Nursing Care Management for a Patient with Colorectal Cancer

ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING

West Avenue Timawa, Molo, Iloilo City
NCM 112 (RLE)

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC
Case Scenario 8
COLORECTAL CANCER
A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College
PRESENTED TO: MRS.

Arvi Tenderly V. Melliza, RN, M.A.N.
(NCM 112 RLE & SKILLS CLINICAL INSTRUCTOR)
PRESENTED BY:
Abenido, Mary Claire
Cartera, Riza June
Alayon, Hannah Marie
Catubay, Jade
Anatan, Raenacet
Claro, Meryll Joy
Camariosa, Shelynar B.
Feliciano, Dee D Rhae
Camarista, Coleen Mae C.
(BSN III-G GROUP 1)
OCTOBER 25, 2021

TABLE OF CONTENTS
I. .. .........................................................................INTRODUCTION
A. Objectives:
1. General Objective
2. Specific objectives (KSA) format
II. ................................................... NURSING HEALTH HISTORY
III . ....................................................... PHYSICAL EXAMINATION
IV. .................................... ANATOMY AND PATHOPHYSIOLOGY
V .. ................. DIAGNOSTICS AND LABORATORY PROCEDURE
VI. ................................................................. NURSING PROCESS
VII. ....................................................................... DRUG STUDY
VIII. ............................ DISCHARGE PLAN/HEALTH TEACHING
IX. ............................................................. ARTICLE/JOURNAL

I. INTRODUCTION
Tumors of the colon and rectum are relatively common; the colorectal area (the
colon and rectum combined) is the third most common site of new cancer cases in the United
States. In the United States, almost 145,000 new cases and 50,000 deaths from colorectal
cancer occur annually (American Cancer Society [ACS], 2016; National Cancer Institute [NCI],
2016a). Colorectal cancer is the third leading cause of cancer death in men or women and the
second leading cause of cancer death among all adults in the United States (ACS, 2016; NCI,
2016a). The most significant risk factor for colorectal cancer is older age. It is most frequently
diagnosed in adults between 65 and 74 years of age; the median age for patients who die from
colorectal cancer is 68 years (Bibbins-Domingo, Grossman, Curry, et al., 2016). However,
recent trends in epidemiologic data from the Surveillance, Epidemiology, and End Results
registry (SEER) of the NCI found an increased incidence of colorectal cancer in adults younger
than 50 years of age. The SEER data revealed that nearly one in seven new diagnoses of
colorectal cancer were among younger adults; furthermore, these patients were more likely to
have more advanced disease at the time of diagnosis but better long-term survival than among
adults older than 50 years of age (Abdelsattar, Wong, Reggenbogen, et al., 2016; Pfeifer,
2016). Approximately 20% of patients with colorectal cancer have a family history of the
disease. The exact cause of colon and rectal cancer is still unknown, but risk factors have been
identified. A specific form of hereditary colorectal cancer is Lynch syndrome, or hereditary
nonpolyposis colorectal cancer (HNPCC) (Bibbins-Domingo et al., 2016). HNPCC-defining
cancers include those of the colorectum, uterus, stomach, ovaries, urinary epithelium, and small
bowel. HNPCC is characterized by early age of onset. Another disorder with high risk of
colorectal cancer is familial adenomatous polyposis (FAP), in which patients develop hundreds
of colonic polyps that can become malignant (Bibbins-Domingo et al., 2016).
A drop in the numbers of Americans who smoke cigarettes and improved screening
strategies have helped reduce the number of deaths from colon cancer (ACS, 2016; Greenwald,
2015a). The stage at presentation affects the prognosis in colon cancer. If the disease is
detected and treated at an early stage before it spreads, the 5-year survival rate is 90%;
however, only 39% of colorectal cancers are detected at an early stage (ACS, 2016). Survival
rates after late diagnosis are very low. Most people are asymptomatic for long periods and seek
health care only when they notice a change in bowel habits or rectal bleeding (ACS, 2016).
Prevention and early screening are key to detection and reduction of mortality rates (Bibbins-
Domingo et al., 2016).
Colorectal Cancer: RISK FACTORS

 Cigarette smoking  High-fat, high-protein (with high
 Family history of colon cancer intake of beef), low-fiber diet
(Lynch syndrome) or polyps  History of genital cancer (e.g.,
 (familial adenomatous polyposis) endometrial cancer, ovarian cancer)
 High consumption of alcohol (i.e., >2  or breast cancer (in women)
drinks daily in men, >1 drink  History of inflammatory bowel
 daily in women) disease
 History of type 2 diabetes  Overweight or obesity

 Increasing age  Previous colon cancer or
 Male gender adenomatous polyps
OBJECTIVES
A. General Objectives
This study aims to convey familiarity and to provide an effective nursing
care to a patient diagnosed with Colorectal Cancer through understanding the patient
history, disease process, achieve and maintain control of symptoms and prevent further
Ulcerative Colitis complications.
B. Specific Objectives
A. Knowledge
• Define the meaning of Colorectal Cancer
• Know the pathophysiological basis of the Colorectal Cancer
• Determine signs and symptoms and risk factors/causes of Colorectal Cancer
• Determine appropriate nursing care management for client with Colorectal
Cancer
• Formulate plan of care for clients with Colorectal Cancer
• Provide accurate information about the topic
B. Skills
• Assess a woman who is experiencing Colorectal Cancer
• Apply different assessment techniques to determine the patients need
• Evaluate the plan of care needed
• Formulate nursing diagnoses that address the needs of the client experiencing
Colorectal Cancer
• Collaborate with health team member in planning and performing client care
• Document expected outcomes for effectiveness and achievement of care.
C. Attitude
• Build rapport with the client to build trust.
• Respect client decision (race, culture, values and beliefs)
• Maintain confidentiality regarding patient records/information
• Explain the importance of follow up check-up.
• Establish therapeutic relationship with client and family
• Acknowledge client needs using holistic approach
• Display confidence in providing nursing care to the client.
• Develop teamwork and collaboration to the health care team member
II. NURSING HEALTH HISTORY
Biographic Data
Name: John
Age: 68
Sex: Male
Marital Status: Married
Occupation: N/A
Religion: N/A
Attending Physician: N/A
Final Diagnosis: Colorectal Cancer
Date and Time of Admission: N/A
2.1 Past Medical History
● Has a history of coronary artery disease and hypertension.

● 2 months ago, 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.
● 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.
2.2 Present medical History
● Diagnosed with colorectal cancer and is preparing for abdominal

surgery for his stage 1 tumor.
● He complains of constipation, bloody stools, abdominal pain, and
weight loss (from 74 kilos to 71 kilos for a period of 1 month).
2.3 Lifestyle History
● He has been smoking at the age of 25 and consumes 1 pack of

cigarettes per day.
● He drinks alcoholic beverages in moderate to heavy consumption at
least twice a week.
2.4 Family History
● Deceased Aunt on his mother’s side who was diagnosed with breast
cancer.
● Hypertension and diabetes are present on both families’ sides.
2.5 Drug History
● Taking antihypertensive medication and 80 mg of aspirin daily.

● 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.
III. PHYSICAL EXAMINATION
I. Vital Signs:
Pain: 8/10 on pain scale
Weight: 71 kg. (from 74 kilos to 71 kilos for a period of 1 month).
II. CEPHALOCAUDAL ASSESSMENT:
1. General Appearance:
a) Lethargic
b) Stressful
2. Nervous System:
a. Fatigue
3. Other systemic region: Pain all over the body
IV. ANATOMY AND PATHOPHYSIOLOGY
ANATOMY
The digestive system consists of the alimentary canal (al′′i-men′tar-e kah-nal′), extending from the
mouth to the anus, and several accessory organs, which secrete substances used in the process of
digestion into the canal. The alimentary canal includes the mouth, pharynx, esophagus, stomach,
small intestine, large intestine, rectum, and anus; the accessory organs include the salivary glands,
liver, gallbladder, and pancreas. Overall, the digestive system is a tube, open at both ends, that has a
surface area of 186 square meters. It supplies nutrients for body cells.
ALIMENTARY CANAL
Mouth. The mouth receives food and begins digestion by mechanically reducing the size of solid
particles and mixing them with saliva.
Pharynx. The pharynx, or throat, is behind the oral cavity, the nasal cavity and the larynx.
Esophagus. Peristalsis pushes food to stomach. The esophagus (e˘-sof′ah-gus), a straight, collapsible
tube about 25 centimeters long, is a food passageway from the pharynx to the stomach.
Stomach. The stomach is a J-shaped, pouchlike organ that hangs inferior to the diaphragm in the
upper left portion of the abdominal cavity and has a capacity of about 1 liter or more.
Small intestine. The small intestine is a tubular organ that extends from the pyloric sphincter to the
beginning of the large intestine. With its many loops and coils, it fills much of the abdominal cavity.
Large intestine. The large intestine is so named because its diameter is greater than that of the small
intestine. This portion of the alimentary canal is about 1.5 meters long, and it begins in the lower
right side of the abdominal cavity, where the ileum joins the cecum.
Rectum. Regulates elimination of feces
PATHOPHISIOLOGY DISCUSSION:
Cancer of the colon and rectum is predominantly (95%) adenocarcinoma (ie, arising from the epithelial
lining of the intestine). It may start as a benign polyp but may become malignant, invade and destroy
normal tissues, and extend into surrounding structures. Cancer cells may break away from the primary
tumor and spread to other parts of the body (most often to the liver).
I. Pathophysiology
Abnormal proliferation of cells in
the colon area
Arising from epithelial lining of the

intestine
Benign polyps occur
If not treated: Continuous

If treated: prolifetion of cells in the
polyps
Surgical Treatment:
•Colonoscopy
•Virtual Colonoscopy Development of malignant tumor
Uncontrolled proliferation of cells in

Reduction likelihood of regrowth the tumor
Colon cancer
Metatases of cancer cells in other

organs
Formation of new tumor and

complication occur.
Death
V. DIAGNOSTICS AND LABORATORY
Biopsy - Biopsies are frequently used to diagnose cancer, but they can help identify
other conditions such as infections and inflammatory and autoimmune disorders. They
may also be done to match organ tissue before a transplant and to look for signs of
organ rejection following a transplant.
Carcinoembryonic antigen - This test measures the amount of CEA in the blood, and
sometimes in other body fluids. CEA is a type of tumor marker. Tumor markers are
substances made by cancer cells or by normal cells in response to cancer in the body. A
high level of CEA can be a sign of certain types of cancers.
TNM Staging System - A system to describe the amount and spread of cancer in a
patient's body, using TNM. T describes the size of the tumor and any spread of cancer
into nearby tissue; N describes spread of cancer to nearby lymph nodes; and M describes
metastasis (spread of cancer to other parts of the body).
Fecal Occult Blood Test - The fecal occult blood test (FOBT) is a lab test used to check
stool samples for hidden (occult) blood. Occult blood in the stool may indicate colon
cancer or polyps in the colon or rectum — though not all cancers or polyps’ bleed.
Complete Blood Count - The complete blood count (CBC) is a group of tests that
evaluate the cells that circulate in blood, including red blood cells (RBCs), white blood
cells (WBCs), and platelets (PLTs). The CBC can evaluate your overall health and detect
a variety of diseases and conditions, such as infections, anemia and leukemia.
MRI - MRI can be used to detect brain tumors, traumatic brain injury, developmental
anomalies, multiple sclerosis, stroke, dementia, infection, and the causes of headache.
Colonoscopy - A colonoscopy (koe-lun-OS-kuh-pee) is an exam used to detect
changes or abnormalities in the large intestine (colon) and rectum.
SGPT – SGPT means Serum Glutamic Pyruvic Transaminase. This test is done to
measure the amount of Glutamate Pyruvate Transaminase (GPT) in blood serum. GPT
is an enzyme found in heart cells, kidney, muscles and liver. An SGPT test is needed on
a regular basis to keep the liver in a healthy state.
SGOT - The SGOT test is a blood test that's part of a liver profile. It measures one of
two liver enzymes, called serum glutamic-oxaloacetic transaminase.
DIAGNOSTIC AND LABORATORY TESTS

Biopsy Result: Atypical cells present, suspicious for malignancy
Rare atypical cells in a hemorrhagic background.
Carcinoembryonic 28.1 ng/mL (Elevated levels of CEA occur when the CEA is higher than 3
antigen: ng/mL. These levels are considered abnormal.)
TNM Staging T4a, N2b, M0
System
Fecal Occult Positive (+) (indicates bleeding somewhere in the digestive tract)
Blood Test
Complete Blood Hgb = 6.0 g/dl (Low, normal is 13.8g/dl)
Count
Hct: 0.53 (high, normal is 41-50%)
RBC: 3.4 (low, normal is 4.7 to 6.1 million cells/mcL)
WBC: 8,000 m/mm3 (normal is 4500-11,000wbc per mcL)
MRI Result There is a solid tumor with a length of 2cm in the low rectum
The lower border is at 3cm from the anorectal angle
At 9’oclock there is 7mm ingrowth into the mesorectal fat.
The shortest distance to the mesorectal fascia is 2mm (not involved)
Conclusion:
cT3C-N2 tumor with 2 mm distance to MRF at 9 o’clock
COLONOSCOPY A 5 mm polyp was found in the rectum (benign-appearing lesion). The polyp
Result was semi-pedunculated. The polyp was removed with a cold biopsy forceps.
Resection and retrieval were complete.
Estimated blood loss: None.
 A 9 mm polyp was found in the sigmoid colon. The polyp was
pedunculated. The polyp was removed with a saline injection-lift
technique using a cold snare. Resection and retrieval were complete.
Estimated blood loss: 1 ml.
 Multiple large-mouthed diverticula were found in the descending colon.
 Non-bleeding prolapsed internal hemorrhoids were found during
retroflexion. The hemorrhoids were Grade II (internal hemorrhoids that
prolapse but reduce spontaneously).
SGPT Result 161 U/L (high, normal is 8-45)

SGOT Result 172 U/L (high, normal is 7-56)
VI. NURSING CARE PLAN

Assessment Nursing Outcome Nursing Rationale Evaluation
Diagnosis Identification Intervention
Subjective: Constipation Long term: Check on the It is very Goals met as
“Masakit akon related to After 7 days of usual pattern crucial to evidenced by
tyan kag kung irregular nursing of elimination, carefully know normal
mamus on defecation intervention including what is pattern of
ako. Kung kis a habits will be able to frequency and “normal” for bowel habits
may dugo regain normal consistency of each patient. and report no
akon tae” as pattern of stool. The normal pain.
verbalized by bowel frequency of
the patient Rationale: functioning stool passage
Constipation and report no ranges from
occurs when pain. twice daily to
Objective: bowel once every
movements third or fourth
Weight loss of become less Short term: day. Dry and
3 kg in 1 frequent than After 8 hours hard feces are
month normal. It is of nursing common
accompanied intervention characteristics
Bloody stools by a difficult the patient of
or incomplete will be able to constipation.
passage of verbalize
stool. decrease of
abdominal
pain and Check out Irregular
shows usual dietary mealtime,
behavior of habits, eating type of food,
improved habits, eating and
chief schedule, and interruption of
complaint liquid intake. usual schedule
can lead to
constipation.
Encourage the Sufficient fluid

patient to take is needed to
in fluid 2000 to keep the fecal
3000 mL/day, if mass soft. But
not take note of
some patients
contraindicated or older
medically patients
having
cardiovascular
limitations
requiring less
fluid intake.
It is important
Provide health for the client
teaching to the and their
client and significant
significant other
other about a understand
balanced diet, the
sufficient fluid importance of
intake, regular these, as these
elimination, steps leads to
and regular establishing
exercise regular bowel
habits.
Assessment Nursing Outcome Nursing Rationale Evaluation

Diagnosis Identification Intervention
Subjective: Fatigue Long term: Assess the Fatigue may be a Goals met as
“Nabudlayan related to After 7 days patient symptom of evidenced by:
kag kalain gd altered body of nursing nutritional protein-calorie
ka pamatyag chemistry, intervention ingestion for malnutrition, -patient show
kada tapos side effects of the patient adequate vitamin improved
chemotherapy pain and other will be able to energy deficiencies or energy
. Wala ko gana medications, report sources and iron deficiencies. -No signs of
magkaon, nga chemotherapy improve metabolic fatigue
daw isuka ko sense of demands -Restlessness
lng ang energy and not evident
ginakaon ko,” Rationale: participate in -Verbalized
as verbalized Cancer recommende understandin
by the patient treatments, d treatment Have Helps in g about the
specifically program patient rate developing a plan treatment
chemotherapy fatigue, for managing program
Objective: , can decrease using a fatigue
the number of Short term: numeric
-Pain scale red blood After 8 hours scale, if
8/10 cells, causing of nursing possible,
-Restlessness anemia. Red intervention and the
-Weak blood cells the patient time of day

apperance deliver oxygen will be able to when it is
-Lethargic throughout verbalize most
the body, so understandin severe.
when tissues g of situation
don't get and decrease
enough feeling of Plan care to Frequent rest
oxygen, you restlessness allow for periods and naps
can feel rest periods. are needed to
fatigue. Schedule restore and
activities for conserve energy.
periods Planning will
when allow patient to
patient has be active during
most times when
energy. energy level is
Involve higher, which may
patient and restore a feeling
SO in of well-being and
schedule a sense of control.
planning.
Encourage Enhances
patient to strength and
do whatever stamina and
possible enables patient to
(self- become more
bathing, active without
sitting up in undue fatigue.
chair,
walking).
Increase
activity level
as individual
is able.
Encourage Acknowledgemen
verbalizatio t that living with
n of feelings fatigue is both
about the physically and

impact of emotionally
fatigue challenging helps
in coping
Aid the Promoting

patient relaxation before
develop sleep and
habits to providing for
promote several hours of
effective uninterrupted
rest/sleep sleep can
patterns contribute to
energy
restoration
VII. DRUG STUDY
Name of Drug Classification Indication and Side effects or Special Nursing

and Contraindication Adverse Precautions Responsibilities
Mechanism of Reactions
Action
Generic Name Classification: Indications Side Effects: This medicine may -Assess for
make you dizzy, extrapyramidal
Metoclopramide Metoclopramide • Metoclopramide is Common side drowsy, or have symptoms and
is in a class of used to treat the effects may trouble with tardive dyskinesia
medications called symptoms of slow include: thinking or (more likely in
prokinetic agents. stomach emptying controlling body older patients).
Brand Name It works by (gastroparesis) in movements. This
speeding the patients with feeling restless; medicine may -Follow the 8 rights
Reglan and movement of food of medication
diabetes. It works by cause tardive
Metozolv ODT. through the increasing the
feeling drowsy or
dyskinesia (a administration.
stomach and tired;
movements or movement
Dosage intestines.
- Assess for
contractions of the lack of energy; disorder).
gastrointestinal
1-2tab/10mg stomach and
Mechanism of complaints, such as
intestines. It relieves nausea, vomiting;
Action: nausea, vomiting
symptoms such as
headache, and constipation.
The antiemetic
nausea, vomiting,
Route confusion; or
action of heartburn, a feeling - In oral
metoclopramide is of fullness after sleep problems administration, for
PO due to its antagonist meals, and loss of (insomnia). better absorption
activity at D2 appetite. allow 30 minutes to
receptors in the one hour before
chemoreceptor Contraindications eating.
Frequency: trigger zone in the :
central nervous
Q6H system — this action • Metoclopramide is
prevents nausea and
contraindicated in
vomiting triggered by
most stimuli. patients with
pheochromocytoma
because the drug may
cause a hypertensive
crisis, probably due to
release of
catecholamines from
the tumor.

Action
Generic Name: Classification: Indication: Side -This medicine may -Check doctors
effects/Adverse cause bleeding in order
Ibuprofen Ibuprofen is in a ibuprofen temporarily reactions: your stomach or
class of relieves minor aches -Observe the 8
intestines. These
medications called and pains due to It can cause side rights of
problems can
NSAIDs. It works by headache, backache, effects such as: medication.
happen without
Brand Name stopping the the common cold, warning signs. This
feeling and being -Check the patient's
body's production minor pain of is more likely if you
Advil sick (nausea and medical record for
of a substance that arthritis, toothache, have had a
vomiting) an allergy or
causes pain, fever, menstrual cramps, stomach ulcer in contraindication to
and inflammation. and muscular aches, stomach pain. the past, if you the prescribed
Dosage: and temporarily smoke or drink
feeling tired or medication
reduces fever. alcohol regularly, if
200mg sleepy.
you are over 60 -Educate patients
Mechanism of about their
black stool and years old, if you
Action: are in poor health, medications.
Contraindication: blood in your
ibuprofen is the vomit – a sign of or if you are using
Route: -Administer drug
non-selective, You shouldn't take bleeding in your certain other
with food or after
PO reversible ibuprofen if you: have stomach. medicines (a
meals if GI upset
inhibition of the a history of a strong, steroid or a blood
ringing in your occurs
cyclooxygenase unpleasant reaction thinner) .
ears (tinnitus)
enzymes COX-1 (hypersensitivity) to
Frequency and COX-2 (coded aspirin or other difficulty
for by PTGS1 and NSAIDs. have a breathing or Serious skin
Q6H current or recent
PTGS2, changes in your reactions can occur
respectively). stomach ulcer, or you heart rate (slower during treatment
have had one in the or faster) with this medicine.
past. have severe
heart failure.

Action
Generic Name: Classification: Indication: Side -Do not take -Check doctors
effects/Adverse aspirin or products order
Flourouracil Fluorouracil is an Fluorouracil injection reactions: containing aspirin
anti-cancer is indicated in the -Advise patient that
The following side unless your doctor
("antineoplastic" palliative rashes and other
effects are common specifically permits
or "cytotoxic") management of some skin reactions (hair
(occurring in greater this.
Brand Name chemotherapy types of cancer, than 30%) for
loss, increased
drug. Fluorouracil including colon, patients taking -Do not receive any sensitivity to UV
Adrucil is classified as an esophageal, gastric, Fluorouracil: kind of light, local
"antimetabolite." rectum, breast, biliary immunization or inflammation
Diarrhea
tract, stomach, head vaccination during topical use)
Dosage Mechanism of and neck, cervical, Nausea and possible without your are likely. Report
Action: pancreas, renal cell, occasional vomiting doctor's approval severe or
1000mg/m2/day and carcinoid. while taking unexpected skin
Fluorouracil blocks Mouth sores
Fluorouracil is an Fluorouracil. reactions to the
Route an enzyme which Poor appetite physician.
antineoplastic anti-
converts the metabolite.
IVTT cytosine Watery eyes, -Monitor IV
nucleotide into the sensitivity to light injection site for
Contraindication: (photophobia)
Frequency: deoxy derivative. signs of
contraindicated for Taste changes, thrombophlebitis
Q2weeks patients in a poor metallic taste in (pain, swelling,
nutritional state, mouth during inflammation).
those with depressed infusion
bone marrow
Discoloration along
function, those with vein through which
potentially serious the medication is
infections or those given
with a known
hypersensitivity to Low blood counts
Your white and red
Fluorouracil Injection.
blood cells and
platelets may
temporarily
decrease.

Action
Generic Name: Classification: Indication: Side -Bevacizumab may -Check doctors

effects/Adverse cause infusion- order
Bevacizumab Avastin is classified Avastin is indicated reactions: related reactions,
as a "monoclonal for the first-line -Monitor for S&S of
which can be life-
antibody" and treatment of The following side an infusion reaction
threatening and
"anti- unresectable, locally effects are (hypersensitivity);
require immediate
Brand Name angiogenesis" advanced, recurrent common
medical attention.
infusion should be
drug. or metastatic non– (occurring in interrupted in all
Tell your doctor
Avastin squamous non–small greater than 30%) patients with
right away if you
cell lung cancer in for patients taking severe infusion
start to have a
combination with avastin: reactions and
Mechanism of fever, chills or
carboplatin and appropriate therapy
Dosage Generalized shaking, dizziness,
Action: paclitaxel. trouble breathing,
instituted.
Weakness.
300mg Bevacizumab acts itching or rash, -Monitor BP at least
Pain. lightheadedness or
by selectively every 2–3 wk; if
binding circulating Contraindication: fainting after hypertension
Abdominal pain.
VEGF(Vascular receiving this develops, monitor
Route
Endothelial Patients were Nausea & medicine. more frequently,
IVTT Growth Factor), classified as having a vomiting. even after
thereby inhibiting contraindication if discontinuation of
Poor appetite.
the binding of they had at least two bevacizumab.
VEGF to its cell claims within 12 Constipation.
Frequency surface receptors. months before first -Monitor for
bevacizumab for any Upper respiratory dizziness,
This inhibition
q2wk of the following infection. lightheadedness, or
leads to a
diagnoses: severe loss of balance.
reduction in Low white blood
cardiac disease, Take appropriate
microvascular cell count.
thrombosis, safety measures.
growth of tumor
blood vessels and hemorrhage, stroke,
thus limits the hemoptysis, or colon
blood supply to perforation.
tumor tissues.

Action
Generic Name: Classification: Indication: Side -Tramadol may -Check doctors

effects/Adverse cause serious or order
Tramadol Tramadol is in a Tramadol is a strong reactions: life-threatening
class of painkiller. It's used to -Observe the 8
breathing
medications called treat moderate to sleepiness. rights of
problems,
opiate (narcotic) severe pain, for medication.
difficulty falling especially during
Brand Name analgesics. It works example after an the first 24 to 72
asleep or staying -After
by changing the operation or a serious hours of your
Ultram asleep. administration, the
way the brain and injury. It's also used treatment and any practitioner should
nervous system to treat long-standing headache. time your dose is continue to monitor
respond to pain. pain when weaker increased.
nervousness. the patient's liver
Dosage painkillers no longer
Mechanism of function, blood
work. uncontrollable pressure,
50mg/tab Action: shaking of a part respiratory system,
Contraindication:
of the body. and mental status.
Route Tramadol is a
centrally acting Contraindicated with
muscle tightness. -monitoring of vital
PO analgesic with a following conditions:
signs, modification
multimode of changes in mood.
decreased function of of patient's life
Frequency action. It acts on
the adrenal gland. heartburn or styles, diet
serotonergic and
Q6H indigestion. modification for the
noradrenergic symptoms from
patient
nociception, while alcohol withdrawal.
its metabolite O-
suicidal behavior.
desmethyltramado
l acts on the µ- suicidal thoughts.
opioid receptor. Its
analgesic potency alcoholism.
is claimed to be
alcohol intoxication.
about one tenth
that of morphine. drug abuse.
depression.
Asthma

Action
Generic Name: Classification: Indication: Side -Before taking -Check doctors

effects/Adverse dexamethasone, order
Dexamethasone Dexamethasone is Dexamethasone is used reactions:
classified as a to treat conditions such tell your doctor -Observe the 8
corticosteroid as arthritis, upset stomach. and pharmacist if rights of
blood/hormone you are allergic to medication.
(more precisely a
Brand Name disorders, allergic stomach irritation.
glucocorticosteroid dexamethasone,
reactions, skin diseases, -Monitor signs of
), and has many vomiting. aspirin, tartrazine
Decadron eye problems, breathing allergic reactions,
uses in the (a yellow dye in
problems, bowel
treatment of headache. some processed
Dosage disorders, cancer, and -Assess any muscle
cancer. One way immune system foods and drugs), or joint pain.
dizziness.
that it works is to disorders. It is also used or any other drugs.
9mg/day
decrease as a test for an adrenal insomnia.
Route inflammation gland disorder
(Cushing's syndrome). restlessness.
(swelling).
Po depression.
Mechanism of
Frequency Action: Contraindication:
Q6h for 2-3 days Dexamethason active, untreated
e is known to tuberculosis.
inhibit the cell inactive tuberculosis.
proliferation of
herpes simplex
certain
infection of the eye.
transformed
cell lines. a herpes simplex
infection.
an infection due to a
fungus.
intestinal infection
caused by the
roundworm
Strongyloides.
a condition with low

thyroid hormone
levels.
diabetes.
VIII. DISCHARGE PLAN/HEALTH EDUCATION
Clients with Colorectal Cancer are instructed to take the following plan for discharge:
 Call your local emergency number (911 in the US) for any of the following:
 You suddenly feel lightheaded and short of breath.
 You have chest pain when you take a deep breath or cough.
 You cough up blood.
Seek care immediately if:

 Your arm or leg feels warm, tender, and painful. It may look swollen and red.
 You vomit multiple times and cannot keep any food or liquids down.
 You see blood in your bowel movements.
 Call your doctor or oncologist if:
 You have a fever.
 You cannot control your diarrhea or constipation.
 Your pain is worse or does not go away after you take your pain medicine.
 You have questions or concerns about your condition or care.
Medicines:
You may need any of the following:
 Antinausea medicine may be given to calm your stomach and prevent vomiting.
 Prescription pain medicine may be given. Ask your healthcare provider how to
take this medicine safely. Some prescription pain medicines contain
acetaminophen. Do not take other medicines that contain acetaminophen without
talking to your healthcare provider. Too much acetaminophen may cause liver
damage. Prescription pain medicine may cause constipation. Ask your
healthcare provider how to prevent or treat constipation.
 Take your medicine as directed. Contact your healthcare provider if you think
your medicine is not helping or if you have side effects. Tell him or her if you are
allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you
take. Include the amounts, and when and why you take them. Bring the list or the
pill bottles to follow-up visits. Carry your medicine list with you in case of an
emergency.
Get screened as directed:

 Screening means you are checked for colorectal cancer, even if you do not have
signs or symptoms. Screening is recommended starting at age 50 and continuing
to age 75 if you are at average risk. Your healthcare provider may suggest
screening starting at age 45. Screening may start before you are 45 or continue
after you are 75 if your risk is high. Your provider will tell you how often to get
screened. Timing depends on the type of screening and if polyps or other

problems were found. Timing also depends on your age and if you are at
increased risk for cancer. Screening may be recommended every 1, 2, 5, or 10
years.
Do not smoke:
 Nicotine can damage blood vessels and make it more difficult to manage your
colorectal cancer. Smoking also increases your risk for new or returning cancer
and delays healing after treatment. Do not use e-cigarettes or smokeless tobacco
in place of cigarettes or to help you quit. They still contain nicotine. Ask your
healthcare provider for information if you currently smoke and need help quitting.
Eat healthy foods:

 Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy
products, beans, lean meats, and fish. You may need to change what you eat
during treatment. Do not eat foods or drink liquids that cause gas, such as
cabbage, beans, onions, or soda. A dietitian may help to plan the best meals and
snacks for you.
Limit or do not drink alcohol as directed:

 Men should limit alcohol to 2 drinks per day. Women should limit alcohol to 1
drink per day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½
ounces of liquor.
Drink liquids as directed:

 Ask how much liquid to drink each day and which liquids are best for you. If you
have nausea or diarrhea from cancer treatment, extra liquids may help decrease
your risk for dehydration.
Be physically active as directed:

 Ask about the best exercise plan for you. Physical activity, such as exercise, may
improve your energy levels and appetite.
IX. ARTICLE/JOURNAL
INTERNATIONAL:
Morphological, immunohistochemical and molecular features of

inflammatory bowel disease associated colorectal carcinoma and
associated mucosal lesions - Single institution experience
Background: Patients with inflammatory bowel disease (IBD) - ulcerative colitis (UC) and
Crohn's disease (CD) have an elevated risk of developing colorectal carcinoma (CRC).
Major risk factor in IBD patients is the continuous chronic inflammation leading to
development of dysplasia and carcinoma. Nevertheless, other types of non-conventional
but suspicious mucosal changes serrated change/dysplasia, NOS and villous
hypermucinous change, have also been reported in IBD patients. Preneoplastic potential
of these lesions is still not well elucidated.
Aims: The aim of this study was identification of IBD-associated CRCs focusing on
finding related precursor lesions in the surgical specimen or in archival biopsy samples
followed by a detailed morphological, immunohistochemical and molecular evaluation.
For the purpose of the study the mucosal lesions were divided into conventional IBD-
associated dysplasia and non-conventional lesions that were merged under a provisory
term of putative preneoplastic lesions (PPL).
Methods: A total of 309 consecutive IBD colectomy specimens diagnosed during a 10-
year period were reviewed. Detailed morphological evaluation, immunohistochemical
analysis of mismatch repair (MMR) proteins, p53 and O6-methylguanine DNA
methyltransferase (MGMT) expression and molecular analysis for KRAS, NRAS and BRAF
gene mutation were performed in the retrieved CRC cases as well as in the detected
dysplasia and PPLs of these patients.
Results: We identified 11 cases of morphologically heterogenous IBD-associated CRCs,

occurring in 5 males and 6 females, aged 26-79 years (mean 44 years). A total of 22
mucosal lesions were revealed in 8 CRC patients comprising conventional IBD-
associated dysplasia (4 lesions), PPLs as serrated change/dysplasia NOS (11 lesions),
villous hypermucinous change (5 lesions), and two true serrated lesions (one sessile
serrated adenoma and one traditional serrated adenoma). More than one type of lesion
was found in 6 patients. Seven CRC cases harbored mutation of KRAS/NRAS and one
case of BRAF. Two patients with KRAS-mutated CRC showed the same mutation in PPL
in the same specimen (one serrated change NOS and one TSA with high-grade
dysplasia). Similarly, one BRAF-mutated carcinoma case presented the same mutation in
serrated change/dysplasia, NOS in the same specimen. Of the CRCs, two showed
deficient MMR system profile, six presented with loss of MGMT expression, and six
showed aberrant p53 expression. PPLs showed deficient MGMT expression (14 cases)
and aberrant p53 (10 cases) as well.
Conclusion: IBD-associated CRCs are very heterogeneous entities. Besides conventional

IBD-related dysplasia, other types of mucosal lesions may be associated with long
lasting IBD and CRC e.g. villous hypermucinous change and serrated change/dysplasia,
NOS. Since these lesions share certain genetic or immunohistochemical changes with
the related CRC, a suspicion is raised that these lesions may also have preneoplastic
potential. Awareness of these changes is necessary to prevent their missing and under-
reporting, and further studies of these lesions should be carried out.
Reference:
Kamarádová, K., Vošmiková, H., Rozkošová, K., Ryška, A., Tachecí, I., & Laco, J. (2019).
Morphological, immunohistochemical and molecular features of inflammatory bowel disease
associated colorectal carcinoma and associated mucosal lesions - Single institution experience.
Pathology, research and practice, 215(4), 730–737. https://doi.org/10.1016/j.prp.2019.01.010
LOCAL
Treatment Outcomes of Patients With Colorectal Cancer

Enrolled in a Comprehensive Benefits Program of the
National Insurance System in the Philippines: Data From the
Pilot Site
Purpose: Cancer treatment causes significant financial burden, especially in developing
countries such as the Philippines. This led the Philippine Department of Health to create
the Z-Package colorectal cancer benefit program, an insurance system specifically
designed to treat Filipinos with colorectal cancers with early to locally advanced-stage
disease. The main goal of this program is to optimize treatment outcomes for this
curable disease without causing financial toxicity.
Materials and methods: Three-year data on patients enrolled in the Z-Package

colorectal cancer benefit program from 2016 to 2018 were reviewed by the University of
the Philippines, Philippine General Hospital Colorectal Polyp and Cancer Study Group.
Results: A total of 251 patients were enrolled in the Z-package colorectal cancer benefit
program from 2016 to 2018. Mean age was 57 years old and a majority of patients
(66%) were male. A majority of patients had rectal cancer (78%) and were diagnosed
with stage III disease (82%). A majority (75%) were compliant to their treatment plans
and clinic follow-up. Specifically, compliance to the prescribed surgery, chemotherapy,
and/or radiation treatment were 90%, 77%, and 96%, respectively. Recurrence,
morbidity, and mortality rates of enrolled patients in the Z-Package program from 2016
to 2018 were 17%, 22%, and 19%, respectively. Morbidities were mostly chemotherapy
related (8%). Finally, patients in this program had a 2- and 3-year survival probability of
74% and 70%, respectively, which are comparable with data from more developed
nations.
Conclusion: Results of this study include real-world data that show that when the
highest standards of patient care are provided through a multidisciplinary team,
patients' overall survival is also maximized.
Reference:
Ting, F., Sacdalan, D., Tampo, M., Apellido, R. T., Monroy, H. J., 3rd, Sacdalan, M., Sacdalan, D. L., & written on behalf of the University
of the Philippines, Philippine General Hospital Colorectal Polyp and Cancer Study Group (2020). Treatment Outcomes of Patients
With Colorectal Cancer Enrolled in a Comprehensive Benefits Program of the National Insurance System in the Philippines: Data
From the Pilot Site. JCO global oncology, 6, 35–46. https://doi.org/10.1200/JGO.19.00332

Nursing Care Management for a Patient with Colorectal Cancer

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ILOILO DOCTOR’S COLLEGE

BACHELOR OF SCIENCE IN NURSING

NCM 112 (RLE)

A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College

PRESENTED TO: MRS.

(BSN III-G GROUP 1)

OCTOBER 25, 2021

III . ....................................................... PHYSICAL EXAMINATION

IV. .................................... ANATOMY AND PATHOPHYSIOLOGY

V .. ................. DIAGNOSTICS AND LABORATORY PROCEDURE

VI. ................................................................. NURSING PROCESS

VII. ....................................................................... DRUG STUDY

VIII. ............................ DISCHARGE PLAN/HEALTH TEACHING

IX. ............................................................. ARTICLE/JOURNAL

Colorectal Cancer: RISK FACTORS

 History of type 2 diabetes  Overweight or obesity

II. NURSING HEALTH HISTORY

Marital Status: Married

Attending Physician: N/A

Final Diagnosis: Colorectal Cancer

Date and Time of Admission: N/A

2.1 Past Medical History

● Has a history of coronary artery disease and hypertension.

2.2 Present medical History

● Diagnosed with colorectal cancer and is preparing for abdominal

2.3 Lifestyle History

● He has been smoking at the age of 25 and consumes 1 pack of

2.4 Family History

2.5 Drug History

● Taking antihypertensive medication and 80 mg of aspirin daily.

● He will have a temporary colostomy, followed by chemotherapy that

III. PHYSICAL EXAMINATION

II. CEPHALOCAUDAL ASSESSMENT:

IV. ANATOMY AND PATHOPHYSIOLOGY

Rectum. Regulates elimination of feces

Arising from epithelial lining of the

Benign polyps occur

If not treated: Continuous

Uncontrolled proliferation of cells in

Metatases of cancer cells in other

Formation of new tumor and

V. DIAGNOSTICS AND LABORATORY

DIAGNOSTIC AND LABORATORY TESTS

SGPT Result 161 U/L (high, normal is 8-45)

SGOT Result 172 U/L (high, normal is 7-56)

VI. NURSING CARE PLAN

Encourage the Sufficient fluid

Assessment Nursing Outcome Nursing Rationale Evaluation

-Weak blood cells the patient time of day

about the physically and

Aid the Promoting

VII. DRUG STUDY

Name of Drug Classification Indication and Side effects or Special Nursing

Name of Drug Classification Indication and Side effects or Special Nursing

Name of Drug Classification Indication and Side effects or Special Nursing

Name of Drug Classification Indication and Side effects or Special Nursing

Generic Name: Classification: Indication: Side -Bevacizumab may -Check doctors

Name of Drug Classification Indication and Side effects or Special Nursing

Generic Name: Classification: Indication: Side -Tramadol may -Check doctors

Name of Drug Classification Indication and Side effects or Special Nursing

Generic Name: Classification: Indication: Side -Before taking -Check doctors

a condition with low

VIII. DISCHARGE PLAN/HEALTH EDUCATION