Care of a Patient with Colon Cancer – 2 pages Case Study

Juan Martinez, a 52-year-old male, had a routine screening colonoscopy last week. He was asked to come into the office for the results this morning. Mr. Martinez was diagnosed with colon cancer and is scheduled for surgery to remove the tumor in 2 days.

  1. What psychosocial concerns should the nurse anticipate in caring for Mr. Martinez and his family? With whom should the nurse collaborate in the provision of Interprofessional care?
  2. Mr. Martinez has the surgery and is recovering without complications. His oncologist has discussed radiation therapy with Mr. Rodriquez and his wife.
  3. When the nurse comes into his room, Mr. Martinez says, “I thought all the cancer was gone when they took the tumor out! Now the doctor says I need radiation therapy. My friend had radiation therapy and he had burns! I don’t want burns!”
  4. What actions should the nurse take to address Mr. Martinez’s concerns? Four years later, Mr. Martinez is back in the hospital with a bowel obstruction. He has been cancer-free since the surgery and radiation therapies were completed. Mr. Martinez states “The doctor said this bowel obstruction was caused by the surgery or the radiation. How can that be?”
  5. How should the nurse respond to Mr. Martinez?

Care of a Patient with Colon Cancer Discussion

Colon cancer arises from the hyperproliferation of the cells lining the inner surface of the large intestines. Patients develop symptoms such as diarrhea, constipation, blood in the stool or rectal bleeding and abdominal discomfort. Treatment aims at eradicating all cancerous cells to prevent relapse of the disease and treat the symptoms.

Like all other cancers, treatment involves one or a combination of interventions: surgery, radiotherapy and chemotherapy as one intervention could at times be ineffective. Colon cancer and the treatment modalities come with complications affecting the patient’s day to day activities as well as relatives and friends.

Mr. Martinez, having been diagnosed with cancer is exposed to many psychosocial problems. These psychosocial problems contribute to clinical suffering, causing anguish and aggravating pain (Mahendran et al, 2017). Emotional concerns form a majority of the psychosocial concerns. The nurse should anticipate shock and denial from Mr. Martinez on receiving his results. Grief and loss are key issues. The emotional support offered is significant in adjusting to the patient’s illness. The nurse should be in a position to identify grief and loss in a patient.

Often, patients experience depression and anxiety. It is estimated that 70% of the patients diagnosed with cancer in the world experience depression (Bhattacharyya et al,

2017). Thoughts of disease burden and financial strains could lead to a co-morbid mental health condition which the nurse should anticipate. The care of this patient should involve a multidisciplinary team. The family should be taught to be emotionally and financially supportive of this patient. The psycho-oncologist is important for the assessment, diagnosis and management of psychosocial problems that arise in this patient suffering from colon cancer.

The oncologist is involved in the management of cancer and determining treatment modalities to be used. The nurse is vital in preparation for theater and also postoperative care. He also is useful in counseling the patient and family on coping mechanisms. The surgeon is very important in carrying out the surgery to remove the tumor and to advise on post-operative care and other treatment modalities where need be.

In resection of a cancerous tumor, some cancerous cells can be left in the body or can have metastasized. These cells could proliferate and produce a relapse of cancer. Additional treatment modalities thus have to be incorporated to clear all cancerous cells from the system. These modalities include chemotherapy and radiotherapy. They both, however, carry risks.

Radiotherapy could lead to the death of normal cells, burns and could also lead to cancer in areas that previously did not have cancer. Chemotherapy is known to cause side effects such as ischemic cardiomyopathies, hair loss, emaciation and nephrotoxicity depending on the type of drug used. The nurse should explain the interdependence between the treatment modalities to enhance patient collaboration and minimize anxiety. He should also explain the side effects of radiotherapy to Mr. Martinez and explain how they are going to be minimized by ensuring safety guidelines are adhered to. Patient reassurance shall also help to minimize patient anxiety and collaboration with health care providers.

The nurse is a nurse advocate. He can also discuss with other health care providers about the patient’s concern. If possible, the nurse can advocate for an alternative intervention; chemotherapy and communicate the same to Mr. Martinez. Patient satisfaction and showing concern to his problems promote trust. The nurse should speak politely to Mr. Martinez to enhance transparency. He should also actively teach him to enhance his knowledge about his condition.

Treatment modalities have short term and long term complications. Surgery of the colon for example could lead to leakage between the joined sections of the colon. There could be bleeding in the large intestines, injury to the bladder, ureters or blood vessels. Scar tissue can lead to intestinal blockage (stricture) which could cause bowel obstruction (Aquina et al, 2017).

Radiotherapy could lead to skin conditions such as burns and infections at the site of radiotherapy. Occasionally, tissue necrosis could occur. Bowel obstruction indeed could have been caused by colon surgery. The nurse should explain the complications of surgery to Mr. Martinez. The nurse should advise Mr. Martinez to take laboratory tests to identify the cause of bowel obstruction to rule out other causes.

Treatment of bowel obstruction depends entirely on the cause. These include the use of opioids, use of therapeutic enemas, stomach decompression and fluid therapy. Surgery, when the cause is strictures in order to remove the scar tissue, could also be used. The nurse should help Mr. Martinez to choose the best method of treatment depending on the cause of the obstruction.

Colon cancer as seen above could lead to many complications arising from the cancer effects and treatment intervention used. These complications range from psychosocial to physical complications. Management by a multidisciplinary team is necessary for the total recuperation of the patient and to ensure the disease does not recur nor lead to either morbidity or mortality.