Colon (Colorectal) Cancer Nursing Diagnosis & Care Plan

Colorectal or colon cancer occurs when polyps in the large intestine become malignant.

The risk of this type of cancer increases with age, with most cases detected in people older than 50. There is an increasing trend of colorectal cancer in people between 20 to 49 years old due to unhealthy diets, sedentary lifestyles, obesity, family history, alcohol consumption, and physical inactivity. 

Colorectal cancer develops slowly, and the symptoms do not usually appear until the disease is already in the advanced stages. Common signs and symptoms of colon cancer include:

Complications of colorectal cancer include metastasis, obstruction, perforation, fistula formation, and peritonitis

In diagnosing colorectal cancer, it is critical to evaluate the patient’s family history, as the risk of developing this type of cancer increases with first-degree relatives having the same condition. A history of inflammatory bowel disease (IBS) also increases the risk.

Colonoscopy is considered the gold standard for colon cancer screening as it can examine, obtain biopsies, and remove polyps in the colon. Other diagnostic tests like fecal tests, abdominal CT scans, ultrasound, and MRI may also be performed. 

Nursing Process

The management of colorectal cancer will correlate with the pathologic staging of the tumor and may include surgery, chemotherapy, and radiation therapy. Nurses play a critical role from the start of the screening process through treatment and follow-up prevention. 

Nurses can help identify symptoms indicative of colorectal cancer and counsel patients regarding their risk factors. They provide support through the different treatment regimens and patient education to ensure understanding and adherence. 

Death Anxiety

Colorectal cancer patients have a higher risk of feeling death anxiety, especially those diagnosed with advanced colon cancer. This is a normal part of accepting a cancer diagnosis, but it can create unnecessary stress and depressive symptoms that require intervention.

  • Anticipation of pain 
  • Anticipation of suffering 
  • Awareness of imminent death 
  • Depressive symptoms 
  • Discussions on the topic of death 
  • Low self-esteem
  • Nonacceptance of own mortality
  • Uncertainty about life after death 
  • Uncertainty about the existence of a higher power 
  • Uncertainty of prognosis 

As evidenced by:

  • Expresses concern about the impact of one’s death on significant other/family 
  • Expresses deep sadness
  • Expresses fear of loneliness 
  • Expresses fear of pain related to dying
  • Expresses fear of premature death 
  • Expresses fear of a prolonged dying process 
  • Expresses fear of separation from loved ones 
  • Expresses fear of suffering related to dying 
  • Expresses fear of the dying process 
  • Expresses fear of the unknown 
  • Expresses powerlessness 
  • Reports negative thoughts related to death and dying

Expected outcomes:

  • The patient will be able to freely express feelings associated with dying
  • The patient will discuss realistic goals concerning their condition and prognosis

Assessment:

1. Consider the psychosocial maturity of the patient.
Females have a higher risk of developing death anxiety compared to men. Determining psychosocial maturity will help better understand how to support and comfort the patient.

2. Assess the patient’s fear of death and the current stage of grief.
This will promote a better understanding of the patient’s current mental and emotional state and allow the provision of appropriate psychosocial support.

3. Determine cultural/religious beliefs.
Patients who have a strong sense of faith may struggle less with their prognosis and lean heavily on their culture or religion. Nurses can support patients in whatever brings them peace.

Interventions:

1. Always use therapeutic communication.
This allows the establishment of interpersonal relationships with the patient.

2. Assist the patient in life planning.
Advanced planning improves end-of-life care and promotes satisfaction for both patients and families. It also reduces stress, depression, and powerlessness.

3. Acknowledge the normality of negative feelings like fear, anger, and denial.
It is normal to feel negative emotions when faced with loss. Allowing the patient to express feelings and emotions can make the patient feel important and acknowledged.

4. Encourage patients with life review and reminiscence.
Finding an acceptable and satisfying completion in life helps relieve discomfort, reduce stress, and gain acceptance of the situation.

5. Encourage mental health or spiritual services.
Chaplains may provide emotional relief for religious patients. Nurses can also involve mental health/grief counselors to aid in supporting the patient and family.


Diarrhea

A change in bowel habits like frequent diarrhea, constipation, and a feeling of incomplete emptying are symptoms of colon cancer. 

  • Disease process
  • Colorectal tumor 
  • Tumor fluid leakage 

As evidenced by:

  • Abdominal cramping 
  • Abdominal pain 
  • Bowel urgency 
  • Dehydration 
  • Blood in the stool
  • Hyperactive bowel sounds

Expected outcomes:

  • The patient will maintain the perianal area free from any irritation or breakdown
  • The patient will utilize medications to control diarrhea and symptoms as prescribed

Assessment:

1. Assess defecation patterns.
Assessment of defecation patterns and any related symptoms such as bloating, pain, or urgency can help identify appropriate interventions and treatment regimens.

2. Assess stool characteristics.
The presence of blood, foul odor, or pus may require further assessment for trauma or infection.

3. Assess abdomen.
Inspect, auscultate, palpate, and percuss the abdomen. Increased frequency of bowel sounds is expected with diarrhea.

Interventions:

1. Monitor intake and output.
Diarrhea can cause dehydration. Monitoring the patient’s intake and output can help monitor the patient’s fluid status and prevent dehydration.

2. Encourage fluid intake as indicated.
Adequate fluid intake can improve bowel consistency and promote hydration.

3. Refer the patient to a dietitian.
Colorectal cancer patients may need specialized meals to help ensure adequate dietary intake and facilitate recovery. Some foods may need to be avoided to reduce gastric irritability.

4. Encourage perianal skin care.
Diarrhea can cause altered skin integrity in the perineal/rectal area. Instruct on proper cleaning and comfort with the use of medicated or wet wipes and barrier creams.

5. Administer medications as needed.
Antidiarrheal medications are prescribed to help relieve symptoms of diarrhea.


Risk for Infection

Colorectal cancer patients often get unusual infections due to the invasion of tissues close to the tumor or transient bacteremia from necrotic tumors. Patients with colorectal cancer treated with chemotherapy are at risk for infection due to immunosuppression. 

  • Chemotherapy
  • Disease process
  • Surgical interventions
  • Colostomy
  • Immunosuppression 

As evidenced by:

A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.

Expected outcomes:

  • The patient will remain free from infection
  • The patient will demonstrate infection control precautions
  • The patient will demonstrate how to care for their ostomy

Assessment:

1. Assess factors contributing to increased risk for infection.
The disease process and chemotherapy or radiation treatment can increase the patient’s risk for infection. Patients who undergo colon resection or receive a colostomy are also at an increased risk.

2. Assess vital signs and laboratory values.
Alteration in laboratory values like neutropenia or leukocytosis can indicate infection. Signs of infection include fever, shaking, chills, and hypotension.

Interventions:

1. Encourage and practice good hand washing before and after patient care.
Handwashing can help prevent the transmission of pathogens and avoid infection.

2. Isolate the patient during ongoing chemotherapy or radiation treatment.
Isolating the patient can help prevent infections easily transmitted through direct contact.

3. Avoid alcohol or smoking.
Both should be avoided completely to allow the immune system to function at its best.

4. Administer antibiotics as ordered.
Antibiotics may be given prophylactically to prevent infection in patients undergoing chemotherapy or surgery.

5. Instruct on incision and colostomy care.
Surgery of the colon/rectum is considered a clean-contaminated procedure due to the presence of fecal bacteria. Nurses must closely monitor incisions after surgery for signs of poor healing or infection. Nurses should instruct patients on caring for their incision sites and ostomies.


References

  1. ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
  2. Colorectal (Colon) Cancer. Centers for Disease Control and Prevention. Reviewed: February 17, 2022. From: https://www.cdc.gov/cancer/colorectal/basic_info/what-is-colorectal-cancer.htm
  3. Colorectal (Colon) Cancer. Cleveland Clinic. Reviewed: November 14, 2022. From: https://my.clevelandclinic.org/health/diseases/14501-colorectal-colon-cancer
  4. Colon cancer. Mayo Clinic. Reviewed: October 8, 2022. From: https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669
  5. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
  6. What Is Colorectal Cancer? American Cancer Society. Updated: June 29, 2020. From: https://www.cancer.org/cancer/colon-rectal-cancer/about/what-is-colorectal-cancer.html
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Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.