Nursing Care Plan
A Client with Colorectal Cancer
William Cunningham is a 65-year-old retired railroad
employee, husband, and father of three grown children. For
the past 3 months, Mr. Cunningham has no-
ticed small amounts of blood in his stools and occasional mucus. He
has a sensation of pressure in the rectum, and notices that his
stools are smaller in diameter, about the size of a pencil. After pal-
pating a mass on digital examination of the rectum, the physician
orders a colonoscopy. A large sessile lesion is found in the rectum
and biopsied.The pathology report shows the lesion to be adeno-
carcinoma. Mr. Cunningham is scheduled for an abdominoper-ineal
resection and sigmoid colostomy.
ASSESSMENT
Madonna Hart, RN, completes the admission assessment. Mr.
Cunningham states that his bowel habits have recently changed,
but denies pain or other symptoms. Physical assessment
findings include T 98.4 F (36.9° C), P 82, R 18, and BP 118/78.
He is 70 inches (178 cm) tall and weighs 185 lb (84 kg).
Laboratory findings are normal except for the previous pathology
report of adenocarci-noma of rectal lesion.
Mr. Cunningham states,“I really don’t want a colostomy, but if
that is what it takes to get rid of this, I’m ready to get it over with.”
DIAGNOSIS
Ms. Hart identifies the following nursing diagnoses for Mr.
Cunningham.
• Pain, related to surgical intervention
• Risk for impaired skin integrity (peristomal), related to
fecal drainage and pouch adhesive
• Risk for constipation/diarrhea, related to effects of surgery
on bowel function
• Risk for disturbed body image, related to colostomy
• Risk for sexual dysfunction, related to wide rectal incision,
radia-tion therapy, and colostomy
EXPECTED OUTCOMES
The expected outcomes specify that Mr. Cunningham will:
• Report pain within an acceptable range that allows ease
of movement and ambulation.
• Perform colostomy care using correct technique.
• Demonstrate willingness to discuss changes in sexual function.
• Wear clothing to enhance physical and emotional self-esteem.
PLANNING AND IMPLEMENTATION
Ms. Hart plans and implements the following nursing
interven-tions for Mr. Cunningham.
• Provide analgesia as ordered, evaluating its effectiveness.
• Discuss foods that cause odor and gas.
• Teach colostomy care.
• Maintain consistent nursing personnel assignment to
facilitate trust.
• Refer to the local United Ostomy Association.
• Provide a list of local medical supply companies for
ostomy supplies.
• Provide for privacy when teaching and discussing
concerns about ostomy.
EVALUATION
On discharge, Mr. Cunningham is able to empty and rinse out his
colostomy pouch. He is changing the pouch and caring for sur-
rounding skin appropriately.Ms.Hart has given him verbal and writ-
ten instructions on colostomy care. He verbalizes understanding of
phantom rectal pain, and the importance of avoiding rectal tem-
peratures and rectal suppositories. He expresses an understanding
of the need to avoid heavy lifting, and the importance of follow-up
care.Ms.Hart has referred Mr.Cunningham to a home health agency
in his community for further questions and follow-up care.
Critical Thinking in the Nursing Process
1. What is the cause of phantom rectal pain?
2. Why is it important to discuss dietary concerns with a client
with a colostomy, especially odor- and gas-forming foods?
3. Outline a plan to teach Mr. Cunningham how to irrigate a
colostomy.
4. Develop a care plan for Mr. Cunningham for the nursing
diag-nosis, Body image disturbance.
See Evaluating Your Response in Appendix C.