Question/Answer: Bowel Cancer, Nursing Interventions, and Patient Care

This assignment addresses a series of questions related to the nursing care of a patient, Mr. Dwight, diagnosed with bowel cancer and admitted to the emergency department and later the palliative care unit. The answers cover various aspects of patient care, including early detection strategies for bowel cancer (FIT and gFOBT), pre-operative education (pressure injuries, DVT, breathing, and pain management), and post-operative care considerations, such as stoma care and management of potential complications. The assignment also delves into the diagnosis and treatment of bowel obstruction, adverse effects of blood product administration and nursing interventions related to fluid and electrolyte balance. Additionally, it discusses the use of a nasogastric tube for monitoring and medication administration, and the importance of palliative care interventions to improve the patient's condition and quality of life. Finally, it addresses potential psychological issues during cancer diagnosis and the evaluation of intervention outcomes.

Running head: QUESTION/ANSWER
Question/Answer
Name of the student
Name of the university
Author’s name

1QUESTION/ANSWER
Q1.
A. Two strategies for early detection of bowel cancer are –
 Faecal immunochemical test (FIT) - Searching for occult (hidden) blood in faeces is one
way of testing for colorectal cancer. The theory of this type of analysis is that blood
vessels are sometimes weak and easily destroyed by the movement of faeces in wider
colorectal polyps or cancers. Usually, the weakened arteries leak into the colon or rectum,
but there is only occasionally ample bleeding to see blood in the faeces. Often known as
an immunochemical faecal occult blood test (iFOBT) is the faecal immunochemical test
(FIT). It is checking in the bowel for latent blood. This analysis responds to some of the
protein in human haemoglobin present in red blood cells (Martin et al. 2017, pp. 93-e1).
 Guaiac-based faecal occult blood test (gFOBT) - The guaiac-based faecal occult blood
check (gFOBT) utilises a chemical process to identify occult (concealed) blood in the
faeces in a different manner than a FIT. Annually, this review must be done (Benito et al.,
2019, pp. 327-334).
B. There are several reasons that why the patients are not able to access the bowel screening
services. According to few studies, it has been observed that the patients are generally afraid
during the bowel preparation and it has been considered as the most significant reason for
people not accessing the services. It has also been seen that due to the lack of appropriate
physician advice, people are not aware fail to access the screening services (Honein-
AbouHaidar et al., 2016). Two significant barriers to accessing the screening tests for bowel
cancer are -
 Demographic factors such as the lack of health insurance, class, and race.

2QUESTION/ANSWER
 Inaccessibility to healthcare services and inadequate colorectal cancer screening
awareness centres.
Q2.
A. In addition to reducing the risk of post-operatory problems, pre-operative awareness is also
necessary to enable the patient to participate actively in their rehabilitation and to assist them
in maintaining composure throughout a period whenever they feel like things are out of grasp
(Sarbaz, Naseri, Ahmadi Simab & Abazari, 2016, pp. 33-42). Four essential pre-operative
topics of education which should be taught to Mr Dwight are –
 Pressure Injuries
 Deep Vein Thrombosis (DVT) Risk Reduction
 Deep Breathing and Coughing
 Pain Management
B. In order to approach this kind of education that will help in increasing the pre-operative
awareness, Mr Dwight will be taught about the importance of doing physical exercise in the
legs and hips and before the surgical procedure to reduce or avoid the sensation of the pain.
Also, the nurse should educate Mr Dwight about the value of sterilising the medical
instruments with the aid of audios and visuals to prevent contamination when explaining the
reasoning of why this procedure is essential to the patient. The specific two education
strategies are -
 Deep Vein Thrombosis (DVT) Risk Reduction - To reduce the likelihood of DVT
growth, patients will also be trained in bed related to the leg exercises and in the
advantages of early mobility (where feasible) (Haig et al., 2016, pp. e64-e71).

3QUESTION/ANSWER
 Pressure Injuries - Patients also need to be trained preoperatively on the risks of stress
injury and how this threat can be minimised by frequent adjustments in the position
(Geistkemper, Murphy, Fleming, Lawrence, Silvestri & Hernandez, 2018, p. 3024435).
C. The effectiveness of education can be evaluated by observing the improvement in the
condition of the patient and observing the vital signs.
Q3.
A. When a problem with skin takes place wherein the stoma device is connected, pain and
itching also manifest and the device is hard to affix. Furthermore, preventive care should be
carried out to avoid skin problems. Surface findings around the stoma that are alerting to
postoperative issues are (Berti-Hearn & Elliott, 2019, pp. 68-78) –
 Abnormalities of the surrounding skin include redness (erythema)
 Maceration and erosion
 Hypopigmentation
 Ulcer and papule
B. When the skin problem arises in the stomal region, the skin may be cleaned with detergent by
moisturising and bubbles to mask the smudge. Then, clean the detergent ingredients with
enough warm water. Wipe the surface 3-4 times with a nonwoven cloth or soft tissue,
immersed in warm water, if the detergent is difficult to wash off (Berti-Hearn & Elliott,
2019, pp. 68-78).

4QUESTION/ANSWER
Q4.
A. Malignant blockage of small-bowel happens most of the time at the duodenum point due
to external pressure or overt tumour attack. The most specific cancers that cause duodenal
obstructions are pancreatic adenocarcinoma, cholangiocarcinoma and gallbladder
carcinoma (Ozturk et al., 2018, pp. 1-8).
B. Three signs/symptoms that indicate a bowel obstruction are (Ozturk et al., 2018, pp. 1-8)
–
 When there is an obstruction in the bowel, it causes a hindrance during the
passage of the stool.
 There is also a little bit of expansion in the intestine and air is swallowed, which
lead to the obstruction of the bowel.
 If there is a proximal obstruction in the bowel, it leads to the vomiting.
Q5.
A. The adverse effects that might be observed when administering blood products are
(Frazier, Higgins, Bugajski, Jones & Brown, 2017, pp. 271-290) –
 Urticarial reactions, hypothermia, iron accumulation and bacterial contamination
 Bronchospasm is also seen in some people who were transfused with different
plasma proteins.
 There is also a chance of bacterial contamination or severe conditions like AIDS
if unsterilised instruments like needles are used or used needles are used on
another person.

5QUESTION/ANSWER
 There is also a slight chance of hypothermia with also a chance of the occurrence
of the iron when there is a rapid transfusion of blood in a person (Benson et al.,
2014, pp. 1028-1059).
B. The standard 7 of the NSQHS enables the healthcare professionals of a healthcare
organisation to incorporate various kinds of healthcare models to guarantee the secure,
suitable, well-organized and effective use of blood products. The healthcare staff
members must use blood products according to the safety system guidelines (Flanigan,
2016, p. 23). It is the responsibility of the healthcare staff members or the registered
nurses specifically to take actions when they suspect that there is an adverse reaction due
to blood product transfusion. There are specific steps which can be taken (Kramer,
Zaaijer & Verweij, 2017, pp. 32-43) -
 Separating the transfusion
 Replacing it with a new I.V. and hydrating the patient with 0.9% NaCl solution
 The vital signs should be monitored
 Maintaining intravenous access
 Checking again that right blood bag has been given to the right patient
 Finally, the senior healthcare staff members should be notified about the critical
situation for further support.
Q6.
A. To view and continuous monitoring of the intestine of Mr Dwight, the nasogastric tube
has been inserted. The NG tube helps in a quick dissolution of the drugs and nourishment
which helps in the improvement of the health condition, and the nourishment of the
patient are met with following requirements of the patient (Gomes et al., 2015). NG tube

6QUESTION/ANSWER
is a bi-functional instrument as it is used in both diagnoses and also in the treatment
procedure. Through the help of the NG tube, healthcare professionals can diagnose the
patient's health condition, administer medications, and provide nourishment (Gomes et
al., 2015).
B. The layout of the nasogastric tube is critical for different reasons for patients. Another
theory is that the tube should discharge the patients ' stomach fluid and air content. Those
with stomach or intestinal disability must have their NG tubes positioned correctly to
prevent the patient from accessing the stomach product. Health caregivers can test the
patient's NG tube structure by performing an X-Ray chest (Gomes et al., 2015). Perhaps
this technique provides the most suitable approaches with testing the NG tube structure.
For the most part, the technique is used as patients with gulping issues for in fuddled
patients and those in the Intensive Care Unit. The health care provider uses the X-beams
in the upper portion of the stomach area of the recipient, searching for a tumultuous white
line under the stomach on the left-hand side (Gomes et al., 2015).
Q7. Two clinical problems that could occur for Mr Dwight during his admission to the ED
concerning fluid and electrolyte balance are –
 There are times when the patient does not feel like eating or do not feel hungry, and
thus this makes the healthcare staff members careless, and they ignore the health and
diet pattern of the patient. These create an issue which is that not having proper diet
leads to deterioration of the health and decrease in the patient weight, and problem in
the vital signs.
 Food is generally provided to a patient to maintain the physical weight and health.
Though, it can be dangerous if solid food is being provided, as it can choke the

7QUESTION/ANSWER
patient and lead to the death of the patient (Barbieux, Plumereau & Hamy, 2016, pp.
31-38).
Q8. To take proper care of Mr Dwight, the safety of the health condition of Mr Dwight will be
based on the instructions provided from the senior healthcare members handling the case of Mr
Dwight and maintain the proper health plan to be highly efficient and accurate in the provision of
proper medications at proper time, and it will also lead to the development of the professional
skills (Valeri et al., 2014, pp. 469-483).
Q9. In terms of the health conditions of the patient, the nursing interventions that could be
provided to Mr Dwight to enhance the patient's condition are –
 Experimenting with different food sizes and prescribe olive oil instead of regular oil in
the diet might be helpful. The multiple serving sizes given by the nurses are appropriate
for the patient, which helps in enhancing their mental and physical health. The consumer
may be highly likely to be overwhelmed by the regular size of the food, and therefore, the
appetite is gradually increased.
 It is seen that olive oil's varying health benefits can be used to cook plates instead of
regular household oil. The olive oil omega-three fatty acids reduce the likelihood of
cancer and help kill cancer cells in the patient's body.
Q10. The methods that can evaluate the outcomes for interventions delivered to Mr Dwight
during the palliative care are –
 Analysing and assessing health improvement in the medical condition of the patient.
 Nursing professionals should continuously evaluate the interventions because of the life-
threatening condition the patient has.

8QUESTION/ANSWER
Q11.
A. Various issues can occur during the cancer diagnosis procedure. Majority of the issues
occur in two different types –
 Anxiety, mood alterations or mood disturbance and fear of reappearance are some
psychological issues that occur during the cancer diagnosis procedure.
 Other issues are varying perceptions and concerns related to the body image that
can hamper the communication due to depression.
B. The healthcare providers must address these psycho-social issues as these issues become
a crucial barrier during the diagnosis and treatment of the cancer disease, which makes it
hard for healthcare providers to manage it.

9QUESTION/ANSWER
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10QUESTION/ANSWER
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11QUESTION/ANSWER
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