a) The exact cause of colorectal cancer remains unknown but certain factors are associated with increased probability of developing the condition, including genetic and lifestyle factors (Day et al., 2009) . They include:
i) Age – Although younger adults are at risk, an notable 9 out 10 people diagnosed with cancer of the colon are at least 50 years of age, which is the case with David Malouf.
ii) History of inflammatory bowel disease -there is increased of colorectcal cancer in individuals who have suffered from inflamed colon or rectum for over a long period of time (Kearney & Richardson, 2005). Malouf has developed invasive colon cancer over the last three months, resulting a change in his bowel habits and accompanying bloating and abdominal pain.
b) The clinical indicators of colorectal cancer include the following:
i) A recent, persistent change in an individual’s normal bowel habits for more than 3 weeks such as diarrhea-like motions or passing stool more reqularly than usual – Malouf had noticed a change in his bowel habits over the last three months.
ii) Persistent, severe abdominal pain, which has been experienced recently for the first time which was true in Malouf’s case. In addition, this is typical in an older age group to which Malouf belongs.
iii) Blood in the stool (either very dark or bright red) – screening for cancer on Malouf indicated occult blood in his feaces.
iv) Frequent bloating, gas pains, fullness, or cramps – Malouf experienced bloating and abdominal pain. He was eventually admitted to hospital for Abdomino-perineal resection.
Question 2
The action of Metoclopramide is such that it blocks dopamine receptors found in the chemoreceptor trigger zone (CTZ) area of the brain, which are directly activated by agents circulating in the blood from anti-cancer medicines. The action of metoclopramide helps in avoiding nausea and vomiting as a result of many causes such as anti-cancer chemotherapy or radiotheraphy after surgery and anaesthetics. Therefore, Malouf was administered with metoclopramide to avoid him becoming nauseous after the 5-hour surgery. The opioid morphine was administered on Malouf to reduce the severe pain caused by his bowel cancer. Morphine acts directly on the patient’s central nervous system to relieve severe pain. As such, Malouf received Morphine PCA (patient controlled analgesia) 50mgs in 50ml NaCl running at 4mL/hr, 0.9% NaCl (Sodium Chloride) IVI running at 125mL/hr via IVC left arm before undergoing the 5 hours of surgery.
Question 3
Morphine administration should preferably be oral because it is convenient, painless and a number of preparations are possible. Many patients with acute pain initially require Morphine by injection because often the oral administration is contraindicated (e.g. vomiting, oral ulceration, or due to need of a rapid response) (Brown, 2007).
IV injections to chosen over intramuscular (IM) or intermittent subcutaneous (SC) injections in managing acute pain because the rapidity and easy titrareability of IV. Also, respiratory depression will occur rapidly if it happens. IM and SC administration could result in varying drug absorption that according to peripheral perfusion (Day et al., 2009).
Question 4
In the immediate post-operative period the patient depends on nursing staff to get care. The stoma characteristics that the nurse needs to observe at this stage include:
– Monitoring and recording the condition of the stoma including such aspects as colour, size and surrounding skin which should be checked more frequently or daily (Cash, 2013).
– Monitoring, measuring and recording the stoma output – the nurse should empty the pouch frequently to avoid it leakage that may contaminate the would resulting in infection.
– Immediately the patient is returned to the ward following an operation or surgery, the nurse should also make sure availability of correct and sufficient stoma equipment in the patient’s locker (Borwell, 2006). The supplies should be checked daily so that the ward never runs out of any item.
References:
Borwell, B. (2006). Bowel Cancer. Chichester: John Wiley & Sons
Brown, G. (2007). Colorectal cancer. New York: Cambridge University Press.
Cash, B. D. (2013). Colorectal cancer screening and computerized tomographic colonography: A comprehensive overview. New York, NY: Springer.
Day, R. A., Brunner, L. S., & Day, R. A. (2009). Brunner & Suddarth’s textbook of Canadian medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.
Kearney, N., & Richardson, A. (2005). Nursing patients with cancer: Principles and practice. Edinburgh: Elsevier Churchill Livingstone.
