Gastrointestinal Nursing.pdf

The Large Intestine 101and altered bowel habits, including constipation, difficulty passing stool andabdominal distension are regularly noted.Clinical investigationsIdeally, colonoscopy is the investigation of choice to detect colorectal cancer.It is more sensitive than barium enema. Endoscopic appearance of a rectaltumour is shown in Plate 7. In addition, lesions can be biopsied and removedduring colonoscopy. Examination with rigid sigmoidoscopy will only detectone-third of tumours. Faecal occult blood (FOB) stool testing is widely advocatedin individuals over the age of 50 in the USA to increase the number ofearly cancers detected.Management of colorectal cancerSurgeryTreatment of colorectal cancer depends on the stage of the disease. Mostpatients with colonic cancer require either curative or palliative surgery, suchas bowel resection or stoma formation. Surgery will involve the resectionof the tumour and associated blood and lymph vessels. In intestinal cancer,patients may require the formation of permanent or temporary colostomy.Formation of a colostomy involves making an outside opening, or stoma, onthe abdomen using a section of the colon.Stoma careThe nurse who has charge of stoma patients has a responsibility for theirnursing care in the immediate pre- and post-operative period, to help themadjust to their new situation and to overcome potential psychological problems,such as difficulties with body-image, as well as providing emotionalsupport, encouragement and advice which may be required. Such patientsrequire conscientious stoma nursing care, with priority given to protecting theskin and to controlling odour and faecal drainage.The growing awareness of this particular field of nursing has seen the developmentof nurse specialists in stoma care. Stoma nurses work closely with allmembers of nursing and medical teams to ensure the successful rehabilitationof stoma patients.Adjuvant therapyNearly two-thirds of patients with colorectal cancer have lymph node or diseasespread at presentation and are, therefore, beyond cure with surgery alone.Additional interventions include radiation therapy and chemotherapy.Prevention and screening of colorectal cancerThere is evidence to suggest that in many instances colorectal cancer maybe preventable. Primary prevention relates to dietary and lifestyle advice.