N211: Health Differences Across the Lifespan I Colorectal Cancer develops in the bowel wall or begins as polyps in the colon and rectum that deteriorate. Cancer of the colon is the fourth most common cancer in the United States. Approximately 45% of cancerous tumors of the colon occur in the rectal or sigmoid area; 25% in the cecum and ascending colon, and 30% in the remainder of the colon. A diet high in fiber, low fat, high in cruciferous vegetables may be a factor in prevention of colon cancer. Metastasis via circulatory or lymphatic system or by direct extension to other areas of the bowel or adjacent organs. Colon cancer can cause abscesses or fistulas, bowel obstruction, hemorrhage or perforation of the bowel, leading to peritonitis. The American Cancer Society recommends for early detection of colon cancer to have a digital rectal examination every year after 40; a stool blood test every year after 50; a colonoscopy or sigmoidoscopy examination every 3 to 5 years after the age of 50. Diagnosti s Include digital rectal exam, stool for occult blood, and flexible fiberoptic sigmoidoscopy with biopsy, colonoscopy and barium enema. Nursing Assessment Includes rectal bleeding, change in bowel habits, sense of incomplete evacuation, abdominal pain, nausea, vomiting, weight loss, abdominal distension or ascites, history of polyps, malaise, anemia, hematest positive or bloody stools, and abdominal mass. • If the tumor is in the ascending colon the client will have diarrhea. • If the tumor is in the descending colon the client will have constipation or diarrhea, flat ribbon-like stools from the partial obstruction. • If the tumor is in the rectum the client will have alternating diarrhea and constipation. Nursing Diagnosis • Altered nutrition, less than body requirements, related to inability to ingest, digest, or absorb nutrients • Pain, related to disease process and medical/surgical interventions • Activity intolerance related to generalized weakness, discomfort, and nutritional deficits • Anxiety related to lack of knowledge of diagnostic tests, unknown diagnostic outcome, disease process and therapeutic regime • Altered elimination, constipation, and/or diarrhea related to change in bowel lumen. Medical Intervention Includes surgery. Hemi colectomy can be done of either the right or left portion of the intestine. A temporary or permanent bowel diversion or colostomy may be required. An abdominal perineal resection can be done if the tumor is close to the anus.
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