Knowledge required for decision making in adult nursing.

There are several psychosocial factors that can influence an individual living with a restricting illness like malignant bowel obstruction. As suggested by Conrad (2001) an illness not only involves the body, it also affects people’s social relationships, self images and behaviour. Bowel obstruction and the eventual formation of a stoma “leads to an alteration of body image and an awareness of change in appearance and function of the individual” (Black, 2004).

Throughout this essay, I am going to consider and explore the impact an altered means of elimination (as a deviation) secondary to malignant bowel obstruction has on my clients everyday life from a holistic stance/perspective subsequent to receiving informed consent (appendix 1) from my client.

Mr X, a 75 year old gentleman with two adult sons, was recently diagnosed with complete bowel obstruction due to the growth of a malignant tumour. After admitting Mr X I wanted to follow his care through to find out the outcome of his treatment.
After Mr X’s eventual diagnosis of colorectal cancer, he was informed of the need for a formation of a stoma. I decided to focus on altered elimination as my choice of deviation. Pellatt (2008) suggested that elimination of faeces is a vital bodily function, and most people become independent in this function from early in their lives and to be suddenly stripped of their independence and privacy must have an adverse effect on any individual going through this. Consistent reports have drawn attention to high levels of depression and low self –esteem (Brown and Jaqueline, 2005) after stoma surgery, which in most cases is performed to save lives. I hoped that through choosing this I would be able to gain a more in depth understanding of the psychosocial issues attached to it for my patients based on Mr X’s experience and perspective.

As acknowledged Lynch and Sarazine (2006), ‘bowel obstruction occurs when the normal flow of intestinal contents is blocked or interrupted by narrowing of the intestinal lumen through impaired motility’. Lynch and Sarazine (2006) further suggested that bowel obstruction may be caused by ‘multiple mechanisms relating to cancer’.
Swan (2005) refers to Fearon and Vogelstein’s concepts of colorectal cancer, which puts forward that ‘colon cancers develop by the accumulation of changes that occur in certain genes within the mucosal lining of the bowel’.

Waugh and Grant (2001, p.53) indicate that a tumour is ‘a mass of tissue that grows faster than normal in an uncoordinated manner, and continues to grow after the initial stimulus is ceased’. This new growth is also referred to as ‘neoplasm’ (Shamley, 2005).
Waugh and Grant (2005, p.53) describe the process of cell changes as ‘carcinogenesis’ and ‘the agents precipitating the change as carcinogens’. It has been suggested by Swan (2005) that carcinogenesis ‘may be of a genetic/and or environmental origin’, however a ‘clear- cut distinction is not always possible’.

The primary stage of cancer growth is ‘the initiation stage’ (Borwell, 2005). Borwell (2005) specifies that this stage occurs as a result of exposure to a carcinogen know as an initiating agent, which brings about mutation in certain genes in the affected cells. Borwell (2005) also considers that ‘one cell is altered in this way and that the growth of the cancer arises from proliferation of the changed cell’.

The following stage is the ‘promotion stage’. In this stage ‘carcinogens called promoting agents stimulate the initiated cell or cells to divide in an uncontrolled way’ (Borwell, 2005) Subsequent to this stage is the ‘progression stage’. Borwell (2005) asserts that ‘ if cell proliferation persists, initiated cells undergo further gene alterations, leading to continuing uncontrolled cell division, producing dysplastic cells and ultimately, the development of an invasive growth’.