Colorectal Cancer Nursing Care Plan

What is Colorectal Cancer Nursing Care Plan and Management?

Colorectal cancer is a type of cancer that affects the colon and rectum. It is the third most common cancer in men and women and the second leading cause of cancer deaths in the United States. The Colorectal Cancer Nursing Care Plan and Management for a patient with colorectal cancer will depend on the cancer stage and the patient’s individual needs and goals. In general, the goals of nursing care for patients with colorectal cancer may include the following:

• Managing symptoms: Nurses may provide symptom management interventions, such as pain and bowel management, to improve the patient’s quality of life.
• Providing education: Nurses may educate patients about their cancer, treatment options, and self-care after treatment.
• Coordinating care: Nurses may coordinate care with other members of the healthcare team, including primary care providers, oncologists, and surgeons, to ensure that patients receive comprehensive and coordinated care.
• Providing emotional support: Nurses may provide emotional support and counselling to patients and their families to help them cope with the physical and emotional challenges of living with cancer.
• Facilitating rehabilitation: Nurses may work with patients to develop a rehabilitation plan to help them regain strength and function after surgery or chemotherapy.
• Promoting healthy habits: Nurses may encourage patients to adopt healthy habits, such as a healthy diet and regular physical activity, to support their overall health and recovery.

The nursing care plan for a patient with colorectal cancer will be tailored to the individual needs and goals of the patient. It may include medications to manage symptoms and side effects, referrals to supportive care services, and strategies to support rehabilitation and healthy habits. Nurses must work closely with patients and other healthcare team members to develop and address patient concerns and support.

Classification of Colorectal Cancer

Colorectal cancer is a type of cancer that affects the colon and rectum. It is generally classified based on the location and stage of cancer.

Location: Colorectal cancer can occur in different parts of the colon and rectum. It is typically classified as either colon cancer (affecting the colon) or rectal cancer (affecting the rectum).

Stage: The stage of colorectal cancer refers to how advanced the cancer is and how far it has spread. The cancer stage is an essential factor in determining treatment options and prognosis. Colorectal cancer is typically staged using the TNM staging system, which considers the size and extent of the primary tumour (T), the presence of lymph node involvement (N), and the presence of metastases (M).

• Stage 0: The cancer is confined to the inner lining of the colon or rectum and has not spread.
• Stage I: Cancer has grown beyond the inner lining of the colon or rectum but has not spread to the lymph nodes.
• Stage II: Cancer has grown through the colon or rectum wall and may have spread to nearby lymph nodes.
• Stage III: Cancer has spread to nearby organs or tissues and may have spread to the lymph nodes.
• Stage IV: Cancer has spread to distant organs or tissues.

Patients with colorectal cancer must receive a thorough evaluation and accurate cancer staging to receive the most appropriate and effective treatment.

Causes of Colorectal Cancer

The exact cause of colorectal cancer is not fully understood, but several factors have been identified as contributing to the development of the disease. These include:

• Age: The risk of colorectal cancer increases with age, with most cases occurring in people over 50.
• Family history: A family history of colorectal cancer or certain inherited genetic conditions, such as Lynch syndrome and familial adenomatous polyposis, can increase the risk of developing the disease.
• Lifestyle factors: Some lifestyle factors, such as a diet high in red and processed meats, obesity, and physical inactivity, have been linked to an increased risk of colorectal cancer.
• Chronic inflammatory conditions: Chronic inflammatory conditions of the colon, such as ulcerative colitis and Crohn’s disease, can increase the risk of colorectal cancer.
• Personal history: A personal history of colorectal polyps or colorectal cancer can increase the risk of developing the disease.
• Environmental factors: Exposure to certain environmental toxins, such as tobacco smoke and certain chemicals, may increase the risk of colorectal cancer.
• Race and ethnicity: Some racial and ethnic groups, such as African Americans and Ashkenazi Jews, have a higher risk of colorectal cancer.
• Alcohol consumption: Heavy alcohol consumption has been linked to an increased risk of colorectal cancer.
• Diabetes: People with diabetes may be at an increased risk of colorectal cancer.
• Chronic constipation: Chronic constipation may increase the risk of colorectal cancer.
• Low-fiber diet: A diet low in fiber has been linked to an increased risk of colorectal cancer.
• High calcium intake: Some research suggests that high calcium intake may be associated with an increased risk of colorectal cancer.

It is essential to be aware of these risk factors and to adopt a healthy lifestyle, including a healthy diet and regular physical activity, to reduce the risk of colorectal cancer. Regular screening tests, such as colonoscopies, can help to detect the disease in its early stages when it is most treatable.

Assessment & Diagnostics of Colorectal cancer

The assessment of colorectal cancer typically involves a thorough evaluation of the patient’s medical history, physical examination, and diagnostic tests. Here are some key components of the assessment process:

Medical history:

The healthcare provider will ask the patient about their medical history, including any previous diagnoses, surgeries, and treatments. The provider may also ask about family history, diet, and lifestyle factors that may be relevant to the development of colorectal cancer.

• Previous diagnoses, surgeries, and treatments: It is important to know if the patient has had any previous diagnoses or treatments for colorectal cancer or other conditions that may be relevant to the current condition.
• Family history: A family history of colorectal cancer or certain inherited genetic conditions, such as Lynch syndrome and familial adenomatous polyposis, can increase the risk of developing the disease.
• Diet and lifestyle factors: The healthcare provider may ask about the patient’s diet and lifestyle habits, such as their intake of red and processed meats, physical activity level, and tobacco and alcohol use, as these factors may be related to the development of colorectal cancer.
• Chronic conditions: The healthcare provider may ask about any chronic inflammatory conditions of the colon, such as ulcerative colitis and Crohn’s disease, as these conditions can increase the risk of colorectal cancer.
• Personal history: The healthcare provider may ask about the patient’s personal history of colorectal polyps or colorectal cancer, as this can increase the risk of developing the disease.

Physical examination:

The healthcare provider will conduct a physical examination, including a rectal examination, to look for any physical signs of colorectal cancer.

• Abdominal examination: The healthcare provider will examine the patient’s abdomen for any swelling, tenderness, or mass related to colorectal cancer.
• Rectal examination: The healthcare provider will conduct a rectal examination to feel for any abnormal growths or abnormalities in the rectum.
• Digital rectal examination: The healthcare provider will insert a gloved finger into the rectum to look for abnormalities.
• Anal examination: The healthcare provider may examine the anus for abnormalities, such as rectal prolapse.
• Palpation of lymph nodes: The healthcare provider will feel for any enlarged lymph nodes in the abdomen, groin, or neck related to colorectal cancer.

Diagnostic tests:

Several diagnostic tests may be used to confirm a diagnosis of colorectal cancer and the stage of cancer. These may include:

a. Colonoscopy:

A colonoscopy is a procedure that uses a flexible camera to examine the inside of the colon and rectum.

Main objectives of colonoscopy as a diagnostic test             

1. To evaluate the inside of the colon and rectum for abnormalities: Colonoscopy allows the healthcare provider to examine the inside of the colon and rectum for abnormalities, such as colorectal cancer or polyps.
2. To take biopsy samples: If necessary, the healthcare provider can take biopsy samples during the colonoscopy to confirm the diagnosis of colorectal cancer or to determine the type of cancer.
3. To detect colorectal cancer in its early stages: Early detection of colorectal cancer is key to improving the chances of successful treatment. Colonoscopy can help to detect the disease in its early stages when it is most treatable.
4. To guide treatment: The colonoscopy results can help guide the patient’s most appropriate and effective treatment plan.

b. Sigmoidoscopy:

A sigmoidoscopy is a similar procedure examining the colon’s lower part.

Main objectives of Sigmoidoscopy Diagnostic tests: To evaluate the lower part of the colon for abnormalities: Sigmoidoscopy allows the healthcare provider to examine the lower part of the colon for any abnormalities, such as colorectal cancer or polyps.

c. A Double Contrast Barium Enema (DCBE):

Is a diagnostic test that uses x-rays and a contrast material to create detailed images of the inside of the colon and rectum. The main objective of a DCBE in evaluating colorectal cancer is to detect abnormalities, such as cancer or polyps, in the colon and rectum.

Main objectives of Double Contrast Barium Enema (DCBE) tests: During the procedure, the patient will be asked to lie on their side on a table, and a tube will be inserted into the rectum. The healthcare provider will then introduce a solution containing barium, a metallic compound that shows up on x-rays, and air into the colon through the tube. The barium coats the inside of the colon and rectum, making it visible on the x-rays. The healthcare provider will then take x-rays of the abdomen to create detailed images of the inside of the colon and rectum. A DCBE can detect colorectal cancer in its early stages when it is most treatable. It is important for patients with suspected or confirmed colorectal cancer to undergo a DCBE as part of their diagnostic and treatment plan.

d. CT scan:

A CT scan is a type of imaging test that uses x-rays to create detailed images of the inside of the body.

Main objectives of CT scan Diagnostic tests: To create detailed images of the inside of the body: CT scan allows the healthcare provider to create detailed images of the inside of the body, including the colon and rectum, to look for abnormalities, such as colorectal cancer or metastases.

e. MRI:

An MRI is another imaging test that uses magnets and radio waves to create detailed images of the inside of the body.

Main objectives of CT scan Diagnostic tests: To create detailed images of the inside of the body: MRI allows the healthcare provider to create detailed images of the inside of the body, including the colon and rectum, to look for abnormalities, such as colorectal cancer or metastases.

f. Blood tests:

Blood tests may be used to check for biomarkers that indicate colorectal cancer.

Main objectives of Blood Diagnostic tests: Blood tests can help diagnose and monitor colorectal cancer. Here are the main objectives of blood tests as a diagnostic test for a patient with colorectal cancer:

1. To check for biomarkers: Blood tests can be used for biomarkers, such as cancer antigen 19-9 (CA 19-9), that may indicate the presence of colorectal cancer.
2. To monitor treatment response: Blood tests can be used to monitor the response to treatment and to check for any cancer recurrence.
3. To assess overall health: Blood tests can be used to assess the patient’s overall health and to check for any underlying health conditions that may affect treatment.

Patients with suspected colorectal cancer must undergo a thorough assessment to confirm the diagnosis and determine the cancer stage. This will help to guide the most appropriate and effective treatment plan.

Primary Nursing Diagnosis of colorectal cancer

The primary nursing diagnosis for a patient with colorectal cancer will depend on the specific needs and circumstances of the individual. Here are some examples of potential primary nursing diagnoses for a patient with colorectal cancer:

• Pain related to cancer and treatment: Colorectal cancer and its treatment can cause pain, which may require pain management interventions.
• Risk for infection related to the weakened immune system: Cancer and its treatment can weaken the immune system, increasing the risk of infection.
• Risk for impaired skin integrity related to chemotherapy: Chemotherapy can cause skin irritation and increase the risk of skin breakdown.
• Risk for altered bowel elimination related to cancer and treatment: Colorectal cancer and its treatment can affect bowel function, leading to altered bowel elimination.
• Risk for malnutrition related to cancer and treatment: Cancer and its treatment can affect appetite and nutrient absorption, leading to malnutrition.
• Anxiety related to cancer diagnosis and treatment: A cancer diagnosis and the uncertainty of treatment can cause anxiety in patients and their families.

Therapeutic Intervention of Colorectal Cancer

The therapeutic interventions for colorectal cancer will depend on the cancer stage and the patient’s overall health. Here are some common therapeutic interventions that may be used to treat colorectal cancer:

Surgery:

Surgery is often the primary treatment for colorectal cancer. The type of surgery will depend on the location and stage of cancer. Options may include removal of the cancerous tissue (resection), removal of the colon or rectum (colectomy or proctectomy), or creation of a colostomy or ileostomy.

• Resection: A resection is a surgical procedure to remove the cancerous tissue and a small margin of healthy tissue around it. This may be done through an open incision (laparotomy) or laparoscopically (using small incisions and specialized instruments).
• Colectomy: A colectomy is a surgical procedure to remove the colon. It may be done through an open incision (laparotomy) or laparoscopically (using small incisions and specialized instruments).
• Proctectomy: A proctectomy is a surgical procedure to remove the rectum. It may be done through an open incision (laparotomy) or laparoscopically (using small incisions and specialized instruments).
• Colostomy: A colostomy is a surgical procedure to create an opening (stoma) in the abdomen through which waste can be collected in a bag. It may be necessary if the cancer is located in a part of the colon that cannot be removed or if the rectum needs to be removed.
• Ileostomy: An ileostomy is similar to a colostomy but involves creating an opening in the small intestine (ileum) rather than the colon.

Chemotherapy:

Chemotherapy is a cancer treatment that uses drugs to kill cancer cells. It may be used before or after surgery to shrink the tumor or to kill any remaining cancer cells.

• 5-fluorouracil (5-FU): 5-FU is a chemotherapy drug commonly used to treat colorectal cancer. It is usually given as an injection or through a vein (intravenously).
• Capecitabine: Capecitabine is a chemotherapy drug taken orally (by mouth) in the form of a tablet. It is converted to 5-FU in the body and works similarly.
• Oxaliplatin: Oxaliplatin is a chemotherapy drug that is usually given intravenously. It is often used in combination with 5-FU and capecitabine.
• Irinotecan: Irinotecan is a chemotherapy drug that is usually given intravenously. It is often used in combination with 5-FU and capecitabine.
• Bevacizumab: Bevacizumab is a chemotherapy drug that is given intravenously. It works by blocking the growth of blood vessels that supply nutrients to the cancer cells. It is often used in combination with chemotherapy drugs such as 5-FU, capecitabine, oxaliplatin, and irinotecan.

Radiation therapy:

Uses high-energy x-rays or particles to kill cancer cells. It may be used before or after surgery to shrink the tumor or to kill any remaining cancer cells.

• How it is given: Radiation therapy is usually given as external beam radiation, where a machine delivers the radiation to the tumor from outside the body. It may also be given in the form of brachytherapy, where a small device containing radioactive material is placed inside the body near the tumor.
• How it works: Radiation therapy damages the DNA of cancer cells, preventing them from growing and dividing. It also damages healthy cells, which can cause side effects.
• Side effects: Common side effects of radiation therapy for colorectal cancer include fatigue, skin irritation, diarrhea, and rectal bleeding. These side effects are usually temporary and will resolve after treatment is completed.
• Treatment duration: Radiation therapy is usually given in a series of treatments over several weeks. The exact treatment schedule will depend on the stage and location of cancer and the patient’s overall health.

Targeted therapy:

Targeted therapy is a type of cancer treatment that targets specific molecules or pathways involved in the growth and spread of cancer cells. It may be used in combination with chemotherapy or radiation therapy.

• How it works: Targeted therapies block specific molecules or pathways that allow cancer cells to grow and divide. They may also stimulate the immune system to attack the cancer cells.
• Types of targeted therapies: Several targeted therapies may be used to treat colorectal cancer. These include monoclonal antibodies, such as bevacizumab, which block the growth of blood vessels that supply nutrients to the cancer cells; kinase inhibitors, such as cetuximab and panitumumab, which block the signaling pathways that allow cancer cells to grow and divide; and PARP inhibitors, such as olaparib, which block enzymes that help cancer cells repair their DNA.
• Side effects: Common side effects of targeted therapies for colorectal cancer include skin rash, diarrhea, and fatigue. These side effects are usually temporary and will resolve after treatment is completed.
• Treatment duration: Targeted therapies are usually given as injections or infusions. The treatment schedule will depend on the specific targeted therapy and the stage and type of cancer.

Immunotherapy:

Immunotherapy is a cancer treatment that boosts the body’s natural immune system to fight cancer cells. It may be used in combination with chemotherapy or radiation therapy.

• How it works: Immunotherapy stimulates the immune system to attack cancer cells. It may do this by blocking immune checkpoint molecules that prevent the immune system from recognizing and attacking cancer cells or activating immune cells directly.
• Types of immunotherapies: Several types of immunotherapies may be used to treat colorectal cancer. These include monoclonal antibodies, such as pembrolizumab and nivolumab, which block immune checkpoint molecules, and oncolytic viruses, such as talimogene laherparepvec, which infect and destroy cancer cells.
• Side effects: Common side effects of immunotherapy for colorectal cancer include fatigue, skin rash, diarrhea, and immune-related adverse events, such as inflammation in various organs. These side effects are usually temporary and will resolve after treatment is completed.
• Treatment duration: Immunotherapies are usually given as injections or infusions. The treatment schedule will depend on the specific immunotherapy and the stage and type of cancer.

Pharmacologic Intervention For Colorectal Cancer

Pharmacologic interventions for colorectal cancer may be used to manage symptoms and side effects of treatment and help prevent cancer recurrence. Here are some examples of pharmacologic interventions that may be used in the treatment of colorectal cancer:

• Pain medication: Pain medication, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be used to manage pain related to cancer or cancer treatment. Examples of NSAIDs include ibuprofen and naproxen.
• Antiemetics: Antiemetics, such as ondansetron and metoclopramide, may be used to prevent or treat nausea and vomiting caused by chemotherapy or radiation therapy.
• Antidiarrheals: Antidiarrheals, such as loperamide and diphenoxylate, may be used to manage diarrhea caused by chemotherapy or radiation therapy.
• Anticoagulants: Anticoagulants, such as warfarin and dabigatran, may prevent blood clots in patients who have undergone surgery or have a higher risk of developing blood clots.
• Iron supplements: Iron supplements, such as ferrous sulphate and ferrous gluconate, may treat or prevent anemia caused by bleeding or a lack of iron in the diet.

Nursing Intervention for Colorectal Cancer

Nursing interventions for colorectal cancer may include providing physical and emotional support to the patient, managing symptoms and side effects of treatment, and providing education and support to help the patient and their family cope with the diagnosis and treatment. Some specific nursing interventions that may be used in the care of patients with colorectal cancer include:

• Assessing and managing pain: Assessing the patient’s pain level and implementing appropriate pain management strategies, such as medication and non-pharmacologic techniques, can help the patient feel more comfortable and improve their quality of life.
• Managing side effects of treatment: Working with the healthcare team to manage side effects, such as nausea, vomiting, diarrhea, and fatigue, can help patients feel more comfortable and improve their quality of life.
• Providing emotional support: Providing emotional support to the patient and their family can help them cope with the diagnosis and treatment of colorectal cancer. This may involve listening to their concerns and providing comfort and reassurance.
• Providing education: Educating the patient and their family about the diagnosis, treatment, and self-care can help them make informed decisions about their care and feel more in control of their health.
• Providing support for physical and functional needs: Providing support for the patient’s physical and functional needs, such as helping with activities of daily living and coordinating with rehabilitation services, can help them maintain their independence and improve their quality of life.

Discharge and Home Healthcare Guidelines for Colorectal Cancer Patients

Discharge and home healthcare guidelines for patients with colorectal cancer are important to ensure they have the necessary support and resources to continue their treatment and manage any ongoing symptoms or side effects at home. Here are some general guidelines for discharge and home healthcare for patients with colorectal cancer:

• Medication management: Ensure that the patient has a clear understanding of their medications, including the names, doses, and frequency of administration.
• Follow-up care: Coordinate follow-up care with the patient’s healthcare team, including appointments for chemotherapy, radiation therapy, or other treatments, as well as monitoring for any changes in the patient’s condition.
• Nutritional support: Provide the patient with information on nutrition and diet during and after treatment, including recommendations for a healthy, well-balanced diet.
• Physical activity: Encourage the patient to engage in physical activity as tolerated to help maintain strength and improve quality of life.
• Symptom management: Provide the patient with information on managing any ongoing symptoms or side effects, such as pain, fatigue, or nausea, and encourage them to report any changes in their condition to their healthcare team.
• Supportive care: Provide the patient with information on available resources for emotional and social support, such as support groups or counseling services, to help them cope with the diagnosis and treatment of colorectal cancer.

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