Case Study: Integrated Nursing Practice for Bowel Cancer Patient

This nursing assignment focuses on the care of Mr. Dwight, a 75-year-old patient with bowel cancer undergoing palliative care. The report discusses the signs and symptoms of bowel cancer, the anatomy, physiology, and necessity of Hartman's procedure, and risk factors associated with the diagnosis. It...Read More

Nursing assignment

Table of Contents
1 Patient background and signs and symptoms of bowel cancer along with the diagnosis.......2
2 Anatomy, physiology, and necessity of Hartman's process....................................................2
3 Risk factors that may contribute to Dwight's diagnosis of bowel cancer...............................3
4 Four signs of bowel obstruction..............................................................................................4
5 Normal BGL level for adults and the intervention process for the development of BGL......4
6a. Clinical use of blood and blood products for the patients of bowel cancer.........................5
6b. 7 standard of NSQHS. Four required actions to ensure safety and administrate blood
products......................................................................................................................................5
7a. Why does Mr. Dwight require a nasogastric tube? 5
7b. requirement and implementation of routine check...............................................................6
8 Identification and discussion on clinical priority for Mr. Dwight..........................................6
9 SMART framework for one short-term goal of the clinical priority......................................6
10 Two interventions to achieve a short-term goal....................................................................7
11Two methods to evaluate and justify outcomes.....................................................................7
12Two risk factors associated with chemotherapy with evidence.............................................8
Reference List............................................................................................................................9
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1 Patient background and signs and symptoms of bowel
cancer along with the diagnosis
Mr. Dwight has been diagnosing with bowel cancer over the last few months. As per the
opinion of the Ambulance officer, Mr. Dwight was vomiting frequently. Moreover, he had
symptoms of kenotic breathing and type2 diabetes. He has also left eating and drinking over
the past few days and was found weak before he was taken to the local healthcare
organization. The bowl cancer treatment of Mr. Dwight was going through Hartman's
procedure with colostomy formation. The symptoms of heart problem were also identified
with the blood glucose level of 22mmol/L.
The signs and symptoms of bowel cancer include the change in normal bowel motion; for
example frequent diarrhea and constipation problem (Rutter, Nickerson, Rees, Patnick, &
Blanks, 2014). Moreover, a feeling of unemptied after a full motion, stomach fullness,
unusual weightless and breathlessness are also the diagnosis symptoms for bowel cancer.
Apart from that, rectal bleeding and bleeding stools are significant symptoms of bowel cancer
(Rutter, Nickerson, Rees, Patnick, & Blanks, 2014).
The symptom of rectal bleeding can be diagnosed through the rectal exam, anemia, and stool
sample testing. CT scan and MRI scan can also be prescribed for the diagnosis process of
bowel cancer (Rutter, Nickerson, Rees, Patnick, & Blanks, 2014). The application of
Hartman's procedure is a useful technique to promote the diagnosis process of rectosigmoid
Colon. As per the case study, Mr. Dwight's bowel cancer has been diagnosed with Hartman’s
process.
2 Anatomy, physiology, and necessity of Hartman's
process
Anatomy: Anatomy defines the structure of Hartman's procedure. The proctosigmoidectomy
includes the Hartman's procedure. A midline incision is made with the number 10 blade and
turns the blade into umbilicus. This umbilicus results in cosmetically incision. The
cosmetically incision qualifies the rectosigmoid colon through anorectal stamp to mitigate the
colostomy. Hence, this helps in nullifying the symptoms of bowel cancer (Llosa et al., 2015).
However, skin irritation is the most notable side effect of Hartman's surgery (Sinha et al.,
2014).
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physiology; The physiological areas that are concerned about Hartman's process are uterus to
avoid complication, excessive bleeding from pelvic plexus, splenic issues and traction on the
liver (Garcia-Allende et al., 2014). The traction of the liver results in unusual venous
bleeding. The Hartman’s treatment process has been followed while diagnosing Mr. Dwight
to avoid the complication of the splenic injury.
Necessity; The Hartman’s operational process is generally used to eliminate the colorectal
mucosa that promotes the growth of bowel cancer (Llosa et al., 2015). Additionally, this
process is helpful in preserving the postoperative bowel to nullify the complications in the
anal route.
3 Risk factors that may contribute to Dwight's diagnosis
of bowel cancer.
Mr. Dwight has been diagnosing with the Hartman’s operational surgery for his bowel cancer
(Llosa et al., 2015). The Hartman’s surgical process is easy and most effective to reduce the
colon and rectum complications (Garcia-Allende et al., 2014). However, the risk factors that
contribute to the diagnosis of bowel cancer anastomotic leak and risk of a hernia.
Anastomotic leak; The anastomotic leak is the resultant of the stoma reversal surgery. It is
one of the most dreaded complications of the Hartman’s surgery (Garcia-Allende et al.,
2014). It generally reduces the mortality rate. The after surgery may increase the morbidity
and mortality rate of Mr. Dwight up to 34%. It develops high stomach pain, unusual fever,
frequent vomiting, and nausea. Mr. Dwight has experienced frequent vomiting before his
admission to the local hospital. It decreases the blood pressure and reduces the urinary free
flow. Additionally, it creates complication as it requires two surgical operations and takes
around 6 to 8 weeks for complete healing (Schuette et al., 2017).
Risk of a hernia; The Hartman's surgical process can reduce generally increases the
abdominal pressure (Garcia-Allende et al., 2014). The increased abdominal pressure can
develop the risk of a hernia for Mr. Dwight. The complications of a hernia can result in
urinary complications, heavy lifting, and fluid transportation in the abdomen (Nam et al.,
2014). It is capable to decrease the tissue strength and reduces the tissue elasticity.
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4 Four signs of bowel obstruction
The existence of colostomy can create a large intestine at the abdominal wall of Mr. Dwight
to divert the colon and create the stoma. Additionally, it infects the lower abdomen and injury
in the lower rectum (Van Rooyen & Mokoena, 2015). It is one of the most significant
symptoms for the bowel obstructions (Garcia-Allende et al., 2014). The four signs of bowel
obstructions are the deterioration of the digestive system in the grinding halt, decrease in
appetite, diarrhea, vomiting, stomach pain and swallowed belly (Van Rooyen & Mokoena,
2015). The bowel obstruction may result in a hernia, damaged blood vessels, and growth of a
tumor. The deterioration of the digestive system may completely damage the grinding halt
and the unusual stomach pain may result in bowel cancer (Van Rooyen & Mokoena, 2015).
5 Normal BGL level for adults and the intervention
process for the development of BGL.
The normal BGL level for the adults is slightly lower than 4.0 to 5.4mmol/L. However, it
is noticed that the BGL level of Mr. Dwight is 22mmol/L which is much above than the
normal level. The high BGL level increases the diabetic symptoms, increases the obesity,
high BMR, excessive body weight, and high heartbeat (Daviaud et al., 2014). As
mentioned in the case study, Mr. Dwight has been suffering from the diabetic symptom.
Moreover, he has become immobilized and has the inability to conduct anything without
external help. It is notable that high BGL upholds the body glucose level that promotes
the colostomy block up (Daviaud et al., 2014).
Intervention; The high BGL level must be reduced in order to control the blood sugar
level and demote the symptoms of type2 diabetes. Thus, effective maintenance of diet
moderation can be most helpful techniques to reduce the BGL level (Daviaud et al.,
2014).
Diet moderation; diet moderation is a most effective technique to reduce all the risk
factors associated with high BGL level (Daviaud et al., 2014). Low calorie and low-fat
food must be taken during the meal time and spicy snacks must be r5educed from the
food habit. This can be an effective technique for Mr. Dwight to control the body glucose
level. Controlled body glucose can always be beneficial for the mitigation of high BGL
level (Daviaud et al., 2014).
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6a. Clinical use of blood and blood products for the
patients of bowel cancer.
Blood transfusion is the most effective clinical use for patients suffering from bowel
cancer. Blood replacement is another clinical use that uses to transmit to the patient's
body to replace the polluted blood cells with fresh blood. (Musso et al., 2014).
6b. 7 standard of NSQHS. Four required actions to
ensure safety and administrate blood products
As per the National Safety and Quality Health Service (NSQHS), the guide is primarily
developed to inform about the criterion for the quality standard ("National Safety and
Quality Health Service (NSQHS) Standards - QIP - Quality Innovation Performance
Limited", 2019). It is a document-based approach to improve the quality based healthcare
services. The seventh standard of the NSQHS promotes the healthcare decision-making
process, develops care models and measures effective systems for the quality care (Jha &
Zaslavsky, 2014). Four required actions to ensure safety and administer blood products
are as follows;
 Ensures the recommendations for blood transfusions
 Promotes the risk benefits by developing awareness
 Develops opportunities to asks blood transfusion-related questions
 Provides consent for the development of the blood transfusion
7a. Why does Mr. Dwight require a nasogastric tube?
The nasogastric tube is used to feed the patients suffering from neck or facial injuries,
facial surgeries and the patients who are in ventilation. It is notable that Mr. Dwight lacks
the food and drinking habit for the past three days and is getting weaker every single day.
Moreover, he has lost mobility and cannot do anything without external help. Thus, a
nasogastric tube can be useful for Mr. Dwight to satisfy his appetite and help to balance
his daily diet. Additionally, a nasogastric tube is an authentic technique for liquid
medication (Kronman et al., 2015). Thus, the nasogastric tube can be more effective to
provide liquid medication to Mr. Dwight.
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7b. requirement and implementation of routine check
A routine check-up is essentially required for the patient having a nasogastric tube. Mr.
Dwight requires a regular blood sugar check and blood pressure check beofre the use of
the nasogastric tube. Moreover, proper flow of medicine and meals through nasogastric
tube should also be checked with high priority The blood sugar check can be helpful to
keep track of the glucose level (Daviaud et al., 2014). Mr. Dwight has the symptoms of
low blood pressure. Thus, regular measurement of blood pressure level can be helpful for
the healthcare personnel to apply effective medication through a nasogastric tube.
8 Identification and discussion on clinical priority for Mr.
Dwight
Clinical priority is essential for patients suffering from cancer and any surgical experiences
(Berra, Rippe, & Manson, 2015). The required clinical priority for Mr. Dwight is the
mitigation of the body glucose level from 22mmol/L to reduce the symptoms of type2
diabetes that may incur further complication in the bowel cancer.
Clinical priority can be implemented in three ways; urgent, semi-urgent and routine check-up.
The urgent and semi-urgent clinical priority is generally applied for acute cancer pain and
functional immobility (Zalai, Panics, Bobak, Csáki & Hamar, 2014). The routine clinical
priority is generally implemented for persistent long-term pain (Berra, Rippe, & Manson,
2015). Mr. Dwight has essentially required the effective implementation of urgent clinical
priority to reduce his body glucose level.
9 SMART framework for one short-term goal of the
clinical priority
The short-term goal that can be implemented to develop the identified clinical priority is to
mitigate there body glucose level and reduce the ED level from 22mmol/L.
Specific Measurable Attainable Realistic Time-bound
The body
glucose and ED
It can be
measured
It can be
attained through
It is realistic
that application
This can be
achieved within
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level can be
mitigated with
the
implementation
of urgent
clinical priority
through blood
sugar test in
both empty
stomach and a
full stomach
low sugar and
low-fat diet and
proper
medication
of urgent
clinical priority
with proper diet
and quality can
reduce the ED
level
4 weeks of Mr.
Dwight's
admission to the
emergency
ward
10 Two interventions to achieve a short-term goal
The aforesaid short-term goal has mentioned reducing the body glucose level by
mitigating the ED level from 22mmol/L to 4mmol/L to 5mmol/L (Daviaud et al., 2014).
Mr. Dwight requires proper quality care to promote the intervention process to achieve
the goal. The required interventions to limit the body glucose level are as follows
Low sugar and low-fat diet: The low sugar and low-fat diet are essential for the holistic
development for the patients suffering from high body glucose level (Daviaud et al.,
2014). The high body glucose level increases the ED level that promotes all the
symptoms for type2 diabetes. However, the low fat and low sugar diet keep control the
sugar level in blood and reduce the obesity level. It can be helpful for Mr. Dwight to limit
the ED level (Daviaud et al., 2014).
Assistance for physical exercise; Mr. Dwight requires a daily exercise to reduce the blood
sugar level. However, he also needs external assistance to continue his physical exercises
due to his immobility (Zalai, Panics, Bobak, Csáki & Hamar, 2014). A regular physical
exercise can always be beneficial to limit body weight and body glucose level (Daviaud
et al., 2014).
11Two methods to evaluate and justify outcomes
The pain management of bowel cancer and mitigation of ED level can be evaluated through
two different methods; regular monitoring and performance evaluation of the caregivers (Pot,
Blom & Willemse, 2015).
Regular monitoring: A regular monitoring is a quality outcome of evidence-based nursing
care. The regular monitoring of the improvement level of the cancerous pain and blood
glucose level (Daviaud et al., 2014) of Mr. Dwight.
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Performance evaluation: The performance evaluation of the nursing care staffs is effective to
evaluate the quality care outcome of the patient. It is capable to develop the treatment process
of Mr. Dwight.
12Two risk factors associated with chemotherapy with
evidence
The standard 3 of NSQHs defines the prevention and control from the healthcare infections.
Mr. Dwight had gone through chemotherapy. The risk factors are a hospital-acquired
infection and lack of Patient-care communication (Elwyn et al., 2014).
Hospital-acquired infection; The hospital-acquired infection includes the nosocomial
infection that spreads toxic items into the patient's body that can create healthcare
complications (Elwyn et al., 2014). For example- an unclean hospital ICU floor can infect
and promotes the morbidity and mortality rate.
Lack of patient care communication: The lack of patient care communication reduces the
interventions process of the patient (Elwyn et al., 2014). For example- the unawareness of the
patient regarding the hygiene and cleaning measures of healthcare organization may affect
the interventional process of the patient.
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standards/
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