Colorectal Cancer Screening

Colorectal cancer is both the third most common cancer in the United States and the third leading cause of cancer death in the United States. The prevalence of the disease increases with age, and over 90% of colorectal cancer is diagnosed in clients over the age of 50.

Colorectal cancer is a disease in which cells in the colon or rectum become abnormal and divide without control, forming a mass called a tumor. The colon and rectum are parts of the body’s digestive system, which takes up nutrients from food and water, and stores solid waste until it passes out of the body (National Cancer, 2008).

Patients who have a history of adenomatous polyps or inflammatory bowel disease, or a family history of colorectal cancer or adenomatous polyps should receive a colonoscopy (Mauk, 2010, p. 373). Most polyps are benign, but experts believe that the majority of colorectal cancers develop in polyps known as adenomas (National Cancer, 2008). Colorectal cancer is more likely to occur as people get older, most people develop colorectal cancer are over age 50. Personal and family history increases the risk of colorectal cancer. People who have ulcerative colitis or Crohn’s colitis may be more likely to develop colorectal cancer than people who do not have these conditions. Diet, exercise, and smoking can increase the risk of colorectal cancer.

Fecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy are several good screening tests to detect early colon cancer. Choice of screening, however, is determined based on client risk factors and preference. Screening for these high risk clients is begun before age 50. Screening strategies for clients of average risk include FOBT, sigmoidoscopy performed every 5 years, or a combination of FOBT performed annually with sigmoidoscopy every 5 years when FOBT testing is negative. If the results of this test are positive, clients are sent for colonoscopy or double barium enema combined with sigmoidoscopy, where colonoscopy is not available. Digital rectal exam (DRE) is another screening test performed, allowing examination of only the lower part of the rectum.

The decision to have a certain test will take into account several factors, including the following:

- The person’s age, medical history, family history, and general health

- The accuracy of the test

- The potential harms of the test

- The preparation required for the test

- Whether sedation is necessary during the test

- The follow-up care after the test

- The convenience of the test

- The cost of the test and the availability of insurance coverage

Colonoscopy is the most sensitive of the screening methodologies but is associated with the highest cost and risks. These risks include a small risk of perforation and bleeding and the risks associated with sedation, which is required for the procedure (Mauk, 2010, p. 374). FOBT advantage include no cleaning of the colon is necessary, samples can be collected at home, and does not cause bleeding or perforation/tearing of the lining of the colon. Disadvantages include possible false positives, fails to detect most polyps and some cancers, and additional screening procedures may be necessary (National Cancer, 2008).

The exact causes of colorectal cancers are not known. However, studies help show certain factors that can increase an individual’s risk for developing colorectal cancer. It is important for these individuals to talk with their healthcare providers about when to begin screening for colorectal cancer, along with the risks and benefits of each test.

References

Mauk, K. (2010). Gerontological Nursing Competencies for Care (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.

National Cancer Institute. (2008). Colorectal Cancer Screening Fact Sheet [Brochure]. National April 7, 2011, Cancer Institute http:/​/​www.cancer.gov/​cancertopics/​factsheet/​detection/​colorectal-screening/​print

NOTE: This blog post reflects the work of a Registered Nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Older adults, that is, those age 65 or older, may face difficult changes in their life such as the death of a spouse or health problems that can lead to depression especially if they don’t have a strong support system. Depression not only makes them suffer from aches, pains and fatigue, but can also have dramatic effects on their overall health. Depression can also affect an older person’s memory and concentration which can lead to a misdiagnosis of dementia. Depression in the elderly is often under recognized and under treated.
The Geriatric Depression Scale: Short Form is an easy to use screening tool (not a diagnostic tool) that was developed for health care providers to use in assessing the possibility of depression in the elderly. The GDS:SF is comprised of 15 questions and takes approximately 7 minutes to complete. It is moderately reliable and useful assessment tool in those folks who are ill or well, easily fatigued, have a short attention span, mild to moderate (not severe) cognitive impairment. It is used on folks who are in acute care settings, home care settings, assisted living or long term care facilities.
Nurses may be the only ones who have the most frequent contact with the patient and therefore recognizing the signs and symptoms of depression we rely heavily on our nursing assessment skills. Look for changes in the patients self-care, recent changes in their health, somatic complaints, medications, personal losses, weight changes, sleep patterns, activity level, appetite, substance use or abuse, and suicidal ideation.
There are other, more thorough, screening and assessment tools for depression in the elderly, but the GDS:SF is so far the best tool to use (Mauk, 2010) (Sherry A. Greenberg MSN, 2007). More information can be found in a series titled: “Try This: Best Practices in Nursing Care to Older Adults” from the Hartford Institute for Geriatric Nursing at New York University College of Nursing.


References

Mauk, K. L. (2010). Gerontological Nursing, second edition. Valparaiso, Indiana: Jones and Bartlett Publishers.
Sherry A. Greenberg MSN, A. R. (2007, October). Geriatric Depression Scale: Short Form. AJN, pp. 60-69.

Pneumonia is the Leading Cause of Death in the Elderly

''Pneumonia is a leading cause of death in the elderly'' (Mauk, 2010, p. 402). Diagnosis of pneumonia in the elderly is often thwarted by difficulties in recognizing infection, as signs and symptoms differ from those observed in younger patients. ''In spite of the availability of potent antibiotics and sophisticated diagnostic techniques, pneumonia continues to be a serious problem among elders'' (Mick, 1997,p.100). Furthermore, the classic picture of high fever and chills, productive cough and pleuritic chest pain may not apply for elderly patients. Subsequently, ''confusion and deterioration in baseline function and performance of activities of daily living are the lone hallmarks of pneumonia among elderly patients'' (Mick,1997,p.99). Nursing observations and communications with the primary health care provider play a crucial role in the care and treatment of elderly patients with pneumonia. ''Although pneumonia may be a terminal event, recognition of symptoms, prompt diagnosis and administration of appropriate antibiotics can reduce complications and morbidity'' (Mick, 1997, p.101).Improvement is expected within 3 to 4 days of implementation of antibiotic therapy. Clinical deterioration and worsening chest radiograms indicate inadequate or inappropriate antibiotics and require reevaluation.
In addition, a number of steps can be taken to help prevent getting pneumonia. The elderly should stop smoking , avoid contact with people who have respiratory tract infections such as colds and the flu. Also, if the elderly have not had measles or chickenpox or gotten vaccines against these diseases, they should avoid contact with people who have these infections. They should wash their hands often. This helps prevent the spread of viruses and bacteria that may cause pneumonia. “Adults over 65 should get a pneumonia vaccine” (Mauk, 2010, p.403). Lastly, yearly vaccinations for influenza may prevent someone from getting the flu. Influenza often can lead to pneumonia especially in older adults.

REFERENCES
Mauk, K. L. (2010). Gerontological Nursing. Competencies for care. (2nd ed). Sudbury, MA: Jones and Bartlett Publishers.
Mick, D. J. (1997). Pneumonia in Elders. Geriatric Nursing, (18) 3, 99-102

NOTE: This blog post reflects the work of A registered nurse with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Atrial Fibrillation

By Lisa Lemenger RN

What is atrial fibrillation? Atrial fibrillation is the two atria of the heart quivering instead of beating effectively. Because the blood isn’t pumped out of the atria effectively, it may pool and form clots (American Heart Association, 2011). Visualized on an EKG rhythm strip, it is an irregular, narrow complex rhythm with no discernable P-waves.
What’s the worst that can happen that can happen with atrial fibrillation? The worst is a blood clot breaking free and lodging in the brain causing a cerebral vascular accident (CVA). While some patients may recover from a CVA with few deficits, the sooner the treatment the better, others suffer deficits that range from motor activity to speech and other senses. Whatever the effect, it is detrimental to a person’s well-being.
Although not all patients with atrial fibrillation experience blood clots and CVA’s, symptoms they may experience include palpitations, shortness of breath, dizziness, chest pain, and syncope. Although none of these cause harm on their own, they cause discomfort and may lead to other illness or injuries.
Treatment for atrial fibrillation ranges from treating underlying causes, such as a thyroid condition, to prescribed medications. Anticoagulant therapy, such as Coumadin, is used to prevent blood clots. Beta blockers and calcium channel blockers are used to slow the heart rate (American Heart Association, 2010).
If medications do not control heart rates, a procedure called radiofrequency catheter ablation can be performed. Multiple catheters are inserted through bilateral veins in the groin, up through the right atrium, and into the left atrium through a transeptal puncture. The pulmonary vein is burned to cause a scar around it to eliminate the abnormal electrical signals sent by the atrial node (Johnson, Jadick, & Knippers, 2011).
Patient education provided by the nurse should include signs and symptoms; when to seek medical attention; medication information; and education regarding any underlying causes or associated chronic illnesses. Equipped with education and encouragement by the nurse, the patient should be able to follow a medication regimen and control his atrial fibrillation, minimizing symptoms and the risk of blood clots.

References
American Heart Association. (2011). Atrial Fibrillation. Retrieved February 23, 2011, from
American Heart Association: http://www.americanheart.org/presenter.jhtml?
Identifier=4451

American Heart Association. (2010, August 11). Treating Atrial Fibrillation. Retrieved February 23,
2011, from American Heart Association: http://www.heart.org/STROKEORG/LifeAfter
Stoke/HealthyLivingAfterStroke/UnderstandingRiskyConditions/Treating-Atrial-
Fibrillation_UCM_310778_Article.jsp

Johnson, T.W., Jadick, E.A., & Knippers, L. (2011). Atrial Fibrillation Ablation. American Journal of
Nursing, 58-61.

Note: This blog post reflects the work of Lisa Lemenger RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Colorectal Cancer

By Margaret Duffy-Chodl RN

Colorectal cancer is found in the colon or the rectum that develops slowly over a period of 10 to 15 years. The cancer usually develops from polyps in the inner lining of the colon or rectum. These polyps can either be benign or malignant. When the polyps are malignant, they invade the wall of the colon or rectum and grow into the blood or lymph vessels which metastasize to other parts of the body. Most colorectal cancers are adenocarcinomas which account for 95% of this type of cancer (ACS).
Diagnosis of colorectal cancer is usually made in the advanced stages of the disease. The diagnosis is made through a biopsy of the tissue in the colon or rectum. The major symptoms of this cancer are a change in bowel habits, rectal bleeding or black tarry stools, abdominal pain, fatigue, or weight loss. It is very important to have colorectal screenings after age 50 to detect this treatable disease. The screenings to detect this disease are flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, CT colonoscopy, or a fecal occult blood test (ACS).
The symptoms can be effectively addressed by having the recommended screenings starting at age 50 and knowing the risk factors. The one major risk factor is age, most colorectal cancers are diagnosis after the age of 50. Other risk factors are history of polyps, inflammatory bowel disease, and family history of colorectal cancer, inherited gene defects, and racial & ethnic background. African Americans and Jews of Eastern European descent have the highest rate of colorectal cancer (ACS).
The prognosis is based upon when the diagnosis is made. Since the symptoms are vague, diagnosis is normally made in advance stages of the disease. This is why screening for this disease is so important and knowing the risk factors (ACS).
The recommended prevention of this disease is to maintain a healthy weight, be physically active, eat a healthy diet with fruits and vegetables, and limit the amount of alcoholic beverages. This along with knowing risk factors and screenings for the disease after age 50 helps with early diagnosis (ACS).

References

American Cancer Society. (2011) Colorectal Cancer Early Detection. Retrieved from http://www.cancer.org/Cancer/ColonandRectum


Note: This blog post reflects the work of Margaret Duffy-Chodl RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Anorexia Nervosa

By: Candice Willingham RN

In today’s society, there seems to be a desperate need to be skinny or to look like the girls on television. Eating disorders have become quite common due to this need. Anorexia nervosa is an eating disorder that compels women to starve themselves in order to lose weight. These women may have an unrealistic body perception and a major fear of becoming fat. Nearly 4% of women now suffer from anorexia (Clark, 2009, p432). The disease typically develops near or during puberty. Anorexia is characterized by excessive dieting, a marked loss of body weight, purging, excessive exercise, and amenorrhea. According to Clark (2008), Anorexia results in mortality rates nearly 12 times higher than the annual death rate for all other causes among women 15-24 years of age.

Primary prevention should be aimed at teaching parents and young girls what the appropriate body size is for their age, promoting proper exercise, giving examples of a healthy diet, promoting adequate rest, explaining the harms of smoking and drinking, helping young girls to develop a strong self image and build self esteem.
Secondary prevention would be promoting annual physicals and pap smears. This will help health care providers notice sudden loss of weight and be able to intervene accordingly. The amount of weight loss determines how aggressive the treatment should be (Harvard, 2009). Women's health care providers are able to assess normal menstrual cycles and explain normal outcomes.
Tertiary prevention would come by helping the female and her family get their lives back together after battling an issue like this. Proper counseling is very important. The counselor can help the patient and the families develop a plan to prevent a relapse.

Clark, Mary Jo. (2008). Community Health Nursing: Advocacy for Population Health (5th Ed.). New Jersey: Pearson
Harvard Mental Health Letter. (2009). Treating Anorexia Nervosa: A Multidisciplinary approach is best, but relapses are common. Harvard Mental Health Letter. 26(2), 1-4.

Note: This blog post reflects the work of Candace Williamson RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Addressing Attention Deficit Hyperactivity Disorder in Children

By: Stephanie Johnson

Does your child have trouble paying attention at home or school? Does he or she exhibit impulsive behaviors? He or she may have a disorder known as Attention deficit hyperactivity disorder (ADHD) formerly known as ADD. ADHD is a chronic condition that affects adults and approximately 5-8% of school age children (NRC, 2009).
Signs and symptoms include excessive talking, difficulty paying attention, losing things, easily distracted, running about or climbing excessively, blurting out answers before question completed, and difficulty remaining seated (NRC, 2009). Children with ADHD tend to perform poorly in school or may be perceived as a nuisance or abnormal.
Primary interventions are focused on educating the public especially caregivers, educators, and families about the disease eliminating the “bad child” stigma that is attached to the condition. Early recognition and diagnosis with parents’ awareness of social disruptions, poor performance in school, and depression may prevent drop out and strained relationships early.
Secondary interventions are aimed at coping with and treating the disorder. ADHD workshops at behavioral health centers offer help with peer adjustment, behavior difficulties, and social and family relationships. Continued parent/child education, behavior management techniques, and stimulant medications are elements of the comprehensive treatment plan (NRC, 2009). The most common stimulant medications used to treat ADHD are Concerta, Adderall and Ritalin. These medications are effective in lessening symptoms and dose adjustments may be necessary.
Tertiary interventions include emotional support for parents, caregivers. The diagnosis of ADHD causes some parents to have feelings of guilt or shame (Clark, 2008).ADHD is chronic and 1/3 of people outgrow the symptoms (NRC). Working with a mental health practitioner, community nurse, ongoing education and support groups aid in maximizing full mental health abilities while attaining a healthy level of well being.

References
National Resource Center on ADHD (NRC).Retrieved from http://www.help4adhd.org/en/about/what.
Clark, M.J. (2008). Community Health Nursing: Adovcacy for Population Health.(5th ed.) Upper Saddler River, New Jersey:Prentice Hall

Note: This blog post reflects the work of Stephanie Johnson RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.