Colorectal Cancer and Ostomy Care Essentials

In this presentation, we will consider the GI system in regard to colorectal cancer and ostomy care. Before you dive into this content, be sure you are free from distractions and can give it your full attention. Be sure that you have read the textbook pages that are associated with this content. Be prepared to actively learn. I will be sharing my knowledge and understanding with you, but you must do the learning. Participate in your learning. You will be the nurse next to that patient, not me. You need to acquire the knowledge, skills, and attitudes to take care of that patient safely, competently, and compassionately. Think beyond your next classroom exam. Rather, think about being that nurse taking care of that patient. That is what you are preparing for, not classroom examinations. Listen with curiosity, asking questions, seeking answers. Imagine being the nurse responsible for the care of this patient. Imagine being the patient needing this nursing care. Think about your prior experiences that are related to this content, from both the healthcare provider's point of view, and or the patient's point of view. Think about building knowledge on the foundation of what you already know. Be prepared to change your understanding of this content if new information is presented. Take advantage of this recorded source. Pause as needed to think about the content or write down notes or questions. Be curious about learning more. Review the content and your notes as needed to gain understanding that you seek. Test yourself on the content to determine if you really learned it or not. The first thing I want you to do is pause and reflect. I want you to start by stopping the recording and thinking and writing down in these three areas. I want you to think about what you already know about this topic and write down at least three to five items. I want you to stop and think about any of your prior experiences related to the content. I want you to write down your thoughts and feelings. related to your experiences. Lastly, I want you to think about what you don't know about this content. Think about your gaps of knowledge and understanding and things that you're curious about learning. Write down at least three to five items. Then you'll be ready to dive into the content. Here are your learning objectives for this recording. Please read over these carefully. Understand what the purpose and outcome from this should be so that you can determine if you're meeting these objectives. In our society, colon cancer is one of the top five most frequently seen cancers. It is among these others breast cancer, lung cancer, prostate cancer, and melanomas. Tumors of the colon and the rectum are relatively common. Over 140,000 new diagnoses are made per year. and over 50,000 deaths are attributed to this type of cancer. It is most frequently diagnosed in patients that are between 65 and 74 years old. It does have a familiar tendency. There are a list of risk factors in the textbook. Among them are cigarette smoking, a family history of colon cancer, High consumption of alcohol as that is toxic to the body. high fat and high protein with a low fiber intake is considered a risk factor having a history of inflammatory bowel disease which causes chronic inflammation and tissue changes including like scarring and that damaged tissue can develop into cancer having a history of type 2 diabetes and being overweight or obese, consider risk factors. The stage at presentation affects the prognosis in colon cancer. If the disease is detected and treated at an early stage before it spreads, the five-year survival rate is 90%. However, only 39% of cancers in this part of the body are detected at this early stage. Survival rates after late diagnosis are rather low. Most people are asymptomatic for long periods and seek health care only when they notice changes in bowel habits or rectal bleeding. Prevention and early screening are key to detection and reduction of mortality rates. Often benign polyps change into cancerous tumors. Therefore, if we can scope the bowel and in the process remove polyps, often we can avoid cancers from developing. Prevention begins with addressing modifiable risk factors like weight and obesity, alcohol consumption, and cigarette smoking. Other non-modifiable risk factors need to be monitored for. and to detect changes as early as possible. So this is where we can start talking about colonoscopy. Polyps can be removed in the process. As I said before, it is recommended that all adults should begin periodic screening for colorectal cancer at about the age of 50, earlier for patients that are higher risk. Repeated colonoscopies are based on risk factors and what is found in the. previous colonoscopy. For instance, if you have a colonoscopy at age 50 and there are no polyps, then frequently you won't have another colonoscopy for five years. If, however, you have a colonoscopy and you have one, two, three, five polyps, then you may have a colonoscopy scheduled again for three years or even more frequently, depending on how the findings are. Let's talk a little bit about the procedure for colonoscopy because nurses often have to answer questions or guide patients through this process. It always requires bowel prep. The bowel must be empty of stool or the scope will not be able to visualize the bowel walls. Prep includes restrictions of certain foods like nuts, seeds, and fruits or veg that have husks or holes on them. Think like corn. and that's a couple of days prior to the test. The patient will begin a clear liquid diet for up to 24 hours prior to the procedure and must abstain from foods or liquids that have red or purple dyes, as that can interfere with the scope, and it changes what they see inside the bowel. For example, the patient could have an orange flavored popsicle but not grape or cherry. The same is true for drinks like Gatorade or foods like Jell-O. The patient will have to drink a bowel prep medication that is designed to empty the bowel of solid contents. Generally, the prep is consumed in doses the night before and early on the morning of the procedure. The goal is to have clear or slightly yellow liquid stools. with no solid pieces. If you are a nurse caring for a patient that's inpatient in a hospitalized setting, then their prep is going to be a little bit different. The patient will still only have clear liquids prior to the test and cannot have red or purple dyes, but it may not be possible for them to have restricted intake of nuts and seeds and hulls in the days prior to the test. prior to their hospitalization. The nurse caring for this patient is responsible to ensure that the stools are clear or yellow liquid before the patient goes to the procedure. If the patient cannot or will not complete the bowel prep, the procedure may have to be canceled or rescheduled. There's no point in scoping a bowel when there's still stool in there and it cannot really see the bowel walls. Most colonoscopies are done under light sedation, and we need to remember our normal nursing considerations regarding patients being NPO prior to sedation. and monitoring for recovery from sedation after the procedure. A patient who has a tumor found on the screen colonoscopy should have the tumor biopsied and probably tattooed during the colonoscopy. It'll help facilitate further workup. And the treatment for colorectal cancer depends on the stage of the disease and consists of surgery to remove the tumor, supportive therapy, and adjuvant. therapy. At this point, I would like you to pause and think and consider the lifestyle considerations that influence the development of cancer. Think about cancers that have a genetic link and think about this statement. Genetics loads the gun, but environment pulls the trigger. The clinical manifestations for colorectal cancer are going to be determined by the location of the tumor and the stage of the disease and the function of that affected segment of the bowel. The most common presenting symptom that patients notice is a change in bowel habits. This is usually what gets them going to the provider. That or having blood in their stools. The change in bowel habits includes the shape of the bowel, stool, the consistency, and or the frequency of stools. One common change in colorectal cancer is in the shape that it is described as ribbon-like. This occurs as the stool is forced to pass around a tumor within the lumen of the bowel and thus creates a change in shape, narrowing the normal stool. Patients may also experience abdominal cramping related to stools passing through a partially blocked bowel lumen. A full obstruction can occur if the tumor encompasses the entire lumen, and then all of the signs and symptoms of bowel obstruction will be seen in addition to other possible manifestations related to the cancer itself. The passage of blood in or on the stool is the second most common symptom seen. Symptoms may also include unexplained anemia, anorexia, weight loss, and fatigue. And those are kind of common in multiple different kinds of cancers. Patients just generally feel fatigued, have some weight loss, don't understand why they don't have their normal energy, perhaps have signs and symptoms of anemia. The symptoms most commonly associated with a right-sided lesion tumor are dull abdominal pain and melanoma. The symptoms associated with a left-sided lesion are a little different. Those are more like having an abdominal bowel obstruction. So you have abdominal pain, cramping, a narrowing of the stool, constipation, distension, and usually bright red blood in the stool. Symptoms associated with rectal lesions are tenesmus, which is cramping pain in the rectal area, rectal pain, the feeling of unable to really empty the bowels, so you just kind of always feel like there's stool sitting there. And it's not stool they're feeling, it's the pressure of the tumor in that location. So they just feel like they can't quite empty their bowels completely. And they may have alternation between constipation and diarrhea and possibly bloody stool because the stool passing past that tumor can the friction of it can cause that tissue to bleed. Some of our assessment and diagnostic findings we're going to be asking the patient about prior histories. We want to know do they have a history of inflammatory bowel disease, Crohn's or ulcerative colitis? Have they had previous scopes? And did they have polyps? What were the results from those other scopes? Do they have fatigue? Do they have abdominal or rectal pain? Past and present elimination patterns. So has there been a change? What's normal for you prior to this? What did a regular routine stool look like? How frequently? And you know all of the other things that go with an assessment of that. There are some genetic conditions that predispose patients to this. We want to find out if they have that connection going on. We want to ask about their dietary intake, their alcohol consumption, and their smoking history. Ask if they've had unintentional weight loss or if they have complaints of fatigue or pain. We want to auscultate the bowel sounds and palpate for tenderness. distension, and solid masses. Stool specimens will be inspected for character and the presence of blood. Some laboratory studies that are often done include a CBC, a BMP, liver function test, and tumor marker. A baseline test, the abbreviation for it is the CEA. all capitalized but it stands for carcinioembryonic antigen and that is specific marker that shows up in the blood related to colon cancers um liver functions we want to know because it may if if their liver function is poor then They may have trouble with some of the treatments like chemotherapies that are often done for these kinds of cancers. These patients may or may not have surgery for their cancers, their tumors. They will almost certainly be referred to a medical oncologist for further management. Generally speaking, all stages of cancer are usually treated with surgical removal of the cancer, possibly some of the surrounding tissues, and in some instances, the local lymph nodes in that area. Then they may also continue on with other therapies like chemotherapy or radiation. There's a thing called targeted therapy that uses drugs. to target specific proteins that control cell growth and maturation function. It's malfunctioning proteins that sometimes contribute to the cancer's uncontrolled growth. So if we can target those kinds of cells, those specific proteins, then often that we can slow down the growth of the cancer while the other therapies are kind of doing their thing. and they also have less severe side effects than like chemotherapy. Immunotherapy is relatively new and it is a way to boost the patient's own immune system to help it Recognize the cancer cells and kill them more effectively so that we let the body do the work of eradicating the cancer, if possible. Think about, additionally, the care of this patient. It's a scary diagnosis, as we saw earlier in the statistics of it. It's fairly common, but it's not. very well treated once it's advanced. So this can be a frightening time for the patient. They're going to have many concerns and needs and fears. They may be needing emotional support. They may have concerns about how this is going to change their life and their life expectancy, their ability to perform in their normal roles. It may impact their financial situation. So we want to think about caring for them in that way in addition to providing pre-op care and post-op care. Pre-operatively, we're going to be looking at similar dietary restrictions to a colonoscopy prep. And all of the normal. pre-op education, informed consent, we're going to have to have an IV and maintain their hydration status and give whatever medications are required. This patient may have an NG tube dissection, especially if the tumor is causing a blockage that the bowel can't move, you know, so it's like an obstruction. Post-operatively, the patient is similar to nursing care for any abdominal surgery patient. including pain management. We're going to monitor for complications as we do for all surgery. We want to listen to those bowel sounds for returning peristalsis, assess the initial stool characteristics. It is important for these patients to move, okay. We want to encourage them up out of bed, ambulating if possible. This will help prevent DDTs as well as help accelerate the return of their peristalsis. We're also going to try to help them maintain optimal nutrition, educating them about the health benefits from consuming a healthy diet. It's going to be individualized to the patient as long as it's nutritionally sound. It doesn't cause them diarrhea or constipation, then it's a good diet for them. After surgery, we're looking also at wound care for surgical incisions and probably a new stoma. We're thinking about pulmonary hygiene with the coughing and deep breathing and so this patient would be needing to have the splinting of the abdomen so they could do their coughing with less pain and less risk of dehiscence. They are probably going to have some drains that have to be managed. They may still have an NG tube during the early phases of their recovery. Remember that abdominal surgeries have a higher incident of developing paralytic ileus, so we want to be very careful to listen to those bowel sounds and monitor that closely. The alterations in the way the bowel functions at this point can lead to fluid and electrolyte imbalances. Peritonitis is a possible complication from these kind of surgeries and some of the signs that we would see in that if it was developing would be patients complaining of nausea. Sometimes they develop hiccups. They have chills, they may have elevated temperature, tachycardia, and a board-like abdomen which is super firm and not um you're not going to be able to do it. palpate like a normal soft abdomen. We're also probably going to be administering antibiotics and fluids. They may have to have surgery if they develop peritonitis and then we're also like I mentioned before watching for dehiscence of the wound and evisceration where the abdominal organs start kind of protruding through this opening. Surgery is one of the mainstay treatments for colorectal cancer. It can be curative or palliative, meaning that sometimes the purpose of the surgery is to remove the cancerous section. And once the cancer is removed, it's curative. And then they still may have radiation or chemotherapy to try to ensure that all the cells... that were cancerous are gone because if we leave some behind sometimes the cancer will redevelop. Palliative would mean removing this section of the bowel brings the patient more comfort. It's not to cure the problem but rather to just make them more comfortable. and it would be hard to believe that having a surgical procedure would help the patient be more comfortable but it is if the situation is that the tumor is blocking and making it more painful and causing a poor quality of life. Sometimes and I'll show it in the next slide there's a procedure that's done that allows the patient to retain the lower end of the GI tract where the sphincter is located and sometimes the bowel is resected, meaning part of it is taken out, and that stump is left in place and sometimes the bowel can be reconnected later and bring the function of the system back. This particular picture shows a resection with a anastomosis. So in this part, part of the bowel is removed, the part that's damaged, diseased, or has a tumor, or whatever that is, and the two ends are brought together so that the tract is re-established. Now we still have a section missing, so we have a shorter bowel which is going to affect the stools in to some extent. I'm going to bring up the next picture and show you what I was talking about. All right so this is a culinary section where a stoma is formed. You can see in the before picture there's a diseased section of the bowel that they remove completely and have healthy tissue on both ends. Okay but they're not connected to each other anymore so they'll sew up that stump so that it stays intact, it keeps its blood supply, it doesn't have any function because the stool can't pass through to it because it's now exiting where that part of the bowel has now been brought to the surface of the abdomen and it is exiting out that hole called the stoma. And so that's where we end up with a colostomy bag attached to catch the stool. In some cases, after a while, it's possible that those two ends can be reconnected and reestablish bowel function without the stoma. Time for another pause and think. I want you to read through these nursing diagnoses and think if they would be appropriate for a patient with a colostomy. why they would be appropriate. So understand your rationales and think of at least two nursing interventions that would address each of these nursing diagnoses. Alright, so some of the specific nursing care considerations for us as we care for patients like these in the hospital is, you know, the prep. for if they're going to have a scope or if they're pre-op there's preparation for that we have post-op care to give we need to be doing lots and lots of education and we need to be truly caring about what's going on with these patients and what they're going through some special complications that can happen with these kind of patients undergoing these kind of surgeries are ball perforation Partial or complete obstructions, hemorrhaging from incisions internal and external, paralytic ileus, peritonitis, abscesses can happen, they can have mesenteric ischemia because we're messing with the abdominal cavity. It can impair that blood flow as well. Infection can set in. And then we have the possibility of wound dehiscence and evisceration as well as fistula formation. So make sure you guys review and apply appropriately the post-op assessments that we need to do. This patient may have drains that have to be managed besides the normal IV lines. They're going to have a new ostomy site that has to be assessed and maintained. They may have an G-tube, they may have a Foley catheter. So there's a lot going on with this patient. There's going to be a lot of lines, tubes, and drains that we're going to be managing. They're probably going to need their SCDs as well as early ambulation, try to get them up and moving so we can prevent some of those complications. They're going to have surgical incisions and ostomies. They should have a pouch already attached to their ostomy when they come out. We want to make sure that we monitor the stoma. The stoma, we need to make sure that it stays kind of pink to bright red, and it should look kind of shiny. If it starts looking dull, then it's probably because of a compromised blood flow, and that's a problem. We're talking about tissue death now when we don't have good blood flow. The patient will need to be taught and the nurse needs to monitor for fecal matter to start coming through. Now remember this patient has been NPO, they had a completely empty bowel going into surgery. So at the beginning there's nothing there, nothing to even come out. But once they start having their diet and advancing their diet, we should start seeing stools 24 to 48 hours after surgery with an ileostomy and three to six days after surgery for a colonostomy, colostomy. The drainage from an ileostomy is going to be pretty continuous and it's going to be a liquid because the small intestine content is what's draining into that pouch and so it's really important that Because that is rather acidic and liquidy, if it comes in contact with the skin, it can actually damage the skin. So we'll need to measure and collect the drainage, the stool that comes through that. In a minute, I'm going to show you a slide that will talk a little bit more about specific locations and what the stool should look like. We want to be monitoring I's and O's for this patient. Depending on location of the stoma, there's going to be perhaps more or less water loss as well as electrolytes. Think about what section of the bowel has been impacted, removed, and what its functions should be. And so now that part is missing and that part of the bowel is not going to be able to do its job anymore and so that can impact some of what the output looks like and how the patient feels because the loss of fluids and or electrolytes as far as the psychosocial and holistic concerns go patients may experience some fear and anxiety they're going to have some disturbed body images concerns and maybe sexuality concerns And this is going to impact lifelong dietary changes. Now they will adjust to it, but there still may be some foods that will always give them trouble or that they must always avoid because now they have this ostomy. Patients also sometimes think that everyone can see it, that everyone knows that they have one, and they may view the stoma as kind of a mutilation. to their system because it's always going to be there. It's a permanent change and it's a loss. So there may be some grief going on. And remember the stages and continuum that a patient goes through when they're grieving. Our support is really important. Understanding their emotional state, supporting where they're at, helping them to grieve in a healthy way. are things that we need to do. And consider the fact that, you know, we may have the best intentions to give this patient excellent education. We want to tell them all about the new diet, all about the supplies they're going to need to care for this, so that they can be a rock star in dealing with this ostomy. But if the patient isn't ready to learn, you're just wasting your time and energy. We need to make sure that the patient is Listening and taking in the information we're giving. We want to be careful not to bombard them with too much information. And this goes in every situation. This goes when a patient gets a new diagnosis of diabetes or they get a new diagnosis of renal failure. At the beginning, they're going to be a little overwhelmed and they may not be able to hear. You know, they may look like they're listening, they're shaking their head, but it's not registering. It's not penetrating because the shock of it or the fear may be influencing their ability to really hear you and understand. Patients may have genuine concerns about how this is going to affect their family relationships, their sexual function, whether a woman believes she should or should never become pregnant again. You know, if this happens to a young woman who wants to have a baby, they're going to have questions about how this is going to impact whether I can carry a pregnancy and deliver a baby. Um. They're going to need to know that someone understands and cares about their concerns. We need to try to maintain a calm and non-judgmental attitude and give them opportunity to talk and then try to give them the resources that they need based on their particular concerns. Sometimes this ostomy represents an illness that's never going to go away. Maybe they have a cancer and maybe now this is just a constant reminder that I have cancer and I have a terminal illness, which can make patients very irritable, anxious, unhappy. So we're kind of the go between for the patient and all these resources that are out there. We need to know who to reach out for social work. or the wound care ostomy nurse who's going to help them learn how to manage the stoma, a dietitian that's going to help them with the right food choices so that they can stay healthy and manage the stool output. There's a lot of concerns for a patient with an ostomy. And then patient and family education. Besides all of that, they need to manage the skin and the stoma. They need to be able to understand how to change the appliance. They need to be able to know what it takes to irrigate the colostomy if it has gas mucus and feces that are building up. It can help kind of irrigate that. There's different locations. We're going to talk about that in a few minutes about like the difference between a colostomy and ileostomy. And then the dietary considerations. Sometimes older adults have a hard time managing their care because of decreased vision, impaired hearing and difficulty sometimes with fine motor control. They may be helped by getting perhaps someone in the family to help manage that or getting some home health. They need to be taught about monitoring the stoma site and what to look for in complications so that they can get help as soon as possible if something starts going awry. All right another pause and think. These are three additional nursing diagnoses for a patient with a colostomy. These tend more towards the holistic psychosocial aspects of caring for this patient. So please look at these. Think about if they would be appropriate for a patient in this situation and what kind of nursing interventions would be helpful. Now we're going to talk a little bit more specifically about the ostomies and caring for them. On this image, you can see a new surgically created stoma. You can see the appliance being put onto, and this is just a picture from a mannequin, like you would do in the simulation lab, practicing putting on the pouching system. And then on the right side. are some of the supplies that are used when patients have an ostomy and we have to put a pouch on it. Think about ostomy surgery. It really is life-saving because if a patient has an impaired bowel function, they can't pass stool through, without an ostomy, they can't survive. You can't live that way. So even though it's traumatic and there's grieving that goes on with it and there's Huge lifestyle things that have to be adjusted. It is still something that saves their life and allows them to continue even though there are going to be some changes. Why are some of the reasons why patients might need an ostomy? Disease processes like diverticulitis where the bowel is so damaged including other inflammatory bowel diseases like Crohn's and ulcerative colitis. Of course, cancers. If paralytic ileus develops for whatever reason, a section of the bowel might have to be removed and a stoma could be created. Cancers, trauma injuries can happen, like say from a motor vehicle crash, obstructions that don't clear up for whatever reason, and vulvulus. are other reasons why sometimes patients have to have a stoma. So on that note, let's do a little pause and think. Consider that this is a life-saving but life-altering situation and compare and contrast in your mind why a patient would be glad to have an ostomy with the reasons why they might be sad or even angry about having to have one. All right, so here's the slide I told you was coming on the different locations of the stoma so that we can talk about different aspects of the changes in the patient's needs and care if they had each one of these different ones. So if you look at where the letter A is pointing to, you'll notice that that's the ileum of the small bowel. Okay, when you think about what kind of Well, it's chyme that's coming through that part of the bowel. Remember that after the food bolus goes into the stomach, it's churned, and then it comes out into the small bowel, and it's called chyme. And as it passes through the small intestines, it is absorbed, the nutrients are absorbed into the bloodstream and sent throughout the body. So that's a very loose and liquidy substance, okay, because it hasn't passed through the large bowel where the water and electrolytes are reabsorbed, which leads to the part of ileostomy that is the biggest nursing consideration. There is a lot of enzymes and acids still in it, and that can cause irritation to the skin if the discharge from this. The drainage from this is in contact with the skin and it's going to have a lot of liquid that normally under a full functioning bowel would be reabsorbed into the body. So now we have a patient who has a loss of water, loss of fluids, and a loss of electrolytes because they're not being reabsorbed also as they go through the large bowel. So this patient has a higher risk of... electrolyte and fluid imbalances. B on here on the picture is the ascending colon that is on the right side of the body so it's called a right colostomy. You'll see that it's past the ileum and into the large bowel but not very far into the large bowel which means the output from there is still going to be pretty fluid pretty liquidy. and have a lot of the electrolytes and stuff still in it because it just hasn't passed through far enough to get all that reclaimed by the body. The one at C is on the transverse colon. That's a transverse colostomy. You can see it's a little further along the system. A little more of the liquid will have been reclaimed by the body and absorbed, but it's still going to be semi-soft. more fluid. More liquid has been removed, but it's still going to have a pretty soft stool. D is back inside the small intestines again. This is the jejunum of the small intestines. So this will be very liquid, chyme. It'll be full of enzymes. It'll be caustic and irritating if it comes into. contact with the skin and because it's not as far along the small intestines it means fewer nutrients have actually been absorbed so this patient would be more likely to have malnutrition as well as dehydration and electrolyte issues and then E is the left-sided colostomy that's looks like it's going into the sigmoid area this stool would be almost normal consistency because by the time the stool passed through the majority of the large bowel, by the time it gets to where that stoma is, it's going to be almost firm as a regular stool would be. So this one would be the one where the patients would be least likely to have fluid and electrolyte issues. So one of the some of the things that that patients need to be taught is how the ostomy is going to affect their intake and their nutrition and you can see by the different locations of these there's going to be some different advice depending on what this patient's situation is. We're probably looking at getting a good dietary consult and a good visit from the wound care ostomy nurse. There are a lot of resources on the internet. There are websites and YouTube channels dedicated to helping people live with these ostomies. And so we want to help our patient to see, to find these resources and utilize them as they're getting used to this major change in their life. I would just like to take a minute to talk about patients that have already got an established stoma but they're in the hospital for something else. Okay so you know the likelihood that you're going to take care of a patient that has a stoma is pretty high and it's not just that they came in to get one but they've lived with one maybe they've lived with one for years but now they're in the hospital for XYZ, just name something else. Okay, they're in the hospital because they have pneumonia. They're in the hospital because they're having a knee replacement. Anything, anywhere in between. If they already have an established stoma, then they probably already do their own self-care. And so, at the point where they're hospitalized, it kind of depends on how sick they are. If they're there for a knee replacement, then they're otherwise healthy. They're probably just going to manage the stoma on their own unless they're having trouble with pain or other things that are related to the surgery that might make it difficult for them to care for it. But people who are very sick with another problem, like say the pneumonia patient, they might need us to do all the care for it until they get recovered. So we need to ask them. you know, and see how frequently we need to change the appliance, empty the pouch, and make sure they have any supplies that they need while they're in the hospital. Ask them about what kind of dietary considerations they need us to be aware of and work out an appropriate diet for them so that their care can be complete. Here is an opportunity for you to look at several different kinds of stomas and to start thinking assessment wise. How would you describe these stomas? Which one do you think is a healthy, good-looking, post-op stoma? And what might be causing the problems in these other ones? So I want you to just kind of think. How would you describe them? Would you consider them healthy stomas? And what might be causing the problems that you see in them? This is the end of the content. Be sure to review these learning objectives. Test yourself on this information. If you still have gaps in your knowledge, review this presentation, dig into your textbook, watch videos, and or seek tutoring until you are sure of your knowledge and understanding of this content. Thank you.

I will be sharing my knowledge and understanding with you, but you must do the learning. Participate in your learning. You will be the nurse next to that patient, not me. You need to acquire the knowledge, skills, and attitudes to take care of that patient safely, competently, and compassionately.

Think beyond your next classroom exam. Rather, think about being that nurse taking care of that patient. That is what you are preparing for, not classroom examinations.

Listen with curiosity, asking questions, seeking answers. Imagine being the nurse responsible for the care of this patient. Imagine being the patient needing this nursing care. Think about your prior experiences that are related to this content, from both the healthcare provider's point of view, and or the patient's point of view. Think about building knowledge on the foundation of what you already know.

Be prepared to change your understanding of this content if new information is presented. Take advantage of this recorded source. Pause as needed to think about the content or write down notes or questions.

Be curious about learning more. Review the content and your notes as needed to gain understanding that you seek. Test yourself on the content to determine if you really learned it or not.

The first thing I want you to do is pause and reflect. I want you to start by stopping the recording and thinking and writing down in these three areas. I want you to think about what you already know about this topic and write down at least three to five items. I want you to stop and think about any of your prior experiences related to the content. I want you to write down your thoughts and feelings.

related to your experiences. Lastly, I want you to think about what you don't know about this content. Think about your gaps of knowledge and understanding and things that you're curious about learning.

Write down at least three to five items. Then you'll be ready to dive into the content. Here are your learning objectives for this recording. Please read over these carefully.

Understand what the purpose and outcome from this should be so that you can determine if you're meeting these objectives. In our society, colon cancer is one of the top five most frequently seen cancers. It is among these others breast cancer, lung cancer, prostate cancer, and melanomas. Tumors of the colon and the rectum are relatively common.

Over 140,000 new diagnoses are made per year. and over 50,000 deaths are attributed to this type of cancer. It is most frequently diagnosed in patients that are between 65 and 74 years old. It does have a familiar tendency. There are a list of risk factors in the textbook.

Among them are cigarette smoking, a family history of colon cancer, High consumption of alcohol as that is toxic to the body. high fat and high protein with a low fiber intake is considered a risk factor having a history of inflammatory bowel disease which causes chronic inflammation and tissue changes including like scarring and that damaged tissue can develop into cancer having a history of type 2 diabetes and being overweight or obese, consider risk factors. The stage at presentation affects the prognosis in colon cancer. If the disease is detected and treated at an early stage before it spreads, the five-year survival rate is 90%. However, only 39% of cancers in this part of the body are detected at this early stage.

Survival rates after late diagnosis are rather low. Most people are asymptomatic for long periods and seek health care only when they notice changes in bowel habits or rectal bleeding. Prevention and early screening are key to detection and reduction of mortality rates. Often benign polyps change into cancerous tumors.

Therefore, if we can scope the bowel and in the process remove polyps, often we can avoid cancers from developing. Prevention begins with addressing modifiable risk factors like weight and obesity, alcohol consumption, and cigarette smoking. Other non-modifiable risk factors need to be monitored for. and to detect changes as early as possible.

So this is where we can start talking about colonoscopy. Polyps can be removed in the process. As I said before, it is recommended that all adults should begin periodic screening for colorectal cancer at about the age of 50, earlier for patients that are higher risk.

Repeated colonoscopies are based on risk factors and what is found in the. previous colonoscopy. For instance, if you have a colonoscopy at age 50 and there are no polyps, then frequently you won't have another colonoscopy for five years.

If, however, you have a colonoscopy and you have one, two, three, five polyps, then you may have a colonoscopy scheduled again for three years or even more frequently, depending on how the findings are. Let's talk a little bit about the procedure for colonoscopy because nurses often have to answer questions or guide patients through this process. It always requires bowel prep.

The bowel must be empty of stool or the scope will not be able to visualize the bowel walls. Prep includes restrictions of certain foods like nuts, seeds, and fruits or veg that have husks or holes on them. Think like corn.

and that's a couple of days prior to the test. The patient will begin a clear liquid diet for up to 24 hours prior to the procedure and must abstain from foods or liquids that have red or purple dyes, as that can interfere with the scope, and it changes what they see inside the bowel. For example, the patient could have an orange flavored popsicle but not grape or cherry.

The same is true for drinks like Gatorade or foods like Jell-O. The patient will have to drink a bowel prep medication that is designed to empty the bowel of solid contents. Generally, the prep is consumed in doses the night before and early on the morning of the procedure. The goal is to have clear or slightly yellow liquid stools. with no solid pieces.

If you are a nurse caring for a patient that's inpatient in a hospitalized setting, then their prep is going to be a little bit different. The patient will still only have clear liquids prior to the test and cannot have red or purple dyes, but it may not be possible for them to have restricted intake of nuts and seeds and hulls in the days prior to the test. prior to their hospitalization. The nurse caring for this patient is responsible to ensure that the stools are clear or yellow liquid before the patient goes to the procedure.

If the patient cannot or will not complete the bowel prep, the procedure may have to be canceled or rescheduled. There's no point in scoping a bowel when there's still stool in there and it cannot really see the bowel walls. Most colonoscopies are done under light sedation, and we need to remember our normal nursing considerations regarding patients being NPO prior to sedation.

and monitoring for recovery from sedation after the procedure. A patient who has a tumor found on the screen colonoscopy should have the tumor biopsied and probably tattooed during the colonoscopy. It'll help facilitate further workup. And the treatment for colorectal cancer depends on the stage of the disease and consists of surgery to remove the tumor, supportive therapy, and adjuvant. therapy.

At this point, I would like you to pause and think and consider the lifestyle considerations that influence the development of cancer. Think about cancers that have a genetic link and think about this statement. Genetics loads the gun, but environment pulls the trigger. The clinical manifestations for colorectal cancer are going to be determined by the location of the tumor and the stage of the disease and the function of that affected segment of the bowel. The most common presenting symptom that patients notice is a change in bowel habits.

This is usually what gets them going to the provider. That or having blood in their stools. The change in bowel habits includes the shape of the bowel, stool, the consistency, and or the frequency of stools. One common change in colorectal cancer is in the shape that it is described as ribbon-like.

This occurs as the stool is forced to pass around a tumor within the lumen of the bowel and thus creates a change in shape, narrowing the normal stool. Patients may also experience abdominal cramping related to stools passing through a partially blocked bowel lumen. A full obstruction can occur if the tumor encompasses the entire lumen, and then all of the signs and symptoms of bowel obstruction will be seen in addition to other possible manifestations related to the cancer itself. The passage of blood in or on the stool is the second most common symptom seen. Symptoms may also include unexplained anemia, anorexia, weight loss, and fatigue.

And those are kind of common in multiple different kinds of cancers. Patients just generally feel fatigued, have some weight loss, don't understand why they don't have their normal energy, perhaps have signs and symptoms of anemia. The symptoms most commonly associated with a right-sided lesion tumor are dull abdominal pain and melanoma. The symptoms associated with a left-sided lesion are a little different. Those are more like having an abdominal bowel obstruction.

So you have abdominal pain, cramping, a narrowing of the stool, constipation, distension, and usually bright red blood in the stool. Symptoms associated with rectal lesions are tenesmus, which is cramping pain in the rectal area, rectal pain, the feeling of unable to really empty the bowels, so you just kind of always feel like there's stool sitting there. And it's not stool they're feeling, it's the pressure of the tumor in that location.

So they just feel like they can't quite empty their bowels completely. And they may have alternation between constipation and diarrhea and possibly bloody stool because the stool passing past that tumor can the friction of it can cause that tissue to bleed. Some of our assessment and diagnostic findings we're going to be asking the patient about prior histories.

We want to know do they have a history of inflammatory bowel disease, Crohn's or ulcerative colitis? Have they had previous scopes? And did they have polyps? What were the results from those other scopes?

Do they have fatigue? Do they have abdominal or rectal pain? Past and present elimination patterns. So has there been a change?

What's normal for you prior to this? What did a regular routine stool look like? How frequently? And you know all of the other things that go with an assessment of that.

There are some genetic conditions that predispose patients to this. We want to find out if they have that connection going on. We want to ask about their dietary intake, their alcohol consumption, and their smoking history.

Ask if they've had unintentional weight loss or if they have complaints of fatigue or pain. We want to auscultate the bowel sounds and palpate for tenderness. distension, and solid masses.

Stool specimens will be inspected for character and the presence of blood. Some laboratory studies that are often done include a CBC, a BMP, liver function test, and tumor marker. A baseline test, the abbreviation for it is the CEA.

all capitalized but it stands for carcinioembryonic antigen and that is specific marker that shows up in the blood related to colon cancers um liver functions we want to know because it may if if their liver function is poor then They may have trouble with some of the treatments like chemotherapies that are often done for these kinds of cancers. These patients may or may not have surgery for their cancers, their tumors. They will almost certainly be referred to a medical oncologist for further management.

Generally speaking, all stages of cancer are usually treated with surgical removal of the cancer, possibly some of the surrounding tissues, and in some instances, the local lymph nodes in that area. Then they may also continue on with other therapies like chemotherapy or radiation. There's a thing called targeted therapy that uses drugs. to target specific proteins that control cell growth and maturation function.

It's malfunctioning proteins that sometimes contribute to the cancer's uncontrolled growth. So if we can target those kinds of cells, those specific proteins, then often that we can slow down the growth of the cancer while the other therapies are kind of doing their thing. and they also have less severe side effects than like chemotherapy.

Immunotherapy is relatively new and it is a way to boost the patient's own immune system to help it Recognize the cancer cells and kill them more effectively so that we let the body do the work of eradicating the cancer, if possible. Think about, additionally, the care of this patient. It's a scary diagnosis, as we saw earlier in the statistics of it. It's fairly common, but it's not.

very well treated once it's advanced. So this can be a frightening time for the patient. They're going to have many concerns and needs and fears.

They may be needing emotional support. They may have concerns about how this is going to change their life and their life expectancy, their ability to perform in their normal roles. It may impact their financial situation. So we want to think about caring for them in that way in addition to providing pre-op care and post-op care.

Pre-operatively, we're going to be looking at similar dietary restrictions to a colonoscopy prep. And all of the normal. pre-op education, informed consent, we're going to have to have an IV and maintain their hydration status and give whatever medications are required. This patient may have an NG tube dissection, especially if the tumor is causing a blockage that the bowel can't move, you know, so it's like an obstruction.

Post-operatively, the patient is similar to nursing care for any abdominal surgery patient. including pain management. We're going to monitor for complications as we do for all surgery. We want to listen to those bowel sounds for returning peristalsis, assess the initial stool characteristics. It is important for these patients to move, okay.

We want to encourage them up out of bed, ambulating if possible. This will help prevent DDTs as well as help accelerate the return of their peristalsis. We're also going to try to help them maintain optimal nutrition, educating them about the health benefits from consuming a healthy diet.

It's going to be individualized to the patient as long as it's nutritionally sound. It doesn't cause them diarrhea or constipation, then it's a good diet for them. After surgery, we're looking also at wound care for surgical incisions and probably a new stoma. We're thinking about pulmonary hygiene with the coughing and deep breathing and so this patient would be needing to have the splinting of the abdomen so they could do their coughing with less pain and less risk of dehiscence.

They are probably going to have some drains that have to be managed. They may still have an NG tube during the early phases of their recovery. Remember that abdominal surgeries have a higher incident of developing paralytic ileus, so we want to be very careful to listen to those bowel sounds and monitor that closely.

The alterations in the way the bowel functions at this point can lead to fluid and electrolyte imbalances. Peritonitis is a possible complication from these kind of surgeries and some of the signs that we would see in that if it was developing would be patients complaining of nausea. Sometimes they develop hiccups. They have chills, they may have elevated temperature, tachycardia, and a board-like abdomen which is super firm and not um you're not going to be able to do it.

palpate like a normal soft abdomen. We're also probably going to be administering antibiotics and fluids. They may have to have surgery if they develop peritonitis and then we're also like I mentioned before watching for dehiscence of the wound and evisceration where the abdominal organs start kind of protruding through this opening.

Surgery is one of the mainstay treatments for colorectal cancer. It can be curative or palliative, meaning that sometimes the purpose of the surgery is to remove the cancerous section. And once the cancer is removed, it's curative.

And then they still may have radiation or chemotherapy to try to ensure that all the cells... that were cancerous are gone because if we leave some behind sometimes the cancer will redevelop. Palliative would mean removing this section of the bowel brings the patient more comfort.

It's not to cure the problem but rather to just make them more comfortable. and it would be hard to believe that having a surgical procedure would help the patient be more comfortable but it is if the situation is that the tumor is blocking and making it more painful and causing a poor quality of life. Sometimes and I'll show it in the next slide there's a procedure that's done that allows the patient to retain the lower end of the GI tract where the sphincter is located and sometimes the bowel is resected, meaning part of it is taken out, and that stump is left in place and sometimes the bowel can be reconnected later and bring the function of the system back. This particular picture shows a resection with a anastomosis.

So in this part, part of the bowel is removed, the part that's damaged, diseased, or has a tumor, or whatever that is, and the two ends are brought together so that the tract is re-established. Now we still have a section missing, so we have a shorter bowel which is going to affect the stools in to some extent. I'm going to bring up the next picture and show you what I was talking about.

All right so this is a culinary section where a stoma is formed. You can see in the before picture there's a diseased section of the bowel that they remove completely and have healthy tissue on both ends. Okay but they're not connected to each other anymore so they'll sew up that stump so that it stays intact, it keeps its blood supply, it doesn't have any function because the stool can't pass through to it because it's now exiting where that part of the bowel has now been brought to the surface of the abdomen and it is exiting out that hole called the stoma.

And so that's where we end up with a colostomy bag attached to catch the stool. In some cases, after a while, it's possible that those two ends can be reconnected and reestablish bowel function without the stoma. Time for another pause and think. I want you to read through these nursing diagnoses and think if they would be appropriate for a patient with a colostomy.

why they would be appropriate. So understand your rationales and think of at least two nursing interventions that would address each of these nursing diagnoses. Alright, so some of the specific nursing care considerations for us as we care for patients like these in the hospital is, you know, the prep. for if they're going to have a scope or if they're pre-op there's preparation for that we have post-op care to give we need to be doing lots and lots of education and we need to be truly caring about what's going on with these patients and what they're going through some special complications that can happen with these kind of patients undergoing these kind of surgeries are ball perforation Partial or complete obstructions, hemorrhaging from incisions internal and external, paralytic ileus, peritonitis, abscesses can happen, they can have mesenteric ischemia because we're messing with the abdominal cavity. It can impair that blood flow as well.

Infection can set in. And then we have the possibility of wound dehiscence and evisceration as well as fistula formation. So make sure you guys review and apply appropriately the post-op assessments that we need to do. This patient may have drains that have to be managed besides the normal IV lines. They're going to have a new ostomy site that has to be assessed and maintained.

They may have an G-tube, they may have a Foley catheter. So there's a lot going on with this patient. There's going to be a lot of lines, tubes, and drains that we're going to be managing.

They're probably going to need their SCDs as well as early ambulation, try to get them up and moving so we can prevent some of those complications. They're going to have surgical incisions and ostomies. They should have a pouch already attached to their ostomy when they come out.

We want to make sure that we monitor the stoma. The stoma, we need to make sure that it stays kind of pink to bright red, and it should look kind of shiny. If it starts looking dull, then it's probably because of a compromised blood flow, and that's a problem.

We're talking about tissue death now when we don't have good blood flow. The patient will need to be taught and the nurse needs to monitor for fecal matter to start coming through. Now remember this patient has been NPO, they had a completely empty bowel going into surgery. So at the beginning there's nothing there, nothing to even come out. But once they start having their diet and advancing their diet, we should start seeing stools 24 to 48 hours after surgery with an ileostomy and three to six days after surgery for a colonostomy, colostomy.

The drainage from an ileostomy is going to be pretty continuous and it's going to be a liquid because the small intestine content is what's draining into that pouch and so it's really important that Because that is rather acidic and liquidy, if it comes in contact with the skin, it can actually damage the skin. So we'll need to measure and collect the drainage, the stool that comes through that. In a minute, I'm going to show you a slide that will talk a little bit more about specific locations and what the stool should look like.

We want to be monitoring I's and O's for this patient. Depending on location of the stoma, there's going to be perhaps more or less water loss as well as electrolytes. Think about what section of the bowel has been impacted, removed, and what its functions should be. And so now that part is missing and that part of the bowel is not going to be able to do its job anymore and so that can impact some of what the output looks like and how the patient feels because the loss of fluids and or electrolytes as far as the psychosocial and holistic concerns go patients may experience some fear and anxiety they're going to have some disturbed body images concerns and maybe sexuality concerns And this is going to impact lifelong dietary changes. Now they will adjust to it, but there still may be some foods that will always give them trouble or that they must always avoid because now they have this ostomy.

Patients also sometimes think that everyone can see it, that everyone knows that they have one, and they may view the stoma as kind of a mutilation. to their system because it's always going to be there. It's a permanent change and it's a loss. So there may be some grief going on.

And remember the stages and continuum that a patient goes through when they're grieving. Our support is really important. Understanding their emotional state, supporting where they're at, helping them to grieve in a healthy way.

are things that we need to do. And consider the fact that, you know, we may have the best intentions to give this patient excellent education. We want to tell them all about the new diet, all about the supplies they're going to need to care for this, so that they can be a rock star in dealing with this ostomy.

But if the patient isn't ready to learn, you're just wasting your time and energy. We need to make sure that the patient is Listening and taking in the information we're giving. We want to be careful not to bombard them with too much information.

And this goes in every situation. This goes when a patient gets a new diagnosis of diabetes or they get a new diagnosis of renal failure. At the beginning, they're going to be a little overwhelmed and they may not be able to hear. You know, they may look like they're listening, they're shaking their head, but it's not registering.

It's not penetrating because the shock of it or the fear may be influencing their ability to really hear you and understand. Patients may have genuine concerns about how this is going to affect their family relationships, their sexual function, whether a woman believes she should or should never become pregnant again. You know, if this happens to a young woman who wants to have a baby, they're going to have questions about how this is going to impact whether I can carry a pregnancy and deliver a baby. Um.

They're going to need to know that someone understands and cares about their concerns. We need to try to maintain a calm and non-judgmental attitude and give them opportunity to talk and then try to give them the resources that they need based on their particular concerns. Sometimes this ostomy represents an illness that's never going to go away. Maybe they have a cancer and maybe now this is just a constant reminder that I have cancer and I have a terminal illness, which can make patients very irritable, anxious, unhappy. So we're kind of the go between for the patient and all these resources that are out there.

We need to know who to reach out for social work. or the wound care ostomy nurse who's going to help them learn how to manage the stoma, a dietitian that's going to help them with the right food choices so that they can stay healthy and manage the stool output. There's a lot of concerns for a patient with an ostomy.

And then patient and family education. Besides all of that, they need to manage the skin and the stoma. They need to be able to understand how to change the appliance. They need to be able to know what it takes to irrigate the colostomy if it has gas mucus and feces that are building up. It can help kind of irrigate that.

There's different locations. We're going to talk about that in a few minutes about like the difference between a colostomy and ileostomy. And then the dietary considerations.

Sometimes older adults have a hard time managing their care because of decreased vision, impaired hearing and difficulty sometimes with fine motor control. They may be helped by getting perhaps someone in the family to help manage that or getting some home health. They need to be taught about monitoring the stoma site and what to look for in complications so that they can get help as soon as possible if something starts going awry. All right another pause and think. These are three additional nursing diagnoses for a patient with a colostomy.

These tend more towards the holistic psychosocial aspects of caring for this patient. So please look at these. Think about if they would be appropriate for a patient in this situation and what kind of nursing interventions would be helpful.

Now we're going to talk a little bit more specifically about the ostomies and caring for them. On this image, you can see a new surgically created stoma. You can see the appliance being put onto, and this is just a picture from a mannequin, like you would do in the simulation lab, practicing putting on the pouching system. And then on the right side. are some of the supplies that are used when patients have an ostomy and we have to put a pouch on it.

Think about ostomy surgery. It really is life-saving because if a patient has an impaired bowel function, they can't pass stool through, without an ostomy, they can't survive. You can't live that way. So even though it's traumatic and there's grieving that goes on with it and there's Huge lifestyle things that have to be adjusted.

It is still something that saves their life and allows them to continue even though there are going to be some changes. Why are some of the reasons why patients might need an ostomy? Disease processes like diverticulitis where the bowel is so damaged including other inflammatory bowel diseases like Crohn's and ulcerative colitis.

Of course, cancers. If paralytic ileus develops for whatever reason, a section of the bowel might have to be removed and a stoma could be created. Cancers, trauma injuries can happen, like say from a motor vehicle crash, obstructions that don't clear up for whatever reason, and vulvulus.

are other reasons why sometimes patients have to have a stoma. So on that note, let's do a little pause and think. Consider that this is a life-saving but life-altering situation and compare and contrast in your mind why a patient would be glad to have an ostomy with the reasons why they might be sad or even angry about having to have one. All right, so here's the slide I told you was coming on the different locations of the stoma so that we can talk about different aspects of the changes in the patient's needs and care if they had each one of these different ones.

So if you look at where the letter A is pointing to, you'll notice that that's the ileum of the small bowel. Okay, when you think about what kind of Well, it's chyme that's coming through that part of the bowel. Remember that after the food bolus goes into the stomach, it's churned, and then it comes out into the small bowel, and it's called chyme.

And as it passes through the small intestines, it is absorbed, the nutrients are absorbed into the bloodstream and sent throughout the body. So that's a very loose and liquidy substance, okay, because it hasn't passed through the large bowel where the water and electrolytes are reabsorbed, which leads to the part of ileostomy that is the biggest nursing consideration. There is a lot of enzymes and acids still in it, and that can cause irritation to the skin if the discharge from this. The drainage from this is in contact with the skin and it's going to have a lot of liquid that normally under a full functioning bowel would be reabsorbed into the body.

So now we have a patient who has a loss of water, loss of fluids, and a loss of electrolytes because they're not being reabsorbed also as they go through the large bowel. So this patient has a higher risk of... electrolyte and fluid imbalances.

B on here on the picture is the ascending colon that is on the right side of the body so it's called a right colostomy. You'll see that it's past the ileum and into the large bowel but not very far into the large bowel which means the output from there is still going to be pretty fluid pretty liquidy. and have a lot of the electrolytes and stuff still in it because it just hasn't passed through far enough to get all that reclaimed by the body.

The one at C is on the transverse colon. That's a transverse colostomy. You can see it's a little further along the system.

A little more of the liquid will have been reclaimed by the body and absorbed, but it's still going to be semi-soft. more fluid. More liquid has been removed, but it's still going to have a pretty soft stool.

D is back inside the small intestines again. This is the jejunum of the small intestines. So this will be very liquid, chyme.

It'll be full of enzymes. It'll be caustic and irritating if it comes into. contact with the skin and because it's not as far along the small intestines it means fewer nutrients have actually been absorbed so this patient would be more likely to have malnutrition as well as dehydration and electrolyte issues and then E is the left-sided colostomy that's looks like it's going into the sigmoid area this stool would be almost normal consistency because by the time the stool passed through the majority of the large bowel, by the time it gets to where that stoma is, it's going to be almost firm as a regular stool would be.

So this one would be the one where the patients would be least likely to have fluid and electrolyte issues. So one of the some of the things that that patients need to be taught is how the ostomy is going to affect their intake and their nutrition and you can see by the different locations of these there's going to be some different advice depending on what this patient's situation is. We're probably looking at getting a good dietary consult and a good visit from the wound care ostomy nurse. There are a lot of resources on the internet. There are websites and YouTube channels dedicated to helping people live with these ostomies.

And so we want to help our patient to see, to find these resources and utilize them as they're getting used to this major change in their life. I would just like to take a minute to talk about patients that have already got an established stoma but they're in the hospital for something else. Okay so you know the likelihood that you're going to take care of a patient that has a stoma is pretty high and it's not just that they came in to get one but they've lived with one maybe they've lived with one for years but now they're in the hospital for XYZ, just name something else.

Okay, they're in the hospital because they have pneumonia. They're in the hospital because they're having a knee replacement. Anything, anywhere in between. If they already have an established stoma, then they probably already do their own self-care.

And so, at the point where they're hospitalized, it kind of depends on how sick they are. If they're there for a knee replacement, then they're otherwise healthy. They're probably just going to manage the stoma on their own unless they're having trouble with pain or other things that are related to the surgery that might make it difficult for them to care for it. But people who are very sick with another problem, like say the pneumonia patient, they might need us to do all the care for it until they get recovered. So we need to ask them.

you know, and see how frequently we need to change the appliance, empty the pouch, and make sure they have any supplies that they need while they're in the hospital. Ask them about what kind of dietary considerations they need us to be aware of and work out an appropriate diet for them so that their care can be complete. Here is an opportunity for you to look at several different kinds of stomas and to start thinking assessment wise. How would you describe these stomas? Which one do you think is a healthy, good-looking, post-op stoma?

And what might be causing the problems in these other ones? So I want you to just kind of think. How would you describe them?

Would you consider them healthy stomas? And what might be causing the problems that you see in them? This is the end of the content.

Be sure to review these learning objectives. Test yourself on this information. If you still have gaps in your knowledge, review this presentation, dig into your textbook, watch videos, and or seek tutoring until you are sure of your knowledge and understanding of this content. Thank you.

Transcript for:Colorectal Cancer and Ostomy Care Essentials

Transcript for:
Colorectal Cancer and Ostomy Care Essentials