Question

Scenario

Patient Introduction Location: Surgical Unit 0800

Report from night nurse:

Situation: Mr. Hayes is a 43-year-old white male who underwent a laparoscopic abdominal perineal resection with a permanent sigmoid colostomy 3 days ago for rectal cancer.

Background: Mr. Hayes experienced weight loss, increasing fatigue, and narrowing stools with blood, which led to the diagnosis of rectal adenocarcinoma and the recent surgery.

Assessment: Vital signs have been stable with a saturation of 94%–97%. Pain level is currently 1 after pain medication was administered an hour ago. The colostomy appliance is an open-ended pouch attached to a skin barrier. The stoma is red and moist with liquid, brown stool output. The three small abdominal incisions are open to air. There is a clean pad covering the perineal incision. Mr. Hayes has been up and ambulating and is taking full liquids.

Recommendation: It is time for Mr. Hayes's morning assessment. Assess his colostomy, and empty the pouch, if necessary. He can advance to a regular diet as tolerated. Start providing patient education to prepare him for discharge in 2–3 days.

Questions

1) State 2 actual nursing diagnosis for this patients case scenario

2) State 2 risk diagnoses for this patients case scenario

Answer 1

Ans.

1 )

Nursing Diagnosis

1. Acute Pain related to inflamed bowel as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

Interventions	Rationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.	Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.	Analgesics are helpful in relieving pain and helping in the recovery process.
Check for number of bowel movements at least once per shift.	Immobility caused by pain may decrease the parasympathetic stimulation to the bowel.
Incorporate nonpharmacologic measures to assist with control of pain.	Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Imbalanced Nutrition: Less than body requirements related to malabsorption.

Desired outcomes:

Within 24 hours of hospital discharge, the client is able to demonstrate progress towards adequate nutritional status as evidenced by progressive weight gain.

Interventions	Rationals
Weigh patient daily. Assess and record (I&O) intake and output.	To assess adequacy of diet and measure the use of diuretic therapy if utilized.
Allow client to eat that are permitted within dietary meal plan. Explain dietary meal plan and restrictions.	Sodium and fluids are restricted due to fluid retention and ascites.
Offer small and frequent meals.	If ascites is present, the patient may not be able to tolerate larger meals.

2 )

Colorectal Cancer Risk Factors

A risk factor is anything that increases your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.

But having a risk factor, or even many, does not mean that you will get the disease. And some people who get the disease may not have any known risk factors.

Researchers have found several risk factors that might increase a person’s chance of developing colorectal polyps or colorectal cancer.

Colorectal cancer risk factors you can change

Many lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer.

Being overweight or obese

If you are overweight or obese (very overweight), your risk of developing and dying from colorectal cancer is higher. Being overweight raises the risk of colon and rectal cancer in both men and women, but the link seems to be stronger in men. Getting to and staying at a healthy weight may help lower your risk.

Physical inactivity

If you're not physically active, you have a greater chance of developing colon cancer. Regular moderate to vigorous physical activity can help lower your risk.

Certain types of diets

A diet that's high in red meats (such as beef, pork, lamb, or liver) and processed meats (like hot dogs and some luncheon meats) raises your colorectal cancer risk.

Cooking meats at very high temperatures (frying, broiling, or grilling) creates chemicals that might raise your cancer risk. It’s not clear how much this might increase your colorectal cancer risk.

Having a low blood level of vitamin D may also increase your risk.

Following a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and that limits or avoids red and processed meats and sugary drinks probably lowers risk.

Smoking

People who have smoked tobacco for a long time are more likely than non-smokers to develop and die from colorectal cancer. Smoking is a well-known cause of lung cancer, but it's linked to a lot of other cancers, too. If you smoke and want to know more about quitting, see our Guide to Quitting Smoking.

Heavy alcohol use

Colorectal cancer has been linked to moderate to heavy alcohol use. It is best not to drink alcohol. If people do drink alcohol, they should have no more than 2 drinks a day for men and 1 drink a day for women. This could have many health benefits, including a lower risk of many kinds of cancer.

Colorectal cancer risk factors you cannot change

Being older

Your risk of colorectal cancer goes up as you age. Younger adults can get it, but it's much more common after age 50.

A personal history of colorectal polyps or colorectal cancer

If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large, if there are many of them, or if any of them show dysplasia.

If you've had colorectal cancer, even though it was completely removed, you are more likely to develop new cancers in other parts of the colon and rectum. The chances of this happening are greater if you had your first colorectal cancer when you were younger.

A personal history of inflammatory bowel disease

If you have inflammatory bowel disease (IBD), including either ulcerative colitis or Crohn’s disease, your risk of colorectal cancer is increased.

IBD is a condition in which the colon is inflamed over a long period of time. People who have had IBD for many years, especially if untreated, often develop dysplasia. Dysplasia is a term used to describe cells in the lining of the colon or rectum that look abnormal, but are not true cancer cells. They can change into cancer over time.

If you have IBD, you may need to start getting screened for colorectal cancer when you are younger and be screened more often.

Inflammatory bowel disease is different from irritable bowel syndrome (IBS), which does not increase your risk for colorectal cancer.

A family history of colorectal cancer or adenomatous polyps

Most colorectal cancers are found in people without a family history of colorectal cancer. Still, nearly 1 in 3 people who develop colorectal cancer have other family members who have had it.

People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk. The risk is even higher if that relative was diagnosed with cancer when they were younger than 45, or if more than one first-degree relative is affected.

The reasons for the increased risk are not clear in all cases. Cancers can “run in the family” because of inherited genes, shared environmental factors, or some combination of these.

Having family members who have had adenomatous polyps is also linked to a higher risk of colon cancer. (Adenomatous polyps are the kind of polyps that can become cancer.)

If you have a family history of adenomatous polyps or colorectal cancer, talk with your doctor about the possible need to start screening before age 45. If you've had adenomatous polyps or colorectal cancer, it’s important to tell your close relatives so that they can pass along that information to their doctors and start screening at the right age.