Signs and symptoms of bowel cancer and its risk factors

(1) Back pain: Mr Dwight might have been experiencing pain in the abdomen as indicated in the history. At times the symptoms of cancer might fail to show until it gets to spread to all the other parts of the body including the bones of the spine. Mr Dwight is experiencing pain in the abdomen a clear indication of discomfort at that part of the body. The pain is normally a discomfort or bloating that is experienced after taking a meal. This may lead to a reduction in the food consumed by the patient and even culminate in loss of body weight (Olsson, 2017).

Loss of weight: As a result of the pain felt in the abdomen, Mr Dwight might have found minimal comfort in eating due to fear of bloating. Still, Mr Dwight might be taking a very low quantity of meals. Either of these results in limited nutrients into the body and hence loss of body weight. At other times, Mr Dwight might not just be feeling hungry hence decided to forego his meals. This would still lead to a significant drop in the weight of the body.

(2) This is a condition in which the end of the ileum is dislodged out o the abdomen and stitched onto the outer surface of the skin to form a stoma. Colostomy is another type of stoma which could be formed after a colectomy. It is achieved when there is any section of the large colon attaching to the small colon. An open hemicolectomy is a surgical process that involves the removal of the caecum, the hepatic flexure, the ascending colon, the first third of the transverse colon as well as a section of the terminal ileum together with fats and lymph nodes (McLatchie, 2013).

It is a treatment that is used for surgical treatment of malignant neoplasms of the right colon.

The surgical procedure for hemicolectomy with the formation of a colostomy involves colostomy formation which is to form an opening or a stoma stitched to the outer surface of the skin. The procedure of the operation is as follow;

A hole is made through the wall of the abdomen

Stitching the upper end of the colostomy (when making an end colostomy)

Removal of the other end/ closing it by the use of a tape

The surgeon may as well decide to form a loop colostomy. Under such a circumstance, the skin surface will have both the downstream and upstream ends stitched to it.

Anatomy and physiology of colostomy and surgical procedure

(3) Old age: People aged above 50 years are found to be at higher risks of contracting bowel cancer compared to those younger than 50. With an increase in the age of an individual, the cell DNA damage tends to increase. The damage can result from some biological processes that are occurring the body of the individual or due to exposure to the risk factors (Yeo, 2012).

A family history of bowel cancer: Up to a third of bowel cancers can result from a variation or fault in one or more genes. The mutant genes can easily be passed from one generation of the family to another. In cases where one has the changed gene, risks of contracting bowel cancer become high at a point in the life of the individual. However, it is not clear which genes take part in the transmission of bowel cancer. Research has established that up to 5% of the cases of bowel cancer are directly associated with the genetic mutation. Some of the genetic conditions include MUTYH Associated Polyposis, Lynch syndrome and Familial Adenomatous Polyposis. The risk of developing bowel cancer among individuals with any of these conditions is high and may be diagnosed with the disease at tender ages.

(4) The normal blood sugar level is not static but fluctuates throughout the day in individuals. While fasting, the normal blood sugar level should for the case of non-diabetic individuals range between 3.9 and 5.5 mmol/L which is 70 to 100mg/dL. The mean normal level of blood glucose in the human body is approximately 5.5 mmol/L. 

 Mr Dwight’s blood sugar level reading is 22mmol/L. This is higher than the above normal sugar level in adults which is 20mmol/L. in this regard, Mr Dwight could be suffering from moderate to severe high blood pressure symptoms (Ruhl, 2017). Such symptoms may include extreme thirst, flush, dry skin, blurred vision, restlessness, or difficulty to wake up. In case Mr Dwight’s body is producing little or no insulin at all, he could be suffering from either diabetes 1 or diabetes 2. Should that be the case, he could be having such symptoms as vomiting, rapid, depth breathing, pains in the belly, vomiting, weak pulse, false heart rate or even loss of appetite as well as a strong fruity breath smell. Some of these symptoms were noticed in Mr Dwight.

Among the interventions that can be used to address Mr Dwight’s diabetes include eating food containing less calories, engaging in regular physical exercise in order to improve the sensitivity of the cells to insulin, seeking medical intervention and avoiding both physical and mental stress as these release stress hormones which lead to a rise in the level of blood sugar (Ruhl, 2017).

Nasogastric tube and its routine checks

(5) A nasogastric tube is a tube used in conducting food and medicine from the source to the stomach via the nose. Dwight uses the tube for feeding. Upon arrival at the hospital, Dwight confesses that he has not eaten for quite some time and this could be attributed to the discomfort he feels when he eats due to bowel cancer.

The routine checks when a patient has nasogastric tube in the body are among them; Taking note of the measurement-This involves ensuring the tape is the correct length of the tape as required. This is done to ensure the tube has neither slid nor moved farther to an extent is not supposed to. It is possible that the tube might not have been correctly placed or the patient changed his position thereby displacing the initial position of the tube. The check is done through auscultation (Cresci, 2016).

Checking the pH-The pH of the contents of the tube also require continuous monitoring to ensure its at the recommended values. A pull back on the syringe gives the gastric contents which can be used to do a pH test in case testing strips are available.

Performing a chest x-ray-This is known to be the standard used in the establishment of the positioning of the tube.

(6) PH checks are done to establish the level of acidity in the stomach of te patient. The normal pH value should not be more that four but this may change depending on the types of drugs the patient is on. The pH value may range between 4 and 6 in case the patient is one drug that are inhibiting acids. Litmus paper is not used in conducting this test since it cannot establish the actual levels of the activity in the body. In case the pH values have not given the expected or normal results for example values higher than 5.5 or in cases, the patient is found to have become unconscious, the initial position of the nasogastric tube is established (Cresci, 2016). This is done through an x-ray.

Regular checking of the position of the nasogastric tube is important as it would help in establishing if it is possible to pull out the tube partially when the patient moves or when the tube is tugged by a confused patient. Upward dislocation upon vomiting or coughing can change the position of the tube. Still, a faulty initial placement may lead to incorrect positioning or placement of the tube. Correct or proper placement of the tube would ensure effective feeding by the patient.

BGL and diabetes interventions

(7) There exist emotional, spiritual, social and psychological needs that patients with palliative care need. The social needs are informative to the caregiver and provide him with an understanding of the social and cultural perspective of the patient. By assessing the social needs, it is possible to understand the patient in the cultural and social context thereby helps in guiding care plans for the patient. Social assessments are done by nurses who would like after that make the necessary arrangements for referral in the cases where there may be nee for comprehensive assessment and special support. By assessing the social needs of the patient, it would be possible to provide enough support should issues arise including anxiety, concerns or distress. These needs can then be assessed by the recommended healthcare professionals or a general healthcare provider as dictated by circumstances.

An understanding of the social needs of Mr Dwright would also help the care providers in understanding the family background and what he believes in. This would provide an easy time to the caregivers while attending to him. Patient-physician conflicts that may arise due to lack of an understanding of the patient would be eliminated (Dodds, 2013).

(8) Assessment item on pain and an item on high-risk medication. An assessment of pain would be conducted to ascertain the quality of pain the patient is feeling. Mr Dwrght has reported abdominal pain that causes him discomfort that even prevents him from taking his meals regularly. This assessment would be able to help the caregivers rate the pain experienced based on the intensity and the interference. Depending on the outcome of the intervention, the level of interference with the body by the pain would be established of which is already clear that it causes him his life enjoyment (Giddens, 2016).

High-risk medication assessment would monitor and assess the most probable risks that Mr Dwright would be exposed to in case he is put on high-risk medication. Through this assessment, the hospital will be able to establish the impact that high-risk medication would have on the patient and hence make an informed decision whether to administer such medication or not.high-risk medication drugs are those drugs that may subject the patient to high risks thereby able to result into significant harm to be the patient should they not be used correctly. The consequences of any errors made in the use of such drugs are devastating to the patient.

Importance of assessing social circumstances in palliative care

(9) The medication prescribed for Mr Dwright in the palliative care unit for pain is 50g of Pethidine that is to administer four times a day. Pethidine is a narcotic analgesic that is associated with multiple actions which have the same properties as morphine medication route for the drug is through injection. Pethidine relaxes the muscles and is sedative at the first stage of pain or labour. The drug works by inhibiting the receptor of pain from reaching the brain, and the effect is felt for about 15 minutes after the time of having a jab. After 30 minutes of administration, the full effect of the drug is felt which lasts for up to 4 hours. The medication is the right one for Mr Dwright. It helps in the relaxation and coping with a strong contraction of the muscles but does not come with a numbing effect (Calvey, 2012). This allows the patient to move around even after administration. Among the side, effects/ complications of the medication include vomiting, dehydration, sepsisscikle cell crisis and dyspnea. Serious adverse effects may include depression of the circulatory system, shock, respiratory depression, cardiac arrest and apnea besides a lesser degree.

(10) High blood sugar level: Mr Dwright is found to be having a blood sugar level is above the normal range. His blood sugar level is found to be 22 mmol/L. Such a high blood sugar level has devastating health effects on the patient and may lead to such conditions as loss of consciousness or impaired mentality. The condition is attributed to the failure of insulin hormone to break down the excess sugars in the body thereby leading extra accumulation of the substance (Aghababian, 2011).

Abdominal pain: This is a symptom of bowel cancer. Abdominal pains have significantly contributed to poor health in Mr Dwright. Ranging from the discomfort to preventing him from taking his meals usually, abdominal pains form an integral part of the findings of the clinical assessment. Mr Dwright is unable to move freely, has to strain to get the nutrients into his stomach due to this condition.

(11) High blood sugar level: Mr Dwright is found to be having a blood sugar level is above the normal range. His blood sugar level is found to be 22 mmol/L. Such a high blood sugar level has devastating health effects on the patient and may lead to such conditions as loss of consciousness or impaired mentality. The condition is attributed to the failure of insulin hormone to break down the excess sugars in the body thereby leading extra accumulation of the substance.

Clinical assessment findings in the emergency department and palliative care

Abdominal pain: This is a symptom of bowel cancer. Abdominal pains have significantly contributed to poor health in Mr Dwright. Ranging from the discomfort to preventing him from taking his meals usually, abdominal pains form an integral part of the findings of the clinical assessment. Mr Dwright is unable to move freely, has to strain to get the nutrients into his stomach due to this condition (Smith, 2013).

(12) Among the nursing diagnoses that can be used in the diagnosis of Mr Dwright include interviews, questionnaire and physical examination. The nurse, using his skills and expertise in nursing would observe the notable symptoms in Mr Dwright that would indicate deterioration of his health status. Mr Dwright can talk despite his medical condition. The nurse may, therefore, engage him in discussions that would enable access to his clinical history. Through an interview, the nurse would be able to access first-hand information from the patient at the same time building on the patient-doctor relationship. The discussion should only be about information that the nurse finds relevant in the understanding and after that establishing a care and treatment plan for him. Questionnaires may be used to get information on what the nurse may feel the patient may not be free to share and is more comfortable writing it. The level of confidentiality of any of the information sought must be highly maintained and should there need of sharing it should be at the discretion of the patient (International, 2012).

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