurse, “what happens if I have to have one of those bags, what am I supposed to do now?” Let’s take a look at critical thinking checks number five and number six below.
Great job! Mr. Hernandez denies the need for further teaching. He says, “that is enough information right now. He says, “this is all very overwhelming”, but he is committed to his plan of care. Now that we have this information, we can go ahead and get into our critical thinking checks number eight and number nine.
Great job guys, that wraps up this case study on colon cancer. Please take a look at the attached study tools and test your knowledge with a practice quiz. We love you guys, now go out and be your best self today, and as always happy nursing!
References:
Clinical presentation, diagnosis, and staging of colorectal cancer
Authors:Finlay A Macrae, MDAparna R Parikh, MD, MSRocco Ricciardi, MD, MPHSection Editor:Kenneth K Tanabe, MDDeputy Editors:Diane MF Savarese, MDShilpa Grover, MD, MPH, AGAF; Overview of the management of primary colon cancer
Authors:Miguel A Rodriguez-Bigas, MDMichael J Overman, MDSection Editors:Kenneth K Tanabe, MDRichard M Goldberg, MD
View the FULL Transcript
When you start a FREE trial you gain access to the full outline as well as:
- SIMCLEX (NCLEX Simulator)
- 6,500+ Practice NCLEX Questions
- 2,000+ HD Videos
- 300+ Nursing Cheatsheets
