PATIENT’S DATA

Biographic Data
Client’s Name: John
Address: N/A
Age: 68 years old
Sex: Male
Civil Status: Married
Occupation: N/A
Religion: N/A
Source of information: Patient
Attending Physician: N/A
Admitting Impression:
Colorectal Cancer
Date & Time of admission: N/A

Chief Complain
Constipation, bloody stools, abdominal pain, and weight loss (from 74 kilos to 71
kilos for a period of 1 month).
Vital Signs
Wt: 71kgs.

Symptoms Manifested
● Constipation
● Bloody stools
● Abdominal pain
● Weight loss of 3kgs
● Lethargic
● Body pain with a pain level of 8/10
● Interference in ADLs
● Fatigue
PAST AND PRESENT MEDICAL HISTORY
A. History of Present Illness
At time of admission, he complains of constipation, bloody stools, abdominal pain,
and weight loss (from 74 kilos to 71 kilos for a period of 1 month). He has been
smoking at the age of 25 and consumes 1 pack of cigarettes per day, has a history
of coronary artery disease and hypertension. He reports taking antihypertensive
medication and 80 mg of aspirin daily. He is prepared for abdominal surgery for his
stage 1 tumor. Postoperatively, he will have a temporary colostomy, followed by
chemotherapy that includes the drug Fluorouracil 1000 mg/m²/day and Avastin 300
mg IV every 2 weeks.

Further investigation revealed that for the past 2 months, he experienced changes
in his bowel habits, alternating constipation and diarrhea. He would sometimes
notice blood in stool in the form of melena. When asked why he was not able to
seek consultation while having the symptoms, he said that it did not bother him
much, that it would prompt immediate medical attention. He has no known
allergies to food and medication.
B. Past Medical History
He states that he has a deceased Aunt on his mother’s side who was diagnosed
with breast cancer. Hypertension and diabetes are present on both families’ side.
He admits that he drinks alcoholic beverages in moderate to heavy consumption at
least twice a week. His last admission to a health care facility was a year ago due
to loose watery stools, was diagnosed with acute gastroenteritis and was later
discharged in an improved condition. He had experienced fever, cough and
seasonal flu but it was managed at home.
C. Social History
He has been smoking at the age of 25 and consumes 1 pack of cigarettes per
day.

PATHOPHYSIOLOGY
Anatomy and Physiology
● Anatomy
o The colon is about six feet long and has four parts namely the ascending
colon, transverse colon, the descending colon, and the sigmoid colon.
Beyond the sigmoid colon are the rectum and the anus. The portion of the
colon from the cecum to the mid-transverse colon is also known as the
right colon.
o The rectum is about eight inches and connects the sigmoid colon with the
anal canal. The anal canal is 2.5-4 centimeters long. It is situated between
the rectum and anus.
 ● Physiology
o The function of the colon are absorption of water and minerals and the
formation and elimination of feces. The small intestine absorbs the
nutrients from the food and pours the leftover sludge into the cecum. This
sludgy waste then moves from the cecum to the colon for further
processing. The colon absorbs the water from the sludge while transporting
it toward the rectum.
Etiology
Colorectal cancer (CRC) most often occurs as transformation within adenomatous
polyps. About 80% of cases are sporadic, and 20% have an inheritable component.
Predisposing factors include chronic ulcerative colitis and Crohn colitis; the risk of
cancer increases with the duration of these disorders.

Patients in populations with a high incidence of CRC eat low-fiber diets that are
high in animal protein, fat, and refined carbohydrates. Carcinogens may be
ingested in the diet but are more likely produced by bacterial action on dietary
substances or biliary or intestinal secretions. The exact mechanism is unknown.

CRC spreads by direct extension through the bowel wall, hematogenous

metastasis, regional lymph node metastasis, and perineural spread.

Symptomatology
● A change in bowel habits
● Diarrhea, constipation, or feeling that the bowel does not empty completely
● Bright red or very dark blood in the stool
● Stools that look narrower or thinner than normal
● Discomfort in the abdomen, including frequent gas pains, bloating, fullness,
and cramps
● Weight loss with no known explanation
● Constant tiredness or fatigue
● Unexplained iron-deficiency anemia, which is a low number of red blood cells