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Polyps of the Large Intestine. Arise from the mucosal surface of colon, project into lumenSessile-flat, attach directly to intestinal wallPendunculated-attach to intestine by a thin stalkRectosigmoid area- most commonClients asymptomatic, may have rectal bleeding or stool with occult blood. Type
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1. Lower GIModule 3
2. Polyps of the Large Intestine Arise from the mucosal surface of colon, project into lumen
Sessile-flat, attach directly to intestinal wall
Pendunculated-attach to intestine by a thin stalk
Rectosigmoid area- most common
Clients asymptomatic, may have rectal bleeding or stool with occult blood
3. Types of Polyps Benign
Hyperplastic
Inflammatory polyps
Lipomas
Juvenile
Neoplastic
Adenomas 3 types
Tubular-most prevalent
Villous adenomas-higher risk for becoming cancerous
Familial adenomatous polyps (FAP)-genetic, autosomal dominant
4. Polyps of the Large Intestine-Diagnosis Barium enema
Sigmoidoscopy
Colonoscopy
Polypectomy
5. Colorectal Cancer Adenocarcinoma most common
Third most common cause of cancer deaths
Most prevalent > 50 years of age
Tumors spread through wall of intestine, spread to lymph nodes, liver
Etiology-risk factors
Age
Familial history
Polyps
Inflammatory bowel disease
Prior history
High fat/low fiber diet
6. Colorectal Cancer-Clinical Manifestations Nonspecific until disease progresses
Left side
Rectal bleeding
Alternating constipation/diarrhea
Ribbon like stools
Sensation of incomplete evacuation
Right side
Crampy, colicky pain
Weakness, fatigue, iron deficiency anemia
7. Colorectal Cancer-Diagnostic Studies IMPORTANT Prevention for client age 50 or older
Annual fecal blood test-avoid red meat, horseradish, iron preparations, NSAIDS, ASA
Colonoscopy or Flexible sigmoidoscopy every 5 years
Diagnosis:
H&P-family history, previous history of
Polyps
Inflammatory bowel disease
Digital rectal exam-important
Flex sig and barium enema
CEA, CBC
CT scan
Colonoscopy is gold standard
8. Colorectal CancerTreatment Tumor staging
Surgery
Right hemicolectomy
Left hemicolectomy
Abdominal Perineal resection
9. Colorectal CancerNursing Care Presurgery
Pain management
Monitor elimination patterns
Psychosocial
Post op
Same as above
If abdominal perineal resection
Two wounds (abdominal and perineal) and a stoma
Stoma care/ wound care as per health care provider
10. Colorectal CancerNursing Post op (Cont)
Perineal area
May have JP/Hemovac drain
May have packing-meticulous care is needed
Sexual dysfunction may occur-psychosocial support
Abdominal wound
Monitor wound for excessive bleeding, odor
11. Ostomy Surgery Surgical procedure, an opening allows passage of intestinal contents
Ileostomy-
Opening from ileum (Brookes ileostomy)
Surgical treatment for Crohns, ulcerative colitis
Cecostomy
Opening between cecum and abdominal wall
Colostomy
Colon and abdominal wall
12. Ostomy Surgery Colostomy
Temporary
Loop
Double barrel
Permanent
Usually transverse
13. Types of OstomiesEnd stoma End stoma
Divide bowel and bring out proximal end as stoma
Distal is either
Removed (permanent colostomy)
Oversown(temporary) left in abdominal cavity (Hartmans pouch)
14. Types of OstomiesLoop stoma Bring a loop of bowel to surface and then open
Stoma with proximal and distal opening
Intact posterior wall
Temporary ostomy
15. Types of OstomiesDouble barrel Similar to loop but posterior wall is not intact
Proximal end is functional
Distal is mucous fistula
Temporary ostomy
16. Types of OstomiesKoch Pouch/Ileoanal Reservoir Koch pouch
Continent ileostomy
Ileoanal reservoir
Total colectomy and ileoanal anastamosis with ileal reservoir
17. Characteristics of Colostomies Ascending and transverse colostomy
Semiliquid for ascending
Semiliquid to semiformed for transverse
Pouch and skin barriers needed
Colostomy indicated for diverticulitis, tumors of the colon
Sigmoid colon
Formed stool
Bowel regulation can be achieved
Can irrigate
Indicated for Cancer of the rectum
18. Characteristics of Ileostomies Liquid to semiliquid stool
Pouch and skin barriers needed
Indicated for Crohns disease, ulcerative colitis
19. Characteristics of a Normal Stoma Color
Pink to rose colored
Edema
Mild to moderate
Bleeding
Small amount
Review ostomy care as per textbook