NSB303 Nursing: Colorectal Cancer Patient Discharge Plan Case Study

This essay presents a case study focusing on the discharge planning for John, a 62-year-old patient recovering from colorectal cancer. It highlights the importance of a comprehensive discharge plan addressing physical, emotional, social, and spiritual aspects of survivorship. The essay discusses potential physical challenges like stomach issues and sexual dysfunction, psychological issues such as anxiety and PTSD, and social challenges like social isolation and loss of functionality. It emphasizes the role of spirituality in coping with cancer and the importance of nurses in addressing the holistic needs of survivors. Furthermore, it suggests strategies such as meditation, relaxation therapy, and collaborative care models involving occupational therapists and primary care nurses to promote self-management and improve the patient's quality of life during the survivorship phase. The essay concludes that survivorship is a distinct phase requiring ongoing surveillance, management of long-term toxicities, and encouragement of healthy lifestyle behaviors.

Running head: NURSING ASSIGNMENT
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Name of the Student
Name of the university
Author’s note

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Introduction
The case study is about John, a 62 years old patient, who had been under treatment for
the several days till he had made a successful recovery. However, a proper discharge planning is
required to be made in order to ensure an ideal recovery planning suitable to the physical and the
emotional grievances of the people. This paper would provide with a discharge planning
mentioning about the survivorship issues that the patient might be facing across physical,
emotional, social and spiritual spheres of health. It will also propose a strategy that can be made
for the prevention of the identified issues.
Discharge planning
John who had been suffering from colorectal cancer is currently getting his last round of
chemotherapy and is now ready for the discharge. Colorectal cancer is the second most common
type of cancer in Australia that affects both the men and women. In addition to physical
examination, the diagnosis of colorectal cancer includes a biopsy. Some of the other types of
tests that are required to diagnose the colorectal cancer is colonoscopy, where a doctor looks
inside the rectum and the colon (Anderson, Steele & Coyle, 2013). Finally a biopsy is used to
understand the occurrence of colorectal cancer. A molecular testing of the tumour can also be
done by using a laboratory test on a tumour sample for identifying the specific proteins and
genes unique to the tumour (D'Souza, Daudt & Kazanjian, 2016). Colorectal cancers are tested
for the problems in the mismatch repair proteins, known as the mismatch repair. Initially it is
used for understanding the Lynch syndrome, next the results would be used for determining if
the immunotherapy can be considered for the patients suffering for the metastatic breast cancer.
A complete blood count test can also be used for the assessing the levels of the proteins CEA.

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John might have been subjected to neo-adjuvant therapy for the rectal cancer using the
preoperative chemoradiation therapy. This indicates towards the fact that John might have been
suffering from stage II or III disease. Preoperative chemoradiation therapy has been proven to be
a standard of treatment options for the patients with stage II and stage II cancer.
The follow care for John would include regular physical examinations and some other
medical tests for monitoring the recovery (Primrose et al., 2014). Apart from a regular visit to the
doctor, some of the tests included a CEA test for detecting the level of CEA proteins that
indicates, whether the cancer has spread to different parts of the body. Again a pelvic CT scan
has to be dome after six or 12 months (Primrose et al., 2014)
Collaborative approaches to education and planning for self-management
Cancer survivorship starts at the diagnosis and continues till the entire life span. The
important care incudes inhibition of the recurrent symptoms, surveillance for the recurrence and
medical or psychosomatic effects of cancer, interventions for the concerns of treatment of cancer
and promotion of health ( McCabe et al., 2013). There are several physical challenged, that the
cancer survivors have to face with. Some of the major physical problems involved stomach ache,
cramping, Incontinence, Constipation and diarrhoea (Duijts et al., 2017). Some of the physical
problems involves urinary incontinence, male sexual dysfunction as well as female sexual
dysfunctions (Averyt & Nishimoto, 2014).
The cancer survivors are subjected to face with several psychological issues like anxiety,
depression. They are also likely to suffer from post traumatic disorder (PTSD). The prevalence
of anxiety and depression symptoms appears to be closely related to physical functioning of the
patients, the economic contraints, cognitive functioning, lack of social support and concerns

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regarding the relapse of cancer (Duineveld et al., 2016). It has been found that approximately
two-third of the cancer survivors could get back to work within 1.5 years after the analysis of
cancer (Averyt & Nishimoto, 2014). Hence, those who can return to the work have sown less
chances of psychological disorders among the patients (Averyt & Nishimoto, 2014). Again,
some of the patients might be concerned about the treatment effects of the colorectal cancer.
Again, patients might report a decline in the mental functioning at the job including
concentration impairment, memory difficulties and decrease ability to multitask. A colonoscopy
can also be done in order to look for secondary cancers or polyps (Averyt & Nishimoto, 2014).
It is again necessary for the patients in relation to the cancer remittance. Sometimes
patients suffering from colorectal cancer suffer from same symptoms as that of the symptoms of
the occurrence for the first time. Recurrent symptoms generally presents as metastasis in the
lungs or liver or as a locoregional recurrence in peritoneum or pelvis (Duineveld et al., 2016).
Recurrent disease can be addressed with a curative intent, depending upon the location and the
number of metastases and on the condition of the patients. Intensive follow up programs and
frequent diagnosis testing can be helpful for the follow up.
Any kind of cancer affects the social and the emotional wellbeing cancer survivors. It can
lead to decreased quality of life. Negative body image might lead to social isolation. Many of the
cancer survivors feel that life takes on a new meaning after the cancer and many wants to renew
their commitments to spiritual practices or organized religion (Clay, Talley & Young, 2012).
Most of the survivors of the colorectal cancer loses their functionality to so their own task and
probably have to rely on some formal or informal care givers, which makes them unsecured in
their life. The long term adult survivors of colorectal cancer suffers from more physical
limitations and chronic diseases. In many cases, the patient might become incompetent and

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might refuse to get back to the normal pace of social life (Denlinger & Barsevick, 2019).
Spiritualty can be considered as an important constituent for evaluating the quality of life and
wellbeing in cancer survivors. Intrinsic spirituality gives a sense of the purpose and meaning in
life and the relationship between meaning in life and spirituality in coping up with stressful
conditions. In an observational study, it has been found that there are people who found feelings
of divine existence or peace reported feelings of least physical problems. Higher spiritual
wellbeing has been reported with better physical health. Many authors of the opinion, that
spirituality and religion can help the cancer patients find meaning in their illness and provide
comfort in the face of fear. Denlinger and Barsevick, (2019) have again argued that while
diagnosis of cancer can encourage some of the people for renewing their faith, it can also have
some negative impact on others. A diagnosis might challenge their feelings and make the
patients doubt their religious or spiritual values. This kind of feeling might again make it difficult
for the patients to survive with cancer.
The nurses play an import ant role in addressing the physical, social, emotional and
psychological needs of patients who had survived cancers. Even after the therapeutic treatment
of cancer, patients should maintain strict follow up with increasing the visits to the primary care
physician and decreasing visits to the oncologists (Duijts et al., 2017). A shared model of care is
necessary for developing a survivorship care which can be facilitated by a survivorship care
plan.
Meditation and the relaxation therapy can reduce the fear in the cancer survivors.
Relaxation techniques like muscle relaxation, meditative relaxation and visualization can be
helpful to reduce the fear of the cancer recurrence. Black et al., (2017) have found that
mindfulness meditation conducted with the patients suffering from CRC at the beginning and

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after the chemotherapy decreases the blunting of the cortisol level. Cortisol blunting has been
associated with the progression of the disease a shorter span of survival. It is the maker if
hypothalamic-pituitary-adrenal (HPA) axis dysregulation (Black et al., 2017). This s caused due
to the emotional and the physical stresses experienced by the patients. The study by Carlson,
(2016) had randomly assigned 57 patients receiving adjuvant chemotherapy for conducting a 20
minute audio-video guided mindfulness based meditation for about 40 minutes. Both the groups
had been watched for the results (Carlson, 2016). The amount of the cortisol has been collected
from the saliva sample that was collected at the baseline. Patient who had received mindfulness
based therapy has been found to be an increased level of cortisol activity in comparison to the
control group. Mindfulness based therapy has been found to be inversely associated to fatigue,
thus, psychological issues can be solved by relaxation techniques and it also tends to increase the
spirituality of the patients (Carlson, 2016). Meditation and yoga can also increase the physical
strength of the muscles.
These health education to the patients can be given during the follow up services. An
occupational therapist in collaboration with a primary care nurse to go for a home visit for
educating the about the self-management of the condition, starting from physical exercises, to
suitable diet and environmental modifications. In case Mr. John is alone and does not have any
informal caregivers, the hospital arrange for nurses or caregivers who would assist the patient in
the household chores and the activities. In case the home visits are not possible, telephonic
follow ups can also be conducted by the nurses to educate the patients.

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Conclusion
Survivorship is considered as a distinct phase of colorectal cancer treatment. The goals of
care would include surveillance for the remittance, managing the long term and the late toxicities
related to multimodality treatment, encouraging a healthy diet and life style behaviours can be
helpful to the patient for leading a healthy life in this survival period.

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References
Anderson, A. S., Steele, R., & Coyle, J. (2013). Lifestyle issues for colorectal cancer survivors—
perceived needs, beliefs and opportunities. Supportive Care in Cancer, 21(1), 35-42.
Averyt, J. C., & Nishimoto, P. W. (2014). Addressing sexual dysfunction in colorectal cancer
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Black, D. S., Peng, C., Sleight, A. G., Nguyen, N., Lenz, H. J., & Figueiredo, J. C. (2017).
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