Our Lady of Fatima University Antipolo City

Rectal Ca S/P LA

Presented to: Mr. Alvin V. Arroyo

Presented by: Vernadette Cantiga Reena Velarde

TABLE OF CONTENTS

I. Introduction II. Nursing Health History a. personal data b. c/c c. history of present illness d. final diagnosis III. Diagnosis Procedure

a. radiology report b. x-ray IV. Laboratory Result a. Blood Report V. Surgical Procedures VI. Definition of complete procedures VII. Anatomy and Physiology Pathophysiology

VIII.

IX.Nursing Care Plan X. Drug Study

INTRODUCTION

Cancer (medical term: malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth ( division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not. The branch of medicine concerned with the study, diagnosis, treatment, and prevention of cancer is oncology. Cancer may affect people at all ages, even fetuses, but the risk for most varieties increases with age. Cancer causes about 13% of all deaths. According to the American Cancer Society, 7.6 million people died from cancer in the world during 2007. Cancers can affect all animals. Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or infectious agents. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. The heritability of cancers are usually affected by complex interactions between carcinogens and the host's genome. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly recognized as important. Genetic abnormalities found in cancer typically affect two general classes of genes. Cancer-promoting oncogenes are typically activated in cancer cells, giving those cells new properties, such as hyperactive growth and division, protection against programmed cell death, loss of respect for normal tissue boundaries, and the ability to become established in diverse tissue environments. Tumor suppressor genes are then inactivated in cancer cells, resulting in the loss of normal functions in those cells, such as accurate DNA replication, control over the cell cycle, orientation and adhesion within tissues, and interaction with protective cells of the immune system.

II. NURSING HEALTH HISTORY A. PESONAL DATA Name of patient: mr. Pepe age of patient: civil status: Religion: 38 y/o single Roman Catholic

B. CHIEF COMPLAIN

The patient went to the hospital to complain about his constipation for about a 4

ago.

C. History of Present Illness The patient is dx case of Rectal CA (2010) S/P LA, colostomy creation (2010), s/p take down colostomy, S/P 6 Cycles Chemotherapy 10 days PTA. pt. Had constipation for 4 days consult done and showed for hypokalemia. D. Final Diagnosis and surgical management The patient diagnose for rectal ca, s/p. The pat. Undergo an operation of colostomy creation.

III. DIAGNOSIS PROCEDURE A. Radiology Report Chest PA Both lung field are clear heart, diaphragm and bony thorax are unremarkable impression: normal Chest Pain

B. X-ray an interval dev't. Of ascites an irregular, asymmetric wall thickening and appears CA densities from the cecal pertinent. Transverse colon, likely represent recurrence. Impression: consider with long segment colonic CA recurrence as described and probable peritoneal and nodal infiltration. ASCITES IV. Laboratory result a. Blood Report Request FBS BUN Creatinen Normal Result 3.8-5.8 mmol/L 1.7-8.3 mmol/L 80-133 umol/L Result 5.67 1.62 79.8 V. Surgical procedures seeding mottled

Exploratory Laparotomy A laparotomy is a large incision made into the abdomen. Exploratory laparotomy is used to visualize and examine the structures inside of the abdominal cavity. Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows physicians to examine the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who has sustained an injury to the abdomen. Injuries may occur as a result of blunt trauma (e.g., road traffic accident) or penetrating trauma (e.g., stab or gunshot wound). Because of the nature of the abdominal organs, there is a high risk of infection if organs rupture or are perforated. In addition, bleeding into the abdominal cavity is considered a medical emergency. Exploratory laparotomy is used to determine the source of pain or the extent of injury and perform repairs if needed.

Laparotomy may be performed to determine the cause of a patient's symptoms or to establish the extent of a disease. Exploratory laparotomy may be used to examine the abdominal and pelvic organs (such as the ovaries, fallopian tubes, bladder, and rectum) for evidence of endometriosis. Any growths found may then be removed. Exploratory laparotomy plays an important role in the staging of certain cancers. Cancer staging is used to describe how far a cancer has spread. A laparotomy enables a surgeon to directly examine the abdominal organs for evidence of cancer and remove samples of tissue for further examination.

Some other conditions that may be discovered or investigated during exploratory laparotomy include:

cancer of the abdominal organs peritonitis (inflammation of the peritoneum, the lining of the abdominal cavity)

appendicitis (inflammation of the appendix) pancreatitis (inflammation of the pancreas) abscesses (a localized area of infection) adhesions (bands of scar tissue that form after trauma or surgery) diverticulitis (inflammation of sac-like structures in the walls of the intestines) intestinal perforation ectopic pregnancy (pregnancy occurring outside of the uterus) foreign bodies (e.g., a bullet in a gunshot victim) internal bleeding

procedure:

1. once an adequate level of anesthesia has been reached, the initial incision may be made.

2. The incision is then continued through the subcutaneous fat, the abdominal muscles and finally the peritoneum. 3. The instrument called retractors may be use to hold the incision once the abdominal cavity has been exposed. 4. The surgeon may then explore the abdominal cavity for disease or trauma. 5. If an abnormality is found, the surgeon has the option of treating the patient before closing the wound or initiating treatment after the exploratory surgery. 6. During exploratory laparotomy for cancer, a pelvic washing may be performed; sterile fluid is instilled into the abdominal cavity and washed around the abdominal organs, then withdrawn and analyzed for the presence of abnormal cells. Upon completion of any exploration or procedure, the organs and related structures are returned to their anatomical position. The incision may be then sutured (stitched closed). The layers of the abdominal wall are sutured in reverse order, and the skin incision closed with sutures or staple. Nursing Management: keep the patient NPO post midnight secured signed consent about the surgery that is explained by the surgeon. Various dx test may be performed to determine the necessity of the exlap. A foley catheter may be inserted into the bladder to drain urine. Instruct the patient to watch for the symptoms of infection such as fever, redness or swelling around of incision, drainage and worsening pain.

VI. Definition of complete procedures

The rectum is the portion of the large bowel that lies in the pelvis, terminating at the anus. Cancer of the rectum is the disease characterized by the development of malignant cells in the lining or epithelium of the rectum. Malignant cells have changed such that they lose normal control mechanisms governing growth. These cells may invade surrounding local tissue or they may spread throughout the body and invade other organ systems.
Rectal cancer is more common in industrialized nations, and dietary factors are thought to be related to this observation. Diets high in fat, red meat, total calories, and alcohol seem to predispose. Diets high in fiber are associated with a decreased risk. The mechanism for protection by high-fiber diets may be related to less exposure of the rectal epithelium to carcinogens from the environment as the transit time through the bowel is faster with a high-fiber diet than with a low-fiber diet.The development of polyps of the colon or rectum commonly precedes the development of rectal cancer. Polyps are growths of the rectal lining. They can be unrelated to cancer, pre-cancerous, or malignant. Polyps, when identified, are removed for diagnosis. If the polyp, or polyps, are benign, the patient should undergo careful surveillance for the development of more polyps or the development of colon or rectal cancer.

Symptoms of rectal cancer most often result from the local presence of the tumor and its capacity to invade surrounding pelvic structure:

bright red blood present with stool abdominal distention, bloating, inability to have a bowel movement narrowing of the stool, so-called ribbon stools pelvic pain unexplained weight loss persistent chronic fatigue rarely, urinary infection or passage of air in urine in males (late symptom) rarely, passage of feces through vagina in females (late symptom)

VII. Anatomy and Physiology

The digestive system is composed of the alimentary canal and accessory organs which contribute their secretions to the tract. The digestion of food begins in the mouth and ends in the bowel. The passage (tract) from the mouth to the rectum (the end portion of the bowel) is called gastrointestinal tract which is like a tube, about 9 metres in length, elaborately looped and coiled within the body. Various processing stations are located along the way to prepare and process the food and absorb useful materials The accessory organs of the digestive system include salivary glands, the pancreas, the liver and gall bladder. Large Intestine or Colon

Next to the small intestine comes the large intestine or bowel. It is much wider 6 to 8 cms. in diameterbut shorteronly about 2 metres in length. First it passes upwards, and is called 'ascending colon'. It bends when it reaches the bottom of the liver and remains horizontal upto the spleen. This is known as transverse colon. It, then, bends downwards and is called 'descending colon'. Its last part is in

the pelvic cavity and is called the rectum, which is about 25 cms. long, and is rich in muscular tissues. Finally it ends at the external opening, the anus. The obvious differences from the small intestine are : larger diameter, a puckard rather than tube-like outside, and the longitudinal muscle being arranged in bands. The lining secretes mucus, but no digestive enzymes. This is the fourth and last processing station of the tract. By the time it is reached, almost all the useful nutrients have already been digested and absorbed. What remain are indigestible stuff together with salts, bile-pigments, and large valuable quantities of water (the digestive juices are about 95% water). The function of the large bowel is extraction of salt and water (that can be usefully recycled) and the formation of the faeces from the indigestible food-stuffs like cellulose, bowel secretions and bacteria. The lower parts contain many organisms which manufacture a variety of useful substances including vitamin-K and several vitamins of B group as well as the smelly compounds responsible for the odour of faeces. Not all the inhabitants of our colon are hostile parasites. Millions of symbiotic (mutually helpful) bacteria live there and cause us no harm; they may indeed protect us from harmful microorganisms.
Metabolism

Metabolism is the name given to the biochemical processes consisting of the breakdown of the basic food-materials with the release of energy and their re-arrangement into complex substances which build up the living tissues. It involves the digestion of food in the stomach and intestines, the absorption and storage of digested materials, their incorporation into the tissues of the body and finally their release and breakdown to water and carbon dioxide with the liberation of energy [3].

VIII> Patophysiology