Asuhan Keperawatan pada Kanker Kolorektal

Diagnosa 1 : Deficient knowledge related to insufficient information

NOC NIC
Knowledge: Cancer Management
Knowledge: Cancer Threat Reduction
Knowledge: Treatment Procedure
Information Processing

Outcomes: 1. Patient verbalizea understanding of disease process

2. patient verbalizes understanding of proposed diagnostic and surgical

procedures

Intervention:

1. Teaching: Disease Process

2. Teaching: Preoperative
3. Teaching: Procedure/Treatment

Interventions
Kaji pengetahuan tanda dan gejala kanker
kolon secara umum
Kaji pengetahuan kebutuhan prosedur
diagnostik
Kaji pengetahuan metode pengobatan dan
hasil tepat yang diusulkan
Rationales
Karena banyak kanker kolon are advanced
by the time of diagnosis, patients may feel
guilty about not having sought treatment
sooner
The patient

Diagnosa 2 : altered bowel elimination: postoperative ileus related to manipulation of bowel

during surgery

Diagnosa 3 : Risk for infection

Diagnosa 4 : deficient knowledge: postoperative

Kanker Kolorektal

Pengkajian

Data subjektif:
Mual
kehilangan selera makan
nyeri abdomen bagian atas, kram
kelemahan umum
merasa defekasi tidak tuntas

Data objektif:
Nyeri abdomen
Perubahan kebiasaan defekasi
Konstipasi dan diare bergantian
Ikterus
Kolon sebelah kanan terkena: anemia, perdarahan GI, penurunan berat badan
Kolon sigmoid: obstruksi, darah per rektum
Kolon sebelah kiri terkena: lendir dalam feses, konstipasi, ukuran feses menurun, darah atau
darah bercampur dengan feses, muntah
Rektum: perdarahan rektum, diare berlendir, tenesmus

Pemeriksaan diagnostik
Pemeriksaan rektum digital
Hitung darah lengkap
Panel elektrolit
Panel koagulasi
Pengujian darah samar
Penanda tumor serum, antigen karsinoembrionik (carcinoembryonic antigen, CEA)
Pencitraan/ pemeriksaan kedokteran nuklir:
- Seri gastrointestinal bagian atas/ bawah
- Duodenoskopi dengan biopsi
- Seri abdomen
- Pemeriksaan kontras barium
- Sigmoidoskopi/ kolonoskopi dengan biopsi

Penatalaksanaan terapeutik
1. kolaborasi dengan ahli diet klinis untuk merencanakan diet yang sesuai dengan penyakit
2. cairan dan nutrisi parenteral
3. dekompresi/ aspirasi nasogastrik/ usus
4. panatalaksanaan nyeri
5. agens kemoterapi
6. terapi radiasi, imunoterapi
7. intervensi pembedahan (reseksi usus, ostomi, reseksi abdominoperineal)
8. wound, ostomy, continence/ ET nurse
9. layanan sosial; kelompok pendukung terapi enterostoma

Studi kasus
Patient profile. L.C., a 58 tahun native american man, is from a Pueblo tribe in northern New
Mexico. L.C.’s wife and family drove 50 miles to take him to the Indian Health Service Hospital
because of his deteriorating health.

Subjective data:
- Complains of bright red bleeding during a bowel movement
- Family states that he has become thinner over the past several months and has little
appetite
- Describes feeling weak and being easily fatigue; he appears ill
- Complains of abdominal pain and a feeling of fullness
- Has episodes of constipation followed by diarrhea
- No prior screening for colorectal cancer; family history of colorectal cancer is unknown

Objective data:
Physical Examination
- Temperature 38ºC
- Heart rate is 110 beats/min; BP is 120/74 mmHg
- Weight 63.6 kg; height 172.5cm
- Mild palpation over transverse and descending colon elicits pain
- Digital rectal examination reveals a maa
Laboratory test
- Colonoscopy shows two medium-sized tumors in the transverse colon
- Hematocrit: 26%
- Hemoglobin: 9 g/dL