Details Brian Jones (aged 50) presented to his GP with a nine month (9/12) history of a change in his bowel habits, abdominal pain and fatigue. His GP ordered Faecal Occult Blood testing which confirmed the presence of blood in Brian's stool. Following this, Brian's GP referred him to a gastrointestinal specialist. The specialist recommended Brian have a colonoscopy. During the colonoscopy, a biopsy was taken of a lesion located in Brian's rectum. The biopsy results confirmed a Stage IIA rectal carcinoma. Brian was admitted to hospital for an abdomino-perineal resection and the formation of a colostomy. Brian returned to the surgical ward postoperatively. On his return, Brian has a patient controlled analgesia (PCA) infusion of 50mgs of Morphine in 50ml NaCl running at 4mL/hr, 0.9% NaCl (Sodium Chloride) IVI running at 125mL/hr via an IVC in his left arm, a sigmoid colostomy with a small amount of haemoserous fluid evident, 2 x Haemovac drains in situ on suction with 100mls frank blood in total, a nasogastric (NG) tube in situ on free drainage with 4/24 aspirations, an indwelling urinary catheter (IDC) with 50mls of urine output, regular medications ordered · metronidazole (Flagyl) IVI 500mgs in 100mLs 8/24 · paracetamol (Panadol) 1g IVI 6/24, · enoxaparin (Clexane) 40mgs sub cutanously daily, and · metoclopramide (Maxalon) 10mgs 8/24 PRN.

Question 1 - (300 words) Describe the pathogenesis of Brian's colorectal cancer from the initial cellular mutation to the diagnosis of stage IIA colorectal cancer (Learning outcome 5 Provides an accurate, clear and comprehensive description of the sequence of events that occurs in the pathogenesis of colorectal cancer from the initial cellular mutation to the diagnosis of Brian's stage IIA colorectal cancer. )

Question 2 - (300 words) Describe two (2) modifiable and three (3) non-modifiable risk factors for colorectal cancer and explain how these risk factors may have contributed to the development of Brian's colorectal cancer (Learning outcome 5 Accurately describes two (2) modifiable and three (3) non-modifiable risk factors for the development of colorectal cancer. Comprehensively, clearly and accurately explains how these risk factors may have contributed to the development of Brian's colorectal cancer).

Question 3 -(150 words) a) Describe the action and mechanism of action of metronidazole (Flagyl) in relation to its administration to Brian. b) Describe the action and mechanism of action of Morphine in relation to its administration to Brian. (Learning outcomes 6 & Provides an accurate description of the action of metronidazole (Flagyl) and Morphine in relation to their administration to Brian. Provides an exceptionally accurate, clear and comprehensive description of the mechanisms of action of metronidazole (Flagyl) and Morphine).

Question 4 -(250 words) Discuss the nursing responsibilities with associated rationales in relation to administering Morphine to Brian. (Learning outcomes 2, 6 & 7 Comprehensively and accurately discusses all relevant nursing responsibilities related to administering Morphine to Brian. Provides detailed and accurate rationales for each of these actions).