Colon: Digestive System's Last Resort for Waste Removal

The colon in the human body is also known as the large intestines, and it is part of the final stage of food digestion. After all the nutrients have been removed from the food by other digestive processes, the colon plays the role of getting rid of any other remaining leftovers, other wastes, and bacteria (Van der Wielen et al., 2017). The processes through which the colon gets rid of such substances from the body are known as peristalsis, and it normally takes up to 36 hours. The first process is to remove salt and liquid from the waste as it passes through the colon and reabsorbs them back into the bloodstream, then the waste moves to the sigmoid where it is stored. The colon plays a key role in the elimination process by absorbing other key nutrients and remaining water from the indigestible materials, which solidifies them and transforming them into the stool. Besides, the feces that eventually will be emptied into the rectum get stored in the descending colon.

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Your patient has been diagnosed with Metastatic Colon Cancer and has Insulin Dependent Diabetes Mellitus. Please describe the pathophysiology of Metastatic Colon Cancer.

In terms of molecular genetics, colon cancer is the best-understood complex cancer. In Metastatic Colon Cancer, cancer cells may break away from the colon tumor and spread to other body parts through the lymphatic system or the bloodstream (Cappell, 2008). Due to such spread, the cells might settle and form new cancer on a different organ. The cancer is still named after the organ from which it originated regardless of the fact that it has spread to a new organ. The liver is the most common site of colon cancer metastases. However, colorectal cancer may also spread to the bones, lungs, brain, and the spinal cord. According to Cappell (2008), if an individual gets treated for colorectal cancer, and cancer cells are found in these mentioned areas, then it is an indicator that the original colorectal cancer has spread. There is a difference between metastatic colorectal cancer and recurrent colorectal cancer. Whereas metastatic colorectal cancer spreads to other organs of the body, recurrent colorectal cancer returns to the same part of the rectum or colon.

What signs and symptoms are present with Colon Cancer?

Colon cancer is a cancer type that begins in the large intestine or the colon. Typically, it affects older adults, but it can happen in any stage of life. Usually, it begins as small noncancerous clumps of cells forming on the inside of the colon, and over time, some of these polyps grow to become colon cancers. Signs and symptoms of colon cancer include the following. There is a persistent change in bowel habits such as constipation, diarrhea, or a change in your stool constituency. There can also be blood in the stool or rectal bleeding. Sometimes, there is persistent discomfort of the abdomen, such as gas, pain, or cramps. Signs can include fatigue, which is a result of internal bleeding or blood loss, or the body's energy being used by the cancer cells. Another sign is the unintentional loss of weight, which can be defined as the loss of 10 or more pounds in less than six months without knowing the reason (Terzic et al., 2010).

What is the focus of your care in the patient who requires palliative care?

For the patient who requires palliative care, my focus would be on mental care. Cancer patients usually have certain symptoms, medications, and treatments that tend to affect how their minds work. For example, the patient may not have enough sleep or might have a hard time thinking clearly due to the feeling of stress. Besides, they may also be very anxious about whether their treatment is working. For this patient, the palliative care that I would offer to cater to her mental health includes counseling, meditation, exercise, and possibly medication to help with their depression, sleep problems, or anxiety. As the nurse, I would advise her to do activities that help in reducing her levels of anxiety and stress, like creating art, yoga, or joining a group of other cancer survivors.

What does it mean to you as the nurse when a patient decides to become a do-not-resuscitate (DNR)?

When a do-not-resuscitate order is given by a doctor to my patient, or if the patient decided to become a DNR, it means a lot to me as a nurse as it significantly impacts the standard of care that I can offer to the patient. Such an order may have an influence on the aggressiveness with which a patient is managed since it may be misconstrued to include more than no cardiopulmonary resuscitation (Henneman et al., 2014). As a nurse, I play a central role in determining the standards of care for the patient, and therefore, confusions on the part of the patient as to the meaning of the term DNR could have a significant impact on the care of the patient.

References

Cappell, M. S. (2008). Pathophysiology, clinical presentation, and management of colon cancer. Gastroenterology Clinics of North America, 37(1), 1-24. https://www.ncbi.nlm.nih.gov/pubmed/18313537Henneman, E. A., Baird, B., Bellamy, P. E., Faber, L. L., & Oye, R. K. (2014). Effect of do-not-resuscitate orders on the nursing care of critically ill patients. American Journal of Critical Care, 3(6), 467-472. https://www.ncbi.nlm.nih.gov/pubmed/7834009Terzic, J., Grivennikov, S., Karin, E., & Karin, M. (2010). Inflammation and colon cancer. Gastroenterology, 138(6), 2101-2114. https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669Van der Wielen, N., Moughan, P. J., & Mensink, M. (2017). Amino acid absorption in the large intestine of humans and porcine models. The Journal of nutrition, 147(8), 1493-1498. https://academic.oup.com/jn/article-abstract/147/8/1493/4584656