Mr John Hemsley, a 56-year-old male, presented to the Emergency Department with abdominal pain, nausea and vomiting associated with recurrent episodes of constipation. The onset of symptoms was three (3) months ago. In the past four (4) weeks Mr Hemsley experienced unexplained episodes of fatigue. On toileting, he also observed that his stools were often long and narrow with small amounts of bright blood on
the toilet paper. He ignored these syndromes as he was too embarrassed to talk about them. The emergency Physician performed a digital rectal examination to rule out haemorrhoids, colorectal cancer or anal fissures. The main finding was a firm irregular non-capsulated mass in John’s rectum. Mr Hemsley was subsequently admitted under the care of a Gastrointestinal specialist for further investigations and management of pain. On day two (2) as an inpatient, a colonoscopy was performed, and a biopsy was resected from the large sessile lesion located in the proximal third of the rectum and three polyps were also removed from the colon. The biopsy results confirmed a stage IIA rectal adenocarcinoma. Following the above findings, Mr Hemsley was scheduled for surgery.
Abdominal-perineal resection and the formation of a sigmoid colostomy was performed. There were no complications reported during his surgical procedure. The surgeon commenced him on analgesia of Morphine 2.5mg – 5mg PRN 2-4 hourly and I.V. 4mg-8mg Ondansetron PRN 8 hourly for nausea while admitted in a Surgical ward.
Medical/Social background: Mr Hemsley stated that his father had 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. Mr Hemsley reported that he was physically active as a “young man” but over the last 10 years; however, he had lived a sedentary lifestyle resulting in 20kgs weight gain (current weight – 107kg). Mr Hemsley had “given up” regular smoking of cigarettes for the last five (5) years but resorted to “occasional” cigarette smoking on the weekends.
Answer the following three (3) Short Answer Questions:
Cancer control is one of the Australian National Health Priority areas; address the following three
(3) questions on bowel cancer based on Mr Hemsley in the case study.
Question 1: Describe how the administration of Morphine alters Mr Hemsley’s conscious perception
of pain (300 words), and discuss three (3) specific nursing responsibilities (with
Question 2: Identify and discuss (giving rationales) the benefits of three (3) non-pharmacological
nursing interventions that may be implemented when managing Mr Hemsley’s post-operative pain.
(300 words)
Question 3: Identify and discuss two (2) possible complications and the associated nursing
interventions of priority when managing Mr Hemsley’s colostomy during the first 24- 48hrs postoperatively. (500 words)
