Case Study: Mr. John Hemsley, 56 years old, presented to his general practitioner (GP) with a three-month history of constipation and abdominal discomfort. More recently he has felt very fatigued and has been experiencing lower abdominal pain. In the weeks prior consulting the GP, Mr. Hemsley noticed his stools were long and narrow with small amounts of bright blood on the toilet paper. He ignored these signs and symptoms as he was too embarrassed to talk about them. The GP performed a digital rectal examination to rule out the haemorrhoids. The findings were a firm irregular non capsulated mass in John’s rectum. The GP arranged a consultation with a gastrointestinal specialist. The specialist scheduled a colonoscopy for John the following week. During the colonoscopy, a biopsy was taken of the large sessile lesion located in the proximal third of John’s rectum. Three polyps were also removed from John’s colon. The biopsy results confirmed a stage IIA rectal adenocarcinoma. Following these findings John was scheduled for surgery the following day to have an abdominal-perineal resection and the formation of a sigmoid colostomy. There were no complications reported during John’s surgical procedure. Postoperatively John has been commenced on analgesia of I.V. Morphine 2.5mg – 5mg PRN 2-4 hourly and I.V. 4mg-8mg Ondansetron PRN 8 hourly for nausea. Additional Medical/Social background: John states that his father died from bowel cancer at the age of 84 years old and his younger brother was diagnosed with Crohn’s disease when he was 18 years old. John states he was quite active as a “young man ”but over the last 10 years does not do any form of regular exercise and has gained 20kgs. He did admit to the “occasional” cigarette on the weekends but did say how he was proud to have now “given up” regular smoking of cigarettes for the last 5 years. John’s current weight is 107kgs.
Three (3) Short Answer Questions In addressing the Australian National Health Priority Area of bowel cancer prevention and treatment use a person centred care approach to respond to the following:
Question 1: Postoperatively, Mr. Hemsley has been ordered PRN I.V. 2.5mg to 5mg Morphine for his pain relief.
Discuss one (1) nursing care consideration for the safe administration of this medication.
Discuss one (1) non-pharmacological nursing comfort measure you can undertake to help manage Mr. Hemsley’s postoperative pain
.Question 3: A sigmoid colostomy was performed on Mr. Hemsley during surgery.
Discuss one (1) nursing consideration when caring for the patient with a colostomy during the postoperative period.