COLORECTAL CANCER

Introduction:

Tumor of the colon and rectum are relatively common, In the Philippines, colorectal cancer is also gaining unwanted ground and is now the third leading
type of cancer. Just this year, the Philippine Cancer Society (PCS) estimates at least 8,000 new cases of colorectal cancer to occur among Filipino.

The incidence increases with age (the incidence is high in people older than 85 years old) Consumption of alcohol drinking excessive amounts of alcohol
has been linked to colon cancer, family history of colon cancer. Research tells us that colon cancer can be genetic, meaning it can be passed down to our family
members through a defected gene. If you have a family history of colon cancer, discuss your risk factor with your doctor. If you personally have had colon cancer
before, you are more at risk at developing it again. This is even true if it was successfully treated, inflammatory bowel disease. Having chronic inflammatory
bowel disease puts you at a higher risk for developing colon cancer. IBD is a condition in which the colon suffers from inflammation for a period of time; colon
cancer can develop from polyps, extra tissue growths. Obesity being overweight can increase your risk factor for developing colon cancer. Lack of exercise is also
a contributor to the increase of one's colon cancer risk factor. Diet high in fat, a diet high in fat especially animal fat, not only raises your risk factor of being
overweight, it increases your risk factor for colon cancer. Smoking, smoking increases your risk factor many types of cancer, colon cancer included. Smokers are
20%-30% more likely to die of colon cancer than non-smoking people with the disease. Smoking may be the culprit of at least 12% of colon cancer
cases. Diabetes, people with diabetes has an increased risk factor for developing colon cancer. In fact, it is estimated that they have a 30-40% increased risk
factor.
Early diagnosis and prompt treatment could save almost 3 of every 4 people. If the disease is detected and treated at an early stage the 5 year survival
rate is 90%, however 34% of colorectal cancer are detected at an early stage. Survival rate after late diagnosis are very low. Most people are asymptomatic for
long periods and seek health care when they notice changes on this bowel habit or rectal bleeding. Prevention and early scsreening is the key to detection and
reducing of mortality rates.

General Objectives:

At the end of my case study, the researchers will be able to develop and enhance nursing skills and responsibilities on how to provide nursing care for a
client with Colon cancer condition and be able to identify the nursing interventions that will be appropriate with the client.

Specific Objectives:

1.To be able to make a Nursing Care Plan based from the obtained data from the client.

2.To be able to determine the appropriate interventions for the client’s specific condition.

3.To be able to determine complications associated that requires further assessment and treatment.
II. Nursing Process
A. Nursing History
Clients Profile:
A case of TC, 65 years old, female, a widow, a roman catholic. A Bicolana who is undergraduate of second year high school, she doesn`t have a work, and
currently residing at District V, Malate, Manila.

Admission Data:
She was admitted at Jose R. Reyes Memorial Medical Center, September 12, 2019 at exactly 10:00 pm in the evening via stretcher, accompanied by her
brother

History of Present Illness:

Five days upon admission, she experienced fowl smelly discharge on her abdomen because of her stoma due to colostomy. Her sister-in-law just wipes
using tissue paper and covers it with moist towel and then observed.
After five days the symptoms did not relieved, her brother decided to took her to the hospital.

Past Medical History:

On her childhood days, she only experienced simple cough and colds, and fever. The client does not have any history of accidents or injuries.
Client was hospitalized 12 years ago because of appendicitis, she could not remember when and where she was hospitalized, last September 2, 2019
client undergone colostomy for the diagnosis of colon cancer.
Patient is currently taking medication such as Cefuroxime 500 mg, 1 capsule, three times a day for seven days, Omeprazole 40 mg, Metronidazole 500
mg 1 tablet, three times a day, and Celecoxib 200 mg for pain only.

Family History:
Client’s father died because of poisoning at the age of 65, her mother died because of snake bite at the age of 67.
She has 9 siblings, two girls and 7 are boys. One of the 2 died of giving birth, 3 of her boy sibling died; one is because of kidney disease, the other one
died because of skin cancer. The rest is living and well and does not have any communicable or genetic diseases.

Gordon’s 11 Functional Pattern:

She only eat two to three teaspoonful of rice with little piece of meat and vegetables. Drinks at least 6 glasses of water per meal every day, urinates 5-6
times a day and defecates three times a day.
Client could not take a bath without assistance, could not make some simple exercise because of having stoma on her abdomen.

Nursing Diagnosis
  Acute Pain related to disruption of skin and tissues due to incision as evidenced by guarding behavior and restlessness.

 Deficient Knowledge related to changes in physiologic function and self-care/treatment needs as evidenced by statement of concern, and inaccurate
follow-through of instruction/development of preventable complications.

 Risk for Impaired Skin Integrity related to absence of sphincter at stoma and chemical irritation from caustic bowel contents, reaction to
product/removal of adhesive, and improperly fitting appliance.

Anatomy and Physiology

The colon is also called the large intestine. The ileum (last part of the small intestine) connects to the cecum (first part of the colon) in the lower right
abdomen. The rest of the colon is divided into four parts. The ascending colon travels up the right side of the abdomen. The transverse colon runs across the
abdomen. The descending colon travels down the left abdomen and the sigmoid colon is a short curving of the colon, just before the rectum.

Responsible for the final stages of the digestive process, the colon's function is threefold: to absorb the remaining water and electrolytes from
indigestible food matter; to accept and stores food remains that were not digested in the small intestine; and to eliminate solid waste (feces) from the body.

The colon works to maintain the body's fluid balance. It absorbs certain vitamins, and processes indigestible material (such as fiber), and stores waste
before it is eliminated. Within the colon, the mixture of fiber, small amounts of water, and vitamins, etc., mix with mucus and the bacteria that live in the large
intestine, beginning the formation of feces.

As the feces make its way through the colon, the lining absorbs most of the water as well as some of the vitamins and minerals present.  Bacteria within
the colon feed on the fiber, breaking it down in order to produce nutrients that will nourish the cells that line the colon. This is why fiber is such a vital part of a
diet geared toward the colon's long-term health.

Feces are moved along until the walls of the sigmoid colon contract, causing waste to move into the rectum. Known as peristaltic action, this wave-like motion
encourages feces to move closer to the rectum and, finally, be expelled through the anus.

Pathophysiology:

Cancer development begins at the level of molecular level and may begin with mutations on damage of one or more genomes.

Cell becomes more specialized or committed to a particular cell line as they mature this process is called differentiation.

Changes in the appearance of the cell, the presence of tumor-specific antigens that are suppressed on the normal cell, and the loss of normal cell function can
result from altered differentiation. Cell membrane changes may result in production of enzymes that aid in cancer spread

Loss of antigens that identify the cell as “self” or production of tumor-specific antigens can alter the immune system’s ability to mount a response. Therefore
malignant cell survive due to the failure of immune system.
As a result the angiogenesis develop growth of new capillaries from the host tissue by the release of growth factors and enzymes such as vascular endothelial
growth factor (VGEF). These proteins rapidly stimulate formation of new blood vessels which helps malignant cells obtain the necessary nutrients and oxygen.

Since there is an abnormal growth of tissue called polyps that slowly grow and most take 5 to 10 years or longer to become malignant.

As a polyp becomes malignant, it increase in size within the lumen and begins to invade bowel wall, the tumor cells penetrates the bowel walls and adheres to or
invades adjacent organs and lymph nodes.

A tumor in right colon tends to be bulky and cause ulceration resulting to dark tarry stool (melena). Since there is a right colon lesion the gastro intestinal tract
tends to loss its function that will result to change in bowel habit.

As the gastro intestinal tract loss its function malabsorption of nutrients, salt and water will occur resulting to alternating chronic diarrhea and constipation.

Nursing Outcome Classification

Maintaining an optimum hygiene of a surgically created opening between colon and abdominal wall that allows fecal elimination.

NOC: Bowel Elimination

NOC:Tissue Integrity: Skin and Mucous Membranes
NOC:Coping

D.Planning

The patient will verbalize understanding of causative factors and rationale for treatment regimen.
Client will assess the current situation accurately

E.Nursing Intervention Classification

NIC: Diarrhea management

NIC: Wound Care
NIC: Coping Enhancement

F. Nursing Evaluation

X. GORDON’S FUNCTIONAL HEALTH PATTERN

HEALTH PATTERN Before Hospitalization
Health perception Client only seeks consultations when she feels
and Management something wrong with her body but she knows
the importance of having monthly check-up.
Nutrition and The client’s diet consists mainly of fish, rice and
Metabolic pattern vegetables however, they just consume meat
and poultry product when they can afford it.
She and her family does not smoke and drinks
alcoholic beverages occasionally
Elimination Patient is able to urinate at least 4 times a day
Pattern and defecate at least once a day
Activity-Exercise She is the one doing the household chores and
pattern also go to their weekly church meetings
Sleep-Rest Pattern She has an average of 6 hours of sleep per day
which starts mostly from 11:00 pm to 5:00 am.
She also takes her afternoon naps for about 30
minutes.
Cognitive- Even if she is now old, her five senses are still
perceptual Pattern unremarkable and her thought process is
clearly not been changed.
Role-relationship She has been a wonderful wife and mother. She
pattern is the one who does the chores and takes care
of their family
Value and Belief She is a roman catholic who goes to church
During Hospitalization
Even if she has been hospitalized twice
she still seek consultations only if she
has been feeling something
The client was ordered clear liquid diet,
then NPO before the operation. After
the operation, she was under NPO then
soft diet and then when with BM, DAT
Client have increased urge on urination
but have difficulties going to the nearest
CR because of pain in incision site
She can move about but can’t do it as
independent as before
Most of the time, the patient is in bed.
Her hours of sleep has been drastically
increased due to lack of activities
She say that there is mild numbing in
her hands
She is now unable to do what she used
to do before she gets hospitalized. Now,
it’s her children who take care of her
She could not go to church but still, her
Analysis
The client know the importance of routine
check-ups but does not do so because of
lack of time and/or resources
Patient may easily get used to her diet
because they don’t usually eat meat and
their usual diet is somewhat soft
Client’s perception of pain interfere with the
urge to urinate
Her physical restrictions and weakness
causes her to have limitations upon
movement
The things that pre-occupies her time are
not met now and because of that, the client
uses those idea time to rest which is good
for her soon recovery
This is because of her state of being
immotile caused by her post-surgical
condition
Even if she want it or not, her responsibility
as a wife and a mother still remains but not
as strong as it was before
It’s her faith to God that gives her strength
 pattern every church meeting and has a strong faith in faith to God still remains to overcome any obstacles
God
Sexuality pattern Before, she and her husband are sexually active She is not sexually active that even her Pain may interfere with emotions that it
but now, because of their age, they are now libido is down would make it hard for someone to achieve
not that active sex drive.
Coping-stress She is a happy person that she always smile to She is still optimistic but it is hard to tell Pain may interfere with emotions that it
pattern everyone whether if she really is happy because of would make it hard for someone to
her lack of facial expression while completely get their minds away from pain.
verbally expressing her optimism

Drugs Study

Drug Name Classification Dosage/Route Mechanism of Indication Contraindication Side Effects Nursing Considerations
/Frequency Action
Bisacodyl Laxative 2 rectal Bisacodyl Treatment of Acute surgical Abdominal ♪Do not use for longer
suppositories Suppositories constipation abdomen or discomfort than 1 week without
at 7 pm and are a stimulant intestinal (colic, cramps) checking with your doctor.
10 pm laxative. It acts obstruction, Faintness Using Bisacodyl
directly on the severe Suppositories for a long
bowels, dehydration, time may result in loss of
stimulating the fecal impaction, normal bowel function.
bowel muscles chronic use ♪Do not take additional
to cause a laxatives or stool softeners
bowel with Bisacodyl
movement Suppositories unless
directed by your doctor.
♪Rectal bleeding or failure
to have a bowel
movement after use of a
laxative may be a sign of a
serious condition. Stop use
and contact your doctor.
♪If you notice a sudden
 change in bowel habits
that lasts for 2 weeks or
more, do not continue
using Bisacodyl
Suppositories. Instead,
check with your doctor.

Drug Name Classification Dosage/Route Mechanism of Indication Contraindication Side Effects Nursing Considerations
/Frequency Action
Cefuroxime Cephalospori 1-5 g IV, ♪Cefuroxime It is effective for Hypersensitivity ♪Thrombophlebi ♪Determine history of
n, second (-ANST) 30 binds to one or the treatment of to tis (IV site) Hypersensitivity reactions
generation mins prior to more of the penicillinase-producing cephalosporins ♪Positive to cephalosporins,
OR penicillin- Neisseria gonorrhoea and related Coombs' penicillins, and history of
binding (PPNG). Effectively treats antibiotics; test. allergies, particularly to
proteins (PBPs) bone and joint infections, pregnancy ♪Diarrhea, drugs, before therapy is
which inhibits bronchitis, meningitis, (category B), ♪Nausea initiated
the final gonorrhea, otitis media, lactation. Use in ♪Antibiotic- ♪Report onset of loose
transpeptidatio pharyngitis/tonsillitis, clients with associated stools or diarrhea.
n step of sinusitis, lower false/negative colitis Although
peptidoglycan respiratory tract reaction in the ♪Rash pseudomembranous
synthesis in infections, skin and soft ferricyanide test ♪Pruritus, colitis.
bacterial cell tissue infections, urinary for blood ♪Urticaria. ♪Monitor I&O rates and
wall, thus tract infections, and is glucose. Use in ♪Increased Pattern: Especially
inhibiting used for surgical clients with serum important in severely
biosynthesis prophylaxis, reducing or severe renal creatinine and ill patients receiving
and arresting eliminating infection failure. BUN, high doses. Report any
cell wall ♪Decreased significant changes
assembly creatinine
resulting in clearance
bacterial cell
death.
Drug Name Classification Dosage/Route Mechanism of Indication Contraindication Side Effects Nursing Considerations
/Frequency Action
Metronidaz Anti- 500 mg/tab, Disrupts DNA Serious infection due to Bloody discrasias ♪Headache ♪Adhere closely to the
ole infective, PO, TID and protein susceptible anaerobic Active organic ♪Vaginitis established regimen
Antibiotic synthesis in bacteria or protozoans disease of CNS ♪Nausea without schedule
susceptible To reduce postoperative Trichomoniasis ♪Metallic taste interruption or changing
organisms anaerobic infection during 1st ♪Genital the dose.
following colorectal trimester of pruritus ♪Refrain from intercourse
surgery, elective pregnancy ♪Bacterial during therapy for
hysterectomy and Lactation infection trichomoniasis unless male
emergency Consumption of ♪Flu-like partner wears a condom
appendectomy alcohol during infection to prevent reinfection.
In treatment of bacterial use ♪Have sexual partners
sepsis receive
concurrent treatment.
Asymptomatic
trichomoniasis in the male
is a frequent source of
reinfection of the female.
♪Do not drink alcohol
during therapy; may
induce a disulfiram-type
reaction Avoid alcohol or
alcohol-containing medica
tions for at least 48 h
after treatment is
completed.

XVIII. Surgical Management:

TAHBSO (Abdominal Hysterectomy Bilateral Salpingo Oophorectomy) - Total Abdominal Hysterectomy Bilateral Salpingo Oophorectomy is a surgical procedure
involving the removal of the uterus, both ovaries, and the fallopian tubes through an incision in the abdomen. This is a treatment for endometrial cancer, uterine
sarcoma and other severe gynecological problems

In the past, the most common hysterectomy was done by an incision (cut) through the abdomen (abdominal hysterectomy). Now, most of the surgeries can
utilize laparoscopic assisted or vaginal hysterectomies (performed through the vagina rather than through abdomen).

XIX. Discharge Planning:

Medication: Amoxicillin 500 mg/tab, 1 tab q6° x 7 days PO

FeSO4 1 tab, PO, BID

Mefenamic acid 500 mg/tab, PO, prn

Multivitamins 500 mg/tab, 1 tab, PO, OD

Exercise: Encourage ambulation

Health Teachings: Daily body and perineal hygiene

Wound care

OPD Date: 2 weeks after discharge,

Diet: Diet as tolerated.

III. Appendices:

Brunner and Suddarth`s, unit.7: Digestive and Gastrointestinal function, pg.1266-1267

www.webmd.com/.../picture-of-the-colon

 www.philcancer.org.ph/...cancer/.../70-colorec...

http://nanda-nursinginterventions.blogspot.com. Powered byBlogger.

Nursing pocket guide 11th edition M.E Doenges, Mary frances Moorhouse, and A.C Murr pg.620-621

CASE STUDY:

Patient Profile
Brief discussion of the case (Include Present Hx of the present illness & incidence of the type of cancer in the Philippines): DOH website
Nursing Assessment (Gordons Functional Assessment)
Anatomy & Physiology
Pathophysiology (Patient centered)
Laboratory exams/diagnostics
Nursing Care Plan (3-priority)
Drug study

Jed is a 56-year-old White male of Irish descent who started having frequent episodes of blood in the stool, changes in bowel habits, sudden weight loss and poor
appetite. These symptoms prompted her to seek medical attention. Blood work indicated that she was anemic (insert Hgb results). Rectal examination and fecal
occult blood test were positive, and was advised to schedule for a colonoscopy as part of the workup to see if there are a polyps or tumor obstructing her colon,
she booked a colonoscopy for the following month. However, 2 days later, she had experienced excruciating abdominal pain and severe constipation for almost
5 days, which prompted her to rush to the emergency room.

She was subsequently admitted for evaluation and treatment. Computed tomography scan and magnetic resonance imaging of the abdomen and pelvis revealed
a mass in the sigmoid colon, diffuse metastatic disease in the right and left lobes of the liver and retroperitoneal lymphadenopathy.

Colonoscopy revealed a completely obstructing 3 cm circumferential mass in the sigmoid colon 20 cm from the anal verge. A colon biopsy was taken for analysis
and shows positive for poorly differentiated adenocarcinoma, she was placed on a low-residue diet.

A fine-needle aspiration biopsy of the largest liver lesion was positive for metastatic adenocarcinoma. Tina’s past medical and surgical history is unremarkable.
Her social history is significant for smoking two packs per day for 26 years and occasional intake of alcohol for social occasions. She is married and has two adult
children. Family history is significant because her father was diagnosed with colon cancer 3 years prior at age 60, which is decease