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Nursing Care Plan

A Client with Colorectal Cancer


William Cunningham is a 65-year-old retired railroad • Perform colostomy care using correct technique.
employee, husband, and father of three grown children. For • Demonstrate willingness to discuss changes in sexual function.
the past 3 months, Mr. Cunningham has no- • Wear clothing to enhance physical and emotional self-esteem.
ticed small amounts of blood in his stools and occasional mucus. He
has a sensation of pressure in the rectum, and notices that his PLANNING AND IMPLEMENTATION
stools are smaller in diameter, about the size of a pencil. After pal- Ms. Hart plans and implements the following nursing
pating a mass on digital examination of the rectum, the physician interven-tions for Mr. Cunningham.
orders a colonoscopy. A large sessile lesion is found in the rectum • Provide analgesia as ordered, evaluating its effectiveness.
and biopsied.The pathology report shows the lesion to be adeno- • Discuss foods that cause odor and gas.
carcinoma. Mr. Cunningham is scheduled for an abdominoper-ineal • Teach colostomy care.
resection and sigmoid colostomy. • Maintain consistent nursing personnel assignment to
ASSESSMENT facilitate trust.
Madonna Hart, RN, completes the admission assessment. Mr. • Refer to the local United Ostomy Association.
Cunningham states that his bowel habits have recently changed, • Provide a list of local medical supply companies for
but denies pain or other symptoms. Physical assessment ostomy supplies.
findings include T 98.4 F (36.9° C), P 82, R 18, and BP 118/78. • Provide for privacy when teaching and discussing
He is 70 inches (178 cm) tall and weighs 185 lb (84 kg). concerns about ostomy.
Laboratory findings are normal except for the previous pathology EVALUATION
report of adenocarci-noma of rectal lesion. On discharge, Mr. Cunningham is able to empty and rinse out his
Mr. Cunningham states,“I really don’t want a colostomy, but if colostomy pouch. He is changing the pouch and caring for sur-
that is what it takes to get rid of this, I’m ready to get it over with.” rounding skin appropriately.Ms.Hart has given him verbal and writ-
DIAGNOSIS ten instructions on colostomy care. He verbalizes understanding of
Ms. Hart identifies the following nursing diagnoses for Mr. phantom rectal pain, and the importance of avoiding rectal tem-
Cunningham. peratures and rectal suppositories. He expresses an understanding
of the need to avoid heavy lifting, and the importance of follow-up
• Pain, related to surgical intervention
care.Ms.Hart has referred Mr.Cunningham to a home health agency
• Risk for impaired skin integrity (peristomal), related to
in his community for further questions and follow-up care.
fecal drainage and pouch adhesive
• Risk for constipation/diarrhea, related to effects of surgery Critical Thinking in the Nursing Process
on bowel function 1. What is the cause of phantom rectal pain?
• Risk for disturbed body image, related to colostomy
2. Why is it important to discuss dietary concerns with a client
• Risk for sexual dysfunction, related to wide rectal incision,
with a colostomy, especially odor- and gas-forming foods?
radia-tion therapy, and colostomy
3. Outline a plan to teach Mr. Cunningham how to irrigate a
EXPECTED OUTCOMES colostomy.
The expected outcomes specify that Mr. Cunningham will: 4. Develop a care plan for Mr. Cunningham for the nursing
diag-nosis, Body image disturbance.
• Report pain within an acceptable range that allows ease
of movement and ambulation. See Evaluating Your Response in Appendix C.