Colon Health

Vol. 7 •Issue 26 • Page 17
Colon Health

Chesapeake General Hospital provides a range of services for colorectal cancer screening and treatment

To make an uncomfortable subject feel familiar, Chesapeake (VA) General Hospital got creative in a big way. In May, the hospital staff rented a 40-feet-long, 4-feet-high replica of a colon, complete with toddler-sized hemorrhoids and polyps. They set up the replica, “CoCo, the Colossal Colon,” in the Greenbrier Mall to educate the public about colon health over a 5-day span.

CoCo travels around the country, creating awareness and generating discussions about colon and rectal – colorectal – cancer prevention. While on display in the Greenbrier Mall, 90-some volunteers from CGH, other Chesapeake Health providers as well as local gastroenterology offices distributed information on colorectal cancer prevention and health. Meanwhile, a video of a real colonoscopy and colonscope played. Every attendee received a card with the names and phone numbers of CGH gastroenterologists and colorectal surgeons.

CoCo is a giant example of CGH community outreach efforts. In the past year, colorectal cancer prevention has been a primary focus for CGH. Among their messages to high-risk populations is to go for a colonoscopy. If the worst case scenario does occur — a diagnoses of colorectal cancer — services including surgery, chemotherapy and hospice make the most of a worrisome and painful situation for the patient.

A Community Need

In the greater Chesapeake City area, the large older adult population prompted CGH to spread colorectal cancer awareness, said Cheryl Small, RN, clinical nurse educator for surgical services. The CDC reports the risk for developing colorectal cancer increases with advancing age, and it is recommended all adults 50 years or older be screened.1 Demographics from the U.S. Census Bureau in 2000 indicate roughly 30 percent of Chesapeake’s population is 45 years old and older.2

Colorectal cancer is more common than the general population may be aware. According to the CDC, colorectal cancer is the second leading cause of cancer-related death in the United States; it is the third most common cancer in both men and women.1

To get this message out to both hospital staff and the community, Small coordinates inservices, presents at health fairs and distributes health information at community events.

“Our inservices keep staff abreast of technologies, new equipment and patient safety,” she explained. “We also have inservices for staff for their own health and safety.” She encourages all attendees to carry the torch and educate their neighbors, families and friends about colonoscopies.

Generally speaking, she said, “people are not aware how, if they are diagnosed with a polyp, it can be treated and why they have to catch it before it turns into cancer. Some people are afraid of what the results might tell them. I tell them to go for the colonoscopy. If they get it in time, they can get rid of it.”

Colonoscopy Technology

During colonoscopies, the CGH endoscopy unit uses video colonoscopies connected to a light and a monitor. Images shown on a monitor reveal polyps and any abnormalities are printed for documentation, explained Kim Cooper, RN, CGRN, endoscopy unit manager.

In the room, along with the endoscopy tech or LPN, the RN monitors the patient’s heart rate, blood pressure and blood saturation of oxygen, and administers medications such as narcotics or tranquilizers through the IV.

What makes the colonoscopies top notch at CGH, Cooper said, are the different-sized scopes and snare technology. “You need different-sized scopes for different procedures or modalities,” Cooper explained. “We have scopes with variable stiffness to make it easier to go through the colon. We have some that have larger internal diameter channels so you can put bigger equipment down it if you need to.”

Snares pushed through the scopes work as an electric lasso. The snare wraps around the polyp and electricity burns it off, minimizing bleeding. “If the polyp has a long stalk, the pathologist will look at that stalk and determine whether there are any cancer cells within it.”

For smaller polyps or for patients who may have diarrhea, the doctor will use biopsy forceps. “We would just take a little snip of tissue,” said Cooper. The tissue sample will indicate any parasites, bacteria and cancerous cells.

Before & After Surgery

If cancer is found, the next step may be radiation to first shrink a tumor, or surgery, depending on the condition. In the 30-bed med/surg unit, which specializes in oncology, nurses prepare and educate the patient about postsurgery recovery.

For patients undergoing a colostomy, for instance, John Fenno, RN, enterostomal therapy nurse, will show the patient the pouch that will connect to the intestines for stool collection. “I give them an overview of what to expect,” he explained. “The day of the surgery, I mark the optimal sites for the surgeons. You want [the pouch] in a good location so the patient can wear their pants without injuring their stoma.”

After surgery, Fenno teaches the patient and a family member about skin care, cleaning the pouch, changing the appliance and odor control. “The goal is to make them self sufficient so they can take care of their appliance, take care of any leaks and of their skin,” Fenno said. “You give them a lot of moral support, too, because it is an image-changing operation.”

During recovery, which can last 3-4 days in the med/surg unit, the nurses focus on minimizing any pain, said Lily Vicente, RN, former med/surg unit director. “We do everything in our power to make sure they are comfortable,” Vicente said. “The main thing people are scared of is pain. We have pain specialists to refer to and the oncologists are good at ensuring patients are given the right medications for their individual pain.”

Undergoing Chemo

For patients with colorectal cancer needing chemotherapy, Terri Panaro, RN, charge nurse, administers a natural kind of pain relief – humor. At Chesapeake Health’s new Sidney M. Oman Cancer Treatment Center, Panaro sets up patients in recliners, conducts an assessment and notes any side effects. During treatment, which can last from 3 minutes to 5 hours, Panaro will talk to the patient about anything from side effects to the therapy itself to current events.

“We keep them as comfortable as possible,” she said. “We try to joke with them. We watch TV together. We have a lot of communication and interaction with the patients – that is the most important thing. We go over questions, but we don’t focus continuously on the treatment. We try to talk about other things to get their mind off what they’re going through.”

Home With Hospice

In the last segment in the continuum of care, Chesapeake ComfortCare Hospice nurses provide hospice services for terminal patients where they ultimately are most comfortable — home.

“Hospice provides palliative and comfort care, which means we focus on the relief of pain and symptoms caused by the illness rather than attempting to cure the underlying disease,” said Imelda Angat, RN, director of Patient Services at ComfortCare Hospice. “We focus on the patient’s quality of life when quantity of life has become limited. We give careful attention to the little details that shape each remaining day for the patient and family.”

Comprised of physicians, hospice medical director, nurses, social workers, therapists, aides, trained volunteers and clergy, ComfortCare provides pain management, symptom control as well as psychological and spiritual support.

ComfortCare also supports family members and friends during the illness and bereavement care after the loved one’s death. Hospice services are provided in Chesapeake and other surrounding cities including Norfolk, Virginia Beach, Portsmouth and Suffolk.

“Our primary purpose is to help them make the most of the time that is left and make their dying more comfortable and less frightening,” Angat said. “We aim to make our patients not just pain free but as alert, as comfortable and as active as possible for as long they can.”

References

1. CDC. (2003). 2004 Fact Sheet – Colorectal cancer: The importance of prevention and early detection. Retrieved October 3, 2005 from the World Wide Web: http://www.cdc.gov/cancer/colorctl/colorect.htm

2. U.S. Bureau of Census. (2000). Census 2000. Retrieved October 3, 2005 from the World Wide Web: http://www.census.gov

Resources

CDC. (2005). Screen for life: National Colorectal Cancer Action campaign. Retrieved October 3, 2005 from the World Wide Web: http://www.cdc.gov/cancer/screenforlife

CDC. (2005). A call to action: Prevention and early detection of colorectal cancer slide set. Retrieved October. 3, 2005 from the World Wide Web: http://www.cdc.gov/|cancer/colorctl/calltoaction

Erin James is associate editor at ADVANCE.

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