FRANCHIE M.

HSU

CASE STUDY

RT is a 64-yr old man who comes to his primary care provider’s office for a yearly examination. He
initially reports having no health problem; however on further questioning, he admits to having
developed some fatigue, abdominal bloating, & intermittent constipation. The nurse completes the
examination, w/c includes a normal rectal exam w/ a stool positive for guaiac. Diagnostic studies include
a CBC w/ a differential, chem 14, & carcinoembryonic antigen (CAE). RT has not had a recent
colonoscopy & is referred to a gastroenterologist for this procedure. A 5-cm mass found in the sigmoid
colon confirms a diagmosis of adenocarcinoma of the colon. A referral is made for surgery. The
pathology report describes the tumor as Duke’s stage B, w/c means that the cancer has extended into
the mucous layer of the colon. A metastatic work-up is negative.

1. What is a risk factor?

- A risk factor is anything that increases the chance of a person developing a disease or condition.

2. Identify 6 risk factors for colon Ca?

 Older age
 Family history of colon cancer.
 Low-fiber, high-fat diet.
 Obesity
 Smoking
 A sedentary lifestyle

3. Discuss the screening procedure r/t colon Ca?

 Colonoscopy- this allows the doctor to look inside the entire rectum and colon while a patient is
sedated. A flexible, lighted tube called a colonoscope is inserted into the rectum and the entire
colon to look for polyps or cancer. During this procedure, a doctor can remove polyps or other
tissue for examination. The removal of polyps can also prevent colorectal cancer.

 Computed tomography (CT or CAT) colonography - this is sometimes called virtual colonoscopy,
a screening method being studied in some centers. It requires interpretation by a skilled
radiologist to provide the best results. CT colonography may be an alternative for people who
cannot have a standard colonoscopy due to the risk of anesthesia, or if a person has a blockage
in the colon that prevents a full examination.

 Sigmoidoscopy- this uses a flexible, lighted tube that is inserted into the rectum and lower
colon to check for polyps, cancer, and other abnormalities. During this procedure, a doctor
can remove polyps or other tissue for later examination. The doctor cannot check the upper
part of the colon, the ascending and transverse colon, with this test. This screening test
allows for the removal of polyps, which can also prevent colorectal cancer, but if polyps or
cancer are found using this test, a colonoscopy to view the entire colon is recommended.
  Fecal occult blood test (FOBT)  and fecal immunochemical test (FIT) - A fecal occult blood
test is used to find blood in the feces, or stool, which can be a sign of polyps or cancer. A
positive test, meaning that blood is found in the feces, can be from causes other than a
colon polyp or cancer, including bleeding in the stomach or upper GI tract and even eating
rare meat or other foods. There are 2 types of tests: guaiac (FOBT) and immunochemical
(FIT). Polyps and cancers do not bleed continually, so FOBT must be done on several stool
samples each year and should be repeated every year.

 Double contrast barium enema (DCBE) - For patients who cannot have a colonoscopy, an enema
containing barium is given, which helps make the colon and rectum stand out on x-rays. A series
of x-rays is then taken of the colon and rectum. In general, most doctors would recommend
other screening tests because a barium enema is less likely to detect precancerous polyps than a
colonoscopy, sigmoidoscopy, or CT colonography.

 Stool DNA tests- This test analyzes the DNA from a person’s stool sample to look for cancer. It
uses changes in the DNA that occur in polyps and cancers to find out if a colonoscopy should be
done.

4. What warning signs did RT have?

- Fatigue, abdominal bloating, intermittent constipation, stool positive for guaiac.

5. Discuss common early vs late s/s found in individuals w/ colorectal Ca?

 Early s/s- constipation, diarrhea, changes in stool color, changes in stool shape, such as
narrowed stool, blood in the stool, bleeding from the rectum, excessive gas, abdominal cramps,
and abdominal pain.
 Late s/s- excessive fatigue, unexplained weakness, unintentional weight loss, changes in your
stool that last longer than a month, a feeling that your bowels won’t completely empty, and
vomiting.

6. What is a CEA? How does it relate to a diagnosis of colon CA?

- Carcinoembryonic antigen (CEA) test is a blood test used to help diagnose and manage certain types of
cancers. It is used especially for cancers of the large intestine and rectum. Colon cancer elevates CEA. If
a person is tested before starting treatment for cancer, the results may show low level of CEA which
means the tumor is small and the cancer has not spread to other parts of your body. A high level of CEA
means a larger tumor and/or the cancer may have spread. If a person is being treated for cancer and the
levels of CEA started high and remained high. This may mean the cancer is not responding to treatment.
If the levels of CEA started high but then decreased. This may mean the treatment is working. If CEA
levels decreased, but then later increased. This may mean the cancer has come back after it has been
treated.

7. After bowel prep, RT is admitted to the hospital for an exploratory laparotomy, small bowel resection
& sigmoid colectomy. List at least 5 major complications for RT.

 Anastomotic leaks and peritonitis

 Wound infections
 Small bowel obstruction
  Postoperative bleeding
 Injuries to the urinary tract structures

8. Four weeks after surgery, RT is scheduled to begin chemotherapy. List 3 chemotherapy drugs used to
treat adenocarcinoma of the colon.

 5-Fluorouracil (5-FU)
 Capecitabine (Xeloda)
 Oxaliplatin (Eloxatin)

9. Discuss some of the toxicities & s/e of these drugs.

 5-Fluorouracil (5-FU)- Diarrhea, nausea and possible occasional vomiting, mouth sores, poor
appetite, watery eyes, sensitivity to light, taste changes, metallic taste in mouth during infusion,
discoloration along vein through which the medication is given, and low blood counts
 Capecitabine (Xeloda)- Nausea, vomiting, loss of appetite, constipation, tiredness, weakness,
headache, dizziness, trouble sleeping, or changes in taste may occur.
 Oxaliplatin (Eloxatin)- Peripheral neuropathy, nausea and vomiting, diarrhea, mouth sores, low
blood counts, fatigue, and loss of appetite.

10. Given the s/e profiles of the drug used to treat colon cancer, develop a teaching plan for RT.

Health Teaching Plan

Objective Activity and Time Teaching Persons Resources Evaluation

procedure frame strategy/method involved
After 30 After 30
minutes of minutes of
health health
teaching, the teaching, the
patient will patient was
be able to: able to:

1. Acquire 1. Oxaliplatin is 10 Lecture/discussion Nurse, Books, 1. Define

knowledge used to treat mins. patient illustration briefly what is
about what is colon or rectal Oxaliplatin
Oxaliplatin cancer that has and how it is
and how it is spread given.
given. (metastasized).
It is often given
in combination
with other
anticancer
drugs. It is
given by
infusion into
the vein
(intravenous,
IV). The
 amount of
Oxaliplatin you
will receive
depends on
many factors,
including your
height and
weight, your
general health
or other health
problems, and
the type of
cancer you
have.

2. Enumerate 2. Oxaliplatin 10 Lecture/discussion Nurse, Books, 2.Enumerate

common side side effects: mins. patient illustration the common
effects of -Peripheral side effects of
Oxaliplatin. neuropathy Oxaliplatin.
-Nausea and
vomiting
-Diarrhea
-Mouth sores
-Low blood
counts
-Fatigue
-Loss of
appetite

3. Know the 3.Precautionary 10 Lecture/discussion Nurse, Books, 3. State the

precautionary measure: mins. patient illustration precautionary
measures -Avoid cold measures
when temperatures when
receiving and cold receiving
treatment objects. Oxaliplatin
with - Cover your treatment.
Oxaliplatin. skin, mouth
and nose if you
go outside in
cold
temperatures.
- Do not drink
cold drinks or
use ice cubes in
drinks.
-Do not put ice
or ice packs on
your body.
-Cover yourself
with a blanket
while you
receive your
Oxaliplatin
infusion.
-Do not
breathe deeply
when exposed
to cold air.
-Wear warm
clothing in cold
weather at all
times.
-Drink fluids
warm or at
room
temperature.
-If your body
gets cold,
warm-up the
affected part
with warm
water.
-Keep your
bowels moving.
-Avoid sun
exposure.
- Avoid drinking
alcoholic
beverages.
-Get plenty of
rest
-Maintain good
nutrition.