Power Point Jacky

8/8/2019 Power Point Jacky

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Capitol University

Corrales Extension, Cagayan de Oro City

A Case Study Presentation of:

Colon Cancer

Submitted to:Raymond Dizon,RN

Clinical Instructor

Submitted by:

Basbao Jackaline P.BSN-3


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Introduction

Colon Cancer is a malignant (cancerous) growth of the cells lining the internal

surface of the large intestine (colon) and rectum. Most colon cancer develop after

many years in benign cell growths called adenomatous polyps. Thus, the complete

removal of the polyps during colonoscopy effectively prevents the development of

cancer.

Colon cancer is one of the few preventable malignancies and is the second-leading

cause of cancer-related deaths in the United States after the lung cancer.

Both men and women of older age are equally affected. Afrin Americans have a

higher cancer incidence and mortality rate.

The incidence of colorectal carcinoma has steadily decreased since 1980s due to

the introduction of screening colonoscopy. It is estimated that 135,000 peopledevelop colon cancer yearly.

The causes of colon cancer are multifactorial and include genetic, chronic

inflammatory diseases of the intestine and environmental factors.


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Most of the colon cancer are sporadic (are not part of a knowninherited cancer syndrome), but even those have a tendency to runin the families. People with personal history of adenomatous polypsor carcinoma, and first-degree relatives of patients with polyps orcarcinoma detected at an age younger than 60 years, are atincreased risk. Approximately 5% of the cases of colon cancerbelong to certain inherited cancer syndromes (Familial

Adenomatous Polyposis, Gardner syndrome, Lynch syndrome).These cases arise due to well-studied genetic mutations that

passed on to some family members. Thus, it is important toexamine and provide genetic consultation to all members offamilies with inherited cancer disease.Similar to adenomatous polyps of colon and rectum, environmental

risk factors for colorectal carcinoma, include older age, high fat andred meat diet, low fiber intake, tobacco and obesity. Other causesfor colorectal malignancies include chronic inflammatory boweldiseases such


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disease. In approximately 70% of the patients none of theabove risk factors can be detected.

People with early colon cancer do not usually have anysymptoms or signs. When the cancer has an acceleratedgrowth rate, it may ulcerate and bleed. Thus the mostcommon sign of locally advanced colon cancer is rectalbleeding (red blood streaks on the stool) or melena (blackstools caused by digested blood). If the bleeding is continuous

and severe, the patient may develop iron deficient anemia.Other symptoms occurring with advanced cancers include lossof appetite, weight loss, abdominal pain and, in the case ofbowel obstruction (blockage) by a large tumor, abdominaldistention, constipation, pain, nausea and vomiting.

In the Philippines colon cancer ranks 6th overall, 5thamong males and 7th among females. An estimated 2,963new cases, 1,548 in males 1,415 in females, together with1,567 deaths will be seen in 1998. Colon cancer increasesmarkedly after age 50.


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I choose this case because this is my first

patient in my duty and since colon cancer iscommon in our country especially in all age.Some person experiences the disease that oftenleads to misconception. This case study helps inallaying the ignorance of culture; it may comefrom with cause how they acquired. Through isnot totally eliminates the misconception of thepeople but it will lessen the wrong information.The case study also awaken that not all minor

complaints are not visible into toxic cases, justlike the case that I had right now, it is only minorcomplaints why the patients admitted.


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CLIENTS PROFILE

Patient is a 52 year old male, married, a Islam, and recentlyresiding at

Marawi City, admitted at Northern Mindanao Medical Center lastNovember 19, 2010.He has history of hypertension. He is a nonsmoker and takes alcoholic beverages until he got colon cancer.

History of Present

Patient complains of on and off pain. He has consultation andmedication in his doctor. He felt pain in right adrenal gland thatcauses her not sleep well. He claims that he had black stool. Also hecomplains of on and off pain at right adrenal gland rating at 4/10

from a scale of 0/10, 10 was the being highest but he not suffer fordifficulty of urination.

History of Past Illness

Patient has no previous hospitalization and has no medical illness.


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History of Past Illness

Patient has no previous hospitalization and has no medical illness.

PHYSICAL ASSESSMENT

EYES

The patients eye was symmetrical lids, and anicteric sclera.

EARS

Auricles are symmetrical and the same color as facial skin has clean

external auditory canal without lesions or of discomfort noted. He can

hear at a distance of about 2 feet by repeating what I said as requested

her to do so. And using the watch tick test he was able to hear ticking andhearing is intact.


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NOSE

External nose color is same as facial skin, symmetricalnares, moist pink mucosal wall without discharges and lesionsnoted. Has patent nasal cavities and no masses noted. Candifferentiate odors since when asked to close her eyes anddiscriminate orange and coffee, he was able to distinguish theodors of the two.

THROAT

The throat was not edematous and no lesions observed.

RESPIRATORY SYSTEM

Patient x has clear breath sounds, no adventitious soundheard upon auscultation with respiratory rate of 20bpm whichis within normal range. He is not suffering from any form ofrespiratory distress.


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CARDIOVASCULAR SYSTEM

The patients blood pressure range from130/90 up to 140/90 mmHg at the left arm

while on setting position. Extremities are

warm to touch and peripheral pulses arepresent, regular and palpable but weak at the

radial. Apical pulse is 82 bpm which is within

normal.


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GASTROINTESTINAL SYSTEM

The abdomen is globular in shape; nondistended, soft, no direct and reboundtenderness. Tympanic sound is heard uponpercussion over the bladder.

GENITO-URINARY SYSTEM

The client eliminates at comfort room. His

urine output ranges from 100- 1000ml, amber incolor for 12hrs and has bowel movement one totwo times a day. No bladder distention uponassessment at the hypo gastric region.


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MASCULO- SKELETAL SYSTEM

The client is not in complete bed rest without

bathroom privileges and needs minimumassistance in moving and performing ADL becauseof inflamed left foot. Client is able to performflexion, extension, abduction and adductionindependently. No other deformities observed.

INTEGUMENTARY SYSTEM

The client has a pink palpebral conjunctiva. Skinis moist and warm to touch. No lesion, cracks, signsof inflammation and bruises noted. The client has ashort, smooth well comb black hair. No dandruffand parasites observed. Nails are clean and welltrimmed.


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NERVOUS SYSTEM

Orientation of three areas (time, place and date)was not limited because the client was able tocommunicate well. Can communicate well byverbalization, understands simple to complex instruction,able to write and read. It is evident that intellectualdevelopment is appropriate on his age.

DURING HOSPITAL CONFINEMENT

Health Perception (Pre-Hospitalization)

Patient x was active in his daily routine. He is a college

graduate and he find herself exhausted at the end of theday.

Nutritional and Metabolic Process


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Patient x said he eats but he said he could eat sweet,spicy foods and fatty foods as well as beverages like

coke. He has a normal appetite and could consumewhatever been served.

Elimination Pattern

Patient x has normal elimination pattern. He defecatesin a day with moderate amount, usually black stool.

Activity and Exercise Pattern

Prior to confinement, the patient was able to do theactivities of daily living by herself not until he foundout that he has colon cancer.

Self Rest Pattern

The patient sleep for almost 8 hours a day but duringadmission, he sleep 3-5hours due to the discomforts hefeels and is anxious.


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Cognitive-Perceptual Pattern

Patient was feels irritable and easily gets upset.

Self Perception

Patient x describes herself as weak. She feels veryupset and he found that he has colon cancer.

Role-Relationship Pattern

Patient was a good husband to his wife anddaughter, though he is having problem he tryingto make self comfortable.


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Sexuality and Reproductive Pattern

Patient x said that he dont have any problem

regarding his sexuality activity.

Coping-Stress Tolerance Pattern

Having this condition makes her irritable at times.

Value-Belief Pattern

He is a Islam and dont believe superstitious

beliefs.


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ANATOMT AND PHYSIOLOGY

Colon cancer may be of the adenocarcinoma type andusually arises from the epithelium (layer of cells) liningthe inside of the large intestine. The colon is part of thelarge bowel. The large bowel starts at the lower end of

the small bowel (the ileum), at the caecum. Theappendix runs off the caecum. The start of the colon isthe ascending colon, which becomes the transversecolon where it meets the liver (the hepatic flexure).The transverse colon goes across the upper abdomen

until it is adjacent to the spleen (the splenic flexure),where it becomes the descending colon. At this point,the


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large bowel goes down the abdomen to the

pelvis, where it becomes the sigmoid colon

(named because it curves in an "S" shape,

sigma being the Greek for "S"). The sigmoid

colon terminates at the rectum, which acts as

a storage pouch for faces before they are

evacuated through the anus.


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IV: Pathophysiology

Predisposing Factors: Colon Cancer Precipitating Factors

- Genetics - spicy foods

- Age -Fatty foods

-salty foods

1. Direct Extension to a nearby Clinical Manifestation

Organ such as to the stomach Tumors Spread -Rectal bleedingfrom the tranverse colon. Into -Abdominal pain

2. Emphatic and hematogenous -Weight loss

Channels usually to the liver.

3. Implanting of cells into the -Vomiting

Peritoneal cavity.

Surgical Management

Colostomy

The client resume usual activities within

4 to 6 weeks and is to able to perform

self-care of stomach


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V:LaboratoryHematology

Complete blood count

HCE 39.0 40.5-49.7 Gm % Eosinophil 4 2-3 %

MCV 73.8 80.0 -96.0 fl

MCH 24. 27.0-31.0 Pg


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Nursing Care PlanAssessment Data Nursing Diagnosis Goals and Objectives Nursing Interventions Evaluation

(Subjective & Objectives ( Problem and etiology) and Rationale

Cues)

Subjective > Risk for prone behavior r/t > After 8 hours of nursing Independent: After 8 hours of nur

Bakit kaya madalas lack of knowledge interventions, the patient >Define and state the sing interventions

Akong mahilo as verbalized will verbalized understanding limits of desired BP the patient was able

of the disease process and R> Provides for under to verbalize understreatment standing elevation tanding of the dise

Objective of BP ase process and

-Request for information > Suggest frequent treatment

-Dizziness position changes leg

-V/S taken as follow: exercise when lying

T: 36.0 down.

P: 66 R> Decrease peripheral

R:20 venus fooloing that mayBP: 140/90 be potentiated by vaso

dilation.

>Eliminate caffeine

like in tea, coffee,

cola and chocolates

R>Caffeine is cardiac

stimulant .


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Assessment Data Nursing Diagnosis Goals and Objectives Nursing Interventions Evaluation

(Subjectives and Objectives and Rationale

Cues)

Subjective: Fatigue r/t body At the end of 8 hours Independent: At the end of 8 hours of nurs

Nanghihina ako, pakiram of nursing interventions, >Have patient rate ing interventions, the patient

dam ko lagi akong pagod the patient will report fatigue was able to report improved

As verbalized improved sense of energy R> Help in developing sense of energy.

a plan for managingfatigue

Objectives: > Plan care to allow rest

-Dizziness periods.

-Lethargy R> Frequent rest periods

BP-140/90 >Encourage nutritional Intake

R> Adequate intake of nutrients

is necessary


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Assessment Data Nursing Diagnosis Goals and O b ejectives Nursing Interventions Evaluation

( Subjective & Objectives and Rationale

cues)

Subjective Constipation r/t After 8 hours of nursing Independent : At the end ofnursing in

Hindi na ako madalas to decrease dietary interventions,the patient >Determine stool terventions thepatient

dumudumi nitong mga intake will establish or return color,consistency was able toestablish or

Nakaraang arawas ver to normal frequent and return tonormal pattern

valized amount of bowelfunctioning

R>Discuss use of

O bjectives: stool softness

Abdominal pain mild stimulants.

U r gency >facilatate defeca

tion with constipa

is present

R> Encourage to

eat high fiber rich foods


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DRUG STUDY

DRUG ORDER MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS NURSING RESPONSI

OF ACTION OF THE DRUGS BILITIES

Generic Name: Exact mechanism Adjunct to diet Contraindicated with . Endocrine: >Monitor urine o r

>Rionet is not understood lower blood allergy to metformin >Hypoglycemia serum glucose level

possibly increase glucose CHF lactic acidosis frequent to determi

Brand Name: peripheral utilization .GI> anorexia, ne effecti veness

>Metformin of glucose, decreases nausea, vomiting of along and dosage

Hydrochloride hepatic glucose alters diarrhea, flatulence

Classification: intestinal absorption .Hypersensitivity

>Antidiabetes of glucose Allergy skin reaction

Dosage eczema, pruritos,

>50 mg enythema, urticaria

Route

>PO

Frequency

>B ID


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Generic Name: >An oral hyper- >Used to control of >Contraindicated to >Hypoglycemia >Take this drug in on time

>Gliclazide glacemia drug hyperglucemia hypersensitivity >Gastrointestinal >Keep appointments for

in gliclazide disturbance frequency blood test

Brand Name: responsive DM >Skin reaction

>Amary >Hematological

disorders

Classification: >Hepatic enzyme

>Anti diabetic rises

Dosage

>600mg

Route

>PO

Frequency

>OD


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Generic Name: >Antibacterial >Indicated for >Contraindicated in > Diarrhea, vomiting >Repert fever, rash,

>CO Amoxiclav combination con- treatmant of the patient with allergy rush vomiting

sisting of amoxici- of the following reaction to any pens- > Allergic to medicati- > Take medication

Brand Name: llia infections due to icillin on, jaundice, fever on time

>Amoxil susceptible: on sense diarrhea

Upper ReapiratoryClassification tract infection

>Antibiotic lower respiratory

tract infection.

Dosage

600mg

Route

>PO

Frequency

>BID


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VIII. Health teaching / Discharge

MEDICATION

Discuss the important of strict compliance tomedication.

Explain the purpose, dosage, schedule and route ofadministration of any prescribed drug, as well as theside effects to report to the physician.

Emphasize the failure to take medication may worsenthe condition

Provide a written schedule of the drug timing, dosage,and frequency.

Explain the expected adverse reaction of themedication.


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EXERCISEEncourage a daily exercise to strengthen the

body system according to her limitation. (e.g.

range of motion and deep breathing).

TREATMENT

Follow strict compliance to treatment regimengiven to improve condition specially

medications, diet and lifestyle.


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HEALTH TEACHINGS

Encourage complete bed rest after delivery, after 24 48 hours encourage client early ambulation

Gradually resume normal activity but avoid strenuousactivity.

Adequate rest, minimize stressful activities that mayworsen condition.

Have a pleasant environment that promotes wellness.

Eat well balance diet every day.

Discourage intake of carbonated and caffeinateddrinks.

Discuss limitations with respect to occupation,reaction, and activities but stress the risk for injury.


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Emphasize compliance in medication regimen as

prescribed by the physician to ensure thetherapeutic effects of drugs.

Encourage the patient to cook the food properly.

Advise not to eat street foods because we were

not sure if the blood is clean.

Teach the patient to do hand washing before andafter meals.

Personal hygiene care should emphasize. Adequate nutrition to ensure faster restoration of

patients health.


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Have a regular check up at nearest clinic to monitor condition.

Status intention of seeking immediate medical care if laborbegins.

Stress the importance of follow up visits. make sure thepatients has the necessary names and telephone numbers.

Stress the importance of any prescribed follow- up care,

including laboratory tests and lifestyle. DIET

Maintain a low sodium, low fat, and low potassium,discourage to eat spicy foods, and fatty foods.

Encourage to follow a nutritionally sound diet, high in fiber

and vitamins C to maintain a good immune system.


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SPIRITUALITY Advice the patients to attends masses every

Saturday and to pray to god everyday asking

for gods continuous protection and guidance


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IX. LEARNING EXPERIENCE

Increase our knowledge and improve our skills in theclinical setting.

Practiced the skills we learned from our lecture duringward class.

Properly handled the taking of vital signs and also preparingmedication to our patients.

Dealing with different personalities of our patients as wellas their significant others.

We learned from our mistakes during in the clinical setting

and trying not to do it again. We learned to give appropriate care with our patients and

provide our nursing interventions according to theirpriorities and needs.


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As our duty ends at Northern Mindanao Center, Igained valuable knowledge and great experiencewhich will be very useful in our future endeavorsas student nurse, and hopefully as future licensednurses. I also appreciate the time we spent withthe staff of the hospitals that were very helpfuland accommodating. I also appreciate our clinicalinstructor who taught us on how to do the

correct procedures. I also experienced fun andenjoyment during our duty day and aside fromthat we learned lots of procedures.


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Case study is one of the nursing requirementsthat must to be submitted at the end of therotation or before the school year will be

ended. It is a bound of papers containing astudy of the case of the patients. It is a studythat needs a lot of time, effort, financialconstraints. It is a study that needs to be fully

understand and lastly, it is a study to test howa student nurse deal with his/her patient witha complete care.


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X. REFERENCE

Black, Joyce M. Ph D, RN, CPSN, CCN, CWCN, et, al.Medical surgical nursing, 8th edition 2008Elsevier(Singapore) Pte ltd.

Hand book of medical-surgical nursing 1994 by

spring house corporation Deglin, J. h., pharmD Vallerand, A. H, PhD, RN, FAAN.

Drug guide for nurses, 11th edition 2009 Philadelpia,pennysylvania F.A. Davis Company

Westwood, O. the scientific basis for health care1999 Harcourt Brace and company.

http://diet.health.com/

http.//www.maxim-energy.com

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