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I. Introduction:

Moderately differentiated adenocarcinoma is made up of cells that, for the most part,
resemble normal, healthy cells. These cells have some malformations in their
components and may divide at an increased rate but are not considered to be as
aggressive as cells that are poorly differentiated. The prognosis for cancers with
moderately differentiated cells depends on a number of factors, such as the organ or
system affected by the cancer, the size of the tumor and how widespread the cancer
is, but it is generally better than the prognosis given when patients have poorly
differentiated cancer cells.

Rectal cancer is common but occurs very rarely in young adults. Rectal cancer
becomes more common as age increases. People in their 50s, 60s and 70s are most at
risk with sex incidence being more common in females. Geographically, the rectal
cancer tumor is found worldwide, but rectal cancer is most common in areas which
have low fiber diets. Areas of the world with high fat consumption and low fiber
consumption such as Europe, USA and Australia.

Furthermore, in the Philippines, 75% of all cancers occur after age 50 years, and only
about 3% occur at age 14 years and below. If the current low cancer prevention
consciousness persists, it is estimated that for every 1800 Filipinos, one will develop
cancer annually. At present, most Filipino cancer patients seek medical advice only
when symptomatic or at advanced stages: for every two new cancer cases diagnosed
annually, one will die within the year. It is estimated that 3050% of cancer patients
in all stages of the disease will experience pain and 7095% with advanced disease
will have significant pain, but only a fraction of these patients receive adequate
treatment.

Patient G, 60 years old female, a resident of Nagpandayan, Guimba, Nueva Ecija was admitted
at Dr. Paulino J. Garcia Memorial Research and Medical Center for complaints of severe
pain in the anorectal area associated with bloody stool on August 08, 2014 at 11:24 am.

The lack of knowledge and information about Adenocarcinoma, Moderately Differentiated is
one of the reasons why we chose this case. Not many Filipino women know about the disease,
that it is preventable and can be cured when detected at the onset. We strongly believe that this
case study will be very helpful in our career someday as future registered nurses. And also we
want to improve our knowledge in studying cancer, because of our subject oncology.

II. Purpose/ Objective:
Learning Goal Student Centered Client Centered
Skills To be able to perform the
nursing skills learned in
To be able to perform
Independent nursing




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school into real life situation
such as
Providing safety and
maintaining privacy
Proper vital signs
monitoring
Giving holistic care
and other necessary
nursing interventions
needed for the patient.
Triaging patients
properly in giving care
Admission care in the
E.R.
Taking ECG.
Placing indwelling
foley catheter
Nebulizing and
suctioning
skills such as
providing comfort,
maintaining privacy,
monitoring, and
keeping the safety of
the patient.

Knowledge To be able to acquire
knowledge regarding
adenocarcinoma
moderately
differentiated, its signs
and symptoms,
pathophysiology and
course of treatment.
Familiarity with
common emergencies
and patient concerns
that cause them to seek
care.
To be able to know the
possible prevention
and proper
management of
adenocarcinoma
moderately
differentiated.
To impart necessary health
teachings to the patient and
explain her disease based on
her level of understanding.
Attitude To be able to behave in
front of the patient in a
therapeutic manner.
To be able to encourage
patient to accept her disease
and act accordingly with her




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To be able to act
professionally with the
supervision of our
clinical instructor.
current condition.

III. Personal Profile:
Name: Patient G
Age: 60 years old
Sex: Female
Birthdate: August 12, 1953
Birthplace: Nagpandayan, Guimba, Nueva Ecija
Marital Status: Married
Address: Nagpandayan, Guimba, Nueva Ecija
Occupation: Housewife
Religion: Roman Catholic
Date and time of consultation: August 08, 2014 at 11:24 AM
Attending Physician: Dr. Salamanca

IV. Chief Complaint:
The patient experienced pain in the anorectal area associated with bloody stool 2 days
PTC.

V. History of Present Illness:
Two (2) days prior to consultation the patient noted pain during defecation
associated with some bleeding and changes in the character of stool. She did not went
to hospital immediately because she thought that the bleeding will stop if she will
take the medicine the doctor gave her during her consultation last April 14, 2014 in
Premiere Medical Center. But 2 days have passed the bleeding didnt stop, so she
decided to go in Dr. Paulino J. Garcia Memorial Research and Medical Center to seek
medical help.

VI. Past Medical History:
Last April 14, 2014 Patient G. went to Premiere Medical Center to seek
consultation because she s experiencing bloody stool and pain while defecating one
day after she ate a lot of spicy foods. Her guaiac stool examination revealed that her
stool has plenty of bacteria and her doctor gave her a prescription of medications. On
the same day that day she had undergone anoscopy with biopsy and was diagnosed
moderately differentiated adenocarcinoma and is malignant.

VII. Past Surgical History:
The patient has not undergone any surgery.





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VIII. Allergies/ Medications:
She claimed that she has no allergies to any foods and medications. The following
are the medications shes taking before consultation:
Metronidazole 500mg
Omeprazole 20mg
Maalox 200mg
Tranexamic Acid 500mg

IX. Smoking, Alcohol, Substance Abuse :
She claimed that she is not a smoker, she doesnt drink alcohol and is not involve
in taking any prohibited drugs.

X. Social/ Work History:
The patient is a married housewife.

XI. Family History:
Upon taking the interview, Patient G. has a family history of colon cancer on
which her brother and sister acquired and is now dead. Her mother has ulcer and
goiter and her father has chronic bronchitis.


























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XII. Review Of System:













































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XIII. Pathophysiology



XIV. Physical Assessment:

I. Vital Signs
Temperature
Pulse Rate
Respiratory Rate
Blood Pressure
Actual Findings
37.1 degree Celsius
110 beats per minute
28 cycles per minute
130/90 mmHg
II. Level of Consciousness Conscious and Coherent

III. BODY PARTS NORMAL
FINDINGS
ACTUAL
FINDINGS
REMARKS
A. GENERAL
APPEARANC
E
With normal weight,
afebrile,
proportionality and
symmetry

B. SKIN The color depends
on race, ethnic
background,
complexion, sun
exposure, and
pigmentation
tendencies.

C. HAIR Grows well,
properly tied, no
hair loss, with
proper hair
distribution

D. NAILS Clean and pink in
appearance.

E. SKULL AND
HEAD
Normal cephalic,
symmetrical facial
structure, absence of
tenderness over the
maxillary sinuses.

F. EYES and
VISION
Normal vision of
20/20,





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G. EARS Hears clearly
H. NOSE AND
SINUSES
Straight Nasal
septum, no
discharge present,
airway is patent,
mucous membranes
are pink, no
swelling.

I. MOUTH Lips are moist and
pink, no masses,
gums are pink and
smooth, The tongue
is midline and
without any
hoarseness of voice.

J. NECK With normal range
of motion, can turn
the head against
force of the hand, no
swelling.

K. THORAX
AND LUNGS
There is no
tenderness, chest
movement should
be symmetric and
without lag or
impairment. With
normal lung sounds

L. HEART No palpitations,
normal PR should
be 60- 100 in adult

M. BREAST AND
AXILLA
Absence of pain,
lumps, discharge, or
any surgery.

N. UPPER
EXTREMETI
ES
Extremities should
be symmetrical and
the skin is warm
without any
fracture.

O. LOWER
EXTREMRTI
Hair covers the legs,
the venous pattern is





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ES normally visible,
both legs are
symmetrical and
without any
swelling.
P. GROSS
MOTOR
FUNCTIONS
Gross motor skills
involve the large
muscles of the body
that enable such
functions as sitting
upright, lifting, and
throwing a ball.

Q. FINE MOTOR
TEST
Fine motor skills
involve the small
muscles of the body
that enable such
functions as writing,
grasping small
objects, and
fastening clothing.

R. SENSORY
FUNCTION
With normal senses.
Can see clearly, can
hear accurately, no
altered taste, can
smell normally.

S. ABDOMEN The contour of the
abdomen is usually
flat and rounded, the
skin surface is
smooth, and even
with homogenous
color and good skin
turgor.

XV. PHARMACOLOGIC TREATMENT
NAME
OF
DRUG
ORDER
ED
DOSE
MECHAN
ISM OF
ACTOIN

INDICAT
ION
CONTRA-
INDICATION
SIDE EFFECTS
&ADVERSE
REACTONS
NURSING
RESPONSI
BILITY
Metronid
azole

500 mg







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Omepraz 20 mg




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ole


Maalox


200 mg
Tranexa
mic acid


500mg




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XVI. Laboratory results

Laboratory Normal Value Result Interpretation
ECG


CHEST X-RAY


CBC







URINALYSIS


PROTHROMBIN
TIME

ANOSCOPY with
BIOPSY

BLOOD TYPING


XVII. Course in E.R.

DATE INTERVENTIONS
08-08-2014 Admitted a 60 year old female patient to FSW under yellow team.
Secure consent of admission.
Monitor vital signs and record.
CBC, APC, BUN, CREA, FBS, BT, PTT done.
ECG done.
IVF of D
5
LRS 1L for 24Hours
Referred.

XVIII. Nursing Care Plan

ASSESSM
ENT
NURSIN
G
DIAGNO
SIS
INFERE
NCE
PLANNI
NG
INTERVENT
ION
RATION
ALE
EVALUAT
ION





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XIX. Discharge Planning

Medications
Advice patient to continue taking medications needed to maintain a normal
functioning of the body and maintain homeostasis. The treatment regimen
ordered by the doctors must be followed strictly and should not be stopped to
prevent the aggravation of the condition. The full course of antibiotics should
be followed.
Advice the patient to observe the any reaction towards the given medications
and signs that needs to call the attention of the physician.

Exercise
Encourage patient to have an active and passive ROM because it will promote
blood circulation and to improve muscle strength in order to promote total
range of motion.

Treatment:
Instruct patient to consult the physician first if what activities must he/she
avoid or put into limits.
Encourage patient to compliance of medication regimen to promote optimal
health.

Health Teachings:
Importance of personal hygiene to prevent infection.
Intake of nutritious foods like vegetables and fruits and intake of foods that is
rich in fiber such as green leafy vegetables and pineapple, also increased fluid
intake to prevent constipation.
Strict compliance of medication regimen to promote wellness.
Immediate report to the physician if unusual occurrences occur.

Out-Patient:




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Return to OPD for further check-up if whether it is improving or not. Also, for
early diagnosis of any other underlying conditions.

Diet:
Encourage client to eat nutritious or healthy foods such as fruits and vegetables
and foods that are high in fiber such as green leafy vegetables, wheat, cereal
and pineapple. Suggest client also to consult to a dietary physician to know
what the correct dietary intake he must maintain are.

Spiritual:
Advice client to pray and have faith in God always because God is the most
powerful of all He knows what happened and He will never leave us.