1: The preliminary characteristics of stage IIA colorectal cancer attribute to its localized impact on the colorectal periphery and absence of metastasis to the nearby lymph nodes and associated organs. The colorectal neoplasm in its IIA stage influences the muscularis propria and invades the perirectal structures in totality. The pathogenic pathways include the development of CpG island methylator phenotype resulting from genetic hypermethylation and leading to microsatellite instability (MSI) as the predominant marker of stage IIA colorectal cancer. Indeed, the pathophysiological dysfunction from somatic mutations of mismatch repair genes (including MLH1 and MSH2) and KRAS genes result in abnormal proliferation of colonic epithelium that eventually leads to the development of stage IIA colorectal cancer among the affected patients (Dellaire et al, 2014, p. 249). The stage IIA colorectal cancer indicated as T3N0M0 in accordance with the AJCC cancer staging system, thereby confirming its localization to the colorectal walls without affecting the regional lymphatic channel. The clinical literature reveals the multiple adenomatous genetic alterations attributing to the development of stage IIA colorectal cancer from chromosomal instability (Magdolen et al, 2012, p. 29). Indeed, the patterns of these genetic changes arise from the sustained expression of CD44 and CD133+ markers leading to allelic manifestations and chromosomal translocations inducing carcinogenesis in the colorectal tissues. Acton (2013, p. 1066-1069) discusses the hyper-expression of RaIBP1 and UHRF1 markers in promoting colorectal carcinoma and its patterns of early relapse among the affected patients. These epigenetic mutations result in replication errors by inducing potential alterations in the structure and morphology of mRNAs resulting in chromosomal aneuploidy attributing to the development of stage IIA colorectal cancer. The clinical studies further confirm the functional destabilization of TP53, APC, MADH4 and DCC markers resulting in defective DNA repair mechanisms attributing to the somatic manifestations in context to the development of colorectal carcinogenesis.
2: The lifestyle fluctuations in relation to physical inactivity and inappropriate diet constitute the modifiable risk factors for Brian’s colorectal cancer. Lyman (2015, p. 500) describes abnormal fat consumption, low intake of vegetables and fruits and obesity as preliminary risk factors in context to the development of colorectal carcinoma. Furthermore, the dietary inappropriateness in terms of excessive consumption of processed meat, red meat and carbohydrates predispose the human population in developing colorectal cancer (Dikeman & Devine, 2014, p. 101). The highest prevalence of these modifiable risk factors displayed across regions of United States, as evidenced by the clinical literature. The dietary fluctuations and alcohol intoxication indeed, influence the physiology of IGF-1 gene expression leading to errors in somatomedin-C functionality attributing to colorectal carcinogenesis among the predisposed population. The dietary mismanagement and obesity could have potentially influenced the gastrointestinal physiology in terms of sustained genetic alterations resulting in Brian’s colorectal carcinoma. The patterns of occult blood from Brian’s stool also indicated the gastrointestinal complication attributing to the predisposition for colorectal manifestations. The clinical literature reveals the factors including age, personal history of adenomatous polyps and inflammatory bowel disease (IBD) and family history of colorectal carcinogenesis as some of the non-modifiable causes in context to the patterns of colorectal carcinogenesis among the predisposed population (Longo et al, 2015, p. 15). Indeed, the individuals between the age ranges pertaining to 60 – 79 years are highly predisposed to developing colorectal cancer; however, the likelihood increases from the age of 40 years onward as evidenced by the clinical literature. Brian’s age of 50 years appears to be the major cause of his colorectal carcinogenesis in context to the clinical predisposition. Furthermore, the gastrointestinal manifestations including abdominal pain and change in bowel habits reported by Brian might indicate history of IBD condition attributing to his colorectal carcinoma under the influence of multiple non-modifiable risk factors.
3: The intravenous administration of metronidazole rendered to Brian in context to the postoperative care after undergoing abdomino-perineal resection. Indeed, metronidazone potentially prevents episodes of postoperative colonic sepsis and enhances bowel movements following the therapeutic intervention. The clinical literature reveals the efficacy of metronidazole in treating the postoperative complications after gastrointestinal surgeries (Trinidade & Ramachandran, 2006, p. 58). In fact, metronidazole administered to Brian with the intent of preventing episodes of hemorrhoids, constipation, rectal bleeding and diarrhea after abdomino-perineal resection.
Morphine administered intravenously to patients for inducing controlled analgesia during the postoperative care. Brook et al (2011, p. 67) illustrate the application of morphine in managing episodes of patient’s acute pain during the postoperative period. Indeed, morphine administered to Brian in postoperative period for managing his acute pain and maintaining the cardiopulmonary functionality. Morphine potentially diminishes the sympathetic overload, enhances cardiopulmonary ventilation and administered accordingly to Brian during the postoperative period.
4: The preliminary responsibilities of nurses in terms of administering morphine to Brian include the careful monitoring of blood pressure, pulse rate, respiratory rate and pulse oximetry during the course of therapeutic intervention. The nurses also require practicing physical induction for reducing hypoventilation during morphine therapy. The clinical complications including loss of consciousness and dizziness require efficient tracking in terms of dose adjustment of morphine to reduce the probability of prospective complications associated with its long-term administration. Furthermore, care and caution warranted in context to administering appropriate morphine dosage following the physician’s instructions. The nurses require executing dose adjustments of morphine for effectively avoiding its psychological dependence among the patients population. The bowel movements of Brian also require consistent monitoring by nurses for avoiding constipation during morphine therapy. Indeed, the rationale in context to the respiratory manifestations by morphine requires the need of regular respiratory assessment while administering morphine during the postoperative tenure (Audrey, 2008, p. 235). Furthermore, the nurses must also take into account the medical and drug history of Brian prior to initiating morphine therapy to evaluate the probability of cardiovascular, pulmonary and renal complications following its administration. The drug history will indeed facilitate the evaluation of drug interactions and their impact on patient’s condition while administering morphine for inducing controlled analgesia. The assessment of sleep patterns helps in identifying disturbances in sleep physiology following morphine administration for subsequently devising therapeutic approaches in antagonizing these side effects in the timely manner. The nurses also bear the obligation to periodically evaluate hepatic function during morphine administration and adjust the therapy in case of reported hepatobiliary complications.
Acton, A. (2013). Colon Cancer: New Insights for the Healthcare Professional. Atlanta: ScholarlyEditionsTM.
Audrey, B. (2008). Kozier and Erb's Fundamentals of Nursing: Concepts, Process, and Practice (8th edn.). India: Dorling Kindersley.
Brook, P., Connell, J., & Pickering, T. (2011). Oxford Handbook of Pain Management. New York: Oxford.
Dellaire, G., Berman, J., & Arceci, R. (2014). Cancer Genomics: From Bench to Personalized Medicine. United Kingdom: Academic Press.
Dikeman, M & Devine, C. (2014). Encyclopedia of Meat Sciences (2nd edn.). United Kingdom: Elsevier.
Longo, W., Reddy, V., & Audisio, R. (2015). Modern Management of Cancer of the Rectum. New York: Springer.
Lyman, G. (2015). Oxford American Handbook of Oncology (2nd edn.). New York: Oxford.
Magdolen, V., Sommerhoff, C., Fritz, H & Schmitt, M. (2012). Novel cancer-related biomarkers: Novel cancer-related biomarkers. Berlin: Walter de Gruyter GmbH.