Asuhan keperwatan pada colon

obstruktif (Ca colorectal)

Arranged by. Ns. Christina Y

 Ca colorectal

• Kanker usus besar dan rektum, juga dirujuk sebagai

kanker kolorektal ( colorectal cancer)
• dapat menyerang dan merusak jaringan-jaringan dan
organ-organ yang berdekatan. Sel-sel kanker juga
dapat pecah dan keluar dan menyebar pada bagian-
bagian lain tubuh (seperti hati dan paru-paru)
dimana tumor-tumor baru terbentuk.
 Tanda

• Tanda-tanda Ca Colorektal tergantung pada

letak tumor. Tanda-tanda yang biasanya
terjadi adalah :
– Perdarahan pada rektal
– Anemia
– Perubahan feces
• Hal pertama yang ditunjukkan oleh Ca
Colorectal adalah :
– Rectal /vaginal toucher.
– teraba massa
– pembuntuan kolon sebagian atau seluruhnya
– perforasi pada karakteristik kolon dengan distensi
abdominal dan nyeri
 Staging DUKES yang dimodifikasi oleh Aster
Coller (1954).

• Stage A: lesi terbatas pada mukosa.

• Stage B1: belum menembus muskularis propia.
• Stage B2: Sudah menembus muskularis propia.
• Stage C1, C2 :adalah type B1,B2 dengan KGB(+)
• Stage D: metastase jauh.
 Diagnostic
• Lab : DL (Hb, dll)
• Hasil tes Gualac positif untuk accult blood pada feces
memperkuat perdarahan pada GI Tract
• sigmoidoscopy dan colonoscopy.
• enema barium  memperjelas keadaan tumor dan
mengidentifikasikan letaknya, kebuntuan pada isi perut,
lumen <
• Computer Tomografi (CT scan)  memperjelas adanya
massa dan luas dari penyakit. Chest X-ray dan liver scan
 susp metastase jauh
 Manajemen
• Radioterapi
• Kemoterapi
• Reseksi colon dgn atau tanpa Colostomi
 Tindakan bedah Ca colon
• Kolon kanan : hemikolektomi kanan.

• Kolon tranversum :tranverse kolectomi.

• Kolon kiri : hemikolectomi kiri.

• Sigmoid : reseksi sigmoid.

 Masalah keperawatan

• Nyeri akut
• Ketidakefektifan koping keluarga
• Ketidakseimbangan nutrisi : Kurang dari kebutuhan
tubuh
• Ketidakberdayaan
 Colostomy
• Colostomy creation is surgery that brings part
of your colon (bowel) to the surface of your
abdomen. This creates a small opening in your
abdomen called a stoma. Bowel movements
pass through the stoma and into a pouch that
is attached to your abdomen.
 Why do you need a colostomy?
• Colostomy creation is often done with surgery
to remove parts of your colon that are
injured or diseased.
• You may need a colostomy for conditions such
as colorectal cancer, diverticulitis, or
inflammatory bowel disease (IBD). Trauma to
the abdomen may also require a colostomy
How long will you need a colostomy?

• A temporary colostomy can last from weeks to years.

After your colon heals, another surgery closes the
stoma and rejoins the sections of your colon. You will
have normal bowel movements after the colostomy is
closed. Sometimes a temporary colostomy needs to
become permanent one.

• A permanent colostomy will last a lifetime. You may

need a permanent colostomy if parts of your colon
have to be removed. A permanent colostomy is also
done when parts of your colon no longer work.
 Types of colostomies include
• Ascending colostomy: The stoma is placed on the right side of your
abdomen. Liquid bowel movements pass through the stoma.

• Transverse colostomy: The stoma is placed in your upper abdomen

on the middle or right side. Bowel movements that pass through
the stoma are loose or soft. Sometimes you will have 2 stomas next
to each other. This is called a loop colostomy. One stoma will pass
bowel movements and the other one may pass mucus.

• Descending or sigmoid colostomy: The stoma is placed on the

lower left side of your abdomen. Firm bowel movements pass
through the stoma.
• Loop Stoma or Loop Ostomy
• A loop stoma is a stoma where both the upstream (proximal)
and downstream (distal) openings of the bowel are brought
out through the same place in the abdominal wall (see photo
A). The proximal opening of the stoma drains stool from the
intestine, while the distal opening of the stoma (the mucous
fistula) drains mucus from the part of the bowel that leads to
the anus (or internal pouch).
• a double-barrel stoma is where two distinct stomas
are made and brought through the abdominal wall.
The stomas may or may not be separated by an
expanse of skin (see photos B and C). As with loop
stomas, one stoma is usually called the proximal
stoma, while the other is called the distal stoma.
• end stoma. Compared with a loop stoma and
a double-barrel stoma, an end stoma has only
one opening