Nursing Considerations for Bowel Cancer Prevention and Treatment

This report provides a comprehensive overview of nursing considerations in the prevention and treatment of bowel cancer. It begins by addressing the use of morphine for post-operative pain management, emphasizing the importance of understanding its pharmacology, risks, and side effects, particularly respiratory depression. The report then explores non-pharmacological interventions, specifically Benson's relaxation technique, as a method for managing pain and promoting patient comfort. It details the steps involved in this technique and highlights its benefits in reducing anxiety and improving sleep quality. Finally, the report discusses potential risks associated with sigmoid colostomy, focusing on impaired skin integrity. It outlines nursing care strategies for maintaining skin integrity around the stoma, including inspection, cleaning, and the use of appropriate pouches. The report emphasizes the importance of early identification of complications and the implementation of interventions to promote healing and prevent skin breakdown.

BOWEL CANCER
PREVENTION AND
TREATMENT

Table of Contents
INTRODUCTION...........................................................................................................................1
Question 1....................................................................................................................................1
Question 2....................................................................................................................................2
Question 3....................................................................................................................................3
REFERENCES................................................................................................................................4

INTRODUCTION
Question 1
In the given case, Mr. Hemsley has been ordered Morphine for his pain relief post-
surgery. According to Odberg, Hansen and Wangensteen, (2019), Morphine falls in the class of
opioids which are recognized to be central in the management of pain. Bounes (2017) found that
there is conflicting information about these medicines which has accounted for confusion and
fear of prescribing them. Therefore, while administering it to Mr. Hemsley, it is important for the
nurses to understand the pharmacology, risks and side effects associated with it. nurses should
consider the appropriate dosage while administering it to Mr Hemsley. Opioids are known to
cause a number of side effects, of which, respiratory depression is one. As per the study by
Murphy, Bechmann and Barrett (2021), the risk of side effects can be decreased if the nursing
consideration related to dosage is appropriately followed. This needs to be followed by
appropriate monitoring of the symptoms and side effects.
According to Quintero (2017), intra venous dosage of Morphine should be 2- 10 mg slow
IV push q 4 hour prn. This should be repeated after intervals of every 5- 15 minutes. As per the
study by Kliewer (2020), it is important that morphine is injected slowly over a period of 4-5
minutes and the patient should be in recumbent position. Kiyatkin (2019) also found that when
morphine is administered rapidly, it a lead to rigidity of the chest wall. This may be a reason
behind opioid induced respiratory depression. Ayad (2020) state that opioids lead to activation of
μ-opioid receptors at various sites in the central nervous system. This impacts the area in the
pons which is responsible for generating respiratory rhythm.
Odberg, Hansen and Wangensteen, (2019) found that while morphine is a powerful drug
used for relieving pain in the medical settings, but higher doses of it can depress breathing. They
further added that high doses of morphine can lead to slow and shallow breaths which are not
sufficient to sustain life. An episode of respiratory depression is characterized by respiratory rate
< 5 breaths per minute. Murphy, Bechmann and Barrett (2021) found that incidence of
respiratory depression in post- operative patients was due to high doses of opiate. It can be
identified that in order to relive pain in the post – operative patients, it is likely that higher doses
of morphine may be prescribed. However, nurses need to consider that this can lead to episodes
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of respiratory depression which can be fatal. Hence, while administering morphine to Mr.
Hemsley, dosage of morphine is an important consideration.
Question 2
In order to help Mr. Hemsley and managing post-operative pain, relaxation therapy such
as Benson’s relation technique can be used. In accordance with Ibrahim & et.al. (2019) this is a
simple technique which can be used by nurses for managing post-operative pain in patient. This
technique has been considered as one of the most effective technique in context of reducing the
extent of pain. As stated by Szulińska & et.al. (2018) non-pharmacological treatment are equally
important as pharmacological treatment. Often, pharmacological management are associated
with certain side effects. However, non-pharmacological management only assures comfort to
patient. Therefore, it is mandatory to select appropriate technique of non-pharmacological care.
As per the views of Kamal & Herawati, (2019) one of the highly valuable attribute is linked to
learning deep relaxation (From Benson’s relation technique). Thus, this is best therapy for Mr.
Hemsley.
Mirhosseini, Rezaei & Mirbagher Ajorpaz, (2021) Elucidates that major steps that are
involved in Relaxation Response given by Benson relation technique are- Sitting quietly in a
comfortable position, closing the eyes, deeply providing relaxation to muscles of the patient. The
initial must be done with feet and progressing up to the face. The next step is aligned with
breathing pattern. Nurse have to assure a keen focus over breathing pattern of patient during
relaxation. As stated by Metz & et.al. (2020) While breathing out, patient must say “one” in
silent context. This should be done in consistent form for approximately 10-20 minutes. During
this course of action distraction needs to be neglected. Therefore, nurse must assure that Mr.
Hemsley does not face any distraction. The technique needs to be practice on regular basis. This
technique should not be performed within two hours of meal as it impacts the digestion process.
Morad & Farrokh, (2018) found that Benson’s relaxation technique has significant effect
on the intensity of pain. This therapy has a healing effect which is known to decrease the anxiety
level and body discomfort which assists in relieving pain. As per the views of Collier, (2018) this
therapy helps in slowing down breath rate, providing relaxation to muscles that helps in giving
relief from pain to patient. Furthermore, it reduces the high blood pressure. As stated by Chan &
et.al. (2018) positive outcomes of relaxation is aligned with reducing anxiety, reduction in pain
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due to muscular pressure, reduction in pain-related anxiety and improves the quality of sleep.
Thus, this is most appropriate nursing comfort measure for management of Mr. Hemsley post-
operative pain. The major steps of the technique need to be communicate with the patient and
guidance should be provided. As a result, patient experience effective relief from pain.
Question 3
There are certain risks that can occur after performing of Sigmoid Colostomy to Mr.
Hemsley. However, the major risk is associated with the Impaired Skin Integrity. As per the
views of Lichterfeld-Kottner and et.al. (2020) skin protects body from heat, infection and injury.
Issues regarding skin integrity leads to damage the skin. As stated by Gumus, Musuroglu, Ozlu
& Tasci, (2020) Major nursing diagnosis for the given case is related to Impaired skin integrity.
Certain risk that are associated with this diagnosis are, absence of the sphincter in stoma, flow of
the effluent from stoma and reaction towards chemical. Therefore, major nursing consideration is
required in this context. The major goals that are related to providing care in relation of Impaired
skin integrity is aligned with maintaining skin integrity around stoma and promoting healing.
The major nursing care for Mr. Hemsley in this context are inspection of stoma and
peristomal skin area within changing the pouch. The major rationale behind this intervention is
aligned with monitoring healing process and identifying the effectiveness of appliances. As per
the views of Telford, (2020) early identification of stoma necrosis of fungal infection from the
change takes place is normal bowel flora provides time for designing intervention and solving
the complexity. Ulcerated area on the stoma might be from pouch opening is too small or the
faceplate which cuts into stoma. Zelga & et.al. (2021) Elucidates that the area needs to be clean
with warm water. Also, the soap needs to be used only when the area is covered with the sticky
stool. In case, paste has been collected over skin then it should let for dry and then nurse must
peel it off. Maintaining clean and dry area on regular basis helps in preventing skin breakdown.
As said by Ratliff & et.al. (2021) In order to manage the impaired skin integrity nurse
must use the transparent odor-proof drainable pouch as it helps in making easy observation of
stoma without removing the pouch. Cleaning ostomy pouch on routine basis needs to done and
appropriate equipment needs to be used. Changing pouch on frequent basis can be irritable for
Mr. Hamsley. Therefore, it should be avoided by the nurse. Emptying and rinsing pouch within
using proper solution removes bacteria along with this it helps in deodorizes the pouch. Proper
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monitoring in regards to burning and itching around stoma needs to be done as it provides idea in
relation of future threat related to any serious infection.
REFERENCES
Journals and Books
Ayad, S., Demitrack, M. A., Burt, D. A., Michalsky, C., Wase, L., Fossler, M. J., & Khanna, A.
K. (2020). Evaluating the incidence of opioid-induced respiratory depression associated
with oliceridine and morphine as measured by the frequency and average cumulative
duration of dosing interruption in patients treated for acute postoperative pain. Clinical
drug investigation, 40(8), 755-764.
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Bounes, V., Charriton-Dadone, B., Levraut, J., Delangue, C., Carpentier, F., Mary-Chalon, S., ...
& Ganetsky, M. (2017). Predicting morphine related side effects in the ED: An
international cohort study. The American Journal of Emergency Medicine, 35(4), 531-
535.
Chan & et.al. (2018). Clinical efficacy of virtual reality for acute procedural pain management: a
systematic review and meta-analysis. PloS one, 13(7), e0200987.
Collier, R. (2018). A short history of pain management.
Gumus,K., Musuroglu, S., Ozlu, Z.K., & Tasci, O. (2020). Determining the Use of
Nonpharmacologic Methods by Surgical Nurses for Postoperative Pain
Management and the Influencing Professional Factors: A Multicenter
Study. Journal of PeriAnesthesia Nursing, 35, 75-
79. https://doi.org/10.1016/j.jopan.2019.04.011
Ibrahim & et.al. (2019). The effect of Benson relaxation method on anxiety in the emergency
care. Medicine, 98(21).
Kamal, M., & Herawati, T. (2019). The effect of sleep hygiene and relaxation Benson on
improving the quality of sleep among health failure patients: A literature
review. IJNHS, 2(1), 101-7.
Kiyatkin, E. A. (2019). Respiratory depression and brain hypoxia induced by opioid drugs:
Morphine, oxycodone, heroin, and fentanyl. Neuropharmacology, 151, 219-226.
Kliewer, A., Gillis, A., Hill, R., Schmiedel, F., Bailey, C., Kelly, E., ... & Schulz, S. (2020).
Morphine‐induced respiratory depression is independent of β‐arrestin2 signalling. British
Journal of Pharmacology, 177(13), 2923-2931.
Lichterfeld-Kottner and et.al. (2020). Maintaining skin integrity in the aged: a systematic
review. International journal of nursing studies, 103, 103509.
Metz & et.al. (2020). Acute experimental venous thrombosis impairs venous relaxation but not
contraction. Journal of vascular surgery, 71(3), 1006-1012.
Mirhosseini, S., Rezaei, M., & Mirbagher Ajorpaz, N. (2021). The effect of Benson relaxation
technique on general health of patients with multiple sclerosis: a randomized
controlled trial. Journal of Research Development in Nursing and Midwifery, 18(1),
17-20.
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Morad, A., & Farrokh, S. (2018). Pain management. In Essentials of Anesthesia for
Neurotrauma (pp. 447-460). CRC Press.
Murphy, P. B., Bechmann, S., & Barrett, M. J. (2021). Morphine. In StatPearls [Internet].
StatPearls Publishing.
Odberg, K.R., Hansen, B.S. and Wangensteen, S., (2019). Medication administration in nursing
homes: A qualitative study of the nurse role. Nursing open, 6(2), pp.384-392.
Quintero, G. C. (2017). Review about gabapentin misuse, interactions, contraindications and side
effects. Journal of experimental pharmacology, 9, 13.
Ratliff & et.al. (2021). Peristomal skin health: a WOCN Society consensus conference. Journal
of Wound, Ostomy and Continence Nursing, 48(3), 219-231.
Szulińska & et.al. (2018). Non-pharmacological modification of endothelial function: An
important lesson for clinical practice. Advances in Hygiene & Experimental
Medicine/Postepy Higieny i Medycyny Doswiadczalnej, 72.
Telford, A. (2020). Role of the nurse in supporting the safe use of opioids. Nursing
Standard, 35(9), 77-82.
Zelga & et.al. (2021). Patient-Related Factors Associated With Stoma and Peristomal
Complications Following Fecal Ostomy Surgery. J Wound Ostomy Continence
Nursing, 48(5):415-430.
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