Nursing Case Study for Colon Cancer

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?”

Critical Thinking Check

Bloom's Taxonomy: Analyze

What assessment findings in this patient are consistent with the need for colorectal cancer screening?

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Critical Thinking Check

Bloom's Taxonomy: Apply

How can the nurse best answer the question about the polyps?

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Critical Thinking Check

Bloom's Taxonomy: Apply

How can the nurse best explain the prep he completed? The procedure?

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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.

Critical Thinking Check

Bloom's Taxonomy: Evaluate

What does the nurse anticipate as the next step in this patient’s course of treatment?

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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?

Critical Thinking Check

Bloom's Taxonomy: Analyze

How can the nurse therapeutically address the patient’s concern?

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Critical Thinking Check

Bloom's Taxonomy: Apply

What should the nurse discuss in regard to treatments?

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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.

Critical Thinking Check

Bloom's Taxonomy: Evaluate

What other specialist(s) does the nurse think may be added to this patient’s case? Why?

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Critical Thinking Check

Bloom's Taxonomy: Apply

What should the nurse do before referring Mr. Hernandez for education at a later time?

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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