RLE – MODULE FOR CANCER (MEDICAL WARD- ONCOLOGY)

Course Code NCM 106

Course Title Care of clients with problems in cellular aberrations, acute biologic crisis
including emergency & disaster nursing
Level Offering 1st Semester AY 2020-2021
Clinical area of assignment Medical Ward
Date of Exposure September 14-16,2020
No. of hours 24 hours

CASE STUDY FOR COLORECTAL CANCER

CONGRATULATIONS! For you are a few steps away of pursuing your dream of becoming a “nurse”.

INSTRUCTIONS:
Read the case of a patient whom you are to provide nursing care. Take time to analyze and process the
information provided, before answering the activities following each section of your module.
You may take a break, as necessary. You can ask your friends, classmates, parents, or any person whom you
think can help you understand but remember a greater amount of output should come from you, as you are
the LEARNER here.
Of course, you can ask me, your clinical instructor, for clarification on areas you do not seem to understand
and do not know what to do. Would be thankful and gladly help you on your learning needs. You can contact
me through my number Messenger/ Mobile number/ Email address at ___________________.

For you to conduct all the requirements for this rotation, we may follow the schedule below:
Online:
Day 1: AM: read on your patient’s case and answer the given activity. In the afternoon
we shall process 1 nursing problem (actual).
Day 2: AM: processing of 2nd nursing problem (actual/potential), PM – partial or full
processing of concept map
Day 3: AM: processing of concept map if not yet done, PM – rotational exam (20 points)
Modular: Remember that you are given 3-5 days to finish this task.

DATE: Sept 14, 2020

ENDORSEMENT: You are on duty in the medical war (oncology area) at 7- 3 shift to a 60 y/o male.

Endorsing a male client, 60 y/o, at bed 10.

 With an IVF of PNSS 1 liter x KVO @ 800cc level at the right hand.
 On low salt, low fat diet and high fiber diet
 Scheduled for Colonoscopy at 1PM today
 Possible Surgery is scheduled after colonoscopy
 Secure consent
 Monitor I & O
 Monitor vital signs q 2 hours.
LAB Findings:
Hemoglobin- 10g/dl
Fecal occult blood: tested positive
CEA level: 3.5ng/ml
V/S as follows:
8:00 AM: T – 36.7 °C PR – 95 BPM RR– 22CPM BP – 130/80mmHg SPO2  93%
12:00PM T 37 °C PR  90 BPPM RR  19 CPM BP 130/90mmHg SPO2  95%
Sept 15. 2020
 IVF to follow: PNSS I liter at KVO
 To start: Administer 5-flourouiracil given IV at 400mg.
 Watch out for side effects of chemo drugs
 V/S every shift
Sept 16, 2020
 On the second day of chemo.
 Give Ranitidine 300mg once a day
 Monitor I/O
 Increase fluid intake
HISTORY:
 Bartolome was admitted last Sept 13, 2020 with a chief complaint of red bloody stools. Several weeks
PTA, he experienced changed in bowel movements. He also experienced general weakness and weight
loss for the weeks. He had loss of appetite as he claimed ne only consumed 50% of his food. NO
consultations was done until 1 day PTA, he had a red bloody stool and severe abdominal cramping.
 Upon admission, Bartolome undergone lab test: CBC, CEA and fecal occult blood test.

Patient’s Profile:
Name: Bartolome Pascual
Age: 60
Sex: Male
Civil status: Single
Address: Abatan, Buguias, Benguet
Occupation: Truck driver
Nationality: Filipino
Religion: Anglican
Date and time of Admission: Sept 13, 2020; 6PM
Ward & Bed no.: Medical ward (Oncology area), Bed 10
Admitting Diagnosis: Stage II Colorectal Cancer
Chief complaints: red bloody stool and abdominal cramping

HISTORY OF PRESENT ILLNESS:

 The patient was experiencing constipation with black tarry stool and weight loss over the past few
weeks prior to hospital consultation. He told the nurse that he often feels abdominal cramping, tired
and loss of appetite. He has difficulty in bowel movement that often leads to restlessness and lack of
sleep. The patient was then accompanied by his helper due to persistence of abdominal cramping and
presence of red bloody stools, hence admission to this institution was recommended.
 During the colonoscopy, a mass in the right colon that extended into the lumen of the colon, with an
apparent ulceration, was discovered. Tissue biopsy indicated a well-differentiated adenocarcinoma. A
computerized tomography (CT) scan of the abdomen was taken and further blood studies were
performed to measure carcinoembryonic antigen (CEA) levels. Surgical intervention was done.

PAST MEDICAL AND SURGICAL HISTORY:

 The patient has no known childhood illnesses. He has no known allergies to any food, drug or
environmental allergy. The patient claimed to take pain relievers only for body pains or as necessary. 2
years ago, the patient underwent minor surgery due to vehicular accident.

FAMILY HISTORY:
 Bartolome’s father died due to respiratory complication of liver cirrhosis. His mother is hypertensive
and his younger brother died at a young age due to leukemia. His older sister is married but has no
child due to ovarian polyps that led to removal of her one ovary. His family also has a history of
diabetes and hypertension.

SOCIAL, ENVIRONMENTAL AND HEALTH HISTORY:

 The patient lives independently and loves traveling to different places. He was never married. He has
no place like home for he considers his truck as his home. He drinks alcohol occasionally, 1-2 bottle per
session, and usually after a delivery of truck services. He does not smoke. The patient loves to eat pork
and beef as well as ready to eat foods like canned or processed food. He loves to drink coffee every
morning upon waking up.

ACTIVITY 1: Underline using a red pen the pertinent positive and negative data or findings that you
think are relevant in the formulation of your nursing diagnoses

Note: Can also be given through text

PHYSICAL EXAMINATION & REVIEW OF SYSTEMS

- Focused assessment on the organs/system affected and state pertinent findings appropriately (+/-)
General Survey Lethargy (+)
Skin Pallor(+)Jaundice(+)
Head, Eyes, Ears, Nose,
Throat
Neck
Breast
Respiratory
Cardiovascular
Gastrointestinal  Abdominal tenderness(+)Macroscopic rectal bleeding (+)Ascites(+)
Urinary
Genital
Peripheral / Vascular
Musculoskeletal
Neurologic
Hematologic
Endocrine
Psychiatric

ACTIVITY 2: Recalling the concepts of health assessment, anatomy and physiology, you have to identify
at least FIVE pertinent PE findings that shows abnormality. Read your books or notes for you to
elaborate on the cause of your patient’s clinical signs and symptoms. In your own words, explain the
condition by summarizing what you have read or understood, this is highly encouraged. You must also
supply the textbooks or materials that you have utilized as references.

PERTINENT ABNORMAL PE/ROS EXPLANATION

1.
2.
3.

4.
5.
Reference/s:

FEEDBACK: You might find it easier, if you have your textbooks with you. Congratulations! You can
now proceed with the activity.

DIAGNOSTIC STUDIES:

ACTIVITY 3: Using a reference book (specify), you have to fill in the values that are asked. Indicate the
appropriate rationale for the diagnostic test done, its purpose, the abnormality and/or nursing
intervention needed.
Laboratory Reference/norma Result Interpretatio What have caused the
test & l values n abnormality/ Purpose/NI
Pertinent
Laboratory
Result
1. Complete Male: 14-18 g/dL Hemoglobin - Hemoglobin Bleeding is considered the
blood or 8.7-11.2 mmol/L - 10g/dl concentration primary cause of anemia when
count (SI units) (Hb) is used the colon is involved. This is
Female: 12-16 clinically to because the tumor releases
g/dL or 7.4-9.9 determine the certain chemicals that stimulate
mmol/L (SI presence of the formation of new blood
units) anemia, vessels. As the tumor grows, the
which is vessel bursts, leading to the loss
functionally of red blood cells.
defined as
insufficient
red blood cell
(RBC) mass to
adequately
deliver
oxygen to
peripheral
tissues.
Negative result. A Fecal occult Positive 1. Growths or polyps of the
Fecal Occult fecal occult blood blood: result. A fecal
colon
Blood Test test is considered tested occult blood
(FOBT) negative if no blood positive test is 2. Hemorrhoids (swollen
is detected in your considered
blood vessels near
stool samples. If positive if
the anus and lower
you have an blood is
rectum that can rupture,
average risk of detected in
causing bleeding)
colon cancer, your your stool
doctor may samples. You 3. Anal fissures (splits or
recommend may need cracks in the lining of the
repeating the test additional anal opening)
yearly. testing — such 4. Intestinal infections that
Positive result. A as a cause inflammation
fecal occult blood colonoscopy —
test is considered to locate the 5. Ulcers
positive if blood is source of the 6. Ulcerative colitis
detected in your bleeding.
stool samples. You 7. Crohn's disease
may need 8. Diverticular disease,
additional testing caused by outpouchings
— such as a of the colon wall
colonoscopy — to
locate the source of
9. Problems in the blood
the bleeding. vessels in the large
intestine
10. Meckel’s
diverticulum, usually seen
in children and young
adults

-
2. CEA TEST A normal level of CEA level: Elevated levels cause levels higher than 3 ng/mL.
CEA is less than or 3.5ng/ml of CEA occur These can include:
equal to 3 when the CEA infection
nanograms per is higher than cirrhosis
milliliter (ng/mL) 3 ng/mL. chronic smoking
These levels inflammatory bowel disease
are considered (IBD)
abnormal.
People with
many types of
cancers can
have levels
that are higher
than 3 ng/mL.
If you have
values that are
that high, it
doesn’t mean
you have
cancer.

FEEDBACK: You might want to have a few minutes break before proceeding to the areas of the module.

MEDICAL/SURGICAL DIAGNOSIS:

ACTIVITY 4: Read about your patient’s diagnosis using your textbook (MedSurg/ specify). Focus on the
description of the disease, the etiology or cause, what are the signs and symptoms and why do they
occur, what are the recommended interventions and nursing interventions. Digest the information
that you have obtained. Take time to process and analyze them. Once you are ready, in 500 words or
briefly answer the following questions.

Signs & Signs & symptoms

Description of the Disease Etiology Symptoms (patient)
(book)
olon cancer is a type of colon cancer begins  A persistent  constipation with
cancer that begins in the when healthy cells in change in your
large intestine (colon). The the colon develop bowel habits, black tarry
colon is the final part of the changes (mutations) in including  weakness and
digestive tract. their DNA. A cell's DNA diarrhea or  weight loss
Colon cancer typically contains a set of constipation or  Loss of appetite
affects older adults, though instructions that tell a a change in the  Abdominal
it can happen at any age. It cell what to do. consistency of cramping
usually begins as small, Healthy cells grow and your stool  restlessness and
noncancerous (benign) divide in an orderly way  Rectal bleeding lack of sleep
clumps of cells called polyps to keep your body or blood in  difficulty in bowel
that form on the inside of functioning normally. your stool movement
the colon. Over time some of But when a cell's DNA is  Persistent
these polyps can become damaged and becomes abdominal
colon cancers. cancerous, cells discomfort,
Polyps may be small and continue to divide — such as cramps,
produce few, if any, even when new cells gas or pain
symptoms. For this reason, aren't needed. As the  A feeling that
doctors recommend regular cells accumulate, they your bowel
screening tests to help form a tumor. doesn't empty
prevent colon cancer by With time, the cancer completely
identifying and removing cells can grow to invade  Weakness or
polyps before they turn into and destroy normal fatigue
cancer. tissue nearby. And  Unexplained
If colon cancer develops, cancerous cells can weight loss
many treatments are travel to other parts of 
available to help control it, the body to form 
including surgery, radiation deposits there
therapy and drug (metastasis).
treatments, such as
chemotherapy, targeted
therapy and
immunotherapy.
Colon cancer is sometimes
called colorectal cancer,
which is a term that
combines colon cancer and
rectal cancer, which begins
in the rectum.

Reference: Textbooks /Online resources allowed but should not come

from blogs, Wikipedia,

FEEDBACK: KEEP UP THE GOOD WORK! What you are doing will keep you focused and enable to
understand your patient the best way possible. It may be hard on you at the start but doing it often,
you will soon find it easier.

PRESCRIBED THERAPEUTIC (MEDICAL/SURGICAL) MANAGEMENT, AND HEALTH PROMOTION

PROGRAMS:

Activity 5: After reading your textbook or notes on pharmacology and/or med-surgical books, answer
what are asked on the following table.
Drug/ Dose/Route/ Mechanism of Common Side Nursing responsibilities
Classification Frequency action Effects
1. 5- injectable solution Antimetabolites kill Loss of appetite  Lab tests: Obtain
Fluorouracil (  50mg/mL cancer cells by Headache total and
5-FU) 400 mg/m² IVP on acting as false Nausea
Vomiting differential
Day 1, followed by building blocks in leukocyte counts
Diarrhea
2400-3000 mg/m² a cancer
Mucositis before each dose
IV as a continuous cell's genes, causing Myelosuppression
infusion over 46 hr the cancer cell to die Alopecia is administered.
q2Weeks in as it gets ready to Discontinue drug
Photosensitivity
combination with divide. The precise Hand-foot syndrome if leukopenia
leucovorin with or mechanism of action Maculopapular occurs (WBC
without has not been fully eruption <3500/mm3) or if
oxaliplatin/irinoteca determined, but the patient develops
n main mechanism of thrombocytopeni
fluorouracil is
a (platelet count
thought to be the
<100,000/mm3).
binding of the
deoxyribonucleotide Baseline and
of the drug (FdUMP) periodic checks of
and the folate Hct and liver and
cofactor, N5–10- kidney function
methylenetetrahydro are also advised.
folate, to thymidylate  Use protective
synthase (TS) to isolation of
form a covalently patient during
bound ternary leukopenic period
complex. This results
(WBC
in the inhibition of
the formation of
<3500/mm3).
thymidylate from  Watch for and
uracil, which leads to report signs of
the inhibition of DNA abnormal
and RNA synthesis bleeding from any
and cell death. source during
Fluorouracil can also thrombocytopeni
be incorporated into c period (day 7–
RNA in place of 17); inspect skin
uridine triphosphate for ecchymotic
(UTP), producing a
and petechial
fraudulent RNA and
interfering with RNA areas. Protect
processing and patient from
protein synthesis. trauma.
 Report
disorientation or
confusion; drug
should be
withdrawn
immediately.
 Establish a
reference data
base for body
weight, I&O ratio
and pattern, food
preferences and
dietary habits,
bowel habits, and
condition of
mouth.
 Report intractable
vomiting to
physician.
 Indications to
discontinue drug:
Severe stomatitis,
leukopenia (WBC
<3500/mm3 or
rapidly
decreasing
count),
intractable
vomiting,
diarrhea,
 thrombocytopeni
a (platelets
<100,000/mm3),
and hemorrhage
from any site.
 Inspect patient's
mouth daily.
Promptly report
cracked lips,
xerostomia, white
patches, and
erythema of
buccal
membranes.
 Report
development of
maculopapular
rash; it usually
responds to
symptomatic
treatment and is
reversible.
 Be aware of
expected
response of lesion
to topical 5-FU:
Erythema
followed in
sequence by
vesiculation,
erosion,
ulceration,
necrosis,
epithelialization.
Applications of
drug are
continued until
ulcerative stage is
reached (2–6 wk
after initial
applications) and
then
discontinued.
 Note: Systemic
toxicity may
follow use of
topical drug on
large ulcerated
area. Report
symptoms
promptly.

Duodenal Potent anti-ulcer drug CNS:Headache,

Ulcer,Gastric Ulcer, that competitively and malaise, dizziness,  Potential toxicity
Gastroesophageal reversibly inhibits somnolence, results from
Reflux histamine action at insomnia, vertigo, decreased
adult: PO  150 mg H2-receptor sites on mental confusion, clearance
b.i.d. or 300 mg h.s. parietal cells, thus agitation, depressio (elimination) and
IV  50 mg q6–8h; blocking gastric acid n, hallucinations in therefore
150–300 mg/24 h by secretion. Indirectly older adults. prolonged action;
 continuous infusion reduces pepsin CV:Bradycardia greatest in the
child: PO  4–5 secretion but appears (with rapid IV older adult patients
mg/kg/d divided q8– to have minimal effect push). or those with
12h (max: 6 mg/kg/d on fasting and GI:Constipation, hepatic or renal
or 300 mg/d) postprandial serum nausea, abdominal dysfunction.
IM/IV 2–4 mg/kg/d gastrin concentrations pain, diarrhea.  Lab tests: Periodic
divided q6–8h; 0.1– or secretion of gastric Skin:Rash. liver functions.
0.125 mg/kg/h by intrinsic factor or Hematologic:Rever Monitor creatinine
continuous infusion mucus. sible decrease in
clearance if renal
infant: PO  < 2 wk, 2 WBC count,
dysfunction is
mg/kg/d divided thrombocytopenia.
Therapeutic effects present or
q12h BodyWhole:Hypers
Blocks daytime and suspected. When
IV 1.5 mg/kg/d ensitivity reactions,
nocturnal basal clearance is <50
divided q12h or 0.04 anaphylaxis (rare).
gastric acid secretion mL/min,
mg/kg/h by
stimulated by manufacturer
continuous infusion
histamine and recommends
reduces gastric acid reduction of the
release in response to dose to 150 mg
food, pentagastrin,
once q24h with
and insulin. Shown to
cautious and
inhibit 50% of the
gradual reduction
stimulated gastric
acid secretion. of the interval to
q12h or less, if
necessary.
 Be alert for early
signs of
hepatotoxicity
(though low and
thought to be a
hypersensitivity
reaction): jaundice
(dark urine,
pruritus, yellow
sclera and skin),
elevated
transaminases
(especially ALT)
and LDH.
 Long-term therapy
may lead to vitamin
B12 deficiency.

IVF Amount Infusion rate Purpose Nursing responsibilities

PNSS 1 liter x 800cc ChlorideSolutionFor Monitor patient
m: IV Sodium and frequently or:
KVO fluidRoute:Dose:800 chloride — major a. Signs of
ml @25gtts/min electrolytes of the infiltration/sluggish flow
fluid compartment b.signs
outside of cells of phlebitis/infection
(i.e., extracellular) c. well time of catheter and
— work together needtobe replaced
to control d.Condition of catheter
extracellular dressing.
volume and blood
pressure. Check the level of the IVF.
Disturbances in a.Correct
sodium solution,medication
concentrations in andvolume.
the extracellular b.Check andregulate the
fluid are associated droprate.
with disorders of c.Change the IVFsolution if
water balance. needed.
d. Do not connect flexible
plastic
 Diagnostic Description Purpose Nursing Responsibilities
Procedure
-COLONOSCOPY It is a diagnostic  Screen for colon Before the procedure
procedure and
that utilizes a rectal cancer The following are the nursing interventions
flexible fiberoptic prior to colonoscopy:
colonoscope  Detect and  Secure an informed consent. Make
inserted into the evaluate sure that the patient or a significant
rectum to allow inflammatory other has signed an informed consent
visual examination and ulcerative form.
of the large intestine bowel disease  Obtain a medical history of the
(colon) lining. It is patient. Check for allergies, bleeding
indicated for  Locate the histories, medications, and information
patients with a source of lower relevant to the current complaint.
history GI bleeding and  Provide information about the
of constipation, perform procedure. Tell the patient that
or diarrhea, hemostasis by colonoscopy permits examination of
persistent coagulation the large intestine’s lining. Describe the
rectal bleeding, and procedure and tell the patient who will
lower  Determine the perform it and where it will take place.
abdominal pain whe cause of lower  Ensure that the patient has complied
n the results of GI disorders, with the bowel preparation. Explain
proctosigmoidoscop especially when that the large intestine must be
y and a barium thoroughly cleaned to be clearly visible.
barium and
enema test are To do so, tell the patient that he must
proctosigmoido
negative or maintain a clear-liquid diet for 24 to 48
inconclusive. scopy results hours before the test, take nothing by
 are mouth after midnight the before, and
inconclusive take a laxative, as ordered, or 1 gallon
 Assist diagnose of GoLYTELY solution in the evening
(drinking the chilled solutions at 8 oz
colonic
[236.6 ml] every 10 minutes until the
strictures and entire gallon is consumed).
benign or  Establish an IV line. Inform the
malignant patient that an IV line will be started
lesions and a sedative will be administered
before the procedure. Because a
 Evaluate the
sedative will be given, advise the
colon patient to arrange for someone to drive
postoperatively him home after the procedure.
for recurrence  Provide reassurance. Assure the
of polyps and patient that the colonoscope is well
malignant lubricated to ease it’s insertion, that it
lesions initially feels cool, and that he may feel
an urge to defecate when it’s inserted
 Investigate and advanced.
iron-deficiency   Explain to the patient that air may
anemia of be introduced through the
unknown origin colonoscope. This is done to distend
the intestinal wall and to facilitate
 Remove colon viewing the lining and advancing the
polyps instrument. Tell him that flatus
normally escapes around the
 Remove foreign
instrument because of air insufflation
objects and
and that he shouldn’t attempt to
sclerosing control it.
strictures by  Instruct the patient to
laser empty bladder prior to the
procedure. It is more comfortable if
 the patient voids immediately before
the procedure and to change into the
gown, robe, and foot coverings
provided.
 Instruct the patient to remove all
metallic objects from the area to be
 examined. Metallic objects such as
jewelry within the examination area
may alter organ visualization and cause
unclear images.
 Instruct the patient to cooperate and
follow directions. Instruct patient to
remain still during the procedure
because movement creates unreliable
results.
During the procedure
The following are the nursing interventions
during colonoscopy:
 Assist with patient positioning as
necessary. Place the patient on the
examination table in a left lateral
decubitus position with a sheet draped
over the body.
 Administer medications as
ordered. Pain medication and sedative
will be given to reduce discomfort and
to promote relaxation.
 Instruct the patient to bear
down. Bearing down as if having a
bowel movement is advised as the
fiberoptic tube is inserted through the
rectum.
 Change the position of the
patient. When the scope is advanced
through the sigmoid. The patient’s
position is changed to supine to allow
passage into the transverse colon. Air is
insufflated through the tube during the
passage to help in visualization.
 Encourage the patient to take slow,
deep breaths. Instruct the patient to
take deep breaths to aid in the
movement of the scope down through
the ascending colon to the cecum and
into the terminal portion of the ileum.
After the procedure
The nurse should note of the following nursing
interventions post-colonoscopy:
 Observe the patient closely for signs
of bowel perforation. Signs of bowel
perforations such as severe abdominal
pain, nausea, vomiting, fever, and chills
must be reported immediately.
 Obtain and record the patient’s vital
signs. Monitor vital signs and
neurological status every 15 minutes
for 1 hour, then every 2 hours for 4
hours, or as ordered. Assess
temperature every 4 hours for 24
hours.
 Instruct patient to resume a normal
diet, fluids, and activity as advised
by the health care provider. After the
patient has recovered from sedation,
allow him to resume his usual diet and
activity unless the practitioner orders
otherwise.
 Provide privacy while the patient
rest after the procedure. Inform that
the patient may pass large amounts of
flatus after insufflation.
  Monitor for any rectal bleeding. If a
polyp has been removed, minimal
rectal bleeding is expected for 2 days
but an increasing amount of bleeding
should be reported immediately.
 Encourage increased fluid
intake. Fluids must be given to replace
fluid lost during the preparation of the
procedure

Reference/s: Textbooks /Online resources are allowed but should not come from blogs or Wikipedia

FEEDBACK: I hope you were not intoxicated by these drugs. Remember that these are important in
saving your patient’s life and it should be monitored for its therapeutic and side effects.

ACTIVITY 6: Applying the nursing process, integrate all the significant findings obtained in the analysis
of the case and formulate a nursing care plan for your patient. Use the given table/format presented.

DATA GOALS/ ACTION/ NURSING RATIONALE RESPONSE &

Expected INTERVENTIONS EVALUATION
outcomes
Subjective findings: STG: Dxtc:  To gain client’s after 3 hours of
“Laging sumasakit trust and nursing interventions
-after 3 hours of  Establish rapport cooperation the patient shall
Tsan ko” as
verbalize
nursing
verbalized by the  To obtain baseline understanding of
interventions the  Monitor and data causative factors and
patient.
record vital signs necessary
patient will
interventions to
 Abdominal verbalize  Assess general  To determine promote optimum
cramping condition interventions nutrition.
understanding of
needed by the
 Tired causative factors client
 Loss of As manifested by:
and necessary
 Determining  Identification and
appetite
interventions to precipitating management of
factors underlying cause STG:
promote optimum
Objective findings is essential to fully/Partially/ not
T 37 °C nutrition recovery
MET
 These may limit Partially met
PR  90 BPPM
LTG: client’s ability to
after 8 hours of  Assess ability to ingest food and
RR  19 CPM
nursing chew, taste and reducing desire to
interventions the swallow eat
BP 130/90mmHg patient will  Hypermotility of After ___________ of NI,
intestinal tract is the patient was able
SPO2  95% demonstrate
behaviour changes common and is to :
to regain weight. associated with -after 8 hours of nursing
Focus/ Nursing Dx: interventions the patient
Txc: vomiting and
(PE/S)_____ diarrhea which shall demonstrate
 Auscultate bowel may affect choice behaviour changes to
IMBALANCED regain weight.
sounds of diet/route
NUTRITION; LESS  Weigh as
THAN BODY indicated,  Indicator of
evaluate weight in nutritional needs
REQUIREMENT R/T terms of and adequacy of As manifested by:

INSUFFICIENT premorbid weight intake

compare serial
INTAKE OF FOOD weights and LTG: fully MET

RICH IN POTASSIUM anthropometric

measures
AND INTESTINAL  Plan diet with
DISTURBANCES client and SO,  Including the pt in
 incorporating planning gives a
foods that client’s sense of control of
want or food from environment and
home may enhance
intake

 Encouraged small  Fulfilling cravings

frequent meals for desired food
and snacks of may also improve
nutritionally intake
dense and non-
acidic foods

 Discussed the
importance of  These provide the
adequate pt information on
nutrition how nutrition
especially fluids, could elevate her
protein, vit.C, chances of faster
vit.B, iron calories recovery
and potassium
rich foods

Edx:  To diminish
 Weigh as gastric irritants
indicated, that may cause
evaluate weight in client to be
terms of reluctant to eat
premorbid weight
compare serial
weights and
anthropometric  Gastric fullness
measures diminishes
 Plan diet with appetite and food
client and SO, intake
incorporating
foods that client’s
want or food from
home

 Encouraged small
frequent meals  It is necessary to
and snacks of make an accurate
nutritionally nutritional
dense and non- assessment
acidic foods

 Discussed the
importance of
adequate
nutrition
especially fluids,
protein, vit.C,
vit.B, iron calories
and potassium
rich foods

FEEDBACK: Continue on what with what you started. Just want to remind in your Nursing intervention
please give 4-5 each category. (E.g. 4 nursing intervention for diagnostics and so on)Make sure your
NCP is realistic and based on actual problems. FIGHTING!!
COLLABORATION
Activity 7: As a future nurse you should be able to work with your co-nurses and other health care
professionals and form a team sharing knowledge and resources to solve or provide patient care.

1. nurses work together and empower each other to achieve more

2. Practice situational awareness and open communication
3. Focus on nurse-to-nurse communication, including patient handoffs
4. Adjust to your audience, especially in nurse-to-patient communication

ETHICO-MORAL-LEGAL CONCERNS:
Activity 8: These principles concern the ethics of caring rather than 'curing' by exploring the everyday
interaction between you as a nurse and the person in your care.
It can be distinguished by its emphasis on relationships, human dignity and collaborative care.
• Beneficence: Acting for the good and welfare of others and including such
attributes as kindness and charity.
• Nonmaleficence: Acting in such a way as to prevent harm to others or to
inflict the minimal harm possible.
• Autonomy: Recognizing the individual’s right to self-determination and
decision-making.
• Justice: Acting in fairness to all individuals, treating others equally and
showing all individuals the same degree of respect and concern.
• Veracity: Being truthful, trustworthy, and accurate in all interactions with
others.
• Fidelity: Being loyal and faithful to individuals who place trust in the nurse.
• Integrity: Acting consistently with honesty and basing actions of moral
standards

FEEDBACK: You are almost done, it’s not time to give up. Take a deep breath, cool down, and proceed.
Now summarize what you have done by formulating the concept map/table.
ACTIVITY 9:
Incorporating all the data that had been presented to you and your readings, create in a diagram form
the pathophysiology of the patient’s disease/condition. Incorporate the risk factors present in your
patient based on his/her history, the signs and symptoms presented by your patient as shown on
his/her PE and ROS, the lab results provided by the various diagnostic exams. Group all cues together
showing how you were able to arrive to a certain nursing diagnosis/es.
Lastly, include the various medications and or procedures. Do not forget to include the arrows to show
connections and/or relationships among the various concepts.

Study the given sample below for you to understand.

BE CREATIVE BUT KEEP IT SIMPLE GOOD LUCK!

Feedback: This will sum up all your hard work, please do good in your concept mapping. Good luck
and Congratulations in advance!

Activity 10: Your shift is about to end, using ISBAR (a patient safety communication structure that aids
simplified, effective, structured and anticipated communication between healthcare personnel). Fill in
your end of shift report to help guide the incoming student nurse.
Identify yourself: your name: Shehada role: _Student nurse____________________
ward/area: ______Oncology_______________
Situation: What is your patient’s name, age & gender, current situation/status (stable but in danger of
deterioration, unstable), concern or your observations, what needs to monitor/observe (ex; abnormal VS,
labs, active clinical signs/symptoms)
Name: Bartolome Pascual
 Patient X at bed 10 , 60 y/o, with PNSS I liter at KVO @ 800cc level at the right hand, On
low salt, low fat diet and high fiber diet
 Monitor I & O
 Monitor vital signs q 2 hours

Background: Give the relevant details such as presenting problems and clinical history that will help the
incoming staff interpret the situation easily; may also include meds / procedures already administered.
 Bartolome was admitted last Sept 13, 2020 with a chief complaint of red bloody stools. Several weeks
PTA, he experienced changed in bowel movements. He also experienced general weakness and weight
loss for the weeks. He had loss of appetite as he claimed ne only consumed 50% of his food. NO
consultations was done until 1 day PTA, he had a red bloody stool and severe abdominal cramping.
 Upon admission, Bartolome undergone lab test: CBC, CEA and fecal occult blood test.
 The patient was experiencing constipation with black tarry stool and weight loss over the past few
weeks prior to hospital consultation. He told the nurse that he often feels abdominal cramping, tired
and loss of appetite. He has difficulty in bowel movement that often leads to restlessness and lack of
sleep. The patient was then accompanied by his helper due to persistence of abdominal cramping and
presence of red bloody stools, hence admission to this institution was recommended.
 During the colonoscopy, a mass in the right colon that extended into the lumen of the colon, with an
apparent ulceration, was discovered. Tissue biopsy indicated a well-differentiated adenocarcinoma. A
computerized tomography (CT) scan of the abdomen was taken and further blood studies were
performed to measure carcinoembryonic antigen (CEA) levels. Surgical intervention was done.

Assessment: What is your assessment? (Base it on your observation on your patient during your shift
what is his/her current condition, risks & needs).
Patient vitals signs was monitored every 2hours, BP went up to 130/90 from 130-80 .
Assisted ROM and shifting body position from side to side every after 2 hours, he is still unconscious and
unresponsive while performing bedside care at the end of the shift but vital signs improved.

Recommendation: What do you recommend being done to correct the situation? Be clear about what you
are requesting. (e.g transfer/review/treatment? When should it happen?
 In collaboration with the dietician, determine number of calories required to provide adequate
nutrition and realistic weight gain
Feedback: CONGRATULATIONS, you have carried out your task. I will be getting back to you after I
have read your output.

Prepared by: CHERRY G. KIM

Noted by: Dr. GINA L. CASI, - DEAN CNSM