I.

Investigation

1. Endoscopy. Endoscopic examination needs to be done, both sigmoidoscopy and

colonoscopy. A typical picture of carcinoma or ulcer can be seen clearly on endoscopy,

and a biopsy is needed to make a diagnosis.

2. Radiology. Radiological examinations that can be done include: chest photo and colon

photo (barium enema).

• Examination with a barium enema may clarify the condition of the tumor and identify

its location. This test may describe a deadlock in the stomach contents, where there is

a reduction in the size of the tumor on the lumen. Minor injuries are not identified

with this test. Barium enema is generally carried out after sigmoidoscopy and

colonoscopy.

• Computer Tomography (CT) helps clarify the presence of mass and extent of the

disease. Chest X-rays and liver scans may find distant sites that have metastasized.

• Chest photo examinations are useful in addition to seeing the presence or absence of

metastatic cancer in the lung can also be used to prepare for surgical procedures. In

the photo of the colon can be seen a filling defect in a place or a stricture.

3. Ultrasonography (USG). This examination is useful for detecting the presence or

absence of metastatic cancer of the lymph nodes in the abdomen and in the liver.

4. Histopathology / In addition to endoscopy, a biopsy should be performed in several

places for histopathological examination to make a diagnosis. The histopathology of

colorectal carcinoma is adenocarcinoma, and cell differentiation needs to be

determined.

5. Laboratory. There are no typical markers for colorectal carcinoma, however, every

patient who experiences bleeding needs to be examined for Hb. The tumor marker
 (tumor marker) commonly used is CEA. CEA levels greater than 5 mg / ml are usually

found in advanced colorectal carcinoma.

6. Scan (for example, MR1. CZ: gallium) and ultrasound: Performed for diagnostic

purposes, metastatic identification, and evaluation of response to treatment.

7. Biopsy (aspiration, excision, needle): Done for diagnostic appeal and describe

treatment and can be done through bone marrow, skin, organs and so on.

8. Complete blood count with differential and platelet: Can show anemia, changes in red

blood cells and white blood cells: platelets increase or decrease.

9. Chest X-ray: Investigate metastatic or primary lung disease.

 CHAPTER III

NURSING CARE

A. ASSESSMENT

1. Client Identity

Includes name, age, gender, MR, occupation.

2. Health History

• Has a history of smoking, drinking alcohol, TD problems, rectal bleeding, stool

changes.

• Usually alopecia, lesions, nausea vomiting, heartburn, stomach upset, dizziness,

• History of family disease with a history of cancer.

• Physical examination

3. Activity / rest

Patients with colorectal cancer usually feel discomfort in the abdomen with

complaints of pain, feeling full, so it is necessary to study the pattern of rest and

sleep.

4. Circulation

Symptoms: Palpitations, chest pain in work movements. Habit: changes in blood

pressure.

5. Ego integrity

• Stress factors (finance, work, role change) and how to deal with stress (eg

smoking,drinking alcohol, delaying seeking treatment, religious / spiritual

beliefs)

• Problems about changes in appearance, for example, alopecia, lesions, defects,

surgery.
 • Denies diagnosis, feeling helpless, hopeless, unable, not feeling, guilty,

losing.

6. Elimination

• Changing colon function will affect changes in patient defecation, alternating

constipation and diarrhea. What are the habits at home, namely: frequency,

composition, number, color, and method of expenditure, whether with the help

of a tool or is there a complaint that accompanies it. Is the habit in the hospital

the same as at home.

• In patients with colorectal cancer a physical examination can be carried out by

observing the presence of abdominal distention, mass due to faecal deposits.

• Abdominal tumor mass, liver enlargement due to metastases, ascites,

enlargement of the inguinal gland, enlargement of the axillary gland and supra

clavicle, measurement of height and weight, abdominal circumference, and

rectal plugs.

7. Food / liquid

Symptoms: eating habits of patients at home in a day, how much and composition

each meal is there any restrictions on a food, there are complaints of anorexia,

nausea, feeling full (sick), vomiting, heartburn, causing weight loss.

Signs: Changes in skin moisture / turgor; edema

8. Neurosensory

Symptoms: dizziness; syncope, because patients lack activity, lots of sleep so that

blood circulation to the brain is not smooth.

9. Pain / comfort

Symptoms: There is no pain, or varying degrees such as mild discomfort to severe

pain (associated with the disease process)

10. Breathing

Symptoms: Smoking (tobacco, marijuana, living with a smoker).

11. Security

Symptoms: Exposure to toxic chemicals, carcinogens. Long / leached sun

exposure.

Sign: Fever. Ku1it rash, ulceration

12. Sexuality

Symptoms: Sexual problems, for example, the impact on the relationship to the

level of satisfaction. Multigravida is greater than 30 years of age. Multigravidas,

multiple sex partners, early sexual activity, genital herpes.

13. Social interaction

Symptoms: inadequacy / weakness of the support system, marital history

(regarding satisfaction at home, support, or assistance).