Nursing Care Essay: Patient With Colorectal Cancer (CRC) and Anaemia

Question

Task: You are required to write a nursing care essay addressing the following points:

Pathophysiology
Discuss the pathophysiology and diagnosis colorectal cancer. Include in your answer the pathophysiological changes that may have contributed to Amanda’s anaemia. Discuss Amanda’s blood results. What other probable causes of anaemia specific to Amanda’s comorbidities need to be considered. Support your answer with rationale. Pharmacology Discuss the medications Amanda is currently prescribed and takes to help manage her Rheumatoid Arthritis symptoms. Include in your answer mechanisms of action, normal dosage, ADR’s and any specific nursing and poly pharmacy considerations. (DO NOT USE TABLES)

Specific Nursing Care
Discuss and provide Evidence Based Research (EBR) and rationale for any pre procedure preparation Amanda may require. Discuss what discharge education would be appropriate post colonoscopy taking into account Amanda’s co morbidities and associated risk factors.

Answer

Introduction
Cancer has been taking over the world by its increasing cases and complications, and colon cancer or colorectal cancer has been the third most frequently occurring type of cancers throughout the world. It is found to be affecting the female population more frequently than the men, as calculated it is one of the second most frequently occurring types of cancer in women. There are approximately 1.8 million fresh cases every year worldwide (Siegel et al., 2017). It has also been found that patients suffering from colon cancer witness anemia in their health condition which is one of the early signs of occurrence of colon cancer. After analyzing and assessing the case study of Amanda Johnson, a 56-year-old woman, it was found that she was witnessing a severe incident of low red blood cells leading her to the condition of anemia. It was found from the assessment that she also has a family history of colorectal cancer which drags the case towards the condition of the occurrence of colon cancer. Thus, the assignment focuses on understanding and evaluating the pathophysiology and diagnosis of colon cancer and its relation to anemia.

It will also focus on the pharmacology of the medications that she has been prescribed with related to her health condition. It will also be discussedregarding the nursing care that needs to be delivered to her in order to provide her a better treatment and recovery option form her condition of colorectal cancer and anemia.

Pathophysiology
Colorectal cancer is one of the difficult types of cancer to identify at an early stage as it generally does not show any early symptoms. The symptoms are generally dependent on the location of the occurrence of the primary tumor. Cancers growing at the location of the colon have a characteristic of growing larger in size before showing any signs of development. Anemia with iron deficiency is one of the early signs of colorectal cancer leading to bleeding (Väyrynen et al., 2018). The bleeding takes place due to abnormal vasculature within cancer along with trauma from the fecal site. Cancer within the colon and rectum often leads to the condition of haematochezia. During the process of development and growth of cancer within the colon region, the increasingsize of cancer often leads to rapturing of the blood vessels, as it stimulates the development of blood vessels. This condition leads to excessive loss of blood from the body by means of stool, which develops the condition of severe blood loss causing anemia (Wilson et al., 2017). Thus, it isconsidered as one of the chief early signs of colorectal cancer in suffering patients which was similar to the condition of Amanda. It was found that her hemoglobin count was 85g/l where the normal range is 115 – 165 g/L, also her Hematocrit (Hct) level showed 0.33mL/L (normal range 0.37 – 0.47 mL/L) and RCC level 3.0L (normal count 4.5 – 6.5 1012/L) which was considerably below the normal range leading clear indication towards the condition of anemia. Apart from the earlier mentioned, her mean cell hemoglobulin count and along with MCV and MCHC were below the normal range. As the blood loss continues, the bodywitnesses an insufficient amount of iron available, even though iron supply is maintained within the body. It is so because the iron molecules get trapped inside the cells of the immune due to inflammation thus continuing the condition of anemia within the body.

The change in the condition of the colon leads to the development of severe changes within the function of the colon which enhances the conditions such as a change in bowel habit, blood in the stool, lethargy, abdominal discomfort, and massive weight loss. The condition Amanda has been experiencing along with the data attained from her physical assessment stated that she has been suffering from anemia which has its relation with the occurrence of colorectal cancer as she has a family history of colon cancer (Hamarneh et al., 2020). It was found that Amanda was on a diet with a high amount of red meat which is known to be one of the high sources of iron in case of anemia, still, she was witnessing low iron availability in the body and a condition of anemia. It explains that the iron source she was intaking was getting trapped within her immune cells. Whereas the consumption of high red meat in the diet and excessive drinking also counted as one of the factors increasing the chances of occurrence of colorectal cancer.It has been found that red meat consumption increases the risk of occurrence of colon cancer by 28 percent.Thus, it also explains her condition of development of colon cancer and anemia. The pathophysiology explains the reason behind the development of the anemic condition in Amanda which has been leading her to the state of feeling lethargy and low with energy and change in her bowel habit.

Pharmacology
Amanda has been suffering from Rheumatoid arthritis which was hampering her mobility as her joint was inflamed by the health condition. Thus, she was administered with Methotrexate 7.5mg orally once a week along with paracetamol and ibuprofen in order to treat her condition of rheumatoid arthritis and minimize the pain and inflammation caused within the conditions. Methotrexate 7.5mg is one of the most effective medications which is used in order to treat and manage the condition of rheumatoid arthritis and has been the most preferred drug in such conditions. it functions in easing the symptoms and signs leading to joint pain, redness, and swelling along with restoring the damage of joints and organs. It is effective in the condition of rheumatoid arthritis as it interferes with the condition which causes Rheumatoid Arthritis inflammation in suffering patients leading to failure in joint mobility (Bianchi et al., 2016).

Methotrexate is a type of drug which falls under the class of disease-modifying antirheumatic drugs or DMARDs.This class of DMARDs medications is generally used at an early phase treatment of rheumatoid arthritisthe drugs falling under the class ofDMARDs were made focusing on the treatment process of rheumatoid arthritis, whereas methotrexate was specificallydevelopedfor another purpose (Friedman &Cronstein, 2019). The chief purpose for which it was developed was for treating cancer which later started showing effective results against rheumatoid arthritis. Thus, it was then used as an oral tablet and injecting solution for the treatment of rheumatoid arthritis under the name Trexall and Rheumatrex. DMARDS, specifically Methotrexate functions for reducing the condition of inflammation by means of suppressing the active immune system of the body. though there is a huge chance of risks of infection associated with the alteration of the active immune response, which acts as a major side effect of the drug, Methotrexate shows effective benefits for the patients suffering from the condition of rheumatoid arthritis (Cronstein&Aune, 2020). It is known to prevent the occurrence of joint damage if taken into consideration at an early stage of the appearance of the health condition. They function by slowing down the further deterioration of the joint and helps by controlling the increasing symptoms of rheumatoidarthritis. There are certain nursing consideration and poly pharmacy case that needs to be taken into account while administrating DMARDS, specifically Methotrexate to a patient as it may lead to the chance of occurrence of severe health complications. It is necessary that the patient is carefully and appropriately assessed related to the health condition of the patient. It is so because, Methotrexate often causes a lowering of white blood cell, red blood cell, and platelet level and often causes lung disease. There are several adverse reactions of Methotrexate which leads the patient towards suffering several health complications such as Ulcerinside the mouth and abnormal gastrointestinal healthsuch as stomatitis,diarrhea, and blood in the stool, hepatotoxicity, bone marrow depression,skin reactions, renal failure,ocular irritation and alopecia (Brown, Pratt & Isaacs, 2016).

Specific nursing care:
In order to prepare Amanda and her body before going through the process of colonoscopy, it will be necessary to maintain and provide certain nursing considerations. The chief goal of providing pre-procedure preparation is to increase her tolerance, relief her pain, maintain the electrolyte and fluid balance as well as avoid any chances of complication during the process of treatment (Bradbury, Murphy & Key, 2020). One of the chief nursing considerations that need to be maintained is that the signs and symptoms of Amanda must be assessed as it will help in analyzing the chances of possible risks and provide and advantage of evaluating the specific requirement of her health conditions.

Another effective nursing care that needs to be maintained in providing a proper diet in order to stabilize her condition of lethargy and abnormalbowel health as her unhealthy diet leads her towards the condition of anemic and feeling low in energy. It will also be a significant step to provide her with NGT installation in order to clear her gastrointestinal section which is generally performed before treatment of colorectal cancer (Nurul&AgusSetyo, 2016). It will help in maintaining the gastrointestinal section clean and safe from any infection. In order to clean the colon section for the reduction of the chances of contamination, it will be necessary to maintain bowel health. It can be achieved by administering antibiotics by means of oral or prenatal process as it keeps the colon clean. After completion of colonoscopy, it will be necessary that a proper diet chart is provided to Amanda in order to maintain her healthy diet which will help her restore her health condition. Also, she needs to be guided about the liquid diet she needs to take per day to maintain her colon health. It will also be required to prepare a diet chart involving all the above-mentioned aspects along with guidance about releasing gas and avoid the condition of bloating. It will also be necessary to guide and educate her about her health condition and the measures she needs to maintain to keep a firm health condition and the routine health care visit for a regular check-up.

Conclusion:
In order to conclude the above-discussed case study of Amanda, it can be stated that the occurrence of colorectal cancer and anemia in her has been associated with several factors. These factors include her family history of colon cancer, her diet of high red meat intake, and excessive drinking as well as the medication she has been intaking due to her condition of rheumatoid arthritis. Coloncancer has been one of the majorly affecting types of cancer and has a greaterprevalence rate within the population of the United States. The occurrence of colorectal cancer is associated with the occurrence of anemia, as it is one of the early signs of the development of cancer within the colon of an individual. Colorectal cancercausessevere bleeding with stool due to damaged blood vessels of the colon region leading to witnessing decrease blood count within the body. Thus, a patient suffering from colorectal cancershowsanemia as one of its major early-stage symptoms. Amanda has been also witnessing a similar sign along with witnessing lethargy, abnormal bowel habit, and the poor urge to eat. One of the reasons behind the occurrence of the condition is stated to have itsassociation with the intake of the drug DMARDS, specifically Methotrexate which has a side effect of increasing the chances of infection and also causes severe bleeding leading to excessive blood loss. In order to maintain a pre-procedure preparation and post colonoscopy response, it will be necessary that the nursing facility provide her with proper evidence-based nursing consideration.

Reference:
Bianchi, G., Caporali, R., Todoerti, M., &Mattana, P. (2016). Methotrexate and rheumatoid arthritis: current evidence regarding subcutaneous versus oral routes of administration. Advances in therapy, 33(3), 369-378. https://link.springer.com/content/pdf/10.1007/s12325-016-0295-8.pdf

Bradbury, K. E., Murphy, N., & Key, T. J. (2020). Diet and colorectal cancer in UK Biobank: a prospective study. International journal of epidemiology, 49(1), 246-258. https://doi.org/10.1093/ije/dyz064

Brown, P. M., Pratt, A. G., & Isaacs, J. D. (2016). Mechanism of action of methotrexate in rheumatoid arthritis, and the search for biomarkers. Nature Reviews Rheumatology, 12(12), 731-742. https://doi.org/10.1038/nrrheum.2016.175

Cronstein, B. N., &Aune, T. M. (2020). Methotrexate and its mechanisms of action in inflammatory arthritis. Nature Reviews Rheumatology, 1-10. https://doi.org/10.1038/s41584-020-0373-9

Friedman, B., &Cronstein, B. (2019). Methotrexate mechanism in treatment of rheumatoid arthritis. Joint Bone Spine, 86(3), 301-307. https://doi.org/10.1016/j.jbspin.2018.07.004

Hamarneh, Z., Symonds, E. L., Kholmurodova, F., & Cock, C. (2020). Older age, symptoms, or anemia: Which factors increase colorectal cancer risk with a positive fecal immunochemical test?. Journal of gastroenterology and hepatology, 35(6), 1002-1008. https://doi.org/10.1111/jgh.14888

Nurul, H., &AgusSetyo, U. (2016). EFFECTIVENESS OF ACHIEVEMENT IN LEARNING MEDIA INSTALLATION OF COMPETENCE NASOGASTRIC TUBE (NGT). http://eprints.ners.unair.ac.id/id/eprint/243

Siegel, R. L., Miller, K. D., Fedewa, S. A., Ahnen, D. J., Meester, R. G., Barzi, A., &Jemal, A. (2017). Colorectal cancer statistics, 2017. CA: a cancer journal for clinicians, 67(3), 177-193. https://doi.org/10.3322/caac.21395

Väyrynen, J. P., Tuomisto, A., Väyrynen, S. A., Klintrup, K., Karhu, T., Mäkelä, J., ... &Mäkinen, M. J. (2018). Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival. Scientific reports, 8(1), 1-11. https://doi.org/10.1038/s41598-018-19572-y

Wilson, M. J., Van Haaren, M., Harlaar, J. J., Park, H. C., Bonjer, H. J., Jeekel, J., ... &Schipperus, M. (2017). Long-term prognostic value of preoperative anemia in patients with colorectal cancer: a systematic review and meta-analysis. Surgical Oncology, 26(1), 96-104. https://doi.org/10.1016/j.suronc.2017.01.005