Clinical Thought Cycle in Colorectal Cancer Patients

Consideration Of The Patient

The purpose of this report is to analyze the case study of Brendan, who was diagnosed with colon cancer. This report is a clinical reasoning cycle that considers the patient’s vital signs and reasons for admission, medical history and social history. Additional data and information is collected, such as clinical records, laboratory results, and delivery reports. Methods for assessing a patient’s current clinical status should be discussed and critically reviewed on a rationale basis. The information and data collected will be analyzed and interpreted. Finally, Brendan’s pressing problem requiring diagnosis is discussed with proven literature support.

Brendan is a member of the Bunjarung tribe and is considered an Australian Aboriginal. Data show that the age-standardized incidence of colorectal cancer in this remote community ranges from 21 to 51 per 100,000 (AIHW, 2022). Considering the patient scenario, it is understandable that Brendan may have faced inequalities in accessing medical services as an Aboriginal. A single man with no family, he is mostly introverted by nature and rarely social. He was hospitalized because colon cancer is a serious health problem and a leading cause of death for Aboriginal people. Therefore, intestinal resection is necessary to prevent cancer. Otherwise, bowel habits and stool consistency may change permanently. Symptoms can become chronic and long lasting and require treatment.

Brendan’s surgery went well. Three days after his surgery, the RN was gathering information on Brendan’s progress. He reported that he was in good health and was awaiting release. But he said he was disappointed to learn that it would still take some time before he was released. It is the RN’s job to assess and identify patient needs and plan medical management accordingly (Hickman et al., 2020). Vital signs collected by a nurse during the visit showed normal body temperature and oxygen saturation. However, his pulse rate was slightly below the normal range. A blood sugar level of 6.9 mmol/L indicated that Brendan was pre-diabetic. He reported a low pain score and asked for no more pain medication. A pathology report showed that Brendan’s sodium level was well within range, while serum potassium and creatinine levels were higher than normal. Kalkouty et al. (2017) suggested that surgical patients often suffer from elevated creatinine levels after surgery. Even a small increase can adversely affect patient health. Brendan needs to be given the proper medication to keep his illness under control.

The Brendan Colostomy Impact (CI) score should be assessed and diagnosed to assess any type of disease exacerbation (Kristensen et al., 2020). In addition, Mr. Brendan has undergone an intestinal resection, so it is necessary to examine the condition of the stoma created in the abdomen and check for any infection. Brendan has moderate hypertension, so it’s important to keep track of his blood pressure, especially in the three days following surgery. Surgery often increases high blood pressure, which increases the risk of cardiovascular and cerebrovascular events. The higher the pressure, the greater the risk. Therefore, it should be monitored regularly and controlled accordingly.

Collecting clues

Given that Brendan is of Aboriginal ethnicity, it’s easy to understand the reason for his anxiety. Aborigines value kinship and family ties as part of their culture (Sylliboy et al., 2021). Brendan doesn’t have a family, but he sees his dog as the only family he wants to see and be with as soon as possible. The Colostomy Impact Score is essential for assessment as it helps identify any type of impairment in the patient’s quality of life due to colostomy (Kristensen et al., 2020). A stoma is an opening in a patient’s abdomen created by an intestinal resection that helps remove waste products from the body. This happens because bowel resection restricts bowel movement from the rectum. The postoperative hyperkalemia condition identified in Brendan requires a thorough medical evaluation and attempts to mitigate it. It has been analyzed that postoperative hyperkalemia causes arrhythmia and arrhythmias, and if left untreated, may cause myocardial infarction (Li et al., 2018).

There are various types of complications associated with stoma creation after surgery. These include necrosis and involution, as well as skin inflammation, defecation problems, surgical site infections, and sepsis. The problem is exacerbated when surgeons and nurses do not receive notification, and patients suffer because they are not properly instructed and have access to readily available resources (Correa Marinez et al., 2020). Complications and risk factors associated with a stoma are not under the surgeon’s control. It is the postoperative caregiver’s responsibility to assess the patient (Hill, 2020). Therefore, the registered nurse caring for Brendan should have a proper ostomy care management plan in place before the patient is discharged to avoid repeat surgery. Patients should also be provided with appropriate guidelines for post-hospital stoma care so that open wounds are properly cared for.

Another issue Brendan needs to grapple with is establishing a culturally safe appearance as he is part of an Indigenous community. Due to the colonization trauma their ancestors faced, these people are not always able to accept the treatment of modern doctors and nurses. A contact person can be helpful in this situation. A liaison officer is someone who acts as a bridge between patients and caregivers by helping to communicate post-discharge policies and practices in a culturally appropriate manner (Orr, Frederico, & Long, 2021 ). Hiring a contact person to do this for Brendan helps build relationships and trust and creates a safe environment.

With the aid of visual aids such as the use of pictures and metaphors, he applies specific communication strategies related to cancer and its treatment, using language easily understood by patients. Liaison officers can accompany patients by calling support staff from the Aboriginal community to assist with communications. The officials will use every strategy and anticipate with open minds the conflict between Western medicine and Aboriginal culture. Liaison officers aim to help develop efficient communication with patients by incorporating patient-centered practices (Olver et al., 2022). He is said to do this for Brendan by staying empathetic, respectful, and honest.

Conclusion

From the above papers, it is clear that Brendan’s colostomy required a large-scale colostomy and a culturally safe nursing intervention that could guide his post-discharge practices in a language and manner that he could understand culturally. It was concluded that there is The attending nurse should ensure effective stoma care and regular monitoring of vital signs. Elevated serum creatinine and potassium levels are treated with appropriate drug therapy. Using a Liaison Officer benefits patients by providing instruction in a culturally safe manner.

Reference List

AIHW. (2022). Cancer in Aboriginal & Torres Strait Islander people of Australia, Colorectal cancer (C18–C20) – Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. Retrieved 26 April 2022, from https://www.aihw.gov.au/reports/can/109/cancer-in-indigenous-australians/contents/cancer-type/colorectal cancer.

Correa Marinez, A., Bock, D., Carlsson, E., Petersén, C., Erestam, S., Kälebo, P., … & Angenete, E. (2021). Stoma?related complications: a report from the Stoma?Const randomized controlled trial. Colorectal Disease, 23(5), 1091-1101. DOI: 10.1111/codi.15494

Hickman, S. E., Parks, M., Unroe, K. T., Ott, M., & Ersek, M. (2020). The role of the palliative care registered nurse in the nursing facility setting. Journal of Hospice & Palliative Nursing, 22(2), 152-158. https://doi.org/10.1097/NJH.0000000000000634

Hill, B. (2020). Stoma care: procedures, appliances and nursing considerations. British Journal of Nursing, 29(22), S14-S19. https://doi.org/10.12968/bjon.2020.29.22.S14

Karkouti, K., Rao, V., Chan, C. T., & Wijeysundera, D. N. (2017). Early rise in postoperative creatinine for identification of acute kidney injury after cardiac surgery. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 64(8), 801-809. https://doi.org/10.1007/s12630-017-0899-8

Kristensen, H. Ø., Krogsgaard, M., Christensen, P., & Thomsen, T. (2020). Validation of the colostomy impact score in patients ostomized for a benign condition. Colorectal Disease, 22(12), 2270-2277. https://doi.org/10.1111/codi.15290

Li, S., Liu, S., Chen, Q., Ge, P., Jiang, J., Sheng, X., & Chen, S. (2018). Clinical predictor of postoperative hyperkalemia after parathyroidectomy in patients with hemodialysis. International Journal of Surgery, 53, 1-4. https://doi.org/10.1016/j.ijsu.2018.03.003

Olver, I., Gunn, K. M., Chong, A., Knott, V., Spronk, K., Cominos, N., & Cunningham, J. (2022). Communicating cancer and its treatment to Australian Aboriginal and Torres Strait Islander patients with cancer: a qualitative study. Supportive Care in Cancer, 30(1), 431-438. https://doi.org/10.1007/s00520-021-06430-3

Orr, E., Frederico, M., & Long, M. (2021). Messages for Good Practice: Aboriginal Hospital Liaison Officers and Hospital Social Workers. Australian Social Work, 1-14. https://doi.org/10.1080/0312407X.2021.1953552

Sylliboy, J. R., Latimer, M., Marshall, E. A., & MacLeod, E. (2021). Communities take the lead: exploring Indigenous health research practices through Two-Eyed Seeing & kinship. International journal of circumpolar health, 80(1), 1929755. https://doi.org/10.1080/22423982.2021.1929755