1. What is a risk factor?
In the epidemiological context, a risk factor is termed as a variable that is associated with a heightened risk of developing a disease or contracting an infection.
2. Colon Cancer: Risk Factors
Older age as a majority of persons diagnosed with colon cancer is above fifty years old.
A personal history of inflammatory intestinal conditions such as ulcerative colitis and Crohn’s disease.
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Intake of diets that have high-fat as well as low-fiber.
A history of colorectal polyps or cancer.
African-American race.
3. Describe the American Cancer Society's current recommended screening procedures related to colon cancer.
Per the American Cancer Society (ACS) guidelines, adults of ages forty-five and above who are at a moderate risk of developing colorectal cancer should be screened often with either a visual (structural exam) or a high-sensitivity stool-based test depending on the availability of the test and the preference of the patient (American Cancer Society, 2020) . The ACS further recommends that timely colonoscopy should be used to follow up all non-colonoscopy tests that turn out positive as part of the screening procedure. Adults with an average risk of colorectal cancer in pristine health and with life expectancies of over ten years should continue screening until they attain the age of seventy-five. According to the ACS, practitioners should individualize screening for persons ages seventy-six through eighty-five based on prior screening history, health status, life expectancy, and the preferences of their patients (American Cancer Society, 2020) . Practitioners are, however, discouraged from continuing screening in persons older than eighty-five.
4. What are the warning signs of colon cancer?
The warning signs and primary symptoms of colorectal cancer have been shown to b attributable to the presence of the tumor at its primary location. These signs include abdominal pain, change in bowel movement or habit, and rectal bleeding. Patients have also been reported to present with systemic manifestations such as fatigue, significant weight loss, anorexia, and symptoms of anemia. However, these latter signs are typically indicative of progressing disease (Jensen, Hvidberg, Pedersen, & Vedsted, 2015) . A combination of a change in bowel movement and rectal bleeding, or rectal bleeding with no perianal symptoms my occur. Nevertheless, such manifestation has limited discriminate value for colorectal cancer.
5. Compare the common early versus late signs and symptoms found in individuals with colorectal cancer.
The symptoms of colorectal cancer may be insignificant or absent initially. However, there could be some early signs like:
Narrow, ribbon-like stools
Sudden unexplained weight loss
Rectal bleeding
Tenesmus
Persistent abdominal pain.
As the disease advances, systemic and constitutional symptoms manifest. These may include:
Anorexia
Anemia
Nausea and vomiting
Fatigue and weakness
Jaundice
Persistent weight loss.
6. What is CEA? How does it relate to the diagnosis of colon cancer?
Carcinoembryonic antigen (CEA) is a widely used tumor marker with a well-established value in the diagnosis, management, and surveillance of colorectal cancer. (Chen & Chen, 2017) The antigen is produced by tumor cells and is sometimes released into the bloodstream. Accordingly, high CEA titers in the blood could be indicative of persistent colorectal cancer especially after a course of treatment or surgery (Chen & Chen, 2017) .
7. After bowel prep, R.T. is admitted to the hospital for an exploratory laparotomy, small bowel resection, and sigmoid colectomy. List at least five major potential complications for R.T.
Intra-abdominal abscess
Paralytic ileus
Wound infection
Enterocutaneous fistula
Abdominal wall dehiscence
8. Would the drainage be expected after abdominal surgery? Explain.
Serosanguineous drainage should be expected after the surgery as it usually appears as a wound is trying to heal (Al Daoud et al., 2018) . It should thus not be a cause for alarm. However, serosanguineous drainage whose color intensifies over time may be indicative of a reopened wound or active bleeding.
9. What are the goals of nursing care after surgery?
The goals of postoperative nursing care are to promote healing of the surgical wound, to prevent complications such as infections, and to ensure the patient returns to the appropriate state of health.
10. Describe three chemotherapy regimens used to treat adenocarcinoma of the colon.
5-fluorouracil (5-FU), a pyrimidine antagonist has been used by practitioners for a long time as the first-choice chemotherapy regimen for the management of colorectal cancer. It is administered intravenously together with leucovorin to enhance its efficacy. 5-FU is converted to its active form, capecitabine in vivo.
Capecitabine is a cytotoxic agent of the antimetabolite class that is often used as neoadjuvant or adjuvant therapy with radiotherapy in patients with colorectal cancer to augment the effects of the radiation on the tumor.
Irinotecan, a topoisomerase I inhibitor is also indicated for the treatment of adenocarcinoma of the colon in combination with a pyrimidine antagonist post-operatively.
11. Discuss the major toxicities and side effects associated with these drugs.
The major toxicities associated with the pyrimidine antagonists 5-FU and cytarabine include bone marrow suppression with anemia, leukopenia, and thrombocytopenia, anal and oral ulceration, keratoconjunctivitis, cardiotoxicity, and hepatorenal dysfunction. Minor side effects include nausea and vomiting, alopecia, and flu-like symptoms, among others. The adverse effects associated with irinotecan include neutropenia, myelosuppression, and severe diarrhea. It may also cause dehydration, alopecia, generalized body weakness, and cholinergic-like toxicity.
12. Given the profiles of the drugs used to treat colon cancer, develop a teaching plan for R.T. focusing on common side effects.
Foremost, R.T. should be made aware of the fact that every person has a different experience with chemotherapy and that the various drugs he is on have side effects. Subsequently, the patient should be educated on the common side effects of his drug. He should, therefore, be on the lookout for signs of anemia, hematochezia, nausea and vomiting, and other debilitating signs. The patient should be advised to notify his provider of any untoward effects so that appropriate measures to mitigate them may be initiated promptly.
13. Interpret R.T.'s CBC results.
The patient’s WBC count is 1200/mm 3 (normal range is 4500-11100/mm 3 ). This is indicative of leukopenia. R.T.’s hematocrit is 24.9% (normal range is 36%-52% in men) and the hemoglobin is 8.7 g/dL (normal range is 13.2-17.3 in men) (University of Rochester Medical Center, 2020) . As such, the patient has anemia. The patient also has thrombocytopenia considering his platelet count is 85,000/mm 3 (normal range is 150,000-450,000/mm 3 ) (University of Rochester Medical Center, 2020) .
14. Calculate R.T.'s absolute neutrophil count (ANC) and describe its significance.
The patient’s ANC is 456 cells/µL indicating severe neutropenia. The ANC is critical to the assessment of an immunocompromised patient for the risk of contracting infections. for a patient like R.T. who is of myelosuppressive chemotherapy, it is important to determine the ANC to inform the commencement of empiric antibiotic therapy.
15. What is the single most important nursing intervention for a patient with an ANC less than 500/mm3?
The most imperative intervention for such an individual with profound neutropenia should entail infection prevention by avoiding unnecessary tubes, drains, or lines, appropriate cleaning, and care, and discontinuing lines promptly.
16. What are the probable causes of the abnormal laboratory findings listed previously?
Elevated BUN and serum creatinine, both of which are waste products points to a problem in their elimination. This could be due to ensuing kidney dysfunction.
17. What is the significance of the lactic acid level?
Lactic acidosis in cancer patients is usually a sign of a negative prognosis. Neoplasia is typified by an increased rate of glycolysis and thus the increased production of lactic acid. Patients may also develop lactic acidosis due to the decreased capacity to eliminate lactate and overproduction of lactate. Malignant cells may also embolize into microvasculature leading to lactic acidosis.
18. What treatment do you anticipate for M.D.?
Treatment should be focused on stabilizing the patient. 5-FU-based adjuvant chemotherapy should be discontinued momentarily and treatment with colony-stimulating factors initiated as well as a blood transfusion initiated. The metabolic derangements should also be corrected and treatment focused on restoring the vitals to normal. Since the patient is febrile, infections should be ruled out.
References
Al Daoud, F., Thayer, A., Sachwani Daswani, G., Maraqa, T., Perinjelil, V., & Mercer, L. (2018). Management of chronic abdominal wall seroma with Doxycycline sclerotherapy using a Negative Pressure Wound Therapy System KCI-V.A.C.Ulta TM —A case report. International Journal of Surgery Case Reports , 51 , 25–28. https://doi.org/10.1016/j.ijscr.2018.08.014
American Cancer Society. (2020). American Cancer Society Guideline for Colorectal Cancer Screening. Retrieved from Cancer.org website: https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
Chen, S.-W., & Chen, Y.-K. (2017). High CEA levels in a case of resected colorectal cancer: delayed diagnosis of metachronous medullary thyroid cancer. World Journal of Surgical Oncology , 15 (1). https://doi.org/10.1186/s12957-017-1303-4
Jensen, L. F., Hvidberg, L., Pedersen, A. F., & Vedsted, P. (2015). Symptom attributions in patients with colorectal cancer. BMC Family Practice , 16 (1). https://doi.org/10.1186/s12875-015-0315-9
University of Rochester Medical Center. (2020). Complete Blood Count with Differential - Health Encyclopedia - University of Rochester Medical Center. Retrieved January 12, 2020, from Rochester.edu website: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=complete_blood_count_w_differential
