I.

INTRODUCTION

Small bowel cancers include adenocarcinomas, carcinoid tumours, lymphomas, and leimyosarcomas. The small bowel is composed of the duedenun, jejenum, and ileum. It is the part of the Gastro-Intestinal tract extending from the pyloric sphincter of the stomach to the ileo-caecal valve separating the ileum from the colon (large bowel).
The small bowel is important for the breakdown and absorption of nutrients from digested food. Food that is partly digested by the acids in the stomach continues to be broken down by enzymes from the pancreas - which drain into the duodenum at the ampulla of vater. Bile salts from the liver and gallbladder also drain into the duodenum at the ampulla of vater. After further digestion, food constituents such as proteins, fats, and carbohydrates are broken down to small building blocks and absorbed into the enteric circulation. 

Risk Factors for Small Bowel Cancer
y y With small bowel cancer the most important predisposing factors are: Crohn's disease - Usually distal ileum. Familial adenomatous polyposis - This inherited condition almost invariably leads to colon cancer in affected individuals, though it less commonly causes adenocarcinomas in other parts of the gastrointestinal tract. Most commonly this is in the region of the duedenum. Adult coeliac disease .

y 

Statistics on Small Bowel Cancer
Small bowel cancer (Adenocarcinoma (AC) of the small bowel) is not common overall - accounting for 3 to 6% of gastro-intestinal tumours, even though it represents 75% of the length of gastr-intestinal tract. Adenocarcinomas are the most common cancer of the small intestine - making up 40%. It occurs with increasing age, most commonly in the sixth or seventh decade. 

Progression of Small Bowel Cancer
These small bowel cancer tumours tend to progress with local extension initially, then lymphatic and distal spread to other organs. Local growth into the lumen of the intestine may cause bowel obstruction, and sometimes bowel perforation. Periampullary small bowel cancer tumours may also cause obstructive jaundice by obstructing bile flow into the ampulla of vater. 

Diagnosis of small bowel cancer
With small bowel cancer a Full Blood Count may reveal anaemia due to chronic lower gastrointestinal (GI) blood loss with iron deficiency. Liver function tests may be abnormal due to obstructive jaundice or disease. An abdominal x-raymay reveal a small bowel obstruction.

PATIENT S PROFILE Name: Mrs. sometimes construction worker earning 300 a day irregularly. 4. Family stays at relative house in Payatas. Patient had not taken medications to relieve pain felt on epigastric region. The husband is Mario. Patient has experienced loss of appetite and vomited previously ingested food.  History of Present Illness Patient has palpable mass on Right Upper Quadrant but no consultation was done. We may be able to render care and services to our patients that would somehow contribute to the improvement of the client's current status. They pay 500 monthly for electricity and pay 200 monthly for water. To educate the client about her condition III. 28 y/o. Tondo. Quezon City for free of charge. To promote a safe and effective environment conducive for the client to attain optimal health.  Specific     To establish rapport and gain the trust of the client. HISTORY  Social History Patient is a 26 y/o female married and a Roman Catholic.  Past History  Family History . 1985 Place of Birth: Samar Civil Status: Married Nationality: Filipino Religion: Roman Catholic Occupation: N/A Date of Admission: April 19. a high school graduate and works as a painter. 2011 Chief Complaint: Vomiting Admitting Diagnosis: IV. Manila Date of Birth: January 26. and 6 months old.II. OBJECTIVES  General This research focuses on the improvement of our skills in managing and administering the extensive range of our nursing interventions to our client. To provide the client the appropriate nursing process and therapeutic communication in order to provide an effective nursing care. This will further expand our knowledge on this particular disease.XXX Age: 26 y/o Address: 414 Pacheco St. She reached Grade VI and a plain housewife. Couple has 3 children ages 6.

It is in the jejunum where the majority of digestion and absorption occurs. Small intestine The small intestine is composed of the duodenum. pancreas and gall bladder have important functions in the digestive system. is the longest segment and empties into the caecum at the ileocaecal junction. The small intestine is compressed into numerous folds and occupies a large proportion of the abdominal cavity. Partly digested food from the stomach is further broken down by enzymes from the pancreas and bile salts from the liver and . Food is propelled along the length of the GIT by peristaltic movements of the muscular walls. ANATOMY AND PHYSIOLOGY Gastrointestinal System The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity. The duodenum is the proximal C-shaped section that curves around the head of the pancreas. It averages approximately 6m in length. The small intestine performs the majority of digestion and absorption of nutrients. continuing through the pharynx. where food enters the mouth. the ileum. the duodenojejunal flexure. There are various accessory organs that assist the tract by secreting enzymes to help break down food into its component nutrients.V. extending from the pyloric sphincter of the stomach to the ileo-caecal valve separating the ileum from the caecum. The duodenum serves a mixing function as it combines digestive secretions from the pancreas and liver with the contents expelled from the stomach. stomach and intestines to the rectum and anus. The final portion. esophagus. liver. The start of the jejunum is marked by a sharp bend. and ileum. Thus the salivary glands. jejunum. where food is expelled.

These secretions enter the duodenum at the Ampulla of Vater.  Ligament of Treitz -is a musculofibrous band that extends from the upper aspect of the ascending part of the duodenum to the right crus of the diaphragm and tissue around the celiac artery.. VITAL SIGNS Blood Pressure NORMAL 120/80 ACTUAL FINDINGS 90/70 INTERPRETATION Cardiac output will often affect the delivery of oxygen to the cells of the body and when the system or tissues does not get the required oxygen for the metabolic process cellular function will be altered Normal range Normal range The rate of loss depends primarily on the surface temperature of the skin which is intern a function of skin blood flow.gallbladder. food constituents such as proteins. VI. 2011 General Survey: Client is endomorphic with a height of 5 feet 3 inches and a weight of 170 pounds. just lying on the bed with an IV line of 1L PNSS x 30mgtts/min. VII. PATHOPHYSIOLOGY PHYSICAL ASSESSMENT Date of Assessment: May 9.5-37.5 20 94 35. She was cooperative during the assessment. The blood flow of the skin varies in response to changes in the body core temperature and to changes in Respiration Rate Pulse rate Temperature 16-20 60-100 36. The patient is conscious and responsive. She was wearing a house dress. fats.9 . and carbohydrates are broken down to small building blocks and absorbed into the body's blood stream. with NGT intact and jejunostomy. Patient appears to be weak and pale. After further digestion.

No edema.blanch testprompt return of pink or usual color (gen. With presence of moles in various body parts. abrasions. lips nail beds) in dark skin people. Head PARTS METHOD NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION . Due to improper nail care or capillary refill is 3-4 prolonged not cutting of nails. Generally uniform except in areas exposed to sun. lesion. angle of nail plate about 160o ..temperature of the external environment. Normal skin pigmentation. Long fingernails. areas of lighter pigmentation (palms.. Temperature is uniform and w/in normal range ACTUAL FINDINGS Uniform complexion with warm moist skin. INTERPRETATION Activated sebaceous and sweat glands due to warm atmospheric temperature. seconds on the hands. No Edema Nails Inspection Convex curvature.with smooth texture . <3 sec) Convex. Skin PARTS Skin METHOD Inspection Palpation NORMAL FINDINGS Skin color varies from light to deep brown.

B. Clean. Dry scalp. occipital. Normal Normal Eyes PARTS Eyebrows METHOD Inspection NORMAL FINDINGS Symmetrically aligned. (Kozier. The lids close symmetrically blinks involuntary and with bilateral blinking. curled slightly outward Equally distributed. Hair isevenly distributed. nits. No infection or infestation. free from masses. free from masses. Equally distributed. lice. Curled slightly outward The skin is intact. Fundamentals of Nursing p. INTERPRETATION / ANALYSIS Normal Eyelashes Inspection Eyelashes are equally distributed and curled slightly outward.Hair Inspection Palpation Scalp Inspection Palpation Skull Inspection Palpation Evenly distributed hair over the scalp with thickness. and lesions no area of tenderness Round (normocephalic). absence of modules or masses Hair is black. lumps scars. bilateral blinking and no visible sclera above corneas when lids are open (Kozier. Fundamentals of Nursing p. evenly Normal distributed over the scalp or presence of hair loss. lice. (2004). lumps scars. B. White. Smooth. with frontal. uniform. Normal findings. (2004). nits. no discharge and no discoloration. parietal. No infection or infestation noted. Shiny. prominences) smooth. dandruff. smooth & pink or red in color ACTUAL FINDINGS Symmetrically aligned and equal movement. variable amount of body hair. absence of nodules or masses. and lesions no area of tenderness Rounded( normocephalic) & symmetrical. clean. smooth skull contour. 1152) Normal findings Eyelids Inspection Lids closes symmetrically. 548 Sclera and Conjunctiva Inspection . dandruff.

(Kozier. Normal findings. B. shiny & smooth. Fundamentals of Nursing p. symmetrical and color is the same as the facial skin. grayish-tan color or sticky.Cornea Inspection transparent. Distal third contains hair follicles and glands. pinna recoils after it is folded. symmetrical. Dry cerumen. firm and not tender. the auricles aligned with outer canthus of the eye. Air conducted hearing is greater than bone conducted hearing (positive Rinne) Mobile. Normal ANALYSIS Palpation Ear Canal Inspection Hearing Acuity Inspection Mobile. shiny & smooth. details of the iris are visible transparent. firm and not tender. Sound is heard in both ears . Distal third contains hair follicles and glands. ACTUAL FINDINGS Auricles aligned at the outer canthus of the eyes. wet cerumen in various shades of brown. details of the iris are visible Normal Ears PARTS Auricles METHOD Inspection NORMAL FINDINGS The color is the same as facial skin. Normal voice tones audible. (2004). Sound is heard in both ears or localized at the center of the head (Weber Negative). pinna recoils after it is folded. Dry cerumen. 556-557) Normal Normal voice tones audible.

uniform in color. Kozier page 560-561 Neck PARTS Neck METHOD Inspection Palpation NORMAL FINDINGS Proportional to size of the head. Freely movable without difficulty.Nose PARTS Nose METHOD Inspection NORMAL FINDINGS Symmetric and straight No discharge in flaring Uniform in color Not tender. (-) retraction Bronchovesicular breath sound ANALYSIS Normal findings. Normal findings (Kozier. Fundamentals of Nursing p. Head can easily flex and rotate. Normal ANALYSIS There are no palpable lymph nodes. No palpable lumps or tenderness . . No discharge or flaring. ACTUAL FINDINGS Proportionate to the size of head and symmetrical. (Fundamentals of nursing by Kozier p549) Normal . (-) tenderness and lesions Normal ANALYSIS Facial Sinuses Palpation No tenderness noted. ACTUAL FINDINGS chest expansion is symmetrical. symmetrical and straight. Thorax PARTS Chest size and shape Breath sounds METHOD Inspection Auscultation NORMAL FINDINGS Anteroposterior to transverse chest is symmetrical. 561) Normal findings Septum Inspection Air moves freely as the client breathes through the nares. no lesion No tenderness ACTUAL FINDINGS Symmetric in shape. Nasal septum intact & in midline Nasal septum intact and in midline. Bronchovesicular breathe sound. (2004). B.

Flat. Vesicular and bronchovesicular breath sound.Posterior Palpation Full and symmetric chest expansion. Abdomen PARTS Skin integrity METHOD Inspection NORMAL FINDINGS Unblemished skin. . rhythmic and effortless respiration. Quiet. rhythmic and effortless respiration. rhythmic and effortless respiration. . uniform in color. Fremitus tactile most clearly at the apex of the lungs Quiet. ACTUAL FINDINGS Unblemished skin. Symmetrical chest expansion. rounded. dry wound due to surgical incision Patient had undergone Jejunectomy. uniform in color (+) ANALYSIS Contour and Symmetry Inspection Flat abdomen. Anterior Inspection Quiet. Symmetric contour.

ANALYSIS Normal Lower Extremities Inspection Palpable Equal size on both side . No lesions. Equal in size on both sides. Normal Levels of Consciousness: Glasgow Coma Scale FACULTY MEASURED Eye Opening RESPONSE Spontaneous To verbal command To pain No response SCORE 5 3 2 1 6 5 Motor response To verbal command To localized pain Flexes and withdraws Flexes abnormally Extends abnormally No response 5 3 2 1 . No lesions. No lesions. coordinated movement. No difficulty upon bending and stretching. no scars and no deformity.No difficulty upon bending and stretching. No difficulty upon bending and stretching. Able to tolerate wide range of motion. Equal in strength. no scars and no deformity. ACTUAL FINDINGS Equal in size on both sides. Able to tolerate wide range of motion. Able to tolerate wide range of motion.Musculoskeletal System PARTS Upper Extremities METHOD Inspection Palpable NORMAL FINDINGS Equal in size on both sides. no scars and no deformity.

No meaningful response. converse Uses inappropriate words Unintelligible No response 4 3 2 5 1 ` Total 15 Interpretation:  Mild (13-15): Client is awake.  Moderate Disability (9-12): Loss of consciousness greater than 30 minutes Physical or cognitive impairments which may or may resolve Benefit from Rehabilitation  Severe Disability (3-8): Coma: unconscious state. REVIEW OF SYSTEMS . but no interaction with environment No localized response to pain  Brain Death: No brain function VI.Verbal Response Oriented. converses Disoriented. no voluntary activities  Vegetative State (Less Than 3): Sleep wake cycles Arousal.

2011 TEST Hgb Hct RBC WBC count Neutrophils Lymphocytes Basophils Monocytes Platelet Eosinophils 110g/L .2 5-10 55 34 1 3 3 150-450 INTERPRETATION Decreased Decreased Decreased Normal Increased Decreased Decreased Decreased Increased Increased HEMATOLOGY REPORT Date: May 9.5 16. 2011 TEST Hgb Hct RBC WBC count Neutrophils Lymphocytes Basophils Monocytes Platelet Eosinophils RESULT 64.2g/L 26g/L 3. LABORATORY RESULTS HEMATOLOGY REPORT Date: April 19.5 7.VII.82 68.4 0.81 9.2 7.38 4.4 11 3.95 7.1 491 5.4 0.6-6.2 5-10 55 34 1 3 3 150-450 INTERPRETATION .6-6.0 RESULT REFERENCE 120-180 40-54 4.06 68.7 679 REFERENCE 120-180 40-54 4.

Gravity Sugar Protein Bilirubin Ketone Urobilinogen Nitrite Physical Dark yellow slightly turbid 60 1.2011 Color: Charac: Reaction(pH): Sp.8sec NV 11.030 (-) (+) (+) (-) (-) (-) Microscopic 0.08sec 27sec 31.1 0.3sec 28-37sec .010-030 NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE NEGATIVE RBC WBC Crystals Epithelial Bacteria Casts NV 0-2/hpf 0-5/hpf none few few none HEMATOLOGY SECTION Date: May 9.3-15. 2011 Test Name Prothrombin Time PT control PT INR APPT APPT control Result 13.1 not found few many none NV amber clear 5-6 1.8sec 13sec 1.URINALYSIS Date: May 6.

drug maybe added to total parenteral nutrition solutions.. for IM. Competitivel y inhibits action of histamine on the H2 at receptor sites of parietal cells. stool.. otiti s media. Adjust dose in patients with impaired renal function. heartburn. . gastroesophage al reflux. antibiotic perioperative prevention. promoting osmotic instability. . use cautiously to patients hypersensitive to penicillin because of the possibility of of cross-sensitivity with other betalactam antibiotics. maintenance theraphy for duodenal or gastric ulcer. contraindicated to patients hypersensitivite to drug or other cephalosporin. MANAGEMENT  MEDICAL MANAGEMENT Drug name Classificatio n Indication Action Contraindicatio n Advers e Effect CNS: headac he. t hrombo phlebiti s GI: diarrhe a. uncomplicated skin and skin structure infection secondary cephalospori n that inhibits cell wall synthesis. assess patient for abdominal pain.. decreasing gastric acid content. use cautiously in breast feeding patients and and in patients with history of colitis or renal Obtain Specimen for culture sensitivity test before giving first dose. Contraindicated to patients hypersensitivite to drug and dose with acute porphyria. vertigo EENT: blurred vision Hepatic : jaundic e Consideratio ns Ranitidin e (Zantac) (H2 receptor antagonist) Active duodenal and gastric ulcer. Use cautiously in patients with hepatic dysfunction. vomitin g GU: vaginiti s HEma tologic: Consideratio ns Cefuroxi me (Ceftin) secondary cephalosporin . use inject deep into large muscle such as the gluteus maximus or the side of the thigh. malaise . pseudo membr anous colitis.VIII. Drug name Classificatio n Indication Action Contraindicatio n Advers e Effect CNS: fever CV: Phl ebitis. anorexi a. usually bactericidal. note pressure of blood in emesis. or gastric aspirate. nausea. absorption of oral drug is enhanced with food.bact erial exacerbations of chronic bronchitis or se condary bacterial infection of acu te bronchitis.

much smaller than that usually required for a normal gastrojejunostomy. or small intestine. Resection is sometimes a part of a treatment plan. Interventional radiologists perform precutaneous gastrojejunostomies. Some patients who have a condition that causes an obstructed bowel may undergo a gastrojejunostomy if they are unable to have a nasogastric tube. y y y Most small bowel cancer patients require surgical exploration to determine the extent of the tumour. No benefit has been shown with chemotherapy or radiotherapy either as adjuvant treatments with surgery or for palliation. Gastrojejunostomies are performed on patients who cannot eat normally or take medicine orally due to a blockage or cancer of the stomach or pancreas. . but duodenal cancer is difficult to remove surgically because of the area that it resides in--there are many blood vessels supplying the lower body. Drug name Classification Indication Action Contraindication Adverse Effect Considerations  SURGICAL MANAGEMENT Small bowel cancer treatment is surgical. thromb ocytope nia. thromb ocytosis . This procedure is typically performed with surgery. a tube that runs from the nose into the stomach. A gastrojejunostomy is the surgical creation of an opening in the stomach to connect it to the upper portion of the small bowel. Even in advanced disease a small bowel resection and/or a bypass may be performed to avoid the development of bleeding or obstruction. where an incision is made in the stomach. Chemotherapy is sometimes used to try and shrink the cancerous mass. A segmental bowel resection with removal of the draining lymph nodes is the usual procedure performed with curative intent in patients in whom the small bowel cancer is not extensive. transien t neutro penia. The tube allows medications and nutritional liquids to be given through the tube directly into the stomach.insufficiency. so that the surgeon can place a tube into the opening. and these procedures usually result in fewer complications and quicker recovery times. Precutaneous gastrojejunostomies are performed through a very small incision. Other times intestinal bypass surgery is tried to reroute the stomach to intestine connection around the blockage.

IX. Cues NURSING CARE PLAN Nursing Diagnosis Inference Planning Nursing Interventions Rationale Evaluation .

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