TABLE OF CONTENTS

CHAPTER I INTRODUCTION ............................................... .............................. 1

A. Background .............................................. ....................................... 1

B. Problem Formulation.............................................. .................................. 2

C. The purpose of .............................................. ................................... 2

CHAPTER II REVIEW OF THEORY .............................................. .......................... 3

A. Definition of colorectal cancer ............................................. ...................... 3

B. The etiology of colorectal cancer ............................................. ...................... 3

C. Pathofisiologi colorectal cancer ............................................. ............ 5

D. Pathway colorectal cancer (ANNEX) ......................................... 6

E. The clinical manifestations of colorectal cancer ............................................ ....... 6

F. Stadium colorectal cancer ............................................. ..................... 7

G. Investigations colorectal cancer .......................................... 7

H. The medical management of colorectal cancer ........................................... 9

I. The theoretical concepts of colorectal cancer nursing care .................... 11

CHAPTER III CLOSING ............................................... ..................................... 19

A. Conclusions ............................................... ............................................ 19

B. Suggestions ............................................... .................................................. . 19

BIBLIOGRAPHY ................................................ ................................. 20

ANNEX ................................................. ............................................... 21

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 PART I

PRELIMINARY
A. Background

Cancer of the colon or colorectal cancer is one of the

cancers with high prevalence. colorectal cancer

is a malignancy or growth of abnormal cells in the intestinal area

and rectum. Number of patients with colon cancer and rectal enough

many in Indonesia, especially in urban areas. Colon cancer

is the third most types of cancer in Indonesia according to MOH

with the amount of 1.8 cases in 100,000 population (RS Dharmais, nd).

Rahmianti (2013) wrote, about 608,000 people around the world die

due to colorectal cancer each year according to the World Healh

Organization (WHO), whereas in Indonesia alone, in every

year about 1,666 people die from colorectal cancer.

The incidence increases with age (most patients

aged over 55 years) and higher in individuals with

a family history of colorectal cancer, inflammatory bowel disease

Chronic or polyps. Risk factors for colorectal cancer more often there

the lifestyle of people in urban areas, among them are obese,

a diet high in fat, red meat consumption, the consumption of processed foods,

lack of fruit and vegetable consumption, alcohol consumption, smoking and

lack of regular exercise and measurable ( Manggasari, 2013).

Colon cancer, if detected and treated early, has

high cure rate. Understanding the symptoms and causes

This disease can allow detection and treatment measures are

early. Basic knowledge about the disease, treatment, and engineering

care is needed to ensure their recovery

quickly and reduce the risk of disease recurrence. Diet

healthy, physical exercise, and appropriate health screening program

greatly reduces the risk of colon cancer.

1
B. Formulation of the problem

1. What is the sense of colorectal cancer?

2. How etiology of colorectal cancer?

3. How pathophysiology of colorectal cancer?

4. How pathway of colorectal cancer?

5. Any clinical manifestations of colorectal cancer?

6. Any staging of colorectal cancer?

7. Any investigations that arise from cancer

Colorectal?

8. How medical treatment for colorectal cancer?

9. How nursing care patients with colorectal cancer?

C. Writing purpose

1. General purpose

To meet the learning and teaching of subjects

Medical Surgical Nursing 2.

2. Special purpose

a. Obtain a general overview of colorectal cancer.

b. Be able to understand the theoretical concepts of nursing care

in patients with colorectal cancer disorders.

2
 CHAPTER II

REVIEW OF THEORY

A. Definition of colorectal cancer

Colorectal cancer is a cancer that attacks the intestine

Great, that is the final part of the digestive system. Most cases

Colorectal cancer begins from a lump / small polyps, and

then grew into a tumor. ( Sudoyo, Aru Wisaksono, 2018)

Colorectal cancer is a malignant form contained in

ascending colon, transverse, desending, sigmoid and rectal. Cancer

Colorectal can be defined as malignancy or growth of cells

abnormal in the area of ​the large intestine (colon) and rectum. ( Manggasari, 2013)

Colorectal cancer is a malignancy that is derived from intestinal tissue

large, consisting of the colon (the longest part of the large intestine) or

rectum (the last small part of the large intestine before the anus). this cancer

can be named colon or rectal cancer, depending on the location

the growth of cancer. ( Kepmenkes, 2018)

B. The etiology of colorectal cancer

The exact cause of colorectal cancer is not known with certainty

(Black & Hawks, 2009). In general the development of colorectal cancer

an interaction between environmental factors and genetic factors. Factor

Multiple environments react to genetic predisposition or defects

obtained and develop into colorectal cancer.

There are many factors that can increase or decrease

the risk of colorectal cancer, the risk factors are divided into two,

ie factors that can be modified and which can not be modified.

Included in the risk factors that can not be modified is

history of colorectal cancer or adenoma polyp individuals and families,

as well as the individual history of chronic inflammatory diseases of the intestine. That

included in the modifiable risk factors is

inactivity, obesity, high consumption of red meat, smoked, and

moderate alcohol consumption-often.

3
1. Genetic factors

Approximately 20% of cases have a family history of colorectal cancer.

First-degree family members (first-degree) new patients

diagnosed with colorectal adenoma or colorectal cancer invasive

have an increased risk of colorectal cancer. genetic susceptibility

of colorectal cancer include Lynch syndrome or hereditary

Nonpolpyposis Colorectal Cancer (HNPCC) and familial

adenomatous polyposis. Therefore, family history need

Asked in all patients KKR.

2. inflammatory bowel

Especially Ulcerative Colitis (UC) or Crohn's disease

etiology or risk factors were also present on colorectal cancer.

Inflammatory bowel disease is a group of chronic diseases (UC and

Crohn's disease) that causes inflammation and or

ulceration of the large intestine, causing abdominal pain, diarrhea,

fever and weight loss (Smeltzer and Bare, 2002).

3. Conditions lifestyle

Urban communities largely be a risk factor of

colorectal cancer. Risk factors for colorectal cancer more

often found in the lifestyle of people in urban areas,

among them is the people's lifestyle, obesity, high-fat diet,

red meat consumption, the consumption of processed foods, lack of

fruit and vegetable consumption, alcohol consumption, smoking and

lack of regular exercise and measurable (Newton, 2009).

Some studies even explained that the lack of

fruit and vegetable consumption is a major risk factor of

colorectal cancer.

4. Smoking and Alcohol

Many studies have proven that smoking can tobako

lead to colorectal cancer. The relationship between smoking and

cancer was stronger in rectal cancer compared to cancer

colon. Moderate alcohol consumption may increase the risk

4
 colorectal cancer. Individuals with an average of 2-4 servings of alcohol per

day during his life, had a 23% higher risk of cancer

Colorectal compared with individuals who consume

less than one serving of alcohol per day.

C. Pathofisiologi colorectal cancer

The existence of cancer cells in a person not only from the effects

carcinogens person, whether obtained from outside or from within

the human body itself. Colorectal cancer in particular, have

relation to the condition of feces from individuals, as well as the history of disease

suffered, wherein the condition is a result of factors

risks that exist in individuals as described earlier.

The colon and rectum cancer can be preceded by a history

polyps in individuals. Polyps are a mass of tissue yangmenonjol

the lumen of the intestine (Smeltzer and Bare, 2002). Polyps that are not addressed or

intervention, could turn out to be malignant. Polyps that have

violent change will attack and destroy the cells

normal and widespread in the surrounding tissue.

Humans basically have carcinogens or substances trigger

cancer in the body. The effects of carcinogens would increase if

find the cause of cancer from the outside. Also a potential carcinogen

to cause proliferation of cancer cells. Corwin (2001) states,

lack of antioxidant intake with minimal consumption of fruit and

vegetables that contain antioxidants (like vitamin E, vitamin C,

and beta carotene) may reduce the protection of cells against the effects of

carcinogens. Fresh fruits and vegetables that have active enzymes that

can nourish and enhance growth of healthy cells.

Stool unfavorable conditions also can trigger cancer

colon. Activities or sports are less regular and measurable can

resulting in feces becomes longer be in the colon or rectum,

especially if the individual performing the low-fiber diet. This condition can

resulting in toxin contained in the feces trigger

the growth of cancer cells (Corwin, 2001). Faeces containing

5
 much fat can also trigger cancer cells. The high fat in the

faeces caused by high consumption of fats such as meat. stool

contains a lot of fat can change the flora in the feces become

Clostrida & Bakteriodes bacterial enzyme that has a 7-alpha

dehidrosilase which becomes acid digest Deoxycholi acid and

Lithocholic (carcinogenic) increases in the feces.

A cancerous mass found in the colon or rectum will

causing blockage or obstruction, which resulted

evacuation of faeces stunted or incomplete after defecation.

Is due to be continued constipation, abdominal distension or pain,

until the bloody stool. If the cancer mass is not detected since

early and left, it is likely that cancer cells will do

metastasis.

D. Pathway colorectal cancer (ANNEX)

E. Clinical manifestations of colorectal cancer

At first the symptoms are not apparent, such as weight loss

(As a general symptom of malignancy) and fatigue are unclear

why. After a few times then came symptoms-

other symptoms associated with the presence of tumor in size

meaningful in the colon. The closer the location of the tumor to anus

symptoms usually increase. When we talk about the symptoms

The symptoms of colon tumors are divided local symptoms and symptoms

general.

1. symptoms local

as :

a. Changes in bowel habits.

b. Onset of pain accompanied by nausea and vomiting during defecation

large, occurs due to blockage of sewerage by

tumor mass.

c. Distension that may be felt by the patient.

6
 d. Other symptoms arise around the tumor site, because

cancer can grow on organ and tissue around the tumor

tersebut.Gejala these symptoms more recently, shows

the larger the tumor and its wider dissemination.

2. symptoms generally

as :

a. Weight loss for no apparent reason (this is a symptom

The most common in all types of malignancy).

b. Loss of appetite.

c. Anemia, the patient was pale.

d. Often feel tired.

e. Sometimes experience a sensation like floating.

F. Colorectal cancer staging

1. Stage I when the presence of cancer cells is still limited to a layer

colon wall (mucosal lining).

2. Stage II occurs when cancer cells have entered into a muscle

mucosa layer.

3. Stage III cancer cells have spread to most of the lymph nodes

that is widely available around the intestine.

4. Stage IV occurs when cancer cells have invaded the entire

lymph nodes or other organs even keorgan.

G. Investigation of colorectal cancer

Individuals at high risk and those who have

The above symptoms should immediately consult a family doctor

and arrange for immediate examination. Medical examination

associated with bowel diseases include:

1. examination of the abdomen

Examination of the abdomen can be done by abdominal palpation

(Small or early stage tumors would be difficult palpable). abdominal palpation

can also check the presence of clinical manifestations of constipation,

abdominal distention and tenderness.

7
2. Fecal Occult Blood Tests

Bleeding in the gut may not physically visible. this test

check the content of occult blood in the stool. If

a tumor is found, the patient may need to undergo a tomography

computed more and more imaging action.

3. Rectal examination

The doctor or nurse will wear gloves lubed

and put his finger into the patient's rectum through the anus and

grope inside to check their

or tumor regions that are not normal.

4. Barium enema examination

Barium enema is a special x-ray procedure used

to see and study the large intestine. The radiologist will

apply barium through the lubricated tube into the rectum.

Barium liquid acts as a contrasting color highlight areas

in particular in the body. Barium flow will be displayed on the screen

x-ray fluoroscope to show abnormalities of wall

the inside of the large intestine.

5. colonoscopy

Colonoscopy is currently the best method for checking

lower gastrointestinal tract. With endoscopy video

flexible, all parts of the colon and small intestine terminal can

carefully checked. The examination is generally

lasts for 10 to 45 minutes. colonoscopy is used

to examine the entire colon. sigmoidoscopy

used to examine the final part of the colon and rectum.

Colonoscopy is not only useful for diagnostic purposes.

By using a different accessory equipment, colonoscopy

may perform a biopsy and implementing medical procedures

targeted, such as removal of polyps.

8
H. Medical management of colorectal cancer

Penatalakasanaan in patients with colorectal cancer include

medical management, surgical, nursing, and diet. Management

Medical include chemotherapy and radiation therapy, surgical penatalakanaan

includes surgical resection and colostomy, management

nursing and dietary management.

1. medical management

a. Chemotherapy is a treatment modality to eliminate

cancer cells. Ideally, chemotherapeutic agents will attack and

stop growing cell tumor, but in

in fact healthy cells also switched off. this effect

eventually lead to nausea, vomiting and hair loss.

b. Radiation therapy, radiation therapy using ionised radiation

such as X-rays or gamma ( •). Radiation therapy has a level

a high cure for cancer. Ray radiation

submitted will be absorbed by the cell, so that it will happen

the destruction of the DNA mutations. Someone who got therapy

radiation should keep the skin in the area that the radiation does not

exposed to water because it can damage the skin.

2. surgical treatment

a. Surgery resection, surgical removal tumor

an act of primary treatment for colon cancer.

The action of this treatment can cure colon cancer

early stage and a small percentage of cases that have spread to

liver or lungs. The advent of minimally invasive surgery

lately not only speed up the rehabilitation,

but also greatly reduces the risk of complications, though

This action is not suitable for all patients.

b. Colostomy, a colostomy is the act of making a hole

(Stoma) formed from spending most of the form

colon (large intestine) kedinding abdomen (stomach). This stoma

temporary or permanent. The purpose of making a colostomy

9
 is for decompression action large intestine case

blockage / obstruction of the bowel.

The types of colostomy by its nature:

1) While

Indications for temporary kolostomo:

a) Hirschsprung disease

b) Stab wounds or gunshot wounds

c) Atresia Ani high layout

2) Permanent

Indications for a permanent colostomy, ie tumor disease

malignant colon that does not allow surgery

bowel resection anastomosis.

3. nursing Management

Management of nursing to patients with colorectal cancer

includes the fulfillment of basic needs of the patient. Nursing actions

to do is (Smeltzer & Bare, 2002):

a. Maintaining elimination patient

b. Maintain or improve comfort

c. Improve exercise tolerance

d. Helping optimal nutrition

e. Maintain fluid and electrolyte balance

f. Do skin care, wound and colostomy (post-surgical)

4. Management diet

a. Consume enough dietary fiber, such as vegetables and

fruits

b. Nuts (five servings per day)

c. Avoid foods that contain saturated laemak

Tarutama high cholesterol found in animal meat

d. Avoid foods that are preserved and synthetic dyes,

because it can trigger carcinogenic cells / cancer cells

e. Avoid alcoholic beverages and cigarettes excessive

f. Carry out physical activity or exercise regularly

10
 I. Theoretical concepts of nursing care for colorectal cancer

Diagnosis

No. nursing NOC NIC RATIONAL

NANDA

1 chronic pain After the action pain management pain management

Definition: nursing 2x24 hour 1. Perform 1. To be a nurse

Experience sensory "Control pain " with assessment of pain could

and emotional not outcomes: comprehensive knowing

fun with NOC: pain control that cover condition

damage network No. Indicator T locations, pain states

actual or potential, 1 Recognize when 5 characteristics, patient then

or illustrated nyer happen duration, frequency, 2. In order patient

as something 2 Using 5 quality, understand

damage; onset action intensity, or cause

sudden or slow reduction displacement pain, appearance

the intensity of without pain and factor painful on

mild to severe, analgesic spark himself

occur constant or 3 Using 5 2. provide information 3. Nurses can

repeated endlessly analgesic about pain, give

which can be anticipated recommended as cause actions

or in the prediction and 4 Identify what 5 pain, how long right for

lasted over which is related painful will resolve

three months. with symptoms didirasakan, and painful with

restriction painful anticipation from well

characteristics: Information: inconveniences by

1. anorexia 1 = never show as a result of the procedure scale

2. Evidence of pain with 2 = rarely show 3. Select and 4. Nurses can

use 3 = sometimes sometimes implemented telling you

standard list show action that drug lowering

check painful for 4 = often show variety to good pain

patients who did not 5 = it consistent facilitate and suitable

11
 could show a decrease in pain, for painful

express corresponding with experienced

3. Expression face needs patient

pain (wince) 4. Teach methods 5. To

4. Focus on yourself pharmacology for reduction

own decrease pain painful could

5. obstacle 5. Supports the break do

ability that adequate optimally

forward to help

activity decrease in pain

6. Complaint about

intensity

use

standard pain scale

7. Complaint about

pain characteristics

with

use

standard instrument

painful

8. Report about

behavior

pain / change

activity

9. Change pattern

sleep

Factor that

related:

1. Agens pencendera

2. Injury medulla

spinal

3. Muscle injury

12
 4. injury collisions

5. emotional distress

6. Fractures

7. genetic Disorders

8. immune Disorders

9. ischemic Disorders

10. disruption

metabolic

11. disruption

muskuluskeletal

chronic

12. disruption pattern

sleep

13. tumor infiltration

14. Social isolation

15. gender women

16. Fatigue

17. damage to the system

nerve

18. Imbalance

neurotransmitters

19. muscle compression

20. contusions

2 Imbalance After the action management management

nutrition: less than nursing 2x24 hour eating disorders eating disorders

body needs "Appetite" with 1. Teach and 1. In order patient

Definition: outcomes: support concept could more

nutritional intake not NOC: Appetite good nutrition aware of nutrition

enough to meet No. Indicator T with clients Good for

metabolic needs. 2. Push client his body

1 desire / craving 5
to eat for 2. In order for client

Batasa characteristics: 2 Enjoys 5 discuss could

13
1. Weight 20% food food that meet

or more below 3 intake of nutrients 5 preferably together nutrients

weight range Information: with a nutritionist well

ideal 1 = severely impaired 3. Push client 3. In order for the client

2. Noisy gut 2 = much disturbed to monitor know how many

Hyperactive 3 = quite disturbed own intake intake

3. fast full 4 = slightly disturbed daily food incoming

after meals 5 = not bothered and weigh in

4. Diarrhea weight his body

5. Impaired sensation right 4. To client

flavor 4. monitor behavior knowing

6. hair loss client that food

excessive related nice for

7. Weakness muscle with pattern add and

masticatory eat , that

8. Weakness muscle additions and decrease

swallow weight loss weight

9. capillary fragility body

10. Error

information

11. Lack of interest in

food

12. mucous membranes

pale

Factor that

related:

1. biological factors

2. economic factors

3. disruption

psychosocial

4. Inability

eat

14
 5. Inability

digesting food

6. Inability

mengasorbsi

nutrients

7. Less intake

food

3 activity intolerance After the action energy management management

Definition: nursing 2x24 hour 1. Assess status energy

energy insufficiency "The level of fatigue" with physiological patient 1. To be a nurse

psychological or outcomes: that could

physiological for NOC: Level of fatigue cause knowing

maintain or No. Indicator T corresponding fatigue level

complete the activity 1 Lethargy 5 with context exhaustion of

everyday life age and patient

2 Disorders 5
should and concentration development 2. In order patient

want to do. symptom 2. Select intervention could

restriction syndrome to reduce receive

3 5
characteristics: fatigue fatigue well treatment

1. dyspnea after chronic in optimal

activity Information: pharmacological for

2. Inconveniences 1 = weight nor non decrease

after the move 2 = heavy pharmacological, fatigue

3. ECG changes 3 = moderate appropriately 3. In order for the patient

4. Responsfrekuensi 4 = mild 3. Encourage period could

abnormal heart 5 = no istirahan and increase

to activity activity in energy in

5. responses pressure alternately optimal

blood abnormal 4. Evaluation in 4. To be a nurse

to activity gradual increase in can assess

Factor that levels activity activity level

related: patient patient

15
 1. Lifestyle less

movement

2. Immobility

3. Imbalance

between supply and

oxygen requirement

4. bedrest

4 Risk deficiency After the action monitor fluid monitor fluid

fluid volume nursing 2x24 hour 1. Decide factor 1. That

Definition: "Elimination gut "with risk factors nurse know

vulnerability experience outcomes: maybe what can

reduction volume NOC: Elimination of intestinal cause triggering patients

fluid intravascular No. Indicator T lack experience

interstitial, and / or Control fluid balance ketidakseimban

intracellular, which can 1 movement 5 2. Monitor intake gan fluid

disturb gut and expenditure 2. To nurse

health. 3. Note the exact knowing

2 Color 5
Risk factors: stool intake and development

1. Agens spending intake and

3 Ease 5
pharmaceuticals CHAPTER spending

2. barier advantages Information: fluid body

fluid 1 = severely impaired patient

3. Weight body 2 = much disturbed 3. In order for nurses

extreme 3 = quite disturbed have

4. Factor that 4 = slightly disturbed documentation

affect 5 = not bothered from record

fluid needs development

5. disruption intake and

regulatory mechanism spending

6. fluid loss

through the normal route

7. loss of volume

16
 active liquid

8. Less

knowledge

about needs

fluid

9. deviation

affecting

fluid absorption

10. deviation

affecting

fluid intake

11. deviation

affecting

excess fluid

12. age extremes

5 anxiety After the action Improved coping Enhancement

Definition: nursing 2x24 hour 1. Support patient coping

Uncomfortable feeling "The level of anxiety" with for 1. In order patient

or concerns outcomes: mengidentifikasik could

accompanied vague responses NOC: Levels of anxiety an description receive

autonomous; fear No. Indicator T realistic about disease

caused by the change suffered and

1 feelings 5
anticipation to agitated in the role want

danger. case this 2. Give assessment do

2 Issues 5
constitute cue behavior about treatment

vigilance that Fear comprehension which is given

warn that patient to 2. To nurse

3 5
individuals will be their be delivered disease process knowing

danger and orally 3. Use how

enable individuals Change approach understand the patient

for Act 4 the pattern 5 quiet and to

face threats urinate give disease

17
restriction big security suffered

characteristics: Information: 3. To patient

behavior 1 = weight do not feel

1. Agitation 2 = heavy afraid to

2. agitated 3 = moderate disease

3. extra movement 4 = mild suffered

4. Insomnia 5 = no

5. Eye contact

bad

6. glimpse

7. Express

worries

because of changes

in event

life

8. reduction

productivity

9. stalking behavior

10. were alert

18
 CHAPTER III

COVER
A. knot

Colorectal cancer is a malignant form contained

the ascending colon, transverse, desending, sigmoid and rectal.

Colorectal cancer can be defined as a malignancy or

the growth of abnormal cells in the area of ​the large intestine (colon) and rectum.

The exact cause of this cancer is unknown but there are

several risk factors that lead to colorectal cancer

among others, genetic factors, inflammatory bowel, lifestyle, and smoking

and aklohol.

The symptoms can include constipation, body

weakness, pain ddaerah colon, for somebody checks

colorectal cancer in the form of abdominal examination, occult

blood stool, rectal examination, barium enema, and colonoscopy.

For its management itself can be a surgical medical,

kepeawatan and diet.

B. Suggestion

Hopefully the papers that have been made can be used as material

lesson for students to understand more about the disease

colorectal cancer that has been documented.

19
 BIBLIOGRAPHY

Bulckhek, Gloria M, et al. 2016. " Nursing Interventions Classification

(NIC) ". Elsevier Singapore Pte Ltd: Elsevier Inc.

Ilustrated Dorland's Medical Dictionary, 29 / E. 2002 Jakarta: Book Publishers

Medical EGC

Kepmenkes RI. NUMBER HK.01.07 / Menkes / 406/2018 CONCERNING

GUIDELINES FOR NATIONAL SERVICE OF MEDICAL PROCEDURES colorectal
cancer

http://hukor.kemkes.go.id/uploads/produk_hukum/KMK_No__HK_01_
07-Menkes-406-
2018_ttg_Pedoman_Nasional_Pelayanan_Kedokteran_Tata_Laksana_
Kanker_Kolorektal.pdf

Accessible: 9/03/2019, 21:10

Manggasari. 2013. Nursing colostomy. Depok

http://lib.ui.ac.id/file?file=digital/20351543-PR-Manggarsari.pdf

Accessible: 9/03/2019, 20:11 pm

Sudoyo, Aru Wisaksono. 2018. HARPA: Colorectal Cancer. Jakarta:

Indonesian Cancer Foundation

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