FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER

PASIG CITY

CASE STUDY: COLON CANCER DRUG STUDY
Generic Name / Trade Name Spironolactone Aldactone, Novospiroton†, Spiractin Dosage Frequency Edema / Classification Pregnancy risk category D Pharmacologic Class: potassiumsparing diuretic Therapeutic Class: diuretic, antihypertensiv e, antihyperkalemi c Indications For Edema, Hypertension , Diureticinduced, hypokalemia, To detect primary, hyperaldosteronism, To manage primary hyperaldosteronism, Hirsutism in women, Premenstrual syndrome, Acne vulgaris and Familial male precocious puberty Contraindications Contraindicated in patients hypersensitive to drug and in those with anuria, acute or progressive renal insufficiency, or hyperkalemia. Use cautiously in patients with fluid or electrolyte imbalances, impaired renal function, or hepatic disease, or in pregnant women. Side Effects CNS: headache, drowsiness, lethargy, confusion, ataxia. GI: diarrhea, gastric bleeding, ulceration, cramping, gastritis, vomiting. GU: inability to maintain erection, menstrual disturbances. Hematologic: agranulocytosis. Metabolic: hyponatremia, hyperkalemia, dehydration, mild acidosis. Skin: urticaria, hirsutism, maculopapular eruptions. • Nursing Responsibilities Nursing considerations: • • • To enhance absorption, give drug with meals. Protect drug from light. Monitor electrolyte levels, fluid intake and output, weight, and blood pressure. Monitor elderly patients closely, who are more susceptible to excessive diuresis. Inform laboratory that patient is taking spironolactone because drug may interfere with tests that measure digoxin level. Drug is less potent than thiazide and loop diuretics and is useful as an adjunct to other diuretic therapy. Diuretic effect is delayed 2 to 3

Adults: Initially, 100 mg P.O. daily given as a single dose or in divided doses. Usual range is 25 to 200 mg P.O. daily. Children: Give 3.3 mg/kg P.O. daily or in divided doses. Hypertension Adults: 50 to 100 mg P.O. daily or in divided doses. Some practitioners use a lower dose range of 25 to 50 mg daily and add another antihypertensive to the regimen, rather than

FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER
PASIG CITY

CASE STUDY: COLON CANCER
continually increasing drug. Other: gynecomastia, breast soreness, drug fever, anaphylaxis. days when used alone. • Maximum antihypertensive response may be delayed for up to 2 weeks. Watch for hyperchloremic metabolic acidosis, especially in patients with hepatic cirrhosis. Breast cancer may occur, but a causal relationship hasn't been established. Look alike-sound alike: Don't confuse Aldactone with Aldactazide.

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Children: Give 1 to 3.3 mg/kg P.O. (up to 100 mg daily) as a single dose or divided b.i.d. Diureticinduced hypokalemia Adults: 25 to 100 mg P.O. daily. To detect primary hyperaldostero nism Adults: 400 mg P.O. daily for 4 days (short test) or 3 to 4 weeks (long test). If hypokalemia and hypertension are corrected, a presumptive diagnosis of

Patient teaching: • Instruct patient to take drug in morning to prevent need to urinate at night. If second dose is needed, tell him to take it with food in early afternoon. Alert: To prevent serious hyperkalemia, warn patient to avoid excessive ingestion of potassium-

with or without cardiac glycoside Adults: 12. tomatoes.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER primary hyperaldosteroni sm is made. and potassium supplements. dates. Heart failure. To manage primary hyperaldostero nism Adults: 100 to 400 mg P. Advise men possible tenderness enlargement.O. daily.O. Hirsutism women in rich foods (such as citrus fruits.5 to 25 mg P. daily. May increase to 50 mg daily after 8 weeks. bananas. salt substitutes containing potassium. daily. and apricots).O. as adjunct to ACE inhibitor or loop diuretic. Use lowest effective dose. . about breast or • Adults: 50 to 200 mg P. • Caution patient not to perform hazardous activities if adverse CNS reactions occur.

O. starting on day 14 of the menstrual cycle. daily with 20 to 40 mg/kg testolactone P. Generic Name / Trade Name Dosage Frequency / Classification Indications Contraindications Side Effects Nursing Responsibilities .d. b.O. 50 mg P. Premenstrual syndrome Adults: 25 mg P.O.O. days 4 to 21 of menstrual cycle.i.d.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER Or.O. daily. Familial male precocious puberty Boys: 2 mg/kg P. Acne vulgaris Adults: 100 mg P. daily for at least 6 months. q.i.

CLIENT TEACHING: *Do not take other medications (e.5-1 g 4-6 hrly when needed. IV >50 kg: 1 g 4-6 hrly (Max: 4 g/day). blood dyscrasias (e. especially in individuals with poor nutrition or who have ingested alcohol over prolonged periods. thrombocytope nia. G6PD deficiency. even with moderate acetaminophen doses. Potentially Fatal: Very rare.g. leucopenia. acute renal tubular necrosis. impairment.. skin rashes. alcoholdependent patients.g. agranulocytosis ). <50 kg: 15 mg/kg 4-6 hrly (Max: 60 mg/kg/day). neutropenia. Nausea. allergic reactions. Analgesics (Non-Opioid) & Antipyretics Mild to moderate Renal or hepatic pain and fever. usually from accidental ingestion or suicide attempts. cold preparations) containing acetaminophen without medical advice. poisoning. *Monitor for S&S of: hepatotoxicity.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER Paracetamol Adult: PO/Rectal 0. Max: 4 g/day. liver damage. overdosing and chronic use can cause liver damage and other toxic . potential abuse from psychological dependence (withdrawal has been associated with restless and excited responses).

or recurrent fever.5° C (103° F). *Do not breast feed while taking this drug without consulting physician. *Do not give children more than 5 doses in 24 h unless prescribed by physician.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER effects. *Do not use this medication without medical direction for: fever persisting longer than 3 d. fever over 39. *Reassess patient’s . Generic Name / Trade Name Dosage Frequency / Classification Indications Contraindications Side Effects Nursing Responsibilities Tramadol Adult & Analgesics Management of Acute Nausea. *Do not self-medicate adults for pain more than 10 d (5 d in children) without consulting a physician.

Supportive Care Therapy moderate to severe intoxication w/ pain. HTN. level of pain at least 30 minutes after administration. alcohol. Max: 8 tab/day. resp depression. hematological reactions including thrombocytope nia. Anticipate need for laxative. *For better analgesic effect. *Monitor bowel and bladder function. Analgesics (Opioid). *Monitor CV and respiratory status. drowsiness. centrally-acting analgesics. (Non-Opioid) & Antipyretics. vomiting. constipation.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER children >16 yr 1-2 tab 46 hrly. Withhold dose and notify prescriber if respirations decrease or rate is below 12 breaths/min. *Monitor patients at risk of seizures. hypotension. opioids/psychotr opic. narcotics. hypnotics. leucopenia. Drug may reduce seizure . give drug before onset of intense pain.

*Withdrawal symptoms may occur if drug is stopped abruptly. *Look alike-sound alike: Don’t confuse tramadol . Drug can produce dependence similar to that of codeine or dextropropoxyphene and thus has potential for abuse. naloxone may also increase risk of seizures. *Monitor patient for drug dependence. *In the case of an overdose.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER threshold. Reduce dosage gradually.

Ranitidine has been effective in preventing ulcer recurrence when given in low doses for prolonged periods of time. 300 mg). dosages of ranitidine need to be lowered in patients with H2-blockers Ranitidine blocks the action of histamine on stomach cells. headache. Since ranitidine is excreted by the kidney and metabolized by the liver. Syrup (15 mg/ml). or Generic Name / Trade Name Dosage Frequency / Classification Indications Contraindications Side Effects Nursing Responsibilities Ranitidine (Zantac) Tablets (150 mg. confusion. and reduces stomach acid production. insomnia. Hypersensitivity Minor side effects include constipation. nausea. depression. they include: agitation. 300 mg). muscle pain. easy bruising or bleeding. -No antiinflamatories should be given. anemia. May be taken with or without food. fatigue. Major side effects are rare. hair loss. This includes aspirin and the like. irregular The nurse should observe the following: -Renal and Hepatic patients are not a good candidate for this med. Ranitidine is useful in promoting healing of stomach and duodenal ulcers. as they inhibit the effectiveness . and in reducing ulcer pain. and vomiting. diarrhea. hallucinations.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER with trazodone trandolapril. Impaired Liver and Kidney Function. Capsules (150 mg. In doses higher than that used in ulcer treatment. -Antacids should be taken one hour before or one hour after ranitidine.

pain. or swelling at the injection . hives. heartbeat. difficulty breathing. muscle spasms or twitching. or tongue). lips. tightness in the chest. Severe allergic reactions (rash. -Avoid stomach and GI irritants -. irritability. redness. face. swelling of the mouth. and yellowing of the skin or eyes. visual changes. rash.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER significantly abnormal liver or kidney function.this includes smoking and ETOH -Watch for signs of GI bleeds. ranitidine has been helpful in treating heartburn and in healing ulcer and inflammation of the esophagus resulting from acid reflux .

cramps). A06AG02 bisacodyl. Child: >4 yr: 5 mg at night time. Used in the treatment of constipation. chronic use Abdominal The nurse should discomfort observe the following: (colic. . Used in the treatment of For bowel evacuation and constipation Acute surgical abdomen or intestinal obstruction.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER site. purgatives A06AB02 bisacodyl. 10-20 mg the night before the procedure followed by 10 mg suppository Laxatives. Belongs to the class of contact laxatives. Suppositories -Renal and Hepatic may cause patients are not a irritation and good candidate for proctitis this med. Elderly: Oral Bowel evacuation Adult: Initiall y. Belongs to the class of enemas. Generic Name / Trade Name Dosage Frequency / Classification Indications Contraindications Side Effects Nursing Responsibilities Bisacodyl Oral Constipatio n Adult: 5-10 mg at night.remind the patient :Do not give antacids or milk within 1 hr of taking the drug (enteric coated) . faecal impaction. severe dehydration.

Child: <10 yr: 5 mg in the morning . Rectal Constipatio n Adult: 10 mg suppository/e nema admin in the morning. . Child: >10 yr: Same as adult dose.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER admin constipation rectally the next morning. 4-10 yr: 5 mg the night before the procedure and 5 mg suppository admin rectally the following morning.

hives. lips. or swelling at the injection site.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER Severe allergic reactions (rash. irritability. difficulty breathing. swelling of the mouth. pain. face. redness. tightness in the chest. muscle spasms or twitching. or tongue). .

heat cramps. adynamia episodica hereditaria & hyperkalemia. Childn 3 mEq/kg:vol of soln proportional to body size.5 mEq/L 10 mEq/hr-200 mEq/day. • • • • • • • Pain in the legs Weaknes s of the muscles Uneven heartbea t Anxiety. Acute hypokalemia Up to 100 mEq by slow IV infusion w/ ECG control at rate not >20 mEq/hr of a soln not >40 mEq/L.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER Generic Name / Trade Name Potassium Chloride (Elin Potassium Chloride) Dosage / Classificati Frequency on Adult Plasma K level >2. confusio n or a feeling of dizziness Constant diarrhea or pain in the stomach Excessiv e vomiting Dark or blackish stools Tingling . <2 mEq/L 40 mEq/hr-400 mEq/day. Electrolytes Indications Contraindicati ons Side Effects • Nursing Responsibilities -Instruct client to take this drug with foods or just after meals Source of K & Cl ions. Untreated Addison's disease. acute dehydration.

Side Effects Hypervitamin osis (large dose) Generic Name / Trade Name Dosage / Frequency Action Side Effects Nursing Responsibilities Ferrous Sulfate 1 tab per day This preparation Liquid oral iron Tell patient of the side preparations effects of the drug . convalescence. Used as dietary suppleme nts. adjuvant in the therapy ofpeptic ulcer & TB. restoration & maintenance of body resistance. Generic Dosage / Classificati Name / Trade Frequency on Name Moriamin Forte Adult 1-2 A11AB cap/day. anemi a. protein & vit deficiencies.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER on your hands or feet • Dizziness and nausea Nursing Responsibilities Tell patient that urine might turn yellow. C Multivitam hildn 1 ins. Indications Malnutrition. pregnancy & lactation. other cap/day combinati ons .

High doses may cause vomiting and diarrhea. It is unclear whether high before administration. In tiny amounts. iron.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER contains the mineral.Acute overdosage or iron accumulation symptoms may include arthritis. loss of libido. early menopause. signs of gonadal failure (amenorrhea. and shortness of breath/dyspnea . It is these cells that carry oxygen through the blood stream. impotence). the mineral is also necessary for the chemical functioning of many of the bodies' cells can possibly blacken teeth. which is necessary for the formation and function of red blood cells. and death. . followed by cardiovascular or metabolic toxicity. If allergic reactions appears halt the administration of drug.

vomiting. diarrhea. coronary heart disease or myocardial infarction (MI). and dark stools have been reported.Gastrointe stinal upset including nausea. constipation.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER levels are associated with cancer. Gastrointestinal side effects are relatively common and corrective bowel regimens such as increasing dietary fiber or over the counter medication might be .

PROBLEM PRIORITIZATION FOR PATIENT WITH COLON CANCER NURSING DIAGNOSIS Constipation related to CUES S: RANK 1 JUSTIFICATION Constipation is the prioritized problem . Supervision by a qualified healthcare provider is recommended.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER recommended to balance these side effects.

nung pagkatapos ng una kong opera tapos ng naospital ako at ng gagamot na ganito na balat ko. - Impaired Skin Integrity related to treatment as manifested by dry. Having breaks on the lining of the colon could worsen the condition and could also be a portal of entry for microbes that can cause infection. Nagbabalat minsan at nanunuyo” as verbalized by the patient. This need is considered under a person’s physiologic needs because providing interventions to this problem could alleviate patient’s problem with body image. Minimal pain felt when palpation was done in the abdomen. Masakit nga minsan sa tiyan pag nagsasabay ang dumi at ihi.2 inches. Pero ngayon dumudumi dalawang beses pero konti lang. Impaired skin integrity is also serious problem that should be . According to Abraham Maslow’s Hierarchy of Needs. This need is considered under a person’s physiologic needs because it’s under elimination needs of humans. skin integrity thus this could be a portal of entry for microbes that can cause infection. S: 2 since it is an actual problem. Abdominal girth – 30. Impaired skin integrity is the 2nd prioritized problem since it is an actual problem. rough and scaly skin.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER obstruction as manifested by decrease bowel frequency - “Bago ako maospital tatlong beses ako dumudumi sa isang araw.” O: - Decrease bowel sounds during assessment. According to Abraham Maslow’s Hierarchy of Needs. - “ di naman ganto itsura ko dati. Constipation is a serious problem that should be addressed first because if a stool will stay long in the colon it will hardened and could lead to further damage in the lining of the colon once it is being forced out by the client during excretion.

FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER addressed because it could lead to breaks in skin integrity thus this could also be a portal of entry for microbes. - Both lower extremities could do flexion. S: 3 - Activity Intolerance related to weakness as evidenced by inability to walk alone without assistance. “pumyat ako ngayon sobrang lusog ko nun dati siguro nakaapekto yun kaya mahina ako” O: Activity Intolerance is the 3rd prioritized problem since it is also evident in the patient. Humina kasi mga binti ko ngayon” as verbalized by the patient. Patient with Poor skin integrity are prone to develop bed sores O: Rough and scaly skin were noted during the assessment Decrease skin turgor. Dry skin / decrease moisture was noted during the assessment. . Activity intolerance is the last one to be addressed because it is not the priority of the patient. - - “Noon sobrang layo ng nalalakad ko pag trip ko maglakad at para makatipid. ngayon di ako makapunta ng magisa sa banyo pag di ako tinutulungan.

FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER extension but with same decrease strength. NURSING CARE PLAN FOR CONSTIPATION Cues Analysis Nursing Diagnosis Goal and Objectives Interventions Rationale Evaluation .

After 24 hours of nursing intervention the client was able to have an improved bowel status. - - - The colon (large intestine) controls the formation and passage of stool from the body. Fiber passes through the intestine essentially unchanged.g. it absorbs water and forms a Encourage physical gel. the patient was able to achieve the following. accurately: • Be assessed on the characteristics of his bowel frequency and bowel status Be assisted on the exploration of methods for having an improved bowel movement. Minimal pain felt (world health “Bago ako maospital tatlong beses ako dumudumi sa isang araw. Anything that changes the colon's ability to regulate the amount of water in stool or that affects the muscles and O: nerves of the Decrease colon that are bowel responsible for sounds moving waste during toward the assessmen rectum and anus t. Encourage daily fluid especially elderly intake of 2000 to 3000 patients. When it reaches the colon. which require that less fluid is taken..” Objectives: After 8 hours of shift. may ml/day. raw a minimum of 20 g fruits. Masakit nga minsan sa tiyan pag nagsasaba y ang dumi at ihi. fresh vegetables) of dietary fiber per day is recommended. Pero ngayon dumudumi dalawang beses pero konti lang. Be able to have continuity of care because of the knowledge that are also imparted to the guardian / family. Be able to have continuity of care because of the knowledge that are also imparted to the • • Ambulation and/or • abdominal exercises Encourage a regular strengthen time for elimination abdominal . The colon absorbs water out of the solid waste and moves the waste to the rectum and anus. accurately: • Be assessed on the characteristics of his bowel frequency and bowel status Be assisted on the exploration of methods for having an improved bowel movement. Objectives: After 8 hours of shift. if not have contraindicated cardiovascular medically. which adds activity and regular bulk to the stool exercise and makes defecation easier. limitations. the patient will be able to achieve the following. • FACILITATIVE: Patients. can lead to constipation. Encourage increased fiber in diet (e.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER S: Constipation related to obstruction as manifested by decrease bowel frequency After 24 hours of nursing intervention the client will be able to have an improved bowel status.

enhances .2 inches. that guardian / family. is o Warm sitz bath fine. o Hemorrhoidal preparations These Exercises. unless contraindicated minimize rectal Allow patient time to discomfort relax. as a result of the gastro colic Encourage isometric reflex. unless shrink swollen contraindicated.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER when palpation was done in the abdomen. - Abdominal girth – 30. location of bathroom and encourage use. any time. depending abdominal and gluteal on the person’s exercises. organization site) muscles facilitate defecation. needed Orient patient to muscles for evacuation. as long as it is regular. strengthen hemorrhoidal tissue. usual schedule. Many persons defecate following first daily meal or coffee. A sitting position with knees flexed straightens the COLLABORATIVE: Digitally remove fecal rectum.

and facilitates Stool that remains in the rectum for long periods becomes dry and hard.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER impaction. use of abdominal muscles. may not be able to pass these stools without manual assistance. . and read Explain or reinforce to patient and caregiver the importance of the following: o A balanced diet that contains adequate fiber. vegetables. It is important for patients and caregivers to determine the fiber content per serving. SUPPLEMENTAL: Teach patients caregivers to product labels. o Regular meals Successful bowel training relies on routine. and grains Twenty grams per day is recommended. fresh fruits. especially elderly patients. o Adequate fluid intake Drink 8 glasses/day or 2000 to 3000 ml/day. debilitated patients.

FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTER PASIG CITY CASE STUDY: COLON CANCER o Regular time for evacuation and adequate time for defecation o Regular exercise/activity o Privacy for defecation Teach use of pharmacological agents as ordered .