NURS334: ADULT NURSING

MANAGING COLORECTAL
CANCER PRE-OPERATIVELY
 PSYCOLOGICAL
• Assess level of anxiety and coping skills
• Ensure/provide adequate information about
the surgery
• Encourage expressions of feelings & concerns
• Answer all questions honestly and truthfully
• Establish and maintain therapeutic
relationship
• Reassure of pain control post operatively
 PSYCOLOGICAL
• Encourage spirituality
• Encourage family/SO to visit and give support
• Provide emotional support
• Educate on possible physical changes post op
• Inform to expect various tubes and invasive
lines post op
• Promote rest and relaxation
• Teach and encourage stress management
 SAFETY AND SECURITY
• Complete bowel preparation/cleansing
• Ensure adequate nutritional status
• Maintain NPO status 6-8 hrs before surgery
• Administer prescribed pre analgesic
• Administer prophylaxis antibiotic therapy
• Complete pre-op checklist accurately
• Monitor for side effects of analgesia
• Provide skin hygiene
 SAFETY AND SECURITY
• Keep bed rails up, bed in lowest position etc
• ID band with accurate, relevant information
• Remove dentures, jewellery etc
• Obtain lab/diagnostic results
• Strict medical asepsis
 NUTRITION
• Assess nutritional status
• Provide high calorie, high protein, low residue
diet
• Give nutrition supplements as indicated
• Monitor laboratory values
• TPN as indicated
• Make necessary dietary adjustment
 NUTRITION 2
• Administer prescribed antiemetic
• Small frequent meals
• Observe and record fluid losses
• Maintain adequate hydration
 ELIMINATION
• Monitor amount, consistency, frequency and
color of stools
• If constipated:
 Laxatives or enemas prn
 Adequate hydration
 High fiber diet
 Promote activity/exercise
• If diarrhea: adequate fluids, antidiarrheals, foods
that slow intestinal transit time
 REST AND COMFORT
• Assess level of pain
• Administer prescribed analgesia
• Monitor effects & side-effects of analgesia
• Assist to a position of comfort
• Use non-pharmacological interventions
• Alleviate anxiety & stress
• Promote rest and relaxation
 ACTIVITY
• Assess activity level and tolerance
• Develop & institute individualized activity plan
• Monitor v/s before during & after activity
• Provide frequent rest periods
• Administer blood products if indicated
• Ensure adequate nutrition
• Administer oxygen if necessary
NURS334: ADULT NURSING

MANAGING COLORECTAL CANCER

POST-OPERATIVELY
 ASSESSMENT FINDINGS
Right-Sided:
Change in bowel habits (diarrhea)
Vague abdominal discomfort
Black, tarry stools
Anemia
Weight loss
Palpable RLQ mass
 ASSESSMENT FINDINGS 2
Left-Sided:
Change in bowel habits (constipation with
bouts of diarrhea)
Cramping pain
Bright, streaked, red blood stools
Anemia
Weight loss
Palpable LLQ mass
 ASSESSMENT FINDINGS 3
Rectal:
Change in bowel habits (constipation/bouts of
diarrhea)
Urgent need to evacuate
Feeling of incomplete evacuation
Rectal fullness with dull constant ache
Bright red blood stools
 BREATHING AND OXYGEN
• Elevate head of bed 30-45 degrees
• Administer prescribed analgesia
• Promote early ambulation and deep breathing
• Teach and encourage splinting of wound
• Teach and encourage effective coughing
• Monitor respiratory status frequently
 BREATHING AND OXYGEN 2
• Teach and encourage incentive spirometry
• Maintain adequate hydration
• Monitor SPO2 and ABG
• Teach and encourage relaxation techniques
• Relieve anxiety
 FLUID AND ELECTROLYTE
• Keep NPO initially
• Administer prescribed IV fluid replacement
• Strict input & output monitoring and recording
• Daily weights
• Monitor electrolytes
• Electrolyte replacement as indicated
• Administer prescribed antiemetics
• Monitor N/G tube drainage and patency
 ELIMINATION
• Auscultate for the return of bowel sounds
• Assess for passage of gas
• Monitor abdominal girth
• Encourage early and adequate ambulation
• Adequate hydration
• Encourage high fiber diet
• Establish bowel evacuation schedule
 REST AND COMFORT
• Assess level of pain
• Administer prescribed analgesia
• Monitor effects & side-effects of analgesia
• Assist to a position of comfort
• Use non-pharmacological interventions
• Alleviate anxiety & stress
• Promote rest and relaxation
• Teach and encourage correct splinting
 PSYCOLOGICAL
• Assess level of anxiety and coping skills
• Ensure/provide adequate information about
the outcome of surgery
• Encourage expressions of feelings & concerns
• Answer all questions honestly and truthfully
• Establish and maintain therapeutic
relationship
• Initiate and maintain pain control measures
 PSYCOLOGICAL
• Encourage spirituality
• Encourage family/SO to visit and give support
• Provide emotional support
• Educate on possible physical changes post op
• Inform to expect various tubes and invasive
lines post op
• Promote rest and relaxation
• Teach and encourage stress management