Beruflich Dokumente
Kultur Dokumente
COLLEGE OF NURSING
La Trinidad, Benguet
A Case Study on
Colonic Carcinoma
Presented to the
Faculty of the College of Nursing,
Benguet State University
Submitted by:
Group 8
Audray Kyle Saydoven
Noreen Paligpig
Kathleen Mae Panagan
Graile Pinas
Aaron Rafael Perkins
Shiki Charelle Reforba
Warren Jae Sandoval
Ma. Lorena Gabrielle Sanqui
Corazon Sepulchre
Marsha Sepulchre
Jo-anne Bray Siadto
Marinel Tabarejos
Bherly Frank Tamid-ay
Submitted to:
Jon Erik Saluta, RN
January 2011
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I. Patient’s Information
Name: Felipe Dacnas Alunday Sr.
Address: Allaguia, Pinukpok, Kalinga
Birthdate: June 11, 1947
Age: 63 years old
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: January 3, 2011
Time of Admission: 4.05 pm
Admitting Physician: : Mathew B. Bawayan
Attending Physician: Ponadon, Besarino, Douglas
Admitting Diagnosis: Colonic Carcinoma S/P Anterior Resection (July 23, 2011)
S/P Third Cycle Chemotherapy
Principal Diagnosis: Colonic Carcinoma S/P Anterior Resection (July 23, 2011) S/P
Fourth Cycle Chemotherapy
II. Clinical History
Chief Complaint: For fourth chemotherapy
Review of systems:
(+) Body Weakness, (-) Nausea and vomiting, (+) Anorexia, (-) Abdominal pain, (-)
Constipation, (-) Diarrhea, (-)Diziness, (-) HA
History of Present Illness:
Present condition started when the patient was diagnosed with colon
cancer last July 2010. Patient underwent colonic resection on July 2010 and was
advised to undergo chemotherapy. Previous chemotherapies were done in
BGHMC institution. There was associated nausea and vomiting. Patient was
scheduled for his fourth chemotherapy hence admitted.
Past medical History:
(-) Other Hospitalization
(+) HPN – 2010
(-) Accidents or trauma in the past
(-) Allergies
Family History:
(+) Hypertension, (-)DM, (-) BA, (-) CAD, (-) PTB
Social and Environmental History
Smoker, Non – alcoholic beverage drinker
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Ascending colon
The ascending colon, on the right side of the abdomen, is about 25 cm
long in humans. It is the part of the colon from the cecum to the hepatic flexure
(the turn of the colon by the liver). It is secondarily retroperitoneal in most
humans. In ruminant grazing animals, the cecum empties into the spiral colon.
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Anteriorly it is related to the coils of small intestine, the right edge of the
greater omentum, and the anterior abdominal wall. Posteriorly, it is related to
the iliacus, the iliolumbar ligament, the quadratus lumborum, the transverse
abdominis, the diaphragm at the tip of the last rib; the lateral cutaneous,
ilioinguinal, and iliohypogastric nerves; the iliac branches of the iliolumbar
vessels, the fourth lumbar artery, and the right kidney. The ascending colon is
supplied by parasympathetic fibers of the vagus nerve (CN X).
Arterial supply of the ascending colon comes from the ileocolic artery and
right colic artery, both branches of the SMA. While the ileocolic artery is almost
always present, the right colic may be absent in 5–15% of individuals.
Transverse colon
The transverse colon is the part of the colon from the hepatic flexure to
the splenic flexure (the turn of the colon by the spleen). The transverse colon
hangs off the stomach, attached to it by a wide band of tissue called the greater
omentum. On the posterior side, the transverse colon is connected to the
posterior abdominal wall by a mesentery known as the transverse mesocolon.
The transverse colon is encased in peritoneum, and is therefore mobile
(unlike the parts of the colon immediately before and after it). Cancers form
more frequently further along the large intestine as the contents become more
solid (water is removed) in order to form feces.
The proximal two-thirds of the transverse colon is perfused by the middle
colic artery, a branch of SMA, while the latter third is supplied by branches of the
IMA. The "watershed" area between these two blood supplies, which represents
the embryologic division between the midgut and hindgut, is an area sensitive to
ischemia.
Descending colon
The descending colon is the part of the colon from the splenic flexure to
the beginning of the sigmoid colon. The function of the descending colon in the
digestive system is to store food that will be emptied into the rectum. It is
retroperitoneal in two-thirds of humans. In the other third, it has a (usually
short) mesentery. The arterial supply comes via the left colic artery.
Sigmoid colon
The sigmoid colon is the part of the large intestine after the descending
colon and before the rectum. The name sigmoid means S-shaped (see sigmoid).
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The walls of the sigmoid colon are muscular, and contract to increase the
pressure inside the colon, causing the stool to move into the rectum.
The sigmoid colon is supplied with blood from several branches (usually
between 2 and 6) of the sigmoid arteries, a branch of the IMA. The IMA
terminates as the superior rectal artery. Sigmoidoscopy is a common diagnostic
technique used to examine the sigmoid colon.
Redundant colon
One variation on the normal anatomy of the colon occurs when extra
loops form, resulting in a longer than normal organ. This condition, referred to as
redundant colon, typically has no direct major health consequences, though
rarely volvulus occurs resulting in obstruction and requiring immediate medical
attention.[4] A significant indirect health consequence is that use of a standard
adult colonoscope is difficult and in some cases impossible when a redundant
colon is present, though specialized variants on the instrument (including the
pediatric variant) are useful in overcoming this problem.
the large intestine, most of the remaining water is removed, while the chyme is
mixed with mucus and bacteria (known as gut flora), and becomes feces. The
ascending colon receives fecal material as a liquid. The muscles of the colon then
move the watery waste material forward and slowly absorb all the excess water.
The stools get to become semi solid as they move along into the descending
colon. The bacteria break down some of the fiber for their own nourishment and
create acetate, propionate, and butyrate as waste products, which in turn are
used by the cell lining of the colon for nourishment. No protein is made
available. In humans, perhaps 10% of the undigested carbohydrate thus
becomes available; in other animals, including other apes and primates, who
have proportionally larger colons, more is made available, thus permitting a
higher portion of plant material in the diet. This is an example of a symbiotic
relationship and provides about one hundred calories a day to the body. The
large intestine produces no digestive enzymes -— chemical digestion is
completed in the small intestine before the chyme reaches the large intestine.
The pH in the colon varies between 5.5 and 7 (slightly acidic to neutral).
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Risk Factors:
Age and health history can affect the risk of developing colon carcinoma .
Risk factors include the following:
Age 50 or older.
A family history of carcinoma of the colon or rectum.
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But a tiny percentage of these polyps keep growing, sometimes for 10 years or more. Various genetic mutations can transform
them into cancerous tumors. The most commonly mutated gene in all colorectal cancer is the APC gene, which produces the APC
protein. The APC protein is the "brake" on the β-cateninprotein. Without APC, β-catenin translocates (moves) into the nucleus, binds
to DNA, and activates the expression of more proteins. (If APC is not mutated in colorectal cancer, then β-catenin itself is.)
The patient is a 63 year old male, suffering from colon cancer (Colonic carcinoma). He
was diagnosed last July 2010 after having a check-up. As stated by his daughter, the patient has
high fiber but low protein intake. Also, he has suffered from peptic ulcer. He is a smoker but not
alcoholic. Moreover, based from the tests done to the patient, polyps were present in his
intestines.
History of ulcer
Formation of Polyps
(intramucosal epithelial
lesion)
Cancers grow.
Colonic Carcinoma
that seems unusual. A history of the patient's health habits and past illnesses
and treatments will also be taken.
Fecal occult blood test: A test to check stool (solid waste) for blood that can
only be seen with a microscope. Small samples of stool are placed on special
cards and returned to the doctor or laboratory for testing.
Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a
lubricated, gloved finger into the rectum to feel for lumps or anything else
that seems unusual.
Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid
that contains barium (a silver-white metallic compound) is put into the
rectum. The barium coats the lower gastrointestinal tract and x-rays are
taken. This procedure is also called a lower GI series.
Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the
rectum and flows through the colon. X-rays are taken to look for abnormal areas.
Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for
polyps, abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum
into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light
and a lens for viewing. It may also have a tool to remove polyps or tissue samples,
which are checked under a microscope for signs of cancer.
Sigmoidoscopy. A thin, lighted tube is inserted through the anus and rectum
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and into the lower part of the colon to look for abnormal areas.
Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal
areas, or cancer. A colonoscope is inserted through the rectum into the colon. A
colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may
also have a tool to remove polyps or tissue samples, which are checked under a
microscope for signs of cancer.
Colonoscopy. A thin, lighted tube is inserted through the anus and rectum and into the colon to
look for abnormal areas.
Surgery
Surgery is the most common treatment for all stages of colon cancer. The
cancer is removed using one of the following types of surgery:
• Local excision: If the cancer is found at a very early stage, the doctor may
remove it without cutting through the abdominal wall. Instead, the doctor may
put a tube through the rectum into the colon and cut the cancer out. This is
called a local excision. If the cancer is found in a polyp (a small bulging piece of
tissue), the operation is called a polypectomy.
• Resection: If the cancer is larger, the doctor will perform a partial
colectomy (removing the cancer and a small amount of healthy tissue around it).
The doctor may then perform an anastomosis (sewing the healthy parts of the
colon together). The doctor will also usually remove lymph nodes near the colon
and examine them under a microscope to see whether they contain cancer.
Colon cancer surgery with anastomosis. Part of the colon containing the cancer
and nearby healthy tissue are removed, and then the cut ends of the colon are
joined.
• Resection and colostomy: If the doctor is not able to sew the 2 ends of
the colon back together, a stoma(an opening) is made on the outside of the body
for waste to pass through. This procedure is called a colostomy. A bag is placed
around the stoma to collect the waste. Sometimes the colostomy is needed only
until the lower colon has healed, and then it can be reversed. If the doctor needs
to remove the entire lower colon, however, the colostomy may be permanent.
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Colon cancer surgery with colostomy. Part of the colon containing the cancer and
nearby healthy tissue is removed, a stoma is created, and a colostomy bag is
attached to the stoma.
• Radiofrequency ablation: The use of a special probe with tiny electrodes
that kill cancer cells. Sometimes the probe is inserted directly through the skin
and only local anesthesia is needed. In other cases, the probe is inserted through
an incision in the abdomen. This is done in the hospital with general anesthesia.
• Microwave ablation destroys liver tumors using heat generated by
microwave energy.
• Cryosurgery: A treatment that uses an instrument to freeze and destroy
abnormal tissue, such as carcinoma in situ. This type of treatment is also called
cryotherapy.
• Even if the doctor removes all the cancer that can be seen at the time of
the operation, some patients may be given chemotherapy or radiation therapy
after surgery to kill any cancer cells that are left. Treatment given after the
surgery, to increase the chances of a cure, is called adjuvant therapy.
Adjuvant Therapy
Even if all the cancer that can be seen at the time of the operation is
removed, some patients may be given radiation therapy or chemotherapy after
surgery to kill any cancer cells that are left. Treatment given after surgery to
increase the chances of a cure is called adjuvant therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of
cancer cells, either by killing the cells or by stopping them from dividing. When
chemotherapy is taken by mouth or injected into a vein or muscle, the drugs
enter the bloodstream and can reach cancer cells throughout the body (systemic
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Radiation Therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other
types of radiation to kill cancer cells or keep them from growing. There are two
types of radiation therapy. External radiation therapy uses a machine outside the
body to send radiation toward the cancer. Internal radiation therapy uses a
radioactive substance sealed in needles, seeds, wires, or catheters that are
placed directly into or near the cancer. The way the radiation therapy is given
depends on the type and stage of the cancer being treated.
X. Drug Study
a. Ranitidine hydrochloride
Brand Name: Zantac
Indications:
Side Effects
Central Nervous System
Rarely, malaise, dizziness, somnolence, insomnia, and vertigo. Rare cases
of reversible mental confusion, agitation, depression, and hallucinations have
been reported, predominantly in severely ill elderly patients. Rare cases of
reversible blurred vision suggestive of a change in accommodation have been
reported. Rare reports of reversible involuntary motor disturbances have been
received.
Cardiovascular
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NURSING IMPLICATIONS/RESPONSIBILITIES
Assess patient for epigastric or abdominal pain and frank or occult blood in the
stool, emesis, or gastric aspirate.
Nurse should know that it may cause false-positive results for urine protein; test
with sulfosalicylic acid.
Inform patient that it may cause drowsiness or dizziness.
Inform patient that increased fluid and fiber intake may minimize constipation.
Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea;
dizziness; rash; confusion; or hallucinations to health car professional promptly.
Inform patient that medication may temporarily cause stools and tongue to
appear gray black.
b. dexamethasone
Brand Name: Decadron
Indications:
Allergic States
Control of severe or incapacitating allergic conditions intractable to adequate
trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug
hypersensitivity reactions, perennial or seasonal allergic rhinitis, and serum sickness.
Dermatologic Diseases
Bullous dermatitis herpetiformis, exfoliative erythroderma, mycosis fungoides,
pemphigus, and severe erythema multiforme (Stevens-Johnson syndrome).
Endocrine Disorders
Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is
the drug of choice; may be used in conjunction with synthetic miner-alocorticoid
analogs where applicable;in infancy mineralocorticoid supplementation is of particular
importance), congenital adrenal hyperplasia, hypercal-cemia associated with cancer,
and nonsuppurative thyroiditis.
Gastrointestinal Diseases
To tide the patient over a critical period of the disease in regional enteritis and
ulcerative colitis.
Hematologic Disorders
Acquired (autoimmune) hemolytic anemia, congenital (erythroid) hypoplastic
anemia (Diamond-Blackfan anemia), idiopathic thrombocytopenic purpura in adults,
pure red cell aplasia, and selected cases of secondary thrombocytopenia.
Miscellaneous
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Neoplastic Diseases
For the palliative management of leukemias and lymphomas.
Nervous System
Acute exacerbations of multiple sclerosis, cerebral edema associated with
primary or metastatic brain tumor, craniotomy, or head injury.
Ophthalmic Diseases
Sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory
conditions unresponsive to topical corticosteroids.
Renal Diseases
To induce a diuresis or remission of proteinuria in idiopathic nephrotic
syndrome or that due to lupus erythematosus.
Respiratory Diseases
Berylliosis, fulminating or disseminated pulmonary tuberculosis when used
concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic
pneumonias, symptomatic sarcoidosis.
Rheumatic Disorders
As adjunctive therapy for short-term administration (to tide the patient over an
acute episode or exacerbation) in acute gouty arthritis, acute rheumatic carditis,
ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, including juvenile
rheumatoid arthritis (selected cases may require low-dose maintenance therapy). For
the treatment of dermatomyositis, polymyositis, and systemic lupus erythematosus.
Side Effects
Allergic Reactions
Anaphylactoid reaction, anaphylaxis, angioedema.
Cardiovascular
Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement,
circulatory collapse, congestive heart failure, fat embolism, hypertension, hyper-trophic
cardiomyopathy in premature infants, myocardial rupture following recent myocardial
infarction (see WARNINGS: Cardio-Renal), edema, pulmonary edema, syncope,
tachycardia, thromboembolism, thrombophlebitis, vasculitis.
Dermatologic
Acne, allergic dermatitis, dry scaly skin, ecchymoses and petechiae, erythema,
impaired wound healing, increased sweating, rash, striae, suppression of reactions to
skin tests, thin fragile skin, thinning scalp hair, urticaria.
Endocrine
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Nursing considerations:
Assessment:
(1) history for systemic administration – renal/hepatic disease,
hypothyroidism,ulcerative colitis.
(2) fistory for ophthalmic preparations – vaccinia, varicella, ocular TB.
(3)Physical for systemic admin. – blood glucose, serum electrolytes, R,
adventitious sounds. (4)physical for topical dermatologic preparations: affected
area for infections, skin injury.
Interventions:
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Don’t give drug to nursing mothers since drug is secreted in the breast
milk forsystemic admin.
Don’t use intranasal product with untreated local nasal infections,
epistaxis,nasal trauma.
Use caution when occlusive dressings, tight diapers over covered areas;
these canincrease systemic absorption for topical dermatologic prep.
Teaching points:
Avoid exposure to infection. Administer decongestant nose drops first if
nasal passages are blocked. Avoid contact with eyes. Report worsening
of condition
c. cefuroxime
Brand Name: Cefuroxime
Indications:
1. Lower Respiratory Tract Infections, including pneumonia, caused by Streptococcus
pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), Klebsiella
spp., Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains),
Streptococcus pyogenes, and Escherichia coli.
2. Urinary Tract Infections caused by Escherichia coli and Klebsiella spp.
3. Skin and Skin-Structure Infections caused by Staphylococcus aureus (penicillinase-
and non-penicillinase-producing strains), Streptococcus pyogenes, Escherichia coli,
Klebsiella spp., and Enterobacter spp.
4. Septicemia caused by Staphylococcus aureus (penicillinase- and non-penicillinase-
producing strains), Streptococcus pneumoniae, Escherichia coli, Haemophilus influenzae
(including ampicillin-resistant strains), and Klebsiella spp.
5. Meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae
(including ampicillin-resistant strains), Neisseria meningitidis, and Staphylococcus
aureus (penicillinase- and non-penicillinase-producing strains).
6. Gonorrhea: Uncomplicated and disseminated gonococcal infections due to Neisseria
gonorrhoeae (penicillinase- and non-penicillinase-producing strains) in both males and
females.
7. Bone and Joint Infections caused by Staphylococcus aureus (penicillinase- and non-
penicillinase producing strains).
Side Effects:
Local Reactions:
Thrombophlebitis has occurred with IV administration in 1 in 60 patients.
Gastrointestinal:
Gastrointestinal symptoms occurred in 1 in 150 patients and included diarrhea
(1 in 220 patients) and nausea (1 in 440 patients). The onset of pseudomembranous
colitis may occur during or after antibacterial treatment
Hypersensitivity Reactions:
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Nursing Considerations
Body as a Whole:
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d. ambroxol
Classification: Mucolytic
Adverse effect
Occasional gastrointestinal side effects may occur but these are almost
invariably mild.
Indication
Adjuvant therapy in patients with abnormal, viscid, or inspissated mucous
secretions in acute and chronic bronchopulmonary diseases, and in pulmonary
complications of cystic fibrosis and surgery, tracheostomy, and atelectasis. Also used in
diagnostic bronchial studies and as an antidote for acute acetaminophen poisoning.
Assessment & Drug Effects
Monitor for S&S of aspiration of excess secretions, and for
Bronchospasm (unpredictable); withhold drug and notify physician immediately
if either occur.
Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry as indicated.
Have suction apparatus immediately available. Increased volume of respiratory
tract fluid may be liberated; suction or endotracheal aspiration may be
necessary to establish
and maintain an open airway.
Patient & Family Education
Report difficulty with clearing the airway or any other respiratory distress.