I. INTRODUCTION

A. Overview of the study

Colon cancer ranks 6th overall leading cause of cancer-related deaths

in the Phillipines , 5th among males and 7th among females. An estimated

2,963 new cases, 1,548 in males 1,415 in females, together with 1,567 deaths

will be seen in 1998. Colon cancer increases markedly after age 50.

A malignancy in the colon or rectum can be referred to as colorectal

cancer. Strictly speaking, a malignancy in the colon is colon cancer and a

malignancy in the rectum is rectal cancer. Most colon cancers occur on the

left side in the sigmoid region.

The colon is a muscular tube approximately 6 feet long connecting the

small intestine to the rectum. The right side of your body has the “ascending

colon” which receives waste from the small intestine. This ascends upward to

the “transverse colon” which crosses over the small intestines and descends

on the left side of the body as the “descending colon”. At the bottom the colon

again crosses the belly toward the rectum as the “sigmoid colon”. Finally, the

sigmoid colon empties into the 8-inch rectum.

When the cells that line the colon or rectum start to proliferate in an

uncontrolled manner it is called a tumor. It is common to find a benign type of

growth called polyps. These are small and produce few, if any, symptoms.

However, over time these polyps can grow and develop into cancer.

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B. Objectives and Purpose of the Study

As a student nurse, it is indeed my vocation to adjoined hands with the

health care team for the promotion of wellness of our clients.

My main goals for this study are the following:

· To establish rapport

· To identify chief complaints of clients to give its specific interventions

· To determine the family and personal history of the client that many affect

client’s present condition

· To identify the cause and effect the main problem through the correct

analysis of the pathophysiology of the case

· To determine the medical management given through identifying doctor’s

order and its rationale

· To make nursing care plans for the different health problems encountered by

the client

· To evaluate the effectiveness of the actual nursing care plan that was

established

C. Scope and Limitation of the Study

Specifically this study is more concerned with the care of one patient in

Polymedic General Hospital, Medical Ward. I performed physical assessment

to the patient to properly identify the nursing problems, which requires

necessary and direct interventions and medical regimen. I had 2 days duty or

16 hours care for the patient and some limited informants.. Thus this care

study focuses on the particular case of the patient. The study of the

medications and doctor’s order are limited to our chosen patient, a case of

Colon Cancer.

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II. HEALTH HISTORY

A. Patients Profile

Name of Patient: RF

Sex: Male

Age: 73

Birthday: May 31, 1938

Birthplace: Misamis Oriental

Religion: PIC

Civil Status: Married

Educational Attainment: CollegeLevel

Occupation: OFW

Number of Siblings: 5

Nationality: Filipino

Date Admitted: July 5, 2011

Time Admitted: 5:15 pm

Informant: Daughter

Blood Pressure: 110/60 mmHg

Temperature: 36.7O C

Pulse Rate: 82 bpm

Respiration: 21 cpm

Allergy: No known allergy

Attending Physician: Dr. O

Admitting Diagnosis: T/C Colon Cancer

B. Past Health History

Mr. RF verbalized he has been confined due to gastritis but he already

forgot about the date he was admitted. He has no allergy to any foods or other

stuffs.

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C. Chief Complains and History of Present Illness

Patient RF, &3 years old, from Lapasan, CDOC, few days prior to

admission he already experienced poor appetite and severe generalized body

weakness and due to this instance,he was brought to PGH by his daughter

last July 5, 2011 with the admitting diagnosis of T/C Colonic cancer. the initial

vital signs of: temperature- 36.7 ˚C, respiratory rate- 44 cpm, and a pulse rate

of 138 bpm.

III. DEVELOPMENT DATA

A. Erik Erikson’s Stages of Psychosocial Development Theory

Erikson describes eight developmental stages through which a

healthily developing human should pass from infancy to late adulthood. In

each stage the person confronts, and hopefully masters, new challenges.

Each stage builds on the successful completion of earlier stages. The

challenges of stages not successfully completed may be expected to

reappear as problems in the future. Each of Erikson's stages of psychosocial

development are marked by a conflict, for which successful resolution will

result in a favourable outcome and by an important event that this conflict

resolves itself around. In the Eriksons 8th stage of psychosocial Development

theory which is Senior: Integrity vs. Despair (65 years onwards). Integrity

means moral soundness, whole or completeness of a person, Despair means

being hopeless. When it comes to my patient he was loosing hope that his

illness will be cure, it is because he feels that he was really old and he don’t

have the capabilities of living the way it should be. But still, because of the

support of the family little by little he was trying to understand his situation

tried to think on positive side and for himr to live longer for his family that still

need him as a father, as a grandfather and as a husband.

B. Sigmund Freud’s Psychosexual Development Theory

According to Freud, people enter the world as unbridled pleasure

seekers. Specifically, people seek pleasure through from a series of

erogenous zones. These erogenous zones are only part of the story, as the

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social relations learned when focused on each of the zones are also

important. Freud's theory of development has 2 primary ideas: One,

everything you become is determined by your first few years - indeed, the

adult is exclusively determined by the child's experiences, because whatever

actions occur in adulthood are based on a blueprint laid down in the earliest

years of life (childhood solutions to problems are perpetuated) Two, the story

of development is the story of how to handle anti-social impulses in socially

acceptable ways. My patient belongs to the genital stage which begins at

puberty involves the development of the genitals, and libido begins to be used

in its sexual role. However, those feelings for the opposite sex are a source of

anxiety, because they are reminders of the feelings for the parents and the

trauma that resulted from all that.

C.Robert J. Havighurst’s Developmental Task Theory

Havighurst categorized the tasks, in first category are the tasks, which

has to be completed in certain period, and the second are the tasks that

continue for a long, sometimes for a lifetime.So what happens if the task is not

completed in that stage or completed in a later date? Havighurst reply to that

it is critical that the tasks should be completed during the appropriate stage,

otherwise result will be the failure to achieve success in future tasks.

D. Jean Piaget’s Theory of Development

According to Piaget, development is driven by the process of

equilibration. Equilibration encompasses assimilation (i.e., people transform

incoming information so that it fits within their existing schemes or thought

patterns) and accommodation (i.e., people adapt their schemes to include

incoming information). My patient belongs to the formal operational stage. In

this stage, individuals move beyond concrete experiences and begin to think

abstractly, reason logically and draw conclusions from the information

available, as well as apply all these processes to hypothetical situations. The

abstract quality of the adolescent's thought at the formal operational level is

evident in the adolescent's verbal problem solving ability. The logical quality of

the adolescent's thought is when children are more likely to solve problems in

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a trial-and-error fashion. Adolescents begin to think more as a scientist thinks,

devising plans to solve problems and systematically testing solutions. They

use hypothetical-deductive reasoning, which means that they develop

hypotheses or best guesses, and systematically deduce, or conclude, which is

the best path to follow in solving the problem.

IV. MEDICAL MANAGEMENT

A. DOCTORS ORDER

Order

7/5/11 Please admit under the service of Dr. O

Secure Consent to care

Monitor or V/S q 4

Start venodysis w/ D5NSS IL @ 15 gtts/min LAB’S:

-CBC

-Urinalysis

-Chest x-ray PA

-Serum Na+, K+ creatinine

MEDS- Vamin 500 cc for 12 hours I & O q shift Refer accordingly

7/6/11 NaCl 1 tab TID

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Iterax tramal7/7/11 hold iterax Morphine 10g 1 tab q 8o

D/C tramal once Morphine is started7/8/11 continue meds7/9/11 Paracetamol 500g 1 tab q 4 PRN for fever D/C vamin when consumed Flanax 275 g 1 tab BID IVF to ff D5NSS1L @ 15 gtts/min7/10/11 d/c flanax refer to Dr. RY for colonoscopy & Biopsy- if for colonoscopy pls. do1. CXR2. ECG 12 leads7/11/11 may change FBC in AM per request 7/12/11 follow – up CXR result for possible colo this am depending on response of bowel prep give morphine 10 mg 1 tab now increase IVF rate to 25 gtts/min 7/13/11 give flanax 1 tab sched for colo @ 9 am tomorrow- do the routine bowel prep- refer to Dr. G

7/14/11 suggest surgical consult colostomy schedule noted resume previous diet resume vamin 500 cc to run for 12 hours refer to Cr. RY for evaluation if ok w/ family plan : Diverting loop colostomy ?& debarment of perineal abcess7/15/11 request CBC, serum Nat, Kt, Crea, SGPT secure unit of PRBC for possible transfusion pls. facilitate hot sitz bath for 15 min 3 x a day for 2 -3 days provide bedside commode pls. transfuse 2 units of PRBCof blod type @ 20 gtts/min please close main IVF line once BT is ongoing7/16/11 secure another units of FWB for possible BT repeat CC result7/17/11

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absolute NPO once vamin glucose is consumed; start kabiverl 2,000 kcal to run for 24

hours decrease IVF rate to 10 gtts/ min when kabivern is started repeat CBC result request for ECG 12 leads for possible sigmoid coop colostomy @ 1 pm7/18/11 hold all meds transfuse: 1 unit of available FWB @ 20 gtts/min start O2 @ 2 L/min check 02 sat proceed scheduled sigmoid loop colostomy @ 1 pm7/19/11 monitor V/S q 15 min I & O q shift Incorporate 20 meq kCl to ongoing IVF of D5NSS 1L regulated @ 20

gtts/min7/20/11 d/c tramadol decrease O2 inhalation to 2 L/min soft diet sinecoid forte 1 tab TID terminate D5NSS line7/21/11 full diet7/22/11 off O2 inhalation fluimucil 2m/sachet7/23/11 repeat CBC7/24/11 start tsenam 500mg IV drip q 8 h encourage deep breathing exercise d/c fluimucil7/25/11 follow – up biopsy result7/26/11 continue tsenam7/31/11 V/S monitoring q 4 Transfer in ICU Increase Dopa to 3cc.hr8/1/11 decrease ivf rate to 15 ggts/min8/2/11 decrease O2 inhaltion to 2 l/min8/3/11 start dopamine via syringe pump meds FeSO4 1 tab OD

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8/4/11 full diet continue vital signs8/5/11 v/s q hourly I & O q shift8/7/11 decrease dopamine rate to 9cc/hr decrease IV rate into 15 ggts/min8/8/11 decrease dopamine rate to 5cc/hr encourage deep breathing exercises8/9/11> decrease dopa to 4 cc/hr> consume stock tsenam

B. LABORATORY TEST

Test Normal

Range

Result Interpretatio

n

Significance

Creatinine 71.0-

133.0

60.4

mmol/L

Low Due to small stature

debilitation, decreased

muscle mass , some

complex cases of hepatic

disease

Potassuim 3.50-

5.10

4.41

mmol/L

Normal

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CHEST XRAY

1. Consider atelectasis versus pneumothorax, right lung

2. Pneumonia, bilateral

3. Consider cardimegally

4. Atherosclerotic aorta

5. Minimal pleural effusion and or/ thicking, bilateral

V. PATHOPHYSIOLOGY & ANATOMY AND PHYSIOLOGY

A. PATHOPHYSIOLOGY COLON CANCER

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B. ANATOMY AND PHYSIOLOGY

COLON

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.

• The sigmoid colon is a short curving of the colon, just before the rectum.

The colon removes water, salt, and some nutrients forming stool. Muscles line

the colon's walls, squeezing its contents along. Billions of bacteria coat the

colon and its contents, living in a healthy balance with the body.

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VI. NURSING REVIEW CHART

IV. PHYSICAL ASSESSMENT

NURSING SYSTEM REVIEW CHART

Name: RFDate: August 8, 2011Vital Signs:Pulse: 82 bpm BP: 110/60 Temp: 36.3 Respi: 20 cpm

EENT [X] impaired vision [] blind[] pain reddened [] drainage [] gums [] hard of hearing [] deaf [] burning [] edema [] lesion teeth[] asses eyes, ears, nose[] throat for abnormality [] no problemRESPIRATION [] asymmetric [] tachypnea [] barrel chest [] apnea [] rales [] cough [] bradypnea [] shallow [] rhonchi [] sputum [] diminished [] dyspnea [] orthopnea [] labored [] wheezing[] pain [] cyanotic[] assess resp rate, rhythm, depth, pattern[] breath sounds, comfort []no problem GASTRO INTESTINAL TRACT[] obese [] distention [] mass [] dysphagia [] rigidly [] pain [] asses abdomen, bowel habits, swallowing [] bowel sounds, comfort [X]no problemGENITO-URINARY and GYNE[] pain [] urine color [] vaginal bleeding[] hematuria [] discharge [] nocturia[] assess urine freq., control, color, odor, comfort[] grip, gait, coordination, speech, [X]no problemNEURO[] paralysis [] stuporous [] unsteady [] seizure[] lethargic [] comatose [] vertigo [] tremors[] confused [] vision [] grip[] assess motor function, sensation, LOC, strength[] grip, gait, coordination, speech, [X]no problem2MUSCULOSKELETAL and SKIN[] appliance [] stiffness [] itching [] petechiae[] hot [] drainage [] prosthesis [] swelling[] lesion [] poor turgor [] cool [] deformity[] atrophy [] pain [] ecchymosis [] diaphoretic[] assess mobility, motion, gait, alignment, joint function

[] skin color, texture, turgor, integrity [x] no problem

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Blurry vision

With pitting edema

Abdominal pain noted with the scale of 5/10

Generalized weakness

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VII. NURSING MANAGEMENT

A. IDEAL NURSING MANAGEMENT

PATIENT XY

Patient: XY

ASSESSMENT DIAGNOSIS objectives INTERVENTIONS

RATIONALE OUTCOME CRITERIA

EVALUATION

Subjective: - “Sakit ahungtiyan” as verbalized by the patient.Objective:-seen patient lying in bed-Facial grimacing noted.

-FBC attached to UB- colostomy noted-garded movement

Pain related to disease process(inflammation) secondary to rectal cancer as evidenced by patient facial appearance of painScientific Basis:Inflammation is the physical reaction of living tissues due to infection. One of the classical signs of inflammation is pain.Source:

http://medical-dictionary.thefreedictionary.com/Inflamation

After 4-6 hours of comprehensive nursing intervention, the patient will be able to verbalized a minimal reduction of pain from score of 7 to 5 (at the pain scale of 10 where 1 is the lowest and 10 is the highest)

-Determine the location

-Provide basic comfort measure like repositioning -Encourage use of stress management like relaxation techniques like music.

-Give medication as ordered-Monitor temperature

-To evaluate need for effectiveness-To promote relaxation and health refocus attention-Enable patient to participate actively and enhance sense o control

-To relieve the pain

-To detect whether the patient has fever

The patient verbalizes minimal retraction of pain

The goal has been partially met

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ASSESSMENT

DIAGNOSIS PLANNING INTERVENTIONS

RATIONALE OUTCOME CRITERIA

ACTUAL EVALUATION

Subjective:-“wa koy gana mo kaon” as verbalized by the patient-coherentObjective:-sagging of skin-w/ on going IVF of D5 LR 1L @ 30 infusing well at the right arm-FBC attached to UBcolostomy noted-sunken eyeballs-thin

Imbalance nutrition less than body requirements related to pain secondary to colorectal cancer sensation as evidenced by patient sagging of the skin

Scientific Basis:Anorexia is lack or poor appetite which may affect the eating pattern and can cause imbalanced nutrition to the patient

Source:Blackwell’s nursing dictionary, 2nd edition

After 4-6 hrs. of comprehensive nursing interventions, the patient will be encouraged to eat even just a little in order to have something or the stomach to digest without triggering nausea and vomiting.

-Monitor daily food intake -Encourage patient to eat high calorie, nutrient-rich w/ adequate fluid intake

-Control environmental factor-Encourage use of relaxation techniques

-Encourage open communication regarding anorexia problem

-Review laboratory studies as indicated

-Identifies nutritional strength / deficiencies-Metabolic tissue needs as increases as will as fluid supplement can play on important rule in maintaining adequate calorie and protein intake-Can trigger nausea/vomiting response-May prevent onset or reduce severity of nausea, decrease anorexia and enable patient to increase oral intake-Often a source of emotional distress, especially for SO who want to feed rejected/frustrated-Help identify to degree of biochemical imbalance/malnutrition and influence choice of dietary interventions

The patient have eaten a little without vomiting.

The goal has been partially met

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Patient: XY

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B. ACTUAL NURSING MANAGEMENT

S

“arang - arang na gani akong ubo” as

verbalized by the pt.

O cough

restlessness

expelled white sputum

A Ineffective airway clearance related to

increased amount of secretion

P At the end of 30 mins the patient will be

able to expectorate secretions & improve /

maintain airway clearance.

I > facilitate maintainace of patient upper

airway by proper positioning

- altered level of consciousness, sedation

are some condition that alters pt. to project

airways

> assist w/ coughing/ deep breathing

exercises position changes

- for easy expectoration of secretions

> increase fluid intake

- oral fluid intake may liquefy secretion/

enhance expectorant

>administer Salbutamol per doctors

order 1 neb q 6o

- to improve ventilation & facilitate removal

of secretions

E Demonstrate improved ventilation and

oxygenation of tissues by ABG within clients

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acceptable range.

18

S “medyo sakit akong tiyan”

As verbalized by the patient

O >C pain scale of7/10>grimace noted>irritable>weakness noted

A Acute painrelated toinflammatoryresponse

P At the end of 30 mins the patient will be

able to demonstrate relief from pain

I Independent:

>monitor v/s

>Instructed tondeep breathing excersise>Encouraged to have Diversional activities like watching t.v.>Placed patient in a comfortable position>Encouraged to have adequate bed rest>Provided therapeutic touchDependent:>Administered Ranitidine as ordered

E > goal partially met, patient demonstrate

relief from pain

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C. DRUG STUDY

NAME

OF

DRUG

DATE

ORDER

ED

CLASSIFICATI

ON

DOSE/

FREQUEN

CY/

ROUTE

MECHANI

SM OF

ACTION

SPECIFIC

INDICATIO

N

CONTRAINDICAT

ION

SIDE

EFFECTS

NURSING

PRECAUTI

ON

DUAVE

NT

July 23,

2011

Brochodilator 1 neb q 6 beta2-adrenergicbronchodila

tor

InhalationSolution is indicated for the relief ofbronchospasm. This drug relaxesthe smooth muscle in the lungsand dilates airways to improvebreathing.

Contraindicated w/

hypersensitivity to

salbutamol;

tachyarrytmias,

tachycardia

causes by digitalis

Cases of urticaria,angioedema, rash,bronchospasm,hoarseness,oropharyngeal edema,and arrhythmias(including atrialfibrillation,supraventriculartachycardia,extrasystoles) have beenreported

- Do not take any of thesemedications without consultingyour doctor (even if you never hada problem taking them before).- Do not allow anyone else to takethis

medication.

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after the use ofsalbutamol

NAME OF

DRUG

DATE

ORDER

ED

CLASSIFICAT

ION

DOSE/

FREQUEN

CY/

ROUTE

MECHANI

SM OF

ACTION

SPECIFIC

INDICATIO

N

CONTRAINDICA

TION

SIDE

EFFECTS

NURSING

PRECAUTI

ON

Ceftriaxon

e

Metronidaz

ole

July 23,

2011

July 23,

2011

Antibiotic

Antibiotic

3grams

IVTT OD

500mg

IVTT Q8H

Bactericid

al; inhibits

synthesis

of bacteria

on the cell

wall

causing

cell death

Inhibits

protein

Treatment

of infection

caus strains

of shigella

salmonella,

E.Coli,

haemophillu

s influenzae

Serious

infection

caused by

Allergy to

cephalosporins

With allergy to

drug

CNS:

Lethargy

CV:

heartfailure

GI: gastritis

Hypersensiti

vity:

Rashes,

fever

>check IV

site for signs

of

thrombosis

>cultureinfe

cted area

>check for

reaction of

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synthesis

in

susceptibl

e gram

neg.

bacteria

appears to

disrupt

functional

integrity of

bacterial

cell

membrane

pseumodo

mas, E.coli,

serios

infection

when

causative

agent is not

known

CNS:Otoxicit

y

CV:

Palpitaion

GI: Hepatic

toxicity

allegy to

drug

> check the

site of

infection.

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VIII. REFERRAL AND FOLLOW – UP

Exercise/Economic Factor Practice deep breathing exercise and coughing

exercises. Resume previous activities. Prevent extraneous work. Have a

regular physical exercise like brisk walking for 30 minutes daily. For financial

insufficiency, there are government drug stores available. The patient may

continue her work in the factory.

Treatment Follow faithfully the regimen for tuberculosis, especially the

medications. Have a regular sputum test, as ordered by the doctor.

Health Teaching You should practice hand washing regularly. Always cover

the mouth and the nose when exposed to person who coughs or sneezes.

You should not spit anywhere, instead spit in a single container to prevent

transfer of M. Tuberculosis.

Out patient Follow-up Always have a regular check up at your nearest

health center, at least once a week to monitor the progress of the treatment.

The client should report immediately to the physician if there is difficulty of

breathing, there is productive cough more than 5 days and there is chest pain

and experiencing fatigue.

Diet The diet should be high caloric. Always drink a lot of water. Also eat fruits

and vegetables. Don’t escape meals. If there are any food supplements

available, consult it with the doctor. Eat vitamin c rich food to strengthen

immune systems.

Spiritual/Sexual Activities Always pray for the guidance of the Lord. Spiritual

health affects the wellness of an individual

IX. EVALUATION AND IMPLICATION

At the end of our hospital duty, We were able to render care to our patient to

help him resolve his health condition. Through observing the patient’s status,

we able to identify priority problems related to his health. The patient was

willing to pursue the medical therapy just to promote health and wellness for

the betterment of her son’s condition. We have also made the patient’s wife

realize the importance of completing the course of therapy by taking the

medicines prescribed or ordered for him by his physician. In addition, eating

healthy or nutritious foods that were prescribed to her by the health providers

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was further been explained to her mother especially the benefits he will gain

in eating those foods. Moreover, this several interventions given to the patient

made her body conditioning normal and We can say that our patient has

somehow recovered from his illness.

X. DOCUMENTATION

(None, we have no written consent that will allow us to take a picture/

photo of the said client.)

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