OUR LADY OF FATIMA UNIVERSITY -VALENZUELA CAMPUS

COLLEGE OF NURSING

“COLORECTAL CANCER”

A Case Study Submitted to the Faculty of College of Nursing

Our Lady of Fatima University

Valenzuela City Campus

In Partial Fulfilment of the Requirements in NCMA 312

Related Learning Experience

For the Degree of Bachelor of Science in Nursing

Presented by:

BSN 3Y1 – 5

Calderon, Monique Rodriguez, Christine Mae

Casumpang, Frencis Ann Roque, Khristine Mae

Casillano, Honeywell Rose Sanding, Hans Jessieron L.

Chan, Michael Gabriel Saulog, Angelica

Gonida, Crystal Jean

1. Conceptualize the pathophysiological alterations distinct to the case.
2. Make a drug study with first column with generic,brand name, dosage, frequency, route and
classification; second column with mechanism of action, third column with rationale why giving
the drug, fourth column with common
3. Make at least two nursing care plan based on your assessment that needs side effects of the
drugs and last column with nursing considerations while taking the drug.to prioritize.

PATHOPHYSIOLOGY OF COLORECTAL CANCER

Risk Factors:

Age, Male, Family history of

Cancer

Cancer cells initiate mutation in DNA

Development of adenomas

Progress and become carcinomas

More cells divide that dying

Formation of mass in sigmoid

Produce angiogenesis obstruction

Contribute in bleeding Abdominal pain Constipation

Mild anemic
 Classification Mechanism Indications & Contraindications Side Nursing
of Drug of Action Rationale effects Considerations
Generic Atorvastatin Hypercholesterolemia Contraindicated Common - Patient should
Name: is an in patients side follow a standard
Atorvastatin inhibitor of Rationale: hypersensitive to effects cholesterol-lowering
calcium reductase Given to patient to drug and in those are: diet before and
3-hydroxy- reduce the levels of with active liver during therapy
Brand Name: 3-methyl- cholesterol and low- disease or - Diarrhea
Lipitor glutaryl density lipoproteins unexplained - Joint - Before treatment,
coenzyme A persistent pain assess patient for
Therapeutic (HMG-CoA), elevation of - underlying causes for
Class: which is transaminase Insomnia hypercholesterolemia
Antilipemics essential to levels. - Loss of and obtain a baseline
hepatic appetite lipid profile. Obtain
Pharmacologic production - Nausea periodic LFT results
Class: of and lipid levels
HMG-CoA cholesterol. before starting
reductase Lipitor treatment and at 6
inhibitors increases and 12 weeks after
the number initiation, or after an
of hepatic increase in dosage
Route:
low- and periodically
Oral
density-lipid thereafter
(LDL)
Dosage:
receptors, - Watch for signs of
10mg
thus myositis and
increasing myopathy
Frequency: LDL uptake (unexplained muscle
Once a day and pain, tenderness,
catabolism weakness, malaise,
of LDL. dark urine, fever).
Drug may need to be
discontinued

Classification of Mechanism of Indications Contraindications Side Nursing

Drug Action & Rationale effects Considerations
Generic Name: Beta-adrenergic Hypertension Contraindicated Common side - Always check
Metoprolol blocking agent in patients effects are: patients apical
tartrate with preferential Rationale: hypersensitive to pulse rate before
effect on beta1 Given to drug or other - Dizziness giving drug. If it’s
Brand Name: adrenoreceptors patient to beta blockers - Depression lower than 60
Toprol XL located primarily treat - Diarrhea beats/minute,
on cardiac hypertension Use cautiously in - Mild itching withhold drug
Therapeutic muscle. At patients with HF, or rash and call
Class: higher doses, diabetes, prescriber
Antihypertensives metoprolol also respiratory or immediately
inhibits beta2 hepatic disease
Pharmacologic receptors - Monitor BP
Class: located chiefly frequently; drug
Selective beta- on bronchial and masks common
adrenergic vascular signs and
blockers musculature. symptoms of
Antihypertensive shock
Route: action may be
Oral due to
competitive
Dosage: antagonism of
25mg catecholamines
at cardiac
Frequency: adrenergic
Twice a day neuron sites,
drug-induced
reduction of
sympathetic
outflow to the
periphery, and
to suppression
of renin activity.

Classification of Mechanism of Indications & Contraindications Side Nursing

Drug Action Rationale effects Considerations
Generic Name: Pyrimidine Colorectal Contraindicated Common side - Watch for and
Fluorouracil antagonist cancer in patients effects are: report signs of
and cell-cycle hypersensitive to abnormal
Brand Name: specific. Rationale: drug. - Diarrhea bleeding from any
Adrucil Blocks action Given to the - Nausea source during
of enzymes patient to - Mouth sores thrombocytopenic
Therapeutic essential to stop cells - Poor appetite period (day 7–17);
Class: normal DNA from making inspect skin for
Antineoplastics and RNA DNA and it ecchymosis and
synthesis and may kill petechial areas.
Pharmacologic may become cancer cells Protect patient
Class: incorporated from trauma.
Pyrimidine in RNA to
analogs form a - Report
fraudulent disorientation or
Route: molecule; confusion; drug
Intravenous unbalanced should be
growth and withdrawn
death of cell immediately.
Dosage:
follow.
50mg/ml
Exhibits higher - Establish a
affinity for reference data
Frequency:
tumor tissue base for body
Once a day
than healthy weight, I&O ratio
tissue. and pattern, food
preferences and
dietary habits,
bowel habits, and
condition of
 mouth.

- Report
intractable
vomiting to
physician.

- Inspect patient's
mouth daily.
Promptly report
cracked lips,
xerostomia, white
patches, and
erythema of
buccal
membranes.

- Report
development of
maculopapular
rash; it usually
responds to
symptomatic
treatment and is
reversible.

Classification of Mechanism of Indications & Contraindications Side Nursing

Drug Action Rationale effects Considerations
Generic Name: A combination Metastatic Contraindicated in Common side - Monitor and
Trifluridine – of trifluridine, colorectal patients effects are: educate the
tipiracil a nucleoside cancer hypersensitive to patient with
hydrochloride metabolic these drugs - Fatigue regards to this
inhibitor, and Rationale: - Nausea treatment and
Brand Name: tipiracil, a Lonsurf - Decreased in possible side
Lonsurf thymidine showed appetite effects
phosphorylase antitumor - Diarrhea
Therapeutic inhibitor. activity
Class: Following against
Antineoplastics uptake into cancer cell
cancer cells, lines that
Pharmacologic trifluridine is were
Class: incorporated resistant to
Pyrimidine into DNA, flourouracil a
analogues interferes standard
with DNA therapy for
synthesis and colorectal
Route:
inhibits cell cancer.
Oral
proliferation.
Dosage:
35mg/m2
Frequency:
Twice a day on
days 1-5
Classification of Mechanism of Indications & Contraindications Side Nursing
Drug Action Rationale effects Considerations
Generic Name: Converted to Metastatic Contraindicated in Common side - Older patient
Capecitabine active 5-FU, colorectal patients effects are: may have greatest
which causes cancer hypersensitive to risk of GI effects
Brand Name: cellular injury 5-FU, patients - Nausea
Xeloda by interfering Rationale: with known - Vomiting - Assess patient
with DNA Given to dihydropyrimidine - Constipation for severe
Therapeutic synthesis to patient dehydrogenase - Loss of diarrhea, and
Class: inhibit cell because it is deficiency and in appetite notify prescriber if
Antineoplastics division and at least as those with severe - Diarrhea it occurs. Give
wit RNA effective as renal impairment fluid and
Pharmacologic processing the current (CrCl <30 electrolyte
Class: and protein gold mL/minute) replacement if
Pyrimidine synthesis standard patient becomes
analogues treatment for dehydrated. Drug
colorectal may be need to
Route: cancer, and is immediately be
Oral associated interrupted until
with fewer diarrhea resolves
side effects or becomes less
Dosage:
intense
1250mg/m2

Frequency:
Twice a day for
two weeks
Assessment Nursing Background Planning Intervention Rationale Evaluation
Diagnosis Knowledge
Independent
Subjective: Acute Cancer cells After 4 hours 1. Encouraged the After 4 hours of
abdominal initiate mutation of nursing patient to assume - Reduces the nursing
“Sobrang pain related to in DNA intervention, position of comfort abdominal tension intervention, the
sakit ng tiyan mass the patient will e.g knee flexed. and promotes sense goal was met.
ko” as compression verbalize of control. The patient
verbalized by as evidenced absence or 2. Provided rest verbalized
the patient. by patient’s decrease level periods. - To promote relief, “medyo masakit
Development of
complaint of of pain as sleep, and relaxation pa rin po”.
adenomas
pain evidence by: and to prevent Patient level of
fatigue which may pain is 5/10.
Objective:
result to
Progress and exaggerated pain.
Pain rating a. Patient will
become
scale of 9/10 be able to The patient still
carcinomas
verbalize 3. Provided - Patient may do not appear
Facial mask
satisfactory comfortable decrease ability to relaxed.
of pain
pain control at tolerate painful
Guarded More cells environment: clean
a level less stimuli if The patient
behavior dividing than bedsheets and
than 3 to 4 on environmental factor demonstrated
Restlessness dying adequate
a rating scale is further stressing use of deep
Irritability ventilation.
of 0 to 10. them. breathing
Vital signs as 4. Encouraged and exercise.
Formation of - Helpful in decreasing
follows: assisted client to do
mass in sigmoid b. Display perception and
PR= 115 bpm deep breathing However, the
improved response to pain.\ patient
RR = 26cpm exercise
BP= 130/90 wellbeing such displayed
as baseline 5. Instructed to - This technique improved well-
Obstruction levels for pulse, perform diversional involves heightening being as vital
BP, activities (listening one’s concentration signs taken as
respirations to music, upon non-painful follows:
Abdominal pain and relaxed stimuli to decrease PR= 86bpm
socialization etc.
muscle tone one’s awareness and RR = 20cpm
and body Dependent experience of pain. BP= 120/80
posture.
1. Administer - To treat underlying The goal was
medications as disease that causes partially met.
c. Display prescribed: pain to the patient.
improvement
Chemotherapy meds:
in mood.
Flouracil 50mg/ml
OD IVT
d. - to kill fast-growing
Demonstrate Trifluridine plus tipiracil cells such as the
use of 35mg/m2 BID OD BID abnormal cells
relaxational for 5 days
skills and - to stop the growth
diversional Capecitabine of cancer cells.
 activities as 1250mg/m2 BID for 2
indicated for wks - to stop or slow the
patient’s growth of cancer cells.
situation.

Assessment Nursing Background Planning Intervention Rationale Evaluation.

Diagnosis knowledge
Constipation Abnormal Short term: Encouraged the To keep the fecal Short term:
SUBJECTIVE: rt intestinal growth of After 2 hours patient to take in mass soft. After 2 hours of
“Apat na araw na obstruction as cancer cells in of nursing fluid 2000 to 3000 nursing
akong hindi natatae” evidenced by the intestine intervention, mL/day, if not intervention,
as verbalized by the infrequent the patient contraindicated the patient will
patient. passage of will identify medically. identify
stool Formation of measures that measures that
Objective: mass in the prevent or Instructed patient prevent or treat
Fiber adds bulk to
sigmoid colon treat to take at least 20 g constipation.
the stool and
Infrequent passage up to the anal constipation. of dietary fiber The patient
makes defecation
of stool verge (e.g., raw fruits, verbalized
easier because it
Long term: fresh vegetable, “iinom po ako
passes through
After 3 – 5 whole grains) per ng maraming
Abdominal distention the intestine
days of day. tubig at kakain
Obstruction in essentially
nursing ng mga
Obstructed feces in the sigmoid unchanged.
intervention, pagkaing
the intestine due to colon up to the
the patient Urged patient for mayaman sa
mass obstruction anal verge Movement
states relief some physical fiber gaya ng
promotes madadahon na
from activity and peristalsis. gulay”
constipation exercise.
Feces cannot Abdominal
as evidence by Considered
pass through exercises
passage of isometric Long term:
the intestine. strengthen
soft, formed abdominal and After 5 days of
abdominal
stool at a gluteal exercises. nursing
muscles that
frequency intervention,
facilitate
perceived as the patient
Constipation. defecation.
“normal” by states relief
Closed the
the patient. from
bathroom door or This will give constipation
pulled curtains eased to the as evidenced by
around the bed. patient to passage of soft,
perform formed stool at
defecating activity a frequency
with ease and perceived as
privacy. “normal” by the
patient (once a
Encouraged a Successful bowel day every
regular period for training relies on morning)
elimination an routine.
adequate time for Facilitating
defection. regular time
Goal was met.
prevents the
bowel from
 emptying
sporadically.
Dependent
- To treat
1. Administer underlying
medications as disease that
prescribed: causes
constipation to
Chemotherapy the patient.
meds:

- to kill fast-
growing cells such
Flouracil 50mg/ml as the abnormal
OD IVT cells

Trifluridine plus - to stop the

tipiracil 35mg/m2 growth of cancer
BID OD BID for 5 cells.
days
- to stop or slow
Capecitabine
the growth of
1250mg/m2 BID
cancer cells
for 2 wks