RECTAL MASS WITH PARTIAL OBSTRUCTION

TABLE OF CONTENTS

OBJECTIVES…………………………………………………….

INTRODUCTION………………………………………………..

GORDON’S FUNCTIONAL HEALTH PATTERNS…………..

PHYSICAL ASSESSMENT…………………………………….

LAB VALUES INTERPRETATION…………………………...

ANATOMY PHYSIOLOGY……………………………………

PATHOPHYSIOLOGY………………………………………….

SIGNS AND SYMPTOMS………………………………………

SUMMARY OF SIGNIFICANT FINDINGS……………………

NURSING CARE PLAN………………………………………...

DRUG STUDY…………………………………………………..

DISCHARGE PLAN……………………………………………..
 RECTAL MASS WITH PARTIAL OBSTRUCTION

OBJECTIVES

• To determine the risks of abdominal distension that the patient experiences

• To interpret the patient’s health examination results

•To construct possible nursing care that is suitable for the patient

•To construct possible clinical management approaches to the patient’s chief

complaints

•To research possible treatments to reduce or control the complaints of the patient
 RECTAL MASS WITH PARTIAL OBSTRUCTION

INTRODUCTION

Rectal mass with partial obstruction. A large bowel (large intestine) obstruction is a
blockage that keeps gas or stool from passing through the body. An intestinal
blockage can occur anywhere in the large intestine. It may block the bowel
completely or partially. A blocked intestine may rupture, causing a life-threatening
infection. Large bowel obstructions account for about 20% of all intestinal blockages.

People of all ages and genders can get large bowel obstructions. Adults who develop a
large bowel obstruction have colorectal (colon) cancer. A cancerous tumor causes the
blockage.

The purpose of this study is to know the patient’s condition before and after the
treatment. This study will record the treatments, results and prescriptions.
 RECTAL MASS WITH PARTIAL OBSTRUCTION

Nursing Assessment

Patient Profile

Name : John Doe

Age : 73

Gender : Male

Address : Brgy. Concepcion, Ormoc City, Leyte

Civil Status : Married

Date of Birth : January 6, 1949

Place of Birth: Ormoc City

Religion : Catholic

Weight : 63 kg

Name of Hospital : Clinica Gatchalian and Hospital

Date of Admission : 05/17/2022

Time of Admitted : 1:01 AM

Chief Complaint : Hypogastric Pain

Admitting Physician : Dr. Michelle Ong Chu

Admitting Diagnosis : Urinary Tract Infection; Sigmoid Colon Mass; Diabetes

Mellitus Type Two

Temperature : 36. 5

Heart Rate : 64 bpm

Respiratory Rate : 20 cpm

Blood Pressure : 120/80 mmHg

 RECTAL MASS WITH PARTIAL OBSTRUCTION

GORDONS FUNCTIONAL HEALTH PATTERN

Health Perception and Health Maintenance Management Pattern

John Doe was recently diagnosed with Diabetes Mellitus Type 2 after being admitted
at ODH for anemia, where he underwent 3 bags of blood transfusion. After he was
discharged, he kept a fair balance between activities and rest, along with one injection
of insulin per day. He is fully vaccinated for SARS-CoV 2.

Nutritional & Metabolic Pattern

John Doe weighs 63 kg. As indicated with Diabetes Mellitus Type 2, he must
maintain a healthy diet with 3 prep-meals (breakfast, lunch and supper), along with
nutritional snacks throughout the day. For breakfast, ½ cup rice and 1 medium egg
with 1 medium orange. Morning snack would consist of 3-4 whole grain crackers or
½ cup of cold cereal. Lunch meals usually consist of 1 cup rice, Sinigang with ½ cup
cooked meat and 1 cup cooked gulay, 1 medium piece of fruit, ½ cup juice or 1 cup
1% milk, along with an afternoon snack of fresh apples. His supper is Pancit: 3
ounces of chopped cooked chicken, 1 cup green beans/carrots, 1 cup noodles, with ½
mango as a side dish. Jon Doe occasionally drinks alcoholic beverages but he makes
sure not to consume alcohol on an empty stomach.

Elimination Pattern
John Doe has verbalized that he has difficulty in bowel movements and urinating. He
has indicated that he urinates 1-2 times a day but he feels discomfort and only
produces a small amount, with a foul smelling odor and it is very yellow. When he is
defecating, it is usually loose and watery.

Activity-Exercise Pattern
During the day, he is able to do simple chores and errands around the house that keeps
his body moving and active. When he has time, he goes walking around his
neighborhood talking with his friends.

Sleep-Rest Pattern
John Doe usually wakes up around 6 am in the morning. In the afternoon at 2 pm, he
usually takes a nap for 1 ½ hours after he has eaten his snack. Then in the evening he
makes sure to be in bed around 8 pm.

Cognitive-Perceptual Pattern
John Doe is able to be aware of his surroundings. He is attentive and responsive when
having a conversation with him. No difficulties in vocalization and hearing but he
only has vision through his left eye because his right eye was injured at his job.

Self-Perception and Self-Concept Pattern

John Doe is a well-mannered man. When asked a question, he will answer and when
he is instructed to do something, he does it without any fuss.
 RECTAL MASS WITH PARTIAL OBSTRUCTION

Role Relationship Pattern

John Doe is a husband and a father. Before his illness, he was the main provider for
his family but now he is being taken care of by his wife and child.

Sexual Functional and Reproductive Pattern

Due to his recent diagnoses he does not have the effective energy nor stamina to
fulfill the sexual functionalities he was once accustomed to during his adolecence.

Coping and Stress Tolerance Pattern

To cope through hard times and stressful situations, he turns to his religious faith for
guidance and protections while spending time with his family.

Value and Belief Pattern

John Doe is a Roman Catholic and goes to church on Sundays.
 RECTAL MASS WITH PARTIAL OBSTRUCTION

PHYSICAL ASSESSMENT

ASSESSMENT INSPECTIO PALPATIO PERCUSSIO AUSCULTATIO

N N N N
 GENERAL Upon
APPERAN inspection,
CE patient is
well-
groomed. No
body odor,
and was
wearing O.R
 SKIN, Gown
HAIR,
AND Upon
NAILS inspection,
skin was
intact, nails
were trimmed
and clean. Upon
Hair was palpation,
well- Lymph
 HEAD, groomed. nodes are
NECK, nonpalpable.
AND Upon No presence
CERVICA inspection, of masses in
L LYMPH the patient's the neck.
NODES head is
normocephali
c and
symmetric.
Muscles of
facial
expressions
 EYE intact. Neck
is
symmetric in
structure.
Upon
inspection,
the right eye
is not
functional
due to trauma
sustained at
his job; Upon
however, the palpation,
 EARS left eye is still there is no
AND functioning; tenderness,
 RECTAL MASS WITH PARTIAL OBSTRUCTION
HEARING pupils round, and firm.
sclera and
conjunctiva
are clear and
free of
lesions.
Upon
inspection ,
no difficulty Upon
of hearing, palpation, no
Equal in size tenderness
 NOSE
and noted.
AND
SINUSES bilaterally,
skin color is
same as facial
skin, no
excessive
cerumen,
 MOUTH redness or
AND discharge.
OROPHAR
YNX Upon
inspection,
nose are
symmetrical, Upon
no discharge Auscultation,
or flarring , hyperactive bowel
uniform in sound were
color. present
Upon
 ABDOME inspection,
N lips are dry,
symmetrical
in contour,
able to purse
lips, tongue is
on central
position.
Gums appear
pink and
moist.

Upon
inspection,
 CELEBRA Skin color
L consistently
FUNCTIO noted no
NS signs of
lesions,
 RECTAL MASS WITH PARTIAL OBSTRUCTION
rashes, or Crackling sound
scars in the were heard.
patient. Hair
distribution
appropriate
for patient’s
age and
gender. No
 THORAX discharge in
AND the umbilicus
LUNGS Upon
inspection,
the patient's
consciousness
is awake,
alert, and
oriented.
Immediate
memory was
intact and
well observed
. Patient
responds
appropriately.
No dysphoria
was noted.

Use of
accessory
muscles when
breathing and
nasal flaring
was well
observed and
noted.

ANATOMY PHYSIOLOGY

LARGE INTESTINE

The large intestine, also known as "colon" or large bowel is a thick tubular organ
wrapped around the small intestine and is the last part of the gastrointestinal tract and
of the digestive system in vertebrates. It is about 5 feet long- about one-fifth of the
whole length of the intestinal canal. There are 4 layers of the large intestine from the
lumen outward are the mucosa, submucosa, muscular layer, and serosa. The muscular
layer is made up of 2 layers of smooth muscle, the inner, circular layer, and the outer,
longitudinal layer it contribute to the motility of the large intestine. The large
intestine consists of the colon,rectum and anal canal. It starts in the right iliac region
 RECTAL MASS WITH PARTIAL OBSTRUCTION
of the pelvis, just at or below the right waist, where it is joined to the bottom end of
the small intestine (cecum). From here, it continues up the abdomen (ascending
colon), then across the width of abdominal cavity (transverse colon), and then it turns
down (descending colon), continuing to it's endpoint at the anus (sigmoid colon to
rectum to anus). The large intestine has 3 primary functions absorbs water and
electrolytes, produces and absorbs vitamins, and forms and propells feces toward the
rectum for elimination.

PATHOPHYSIOLOGY
 RECTAL MASS WITH PARTIAL OBSTRUCTION

SUMMARY OF SIGNIFICANT FINDINGS

Significant Findings Nursing Diagnose
 RECTAL MASS WITH PARTIAL OBSTRUCTION
Gordon’s
1. Anemic; underwent 3 bags of blood
transfusion
2. Diagnosed with DM 2
3. Bowel movement: loose, watery stool
4. Urination pattern: 1-2 times/day; very
yellow; foul odor
5. Drinks alcoholic beverages
6. Minimal intake of water
7. Insulin injection once a day
8. Vision impairment on the right eye
9. No maintenance medications
indicated
10. Dependent on his wife and kids
11. Decrease mobility
12. Inability to perform sexual activities
Physical Assessment
1. Right eye is not functional
2. Stomach is distended and tender
Laboratory Results
1. Decreased potassium = 3.0 mml/I
2. Low pO2 = 77 mmHg
3. Low sodium = 127 mmol/I
4. Increased creatinine = 140.2 mmol/I
5. Low albumin = 37.68 mmol/I
6. Increased WBC = 20.70
7. Increased RBC = 5.97
8. X-Ray = Pneumonia, indicated in the
left-base of the lung
DISCHARGE PLAN
MEDICATION
 Take the doctor’s medical prescription
1. Ineffective health maintenance r/t
unhealthy lifestyle
- Sub-problem: Sedentary
lifestyle (Gordon’s # 5, 6)
2. Risk for decreased cardiac output r/t
fluid imbalances affecting circulating
volume
- (Gordan’s 11, LR # 3, 4, 5, 6, 7)
3. Risk for unstable blood glucose level
r/t decreased uptake of glucose
(Gordon’s # 3, 4, 7, 11)
4. Diarrhea r/t to loose, watery stool
- (Gordon’s # 3, 5, 6)
5. Risk for fluid volume deficit r/t limited
fluid intake
(Gordon’s # 3, 4, 6, LR #, 8)
6. Imbalanced nutrition less than body
requirement r/t insufficient nutrient
intake
(Gordon’s # 3, 4, 11, LR # 3, 4, 5, 8)
7. Risk for infection r/t blood glucose
level secondary to DM 2 and anemia
(Gordon’s # 1, 2, 5, 6, LR # 8)
8. Ineffective breathing patterns
secondary to pneumonia
(LR # 2, 7, 8)
9. Activity intolerance r/t to imbalance
between oxygen supply and demand
secondary to pneumonia
(Gordon’s # 10, 11, 12, LR # 2, 7, 8)
10. Disturbed sensory perception r/t poor
visual acuity secondary to trauma
(Gordon’s # 8, 11, 10, PA # 1)
 RECTAL MASS WITH PARTIAL OBSTRUCTION

 Take medicines religiously.

Ceftriaxone(keptrix) 1 gm IVTT every 12 hours
Omeprazole (omepron) 40 gm IVTT once daily
Metronidaxole (dazomet) 500 grams IV drip every 8 hours
Paracetamol 1 gm with drip at 12 noon then every 6 hours for 3 days
Tramadol 50 mg slow IVTT at 4pm and 9pm then every 6 hours

ENVIRONMENT
 Advise patient to maintain a quite, pleasant environment to promote relaxation.
 Provide clean, safe, comfortable and well ventilated environment.

TREATMENT
 Continue home medication as prescribed
 Remind patient on his follow up check up

HEALTH TEACHING
 Instruct Patient for general health measures such as having adequate sleep, proper
diet, maintaining clean surroundings .
 Restrict caffeine containing beverages.
 Use of over the counter drug should be discouraged.
 Instruct the patient to change the pouching system regularly to avoid leaks and
skin irritation.
 Teach the importance of colostomy care.

OBSERVABLE SIGNS AND SYMPTOMS

Advise patient to seek medical consult; if signs and symptoms occur such as,
 Skin around the stoma looks red, raw or it leaks fluid
 Fever (101⁰f higher)
 Nausea, vomiting
 Pain in gut
 Severe constipation or diarrhea
 Have muscle cramps or dehydration

DIET
Instruct patient to avoid caffeinated drinks
Instruct patient to follow the given meal plan
Encourage patient to follow prescribe diet:
 Low-fiber diet
 Low-fat diet
 Bland diet
 Clear liquid diet

SPIRITUALITY
 Encourage patient to participate in religious practice.
RECTAL MASS WITH PARTIAL OBSTRUCTION
RECTAL MASS WITH PARTIAL OBSTRUCTION
RECTAL MASS WITH PARTIAL OBSTRUCTION