Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

In Partial Fulfillment
Of the Requirement in
________________________
Related Learning Experience (RLE)

A CASE STUDY ON
COLORECTAL CANCER

Presented by:

Viloria, Anjanette V.
BSN III-A

Presented to:

Ariel Paiste, RN

Date:
May 22, 2021

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 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

PARAMETER PERCENTAGE ACTUAL

(%) GRADE

Introduction and Objectives

Personal Data 5

Nursing History of Past and Present Health Illness 5

PEARSON Assessment 15

Diagnostic Procedures
a. Ideal 5
b. Actual

Anatomy and Physiology 5

Pathophysiology
a. Algorithm 15
b. Explanation

Management
a. Medical and Surgical (Ideal and Actual) 5
b. Nursing Care Plan (NCP) 25
c. Promotive and Preventive Management 5
Drug Study 5

Discharge Plan 5

Updates 5

Organization/Documentation 2.5

Bibliography 2.5

TOTAL: 100

REMARKS:
________________________________________________________________________
________________________________________________________________________
__________________________

SIGNATURE OF THE CLINICAL INSTRUCTOR:

________________________________________

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 TABLE OF CONTENTS

I. Introduction and Objectives …………………………………………………………………………4

II. Patient’s Profile.……………………………………………………………………………………………6
III. Nursing History of Past and Present Illness …………………………….........................7
IV. PEARSON Assessment …………………………………………………………………………….….7
V. Diagnostic Procedures
A. Ideal………………………………………………………………………………………………………..9
B. Actual……………………………………………………………………………………………………11
VI. Anatomy and Physiology of the Organ Involved …………………………………………11
VII. Pathophysiology
A. Algorithm…………………………………………………………………………………………..…13
B. Explanation……………………………………………………………………………………..……14
VIII. Management
A. Medical…………………………………………………………………………………………………16
a. Ideal
b. Actual
B. Surgical…………………………………………………………………………………………………17
a. Ideal
b. Actual
C. Nursing Care Plan……………………………………………….…………………………………18
IX. Promotive and Preventive…………………………………………………………………………. .19
X. Drug
Study…………………………………………………………………………………………………………..19
XI. Discharge Plan ……………………………………………………………………………………………19
XII. Bibliography …………………………………………………………………………………………...…21

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Introduction:

Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is

the development of cancer from the colon or rectum (parts of the large intestine). Signs and

symptoms may include blood in the stool, a change in bowel movements, weight loss, and

fatigue.

Most colorectal cancers are due to old age and lifestyle factors, with only a small number

of cases due to underlying genetic disorders. Risk factors include diet, obesity, smoking,

and lack of physical activity. Dietary factors that increase the risk include red meat,

processed meat, and alcohol. Another risk factor is inflammatory bowel disease, which

includes Crohn's disease and ulcerative colitis. Some of the inherited genetic disorders that

can cause colorectal cancer include familial adenomatous polyposis and hereditary non-

polyposis colon cancer; however, these represent less than 5% of cases. It typically starts

as a benign tumor, often in the form of a polyp, which over time becomes cancerous.

Bowel cancer may be diagnosed by obtaining a sample of the colon during a

sigmoidoscopy or colonoscopy. This is then followed by medical imaging to determine

whether the disease has spread. Screening is effective for preventing and decreasing deaths

from colorectal cancer. Screening, by one of a number of methods, is recommended

starting from the age of 50 to 75. During colonoscopy, small polyps may be removed if

found. If a large polyp or tumor is found, a biopsy may be performed to check if it is

cancerous. Aspirin and other non-steroidal anti-inflammatory drugs decrease the risk. Their

general use is not recommended for this purpose, however, due to side effects.

Treatments used for colorectal cancer may include some combination of surgery, radiation

therapy, chemotherapy and targeted therapy. Cancers that are confined within the wall of

the colon may be curable with surgery, while cancer that has spread widely is usually not

curable, with management being directed towards improving quality of life and symptoms.

The five-year survival rate in the United States is around 65%. The individual likelihood

of survival depends on how advanced the cancer is, whether or not all the cancer can be

removed with surgery and the person's overall health. Globally, colorectal cancer is the

third most common type of cancer, making up about 10% of all cases. In 2018, there were

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1.09 million new cases and 551,000 deaths from the disease. It is more common in

developed countries, where more than 65% of cases are found. It is less common in women

than men.

People with inflammatory bowel disease (ulcerative colitis and Crohn's disease) are at

increased risk of colon cancer. The risk increases the longer a person has the disease, and

the worse the severity of inflammation. In these high risk groups, both prevention with

aspirin and regular colonoscopies are recommended. Endoscopic surveillance in this high-

risk population may reduce the development of colorectal cancer through early diagnosis

and may also reduce the chances of dying from colon cancer. People with inflammatory

bowel disease account for less than 2% of colon cancer cases yearly. In those with Crohn's

disease, 2% get colorectal cancer after 10 years, 8% after 20 years, and 18% after 30 years.

In people who have ulcerative colitis, approximately 16% develop either a cancer precursor

or cancer of the colon over 30 years.

Those with a family history in two or more first-degree relatives (such as a parent or

sibling) have a two to threefold greater risk of disease and this group accounts for about

20% of all cases. A number of genetic syndromes are also associated with higher rates of

colorectal cancer. The most common of these is hereditary nonpolyposis colorectal cancer

(HNPCC or Lynch syndrome) which is present in about 3% of people with colorectal

cancer. Other syndromes that are strongly associated with colorectal cancer include

Gardner syndrome and familial adenomatous polyposis (FAP). For people with these

syndromes, cancer almost always occurs and makes up 1% of the cancer cases. A total

proctocolectomy may be recommended for people with FAP as a preventative measure due

to the high risk of malignancy. Colectomy, removal of the colon, may not suffice as a

preventative measure because of the high risk of rectal cancer if the rectum remains. The

most common polyposis syndrome affecting the colon is serrated polyposis syndrome,

which is associated with a 25-40% risk of CRC.

Mutations in the pair of genes (POLE and POLD1) have been associated with familial

colon cancer.

Most deaths due to colon cancer are associated with metastatic disease. A gene that appears

to contribute to the potential for metastatic disease, metastasis associated in colon cancer

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1 (MACC1), has been isolated. It is a transcriptional factor that influences the expression

of hepatocyte growth factor. This gene is associated with the proliferation, invasion and

scattering of colon cancer cells in cell culture, and tumor growth and metastasis in mice.

MACC1 may be a potential target for cancer intervention, but this possibility needs to be

confirmed with clinical studies.

Epigenetic factors, such as abnormal DNA methylation of tumor suppressor promoters,

play a role in the development of colorectal cancer.

Objective of the study

1. Assess and monitor the health status and vital signs of my patients.

2. Identify actual and potential health problems of the patient.

3. Plan for the patient’s care

4. Perform nursing interventions (medications included) effectively and efficiently

5. Evaluate patient’s response and reaction and

6. Impart health teachings to our patient

II: Patient’s Profile

Name: John Red

Age: 65 year-old
Sex: Male
Civil Status: Married
Address: Caoayan, Vigan City
Birthday: 05-23-1956
Nationality: Filipino
Date of admission: March 05,2021

Patient John Red was admitted at Northside Doctor’s Hospital with a chief

complaint of, constipation for almost a week with blood on the stool, abdominal pain and

weight loss.

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 The patient had been admitted for abdominal surgery for his stage 1 tumor but 5

days post-operatively, he developed abdominal bloatedness with tenderness accompanied

with vomiting.

Patient John Red is a heavy drinker and smoker. He presented a history of coronary

artery disease and Stage II hypertension, maintaining with Losartan 50mg tablet in the

morning, Amlodipine 5mg tablet in the evening and Aspirin 80mg tablet daily. He was

scheduled for re-ExLap followed with temporary colostomy after assessment of patient’s

condition.

III: NURSING HISTORY OF PAST AND PRESENT ILLNESS

John Red has a history of coronary artery disease and during his hospitalization before, he

was also diagnosed to have Stage II hypertension. He is currently taking Losartan 50mg

tablet in the morning, Amlodipine 5mg tablet in the evening and Aspirin 80mg tablet daily.

Patient was admitted for a colon resection and was diagnosed with stage 1 Colorectal

Cancer. Upon Admission, he presented a chief complaints of constipation, bloody stool,

abdominal pain and weight loss. Series of test was done to patient and medications are

prescribed as ordered. NPO diet was also prescribed to patient prior to surgery.

IV: PEARSON ASSESSMENT

ASSESSMENT Hospital

Date: 03-10-21
Patient is conversant. Able to answer
my queries on what does he feels
Physiological prior to the surgery

Has excessive perspiration because

of the hot weather.
Elimination

With IVF od D5LRS 1Lx8hours

regulated at 41-42 gtts/min

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 He is on bed. He can do minimal
movement like turning from other
Activity and Rest
side, helping in changing his clothes
but he cannot rest well and had
difficulty sleeping.

Initial vital signs taken as follows:

T=36.5 ‘C
PR= 110 bpm
Safety and Security RR= 20 cpm
BP= 100/60mmHg
IV site intact and patent
Side rails are working properly

No o2 supplement

RR= 22 cpm
Oxygenation

With poor appetite

Doctor orders D5LRS1Lx8hours and

Nutrition
is regulated @ 41-42 gtts/min

V. DIAGNOSTIC PROCEDURE

A. IDEAL

Physical exam
Doctors often perform a physical exam along with taking a medical history.

A physical exam is a study of your body for signs of disease. To start, your

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 basic body functions will be measured. These functions include your

temperature, blood pressure, and pulse and breathing (respiration) rate.

Your weight will also be checked. During the exam, your doctor will listen

to your lungs, heart, and gut. Your doctor will also look at and feel parts of

your body. This is done to see if organs are of normal size, are soft or hard,

or cause pain when touched. Cancer and other diseases can cause organs to

become enlarged and hard.

Biopsy

A biopsy involves removing small pieces of tissue, which are sent to a

pathologist for testing. A biopsy can be done during a colonoscopy.

Sometimes a needle is used to do the biopsy. In this case, a CT scan or

ultrasound may be used to help guide the needle into the tumor in order to

remove the tissue sample.

Colonoscopy

A colonoscopy is a procedure that allows your doctor to examine your colon

for polyps and other diseases.

A colonoscope is the device used for the test. Part of it looks like a thin tube.

It has a light and camera. This part will be inserted into your anus and gently

guided through your large intestine.

Blood tests

Blood tests are used to look for signs of disease. A needle will be inserted

into your vein to remove a sample of blood. The needle may bruise your

skin and you may feel dizzy from the blood draw. Your blood sample will

then be sent to a lab where a pathologist will test it. A pathologist is a doctor

who’s an expert in testing cells to find disease.

Complete blood count

A CBC (complete blood count) measures the number of blood cells in a

blood sample. It includes numbers of white blood cells, red blood cells, and

platelets.

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 Cancer and other health problems can cause low or high counts.

CEA blood test

When colon cancer spreads, it can cause high or low levels of chemicals in

the blood. One example is a high CEA (carcinoembryonic antigen) level.

CEA is normally low in healthy adults unless a woman is pregnant. High

CEA levels suggest the cancer has spread far.

Imaging tests CT Scan, X-Ray, MRI)

Imaging tests make pictures (images) of the insides of your body. They can

show areas of the body that have cancer. This information helps your

doctors stage the cancer and plan treatment. Certain imaging tests also

reveal some features of a tumor and its cells.

A radiologist is a doctor who’s an expert in reading images. Your radiologist

will convey the imaging results to your cancer doctor. This information

helps your doctor decide what the next steps of care should be.

Tumor marker testing

Just like each person’s DNA is unique, each person’s cancer is unique. This

means that a treatment that helps one person might not help you. To find

out if certain treatments might help you, your doctor may offer you tumor

marker testing. This is also called biomarker (short for biological marker)

testing.

Tumor markers can be substances, like molecules or proteins, that are made

by your body because you have cancer. Tumor markers can also be

processes, such as the way your DNA “acts” that makes it unique. To find

out if your cancer has any markers, the primary tumor removed during

surgery is tested in a laboratory.

B: ACTUAL
Blood tests

Blood tests are used to look for signs of disease. A needle will be inserted

into your vein to remove a sample of blood. The needle may bruise your

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 skin and you may feel dizzy from the blood draw. Your blood sample will

then be sent to a lab where a pathologist will test it. A pathologist is a doctor

who’s an expert in testing cells to find disease.

Complete blood count

A CBC (complete blood count) measures the number of blood cells in a

blood sample. It includes numbers of white blood cells, red blood cells, and

platelets.

Cancer and other health problems can cause low or high counts.

CEA blood test

When colon cancer spreads, it can cause high or low levels of chemicals in

the blood. One example is a high CEA (carcinoembryonic antigen) level.

CEA is normally low in healthy adults unless a woman is pregnant. High

CEA levels suggest the cancer has spread far.

VI. ANATOMY AND PHYSIOLOGY

The colon is part of the digestive system. This system breaks down food for the

body to use. After being swallowed, food moves through four organs known as

the digestive tract. First, food passes through the esophagus and into the stomach,

where it is turned into a liquid. From the stomach, food enters the small intestine.

Here, food is broken down into very small parts to allow nutrients to be absorbed

into the bloodstream.

Food then moves into the large intestine, which turns unused food from a liquid

into a solid by absorbing water. This solid, unused food is called feces or stool.

The large intestine has four parts, including the colon.

Cecum. This pouch is the first part of the large intestine. Food comes here

first after leaving the small intestine. It is around the size of a small orange.

Sticking out from the cecum is a skinny tube called the appendix. It is closed at

one end, and is about the size of a finger.

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 Colon. The colon is the longest part of the large intestine. It is almost 5

feet long and has four parts: the ascending, transverse, descending, and sigmoid

colon.

Rectum. This is the last part of the large intestine, and is about 5 inches

long.

Anus. The anus is the opening at the bottom of the rectum. This is where stool

leaves the body.

The wall of the colon has four main layers. The names of the layers (from inner

to outer) are the mucosa, submucosa, muscularis propria, and serosa or

adventitia. Cancer starts in the inner layer and grows towards the outer layer.

The digestive tract

The digestive tract consists of four main parts. The esophagus moves food from

your throat to your stomach. In the stomach, food is turned into a liquid.

Nutrients from the liquid are absorbed into your body in the small intestine. The

large intestine absorbs liquid from and pushes unused food out of the body.

The colon is part of the large intestine. It is almost 5 feet long and has four

sections: the ascending, transverse, descending, and sigmoid colon.

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VII: PATHOPHYSIOLOGY

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Your body is made of over 30 trillion cells. All cells have built-in rules that tell them how
to act. These rules, or instructions, are called genes.
Genes are a part of your DNA (deoxyribonucleic acid). Changes (called mutations) in
genes cause normal cells to become cancer cells.

Cancer cells don’t act like normal cells. The three most important differences between
cancer cells and normal cells are:

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 Normal cells grow and then divide to make new cells when needed. They also die
when old or damaged. Cancer cells make new cells that aren’t needed and don’t die quickly
when old or damaged. Over time, cancer cells form a lump called a tumor.

Normal cells listen to signals from nearby cells telling them to “stop” when they
get too close. Cancer cells ignore the “stop” signals from nearby cells and invade nearby
tissues.

Normal cells stay in the area of the body where they belong. For example, stomach
cells stay in the stomach. Cancer cells can travel to other parts of your body (metastasize).
They can then grow and make more tumors in the new area of your body.

The colon is the longest part of the large intestine and has four parts: the ascending,
transverse, descending, and sigmoid colon.

Cancer starts on the inside of the colon wall and grows toward the outside.

Cancer cells form a tumor since they don’t grow and die as normal cells do.

Cancer cells can spread to other body parts through lymph or blood. This is called
metastasis.

Most colon cancers start in polyps called adenomas.

The cancer stage is a rating of how much cancer there is in your body.

VIII. MANAGEMENT

A. MEDICAL

a.Ideal

Chemotherapy

The goal of chemotherapy is to stop cancer from growing or

spreading. It does this by using medicines to either kill the cells or

stop them from dividing. If the medicines are given in a way that lets

them enter the bloodstream, they treat cancer cells throughout the

body. That way they can treat cancer that has spread. This type of

treatment is called systemic. Medicines can also be given to attack

15
cancer cells in specific organs, such as the liver. This treatment is

called local. Chemotherapy might also be used before surgery to

shrink tumors. When used before surgery, it is called neoadjuvant

therapy. It might be used after surgery to kill or control any remaining

cancer cells. When used after surgery, it is called an adjuvant therapy.

Radiation therapy

The goal of radiation therapy is to kill cancer cells using high-energy

X-rays. It has a major role in treating rectal cancers, but it may be used

in some colon cancers as well. Like chemotherapy, it may be used

before surgery to shrink tumors. This treatment is called neoadjuvant

radiation therapy. This may lower the chance that a person will need

a permanent colostomy. When it's used after surgery, it is called

adjuvant radiation therapy. Then the goal is to reduce the chance that

the cancer will come back.

Targeted therapy

This type of therapy uses medicines that target proteins or cell

functions that help cancer cells grow. Some of these medicines are

given along with chemotherapy medicines, while others are used by

themselves. The goal is to prevent the cancer from growing. It may

also be used to help chemotherapy get inside the tumor. This can help

it be more effective.

Immunotherapy

The goal of this type of treatment is to help the body's own immune

system attack the cancer cells. Medicines called checkpoint inhibitors

can be used to treat some advanced colorectal cancers in which the

cells have certain gene changes. This treatment might be an option for

some people who have already had chemotherapy.

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 Ablation and embolization

These methods can be used to treat tumors that have spread to other

parts of the body, such as the liver or lungs. Ablation is the use of heat,

cold, or other methods to destroy tumors rather than removing them.

For embolization, a substance is injected into a blood vessel to try to

cut off a tumor's blood supply or to deliver chemotherapy or radiation

directly to the tumor.

b.Actual

The patient was given medications as per physician’s order. He was still

at the Surgical ward with NGT connected, open to drain. He had been

taking tramadol 50 mg IV for pain, Ketorolac 30 mg IV, Meropenem

1gm IV, Omeprazole 40 mg IV and paracetamol 300 mg IV for fever

and on IVF series of D5LRS1Lx8hours, D5NM 1Lx8hours, D5NSS

1Lx 8 hours regulated @ 41-42 gtts/min.

B. SURGICAL

a.Ideal

Colostomy

A colostomy is a surgical procedure that brings one end of the large

intestine out through the abdominal wall. During this procedure, one end of
the colon is diverted through an incision in the abdominal wall to create a
stoma. A stoma is the opening in the skin where a pouch for collecting feces
is attached. People with temporary or long-term colostomies have pouches
attached to their sides where feces collect and can be easily disposed of.

Colectomy

Colectomy is a surgical procedure to remove all or part of the colon. When

only part of the colon is removed, it is called a partial colectomy. The

procedure is also known as a bowel resection.

The colon is part of the body's digestive system. The digestive system

removes and processes nutrients ( vitamins, minerals, carbohydrates, fats,

17
proteins, and water) from foods and helps pass waste material out of the

body. The digestive system is made up of the esophagus, stomach, and the

small and large intestines.

The first 6 feet of the large intestine are called the large bowel or colon.

The last 6 inches are the rectum and the anal canal. The anal canal ends at

the anus (the opening of the large intestine to the outside of the body).

Lymphadenoctomy

Lymphadenectomy or lymph node dissection is the surgical removal of one

or more groups of lymph nodes. It is almost always performed as part of the

surgical management of cancer.

b.Actual

Exploratory Laparotomy

It is surgery to open up the belly area (abdomen). This surgery is done to

find the cause of problems (such as belly pain or bleeding) that testing could

not diagnose. It is also used when an abdominal injury needs emergency

medical care. This surgery uses one large cut (incision).

Colostomy

A colostomy is a surgical procedure that brings one end of the large intestine

out through the abdominal wall. During this procedure, one end of the colon

is diverted through an incision in the abdominal wall to create a stoma. A

stoma is the opening in the skin where a pouch for collecting feces is

attached. People with temporary or long-term colostomies have pouches

attached to their sides where feces collect and can be easily disposed of

c.NURSING CARE PLAN

(please see attached other file)

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IX: PROMOTIVE AND PREVENTATIVE

• Getting screened for other types of cancer. Your primary care doctor should tell

you what cancer screening tests you should have based on your gender, age, and risk level.

• Getting other recommended health care for your age and gender, such as blood

pressure screening, hepatitis C screening, and immunizations (such as the flu shot).

• Exercising at a moderate intensity for at least 30 minutes most days of the week. If

you have an ostomy or nerve pain, your doctor may recommend doing low-intensity

exercise or exercising fewer days per week.

• Eating a healthy diet with lots of plant-based foods.

• Drinking little to no alcohol. This means no more than 1 drink/day for women, and

no more than 2 drinks/day for men.

If you are a smoker, quit! Your doctor will be able to provide (or refer you for) counseling

on how to stop smoking.

X: DRUG STUDY

(please see attached file)

XI: DISCHARGE PLAN:

 Take medicines as prescribed

 Don’t take any over-the-counter medicine, supplements, or herbal remedies unless

your healthcare provider says it’s OK.

 Don’t lift anything heavier than 5 pounds or use a vacuum cleaner until your

healthcare provider says it’s OK.

 If you ride in a car for more than short trips, stop often to stretch your legs.

 Call health care provider if you have the following:

Excessive bleeding from your stoma

Blood in your stool, hard stool, or no gas or stool

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 Change in the color of your stoma

Bulging skin around your stoma or the stoma

appears to be getting longer

Fever above 100.4°F (38°C) or shaking chills

Redness, swelling, bleeding, or drainage from your incision

Constipation or diarrhea

Nausea or vomiting

Increased pain

XII: BIBLIOGRAPHY

Book:

Medical –Surgical Nursing

Brunner and Suddarth’s

Vol 1&2, 10th edition

Medical –Surgical Nursing

Brunner and Suddarth’s

Vol 1&2, 14th edition

Nursing Care Plan

Guidelines for Individualizing Client Care Across Life Span

8th edition.

Davis’s Drug Guide for Nurses

Judith Hopfer Deglin, April Hazard Vallerand

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20th edition, 2009

Internet:

Colorectal Cancer, SCRBD

Rein Butron Calaunan Apr 06, 2013

Colorectal Cancer, St. Luke’s Gastro Intestinal Program Page

Washington

MAYO Clinic

Colon Cancer

NCCN Guidelines for patients

Colon Cancer, 2018

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