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COLEGIO DE SAN JUAN DE LETRAN – CALAMBASchool of Nursing

Brgy. Bucal, Calamba City

Case StudyOn

COLON CANCER

Submitted by:PANGANIBAN, DANICA D.

Submitted to:Ms. Carol Alcantara RN, MAN

I. INTRODUCTION

BACKGROUND OF THE STUDY:

Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they're often referred to as colorectal cancers. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers. Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer.

SIGNS AND SYMPTOMS:

A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool

Rectal bleeding or blood in your stool

Persistent abdominal discomfort, such as cramps, gas or pain

A feeling that your bowel doesn't empty completely

Weakness or fatigue

Unexplained weight loss

CAUSES:

Precancerous growths in the colon Colon cancer most often begins as clumps of precancerous cells (polyps) on the inside lining of the colon. Polyps can appear mushroom-shaped, or they can be flat or recessed into the wall of the colon. Removing polyps before they become cancerous can prevent colon cancer.

Inherited gene mutations that increase the risk of colon cancer Inherited gene mutations that increase the risk of colon cancer can be passed through families, but these inherited genes are linked to only a small percentage of colon cancers. Inherited gene mutations don't make cancer inevitable, but they can increase an individual's risk of cancer significantly.

RISK FACTORS:

Older age A personal history of colorectal cancer or polyps Inflammatory intestinal conditions Family history of colon cancer and colon polyps Low-fiber, high-fat diet A sedentary lifestyle Diabetes Obesity Smoking Alcohol Radiation therapy for cancer

DIAGNOSTIC TEST:

Colonoscopy

CT Scan

STAGES OF COLON CANCER:

Stage I. Your cancer has grown through the superficial lining (mucosa) of the colon or rectum but hasn't spread beyond the colon wall or rectum.

Stage II. Your cancer has grown into or through the wall of the colon or rectum but hasn't spread to nearby lymph nodes.

Stage III. Your cancer has invaded nearby lymph nodes but isn't affecting other parts of your body yet.

Stage IV. Your cancer has spread to distant sites, such as other organs — for instance to your liver or lung.

TREATMENT:

Chemotherapy

Radiation Therapy

Drug Therapy

RATIONALE FOR CHOOSING THE CASE:

• I chose this study to promote awareness to the people who had this kind of disease by giving them information about the actions to be done and those contributing factors that made the treatment more seriously. I also want to determine management that can be done to help them to relieve some of the signs and symptoms of the disease as well as to teach them to prevent further complications.

SIGNIFICANCE OF THE STUDY:

• The importance of this study is to have information about the proper management and care for those clients who have this kind of illness. We can also educate people on how they can prevent and reduce the complication of the disease even if they already have the disease or not. It can also promote awareness and consciousness.

SCOPE AND LIMITATION OF THE STUDY:

• I will be focused on the nursing aspect of care, to give a basic knowledge about Colon Cancer.

II. CLINICAL SUMMARY:

A. PERSONAL DATA

Name: Patient C

Age: 72

Sex: Male

Address: 110 Pulo, Cabuyao, Laguna

Birth Date: May 28, 1941

Religion: Roman Catholic

Date of Admission: December 4, 2013, 11:30 am

Diagnosis: Caloric Mass T/C Colon Cancer

B. CHIEF COMPLAINT

Loss of Appetite

C. HISTORY OF PRESENT ILLNESS:

1 week prior to confinement patient have mass on the abdomen

D. PAST MEDICAL HISTORY:

(+) Acute Gastritis

(+) Hepa A

III. PHYSICAL EXAMINATION

AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND INTERPRETATION

body built, height and weight in relation to client’s age

Inspection Proportionate, varies with lifestyle Small body built, height and weight was not taken

ABNORMALDue to his present

conditionPosture while sitting Inspection Relaxed, erect, posture, coordinated

movementThe patient can’t sit ABNORMAL

Due to his present condition

.body and breath odor Inspection (talking with the patient)

No body odor or minor odor relative to work, or exercise; no breath odor

No body odor and breath odor NORMAL

signs of distress in posture or facial expression

Inspection No distress noted The patient looks weak ABNORMALDue to his present

conditionsigns of health and illness Inspection Healthy appearance The client appears weak ABNORMAL

Due to his present condition

client’s attitude Inspection Cooperative, able to follow instructions

The patient was cooperative NORMAL

client’s affect/ mood; appropriateness of client’s responses

Inspection Appropriate to the situation The patient answers questions coherently without assistance

NORMAL

quantity of speech, quality and organization

Inspection Understandable, moderate pace, clear tone, exhibits thought association

Understandable, moderate and clear

NORMAL

relevance and organization of thoughts

Inspection Logical sequence, makes sense, has sense of reality

Makes sense and has sense of reality

NORMAL

I. SKINAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATIONskin color Inspection Varies from light to deep brown;

from yellow overtones to oliveUniform skin color NORMAL

. uniformity of skin color

Inspection Generally uniform except in areas exposed to the sun; areas lighter pigmentation (palms, lips, nailbeds) in dark skinned

Uniform in skin color NORMAL

assess edema Inspection No edema No edema NORMALskin lesions Inspection Freckles, some birthmarks, no

abrasions or other lesionsNo lesions NORMAL

skin moisture Inspection Moisture in skin folds and axillae

Skin is dry ABNORMALDue to dehydration.

II. HAIRAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATIONevenness of the growth, thickness or thinness of hair

Inspection Evenly distributed and covers the whole scalp

Evenly distributed and covers the whole scalp

NORMAL

texture and oiliness over the scalp

Inspection Silky, resilient hair Silky resilient hair NORMAL

presence of infection and infestation

Inspection No infection and infestation No Infection and Infestation NORMAL

amount of body hair Inspection Variable Variable. No abnormal hairiness

NORMAL

III. NAILSAREA TECHNIQUE NORMS FINDINGS ANALYIS AND

INTERPRETATIONfingernail plate shape Inspection Convex, curvature; angle of nail

plateConvex NORMAL

fingernail and toenail texture

Inspection Smooth texture Smooth texture NORMAL

fingernail and toenail bed color

Inspection Highly vascular and pink in light skinned clients; dark skinned clients may have brown or black

Pale in color ABNORMALDue to anemia

pigmentation in longitudinal streaks

tissues surrounding nails Inspection Intact epidermis Intact epidermis NORMALblanch test of capillary refill

Inspection, palpation

Promptly return of pink or usual color (generally less than 4 seconds)

Less than 4 seconds ABNORMAL Due to low

hemoglobin or anemia

IV. HEADAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATIONsize, shape and symmetry of the skull

Inspection Round (normocephalic with symmetrical frontal, parietal, and occipital prominences) smooth skull contour

The client’s head is round, normocephalic with symmetrical frontal, parietal, and occipital prominences

NORMAL

presence of nodules, masses and depressions

Inspection and palpation

Smooth uniform consistence; absence of nodules, or masses

Smooth, absence of nodules or masses

NORMAL

presence of edema and hollowness in the eye

Inspection and palpation

No edema and hollowness No edema or hollowness NORMAL

V. EYESAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATIONcolor, texture and presence of lesions in the palpebral conjunctiva

Inspection Pinkish in color with presence of small capillaries; moist, no foreign bodies

Pale in color ABNORMALDue to low hemoglobin

sclera: color and clarity Inspection White in color; clear, no yellowish discoloration, some capillaries may be visible

Yellowish in color ABNORMALDue to past medical history of HEPA A

iris: shape and color Inspection Anterior chamber is transparent; no noted visible materials, color depends on the person’s race

Anterior chamber is transparent; no noted visible materials, black in color

NORMAL

cornea: clarity and texture

Inspection No irregularities on the surface, looks smooth, clear or transparent

No irregularities on the surface; clear

NORMAL

pupils: color, shape and symmetry of size

Inspection Color depends on person’s race; size ranges from 3- 7 mm; and are equal in size; equally round

Black, equal in size; equally round; 4mm in size

NORMAL

light reaction and accommodation

Inspection Constrict briskly/ sluggish Constricts briskly NORMAL

visual acuity: near vision Inspection Can detect light and dark Can detect light and dark NORMALlacrimal gland: palpability and tenderness of lacrimal gland

Palpation No edema or tenderness over lacrimal gland

No edema or tenderness NORMAL

extraocular muscles eye alignment

Inspection Both eyes coordinated, moved in unison with parallel alignment

Both eyes are coordinated in movement; parallel alignment

NORMAL

visual fields: peripheral visual fields

Inspection When looking straight ahead the client can see objects in the periphery

Patient sees objects in periphery

NORMAL

VI. EARSAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATIONauricles: color, symmetry of size and position

Inspection Color same as facial skin; symmetric; auricle aligned with outer canthus of the eye; about 10 degrees from vertical

Aligned with outer canthus of the eye, same color as facial skin, both auricle are symmetrical

NORMAL

texture, elasticity and areas of tenderness

Inspection and palpation

Mobile, firm and not tender, pinna recoils after it is folded

Mobile firm and not tender; pinna recoils after folded

NORMAL

hearing acuity test: client response to normal voice tones

Inspection/ rinne test

Normal voice tones audible The client can hear whispered voices

NORMAL

VII. NOSE

AREAS TECHNIQUES NORMS FINDINGS ANALYSIS AND INTERPRETATION

any deviation in shape, size or color and flaring or discharge from nares

Inspection Symmetric and straight; no discharge; uniform in color

Symmetric and straight; no discharge; uniform in color; not flaring and has no discharge

NORMAL

nasal septum (between the nasal chambers)

Inspection Nasal septum intact and in midline

Nasal septum is in midline and intact

NORMAL

patency of both nasal cavities

Inspection Air moves freely as the client breathes through the nares

Air moves freely in both nares NORMAL

tenderness, masses and displacement of the bones and cartilage

Palpation Not tender; no lesions No lesions, not tender NORMAL

sinuses: identification of the sinuses for tenderness

Palpation not tender Not tender NORMAL

VIII. MOUTHAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATION lips: symmetry and contour, control and texture

Inspection Uniform pink color, soft, moist, smooth texture, symmetry of contour, ability to purse lips

Pale in Color ABNORMALDue to low

hemoglobin or anemiabuccal mucosa Inspection Pink color, moist, smooth, soft

glistening and classic texturePale in color ABNORMAL

Due to low hemoglobin or anemia

gums: color and condition

Inspection Pink gums; no retraction Pale in color ABNORMALDue to low

hemoglobin or anemia tongue/ floor of the mouth: color and texture of the mouth and frenulum

Inspection Pink color; moist, slightly rough; thin; whitish coating; moves freely; no tenderness

Pink color; moist, slightly rough; thin; whitish coating; moves freely; no tenderness

NORMAL

position, color, and texture, movement and base of the tongue

Inspection Central position, pink in color, smooth tongue, base with prominent veins

Pink in color; smooth tongue; base with prominent veins

NORMAL

any nodules, lymph nodes or exocrated areas

Inspection Smooth with no palpable nodules lumps or excoriated areas

Smooth with no palpable nodules

NORMAL

plates and uvula: color shape texture and presence of bony prominences

Inspection and palpation

Light pink, smooth, soft palate, lighter, pink hard palate, move irregular texture

Soft palate, lighter pink hard palate

NORMAL

position of the uvula and mobility (while examing the palates)

Inspection Positioned in midline of soft palates

Positioned in midline NORMAL

oropharynx and tonsil: color and texture

Inspection Pink, smooth posterior wall Smooth posterior wall NORMAL

size, color and discharge of tonsils

Inspection Pink and smooth posterior wall Smooth posterior wall NORMAL

gag reflex Inspection Present Present NORMAL

IX. THORAXAREA TECHNIQUES NORMS FINDINGS ANALYSIS AND

INTERPRETATIONanterior thorax: breathing patterns

Inspection Quiet, rhythmic, and effortless respiration

Effortless respiration NORMAL

temperature, tenderness and masses

Palpation Skin intact, uniform temperature, chest wall intact; no tenderness; no masses

Uniform temperature; no tenderness or masses

NORMAL

anterior thorax auscultation

Auscultation Bronchovesicular and vesicular breath sounds

Bronchovesicular NORMAL

posterior thorax: shape, symmetry and comparison of anteroposterior thorax to transverse diameter

Inspection Anteroposterior to transverse diameter in ration 1;2 chest symmetric

Anteroposterior to transverse diameter; symmetric

NORMAL

spinal alignment Inspection and palpation

Spine vertically aligned Spine aligned vertically NORMAL

temperature, tenderness and masses

Palpation Skin intact, uniform temperature; chest wall intact, no tenderness no masses

No tenderness or masses; intact

NORMAL

posterior thorax auscultation

Auscultation Bronchovesicular and vesicular breath sounds

Bronchovesicular NORMAL

X. ABDOMENAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATION skin integrity Inspection Unblemished skin, uniform color Uniform color, unblemished

skinNORMAL

abdominal contour Inspection Flat, rounded (convex), scaphoid (concave)

Presence of abdominal mass ABNORMAL Due to his present condition (colon

cancer)enlargement of liver or spleen

palpation No evidence of enlargement of liver or spleen

No evidence of enlargement of spleen or liver

NORMAL

symmetry of contour Inspection Symmetric contour Symmetric contour NORMALabdominal movements associated with respiration, peristalsis or aortic pulsations

Auscultation Symmetric movements caused by respiration; visible peristalsis in very lean people; aortic pulsations in thin persons at epigastric area

Symmetric movement NORMAL

vascular pattern Inspection No visible vascular patter No visible vascular pattern NORMAL

XI. MUSCULOSKELETAL SYSTEMAREAS TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATION

muscle size and comparison on the other side

Inspection Proportionte to body; even in both sides

Proportionate to body, equal strength on both sides

NORMAL

fasciculation and tremors in muscle

Inspection No fasciculation and tremors No fasciculation and tremors NORMAL

muscle tonicity Inspection Even and firm in muscle tone Even and firm in muscle tone NORMALmuscle strength Inspection Has equal strength on both sides Has equal strengths NORMAL

XII. JOINTSAREA TECHNIQUE NORMS FINDINGS ANALYSIS AND

INTERPRETATIONjoint swelling Inspection and

palpationNo swelling; no warmth, no redness, no pain, no crepitus

No swelling, redness, pain or crepitus

NORMAL

Extremities Inspection and palpation

No swelling, no warmth, no redness, no pain

No swelling, warmth or redness

NORMAL

IV. GORDON’s 11 FUNCTIONAL HEALTH PATTERN OF ASSESSMENT

GORDON’S FUNCTIONAL HEALTH PATTERNS

PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION

Health Perception and Health Management

The client thinks that health is a state of being well. The client thinks that it is important to consult to the doctor when he doesn’t feel well.

Nutritional- Metabolic He eats 3 times a day and drinks 8 glasses of water a day. He can’t eat everything he wants because of some restrictions on foods.

Elimination The client said he defecates 1-2 times daily and urinates 3-4 times a day

The client can defecate and urinate.

Activity and Exercise The client said he is not doing any exercise. He is unable to perform any exercise at all.

Cognitive- Perceptual The client said he is a positive thinker. The client is still positive thinker.

Sleep and Rest The client said the he always have 8 hours of sleep every day The client said that he can’t sleep well

Role Relationship The client is a responsible father. He is being dependent to everyone because of his condition.

Coping Stress The client said he is coping to stress by means of rest. During hospitalization the client copes to stress by means of sleeping.

Value Belief The client said she is a Roman Catholic. God serves as a guide to his family.

The client thinks the same.

V. ACTIVITIES OF DAILY LIVING

ASPECT PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION ANALYSIS AND INTERPRETATION

1. NUTRITION LOW APPETITE LOW APPETITE Due to hospitalization the patient has low appetite because she doesn’t feel well.

2. ELIMINATION Urinates 3-4 times a day and defecates 1-2 times a day.

Urinates 2-3 times a day and defecates once a day

Due to hospitalization the patient can eliminate properly.

3. EXERCISE The patient cannot exercise The patient cannot exercise Due to hospitalization the patient cannot do his daily routine because of his condition.

4. HYGIENE Proper hygiene The patient cannot go to CR to take a bath.

Due to hospitalization the patient cannot go to CR to take a bath and need relative to assist him in doing his personal hygiene

5. SLEEP AND REST 8 hours of sleep and take a naps during the afternoon

He can’t sleep well because he feels uncomfortable.

Due to hospitalization the patient have altered sleeping pattern because he doesn’t feel comfortable.

VI. ANATOMY AND PHYSIOLOGY

The large intestine is a hollow tube that makes up the last 6 feet of the digestive tract. It is often referred to as the large bowel or colon (which is technically just one part of the large intestine). The large intestine consists of the cecum (a pouch-like structure at beginning of the large intestine), colon, rectum and anus. The colon and rectum are next to other organs, including the spleen, liver, pancreas, and reproductive and urinary organs. Each of these organs can be affected if colorectal cancer spreads beyond the large intestine.

STRUCTURE:

The colon begins at the cecum, where it joins the end of the small intestine (ileum). The colon changes to rectal tissue in its last 6 inches. Because there is not a clear border between the colon and rectum, colon and rectal cancers are grouped together as colorectal cancer. The colon is divided into 4 parts:

ascending colon – begins at the cecum, where it joins the end of the small intestine, and travels upward along the right side of the body to the transverse colon

transverse colon – connects the ascending colon to the descending colon and lies across the upper abdomen

descending colon – connects the transverse colon and the sigmoid colon and lies along the left side of the body

sigmoid colon – connects the descending colon and the rectum

FUNCTION:

The main functions of the colon and rectum are to absorb water and nutrients from what we eat and to move food waste out of our body.

The colon receives partially digested food, in a liquid form, from the small intestine.

Bacteria (bowel flora) in the colon break down some materials into smaller parts.

The epithelium absorbs water and nutrients. It forms the remaining waste into semi-solid material (feces or stool).

The epithelium also produces mucus at the end of the digestive tract, which makes it easier for stool to pass through the colon and rectum.

Sections of the colon tighten and relax (peristalsis) to move the stool to the rectum.

The rectum is a holding area for the stool. When it is full, it signals the brain to move the bowels and push the stool from the body through the anus.

VII. PATHOPHYSIOLOGY

Predisposing Factors:*Genetics

Precipitating Factors:*Environment

*Viruses*Diet

*Tobacco Use*Lifestyle

*UV exposure*Other carcinogens

Malignant Cellular Proliferation

Immune system failure to destroy cancer cells

Malignant Cellular Survival

Cellular DNA mutation

Malignant Cellular Deprivation of Normal Cells of Nutrition and other substances for sustenance

Malignant Cellular Compression of Normal Cells

Normal Cell DeathC-hanges in bladder or bowel habitsA-sore that doesn’t healU-nusual bleeding or dischargesT-hickening or lumpsI-ndigestion ordiffuclty swallowingO-bvious changes in warts, moles, or the skinN-agging cough or hoarseness of voiceU-nexplained anemiaS-udden loss of weight

VIII. LABORATORY RESULT

HEMATOLOGY

RESULTS NORMAL VALUE ANALYSIS

HGB 9.6 13-17 ABNORMALDecreased in hemoglobin can cause

anemia

HCT 29 40-54 ABNORMALDecreased in hemoglobin can cause

anemia

RBC 3.2 4-6 ABNORMAL

Decreased in hemoglobin can cause anemia

WBC 11,900 5000-10000 ABNORMALThere is an increase in WBC this

means that the patient has infection. Increase in wbc may lead to

leukocytosis, this can result from bacterial infection..

SEGMENTERS 83% 30-70 ABNORMALIncreased in segmenters means that

there is infection.

LYMPHOCYTES 14% 20-40 ABNORMALIncreased in lymphocytes means that

there is infection.

IX. DRUG STUDY

NAME OF DRUG

CLASSIFICATION MECHANISM OF ACTION

SIDE EFFECTS CONTRAINDICATION NURSING RESPONSIBILITY

Appetite Plus 1 cap BID

Appetite Enhancers Stimulates appetite & enhances weight gain

Headache Nausea Constipation Upset stomach

Hypersensitivity Should be taken with food.

Monitor vital signs

Monitor Intake and Output

Heraclene Forte 1 tab OD

Appetite Enhancers Used for taking care of weight loss, It also may be used for treating tuberculosis and additional persistent diseases, recuperating from severe surgery or infection and defective nutrition in elderly patients.

Nausea and vomiting

Diarrhea Acidity Headache GI disorders

Hypersensitivity Pregnancy Lactation

Monitor vital signs

Monitor I & O

X. FDAR

FOCUS DATA ACTION

IMBALANCED NUTRITION

Received patient awake, lying on bed with ongoing D5NM 1L @ 800 cc Level.

Body Malaise

Weight Loss

Poor muscle tone

VS taken as follows:

• BP- 100/60

• T- 36.3

• P-76

• R- 26

IV fluids maintained and

regulated

Encouraged to consume high-

caloric diet with adequate fluid

intake

Provided health teaching

regarding healthy nutritious food

Monitored intake and output

Administered prescribe

medication

RESPONSE:

Still for Continuity of care

XII. DISCHARGE PLANNING

Medications • Write the exact time and instruction when to take the medication and how to take the

medication.• Emphasize proper dosage of medication to be taken for the proper continuity of care.

Exercise • Instruct client to have light exercises.

Treatment • Continue medication as ordered by the physician

Health Teachings • Instruct the client’s relative to provide adequate rest

Out -patient • Follow up check up

Diet • Advise client’s relative to provide increased intake of fluid

• Advise client’s relative to provide high- calorie and food that rich in protein

Spiritual/sexual activity • Encourage patient to Pray always