colorectal cancer

corectal cancer with colostomy care

1. Colorectal cancer Presented by . LIKHILA ABRAHAM

2. DEFINITION Colorectal cancer is a disease in which cancer cells grow either colon or in rectum .the colon are the parts of digestive system ,normally the cells of colon and rectum divide in a regular manner .,if cells keep on dividing a mass of tissue forms called tumor, that may b benign or malignant.(medical encyclopedia )

3. Colorectal cancer commonly known as colon cancer or bowel cancer ;which is a cancer from uncontrolled cell growth in the colon or rectum ,genetic analysis shown that essentially colon and rectum tumors are the same type of carcinomas..national cancer institute)

4. etiology 1.inflammatory bowel disease 2.genetic mutations 3.polyps Risk factors 1.Dietary factors 2.Environmental factors 3.Lynch syndrome 4.Familial adenomatous polyposis

5. Cancer distribution 15% 5% 9% 20% 50%

6. Classifications(duke’s ) Duke A:the tumor penetrates into the mucosa of bowel wall no further DukeB :B1:tumor penetrates into but not through the muscular layer B2;tumor penetrates into through the muscular layer Duke C:C1:tumor penetrates into but not through the muscular layer there is pathogenic evidence of colon cancer in the lymph nodes

7. C2;tumor penetrates into the muscular layer with pathological evidence of colon cancer in the lymph nodes Modified duke D:the tumor spread beyond the confines ..metastasis to other organs

8. TNM STAGING T;TUMOR T1:tumor invades submucosa T2:tumor invades muscular layer T3:tumor invades to muscular and peri rectal tissues T4:tumor perforates the organ and other structures

9. Node (N) N0: No regional lymph node metastasis N1:metastasis to 1 to 3 regional lymph nodes N2: Metastasis in 4 or more regional lymph nodes Metastasis (m) M0:no metastasis M1 :distant metastasis

10. Stages Stage1: T1N0M0;T2N0M0(cancer has begun to spread but still in the inner linig Stage2: T3N0M0 ,T4N0M0(cancer has spread to other organs near colon and rectum Stage3:T4N1 M0 (cancer has spread to lymph nodes . Stage 4(cancer spread through lymph nodes to other distant parts of the body

11. pathophysiology

12. Clinical features Right side 1 .abdominal pain 2.bleeding 3.weakness 4. Fatigue 5. Palpable abdominal mass 6.Malena 7.Bowel obstruction Left side 1.coliky pain 2.bleeding 3.obstruction 4.weakness and fatigue 5 ribbon like stools 6.nausea and vomitting

13. Rectum 1.Pain 2.Rectal bleeding 3.Bloody stools 4. Altered bowel pattern 5. Perineal and buttok pain

14. Management Medical management 1.chemotherapy 2.Bilogic or targeted therapy 3.Radiation therapy

15. Surgical management 1.colectomy (right hemicolectomy-asending colon Left hemi colectomy ( decending colon) Extended hemicolectomy ( transeverse colon) Sigmoidectomy Tottal colectomy Subtottal colectomy Colostomy

16. Colostomy A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine though the abdominal wall and suturing in to place (medical encyclopedia) Colostomy is a surgical procedure that allows intestinal contents to pass from the bowel through an opening is called STOMA .the stoma created when the intestine is brought through the abdominal wall and sutured to the skin.(colostomy nursing care)

17. Types of ostomies End stoma

18. Loop stoma

19. Double-barreled stoma

20. Knock pouch

21. Colostomy care Emotional support as the patient cope with a radical body change Patient teaching about stoma care

22. Normal stoma

23. Equipments Pouching system Gloves Bed pan Plastic bags Tissue paper Wash cloth Cleansing solution clamp

24. Explain the procedure to the patient Screen the patient Hand wasing Wear gloves Arrange all the article near to the patient

25. Remove contents from the pouch

26. Remove all the content to a bed pan by opening the clamp ,after procedure return the clamp and remove the pouch from the skin wipe the stoma with wash cloth.if physian approves cleansing solution use that.dry the area Select flange size 1or 2cm larger than the stoma,trace the size.make the strter hole.attach the pouch on skin barrier.remove pouch when it is 1/3 rd filled

27. colostomy irrigation Gather Necessary Materials Needed  - You will need the following materials: a  colostomy irrigation water bag with tubing and cone   . This is good because it has a very handy temperature indicator to prevent any stomach cramping and has a flowmeter to control water flow. Another thing is your  Irrigation   drainage bag with belt  (ask about the variant from hollister 7724) this is a reusable bag which comes very handy. Of course you also need your paper towels .

28. Irrigation kit

29. Cone with sleeve

30. Fill the colostomy irrigation bag   -   can always use mineral water. Just make sure the temperature is a variant of your body temperature and not on any extremes.(normal body temp is 37.5 degree celsius ). The amount of water still varies per individual; some use 750ml and some use 1.5 Liters of water. can start with 750mL (again, your doctor's advise is important) Attach irrigation sleeve  - your irrigation drainage bag can now be attached using your belt placing your stoma on the middle of the ring .

31. Insert the cone of the irrigation water bag to stoma  - . Just make sure you insert the cone firm enough to avoid water leaks. Infuse the water to your stoma  - Start at a slower rate and gradually increase water flow. The infusion will last from 3-5 minutes. You dont have to fill in the whole 1,000mL in.  (Remember: if you encounter any discomfort at this stage, stop the water infusing, remove the cone for a while, then continue again and start at a slower rate of infusion )

32. Let the stool exit  - After infused, remove the cone and let the stool exit to the sleeve or the collection bag with belt that you have attached earlier. This process will take around 45 to 60 minutes. . If you see enough stool has collected in the bag, go back to the bathroom, deposit the contents to the bowl and close the sleeve again. Repeat this process until everything has evacuated from the bowel.

33. Remove the sleeves and Put on regular pouching system  - After the bowel is empty, remove the sleeves, wash it with soap and water, rinse and dry them. You may way to use disinfectant to make it odorfree and clean. After this, you can now freely use a patch or your regular pouching system.

34. Nursing management Accute pain related to inflammatory process Deficient fluid volume related to vomiting Imbalanced nutrition less than body requirement related to dietary restriction Disturbed body image related to fecal diversion Anxiety related to the loss of bowel control Risk for impaired skin integrity related to discharge in the peristomal area

35. Complication Liver cancer Lung cancer Intestinal obstruction Intestinal perforation Prevention Colonoscopy Polyps removal NSAID

36. ADVANCEMENTS NANOTECHNOLOGY DMFO .. CELECOXIB ANDCOMBINATION OF SULINADAC ,DIFLUROETHYL LORNITHINE REDUCE RISK OF POLYPS DEVELOPMENT