Chevonne Abigail anak Jefry A189569

COLORECTAL CANCER

1. Define Colorectal Cancer

Colorectal cancer is defined as tumors of colon and rectum.

2. Pathophysiology
Cancer of the colon and rectum is predominantly (95%) adenocarcinoma (i.e., 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 migrate away from the primary tumor and spread to other parts of the
body (most often to the liver, peritoneum, and lungs).

3. Etiology
- Genetic factors
- Diet
- Environmental factors
- Inflammatory conditions of digestive tract
- Smoking

4. Signs & Symptoms

- Blood in urine & stools (melena)
- Unexplained anemia
- Anorexia
- Weight loss
- Fatigue
- Abdominal Pain
- Rectal Pain
- Constipation
- Diarrhea

5. Diagnostic Tests
- History and physical examination
- Digital rectal examination
- Testing of stool for occult blood
- Complete Blood Count
- Liver Function Test
- Barium enema
- Carcinoembryonic Antigen (CEA) Test
- Colonoscopy
- CT scan, ultrasound / MRI of abdomen, pelvis, chest
6. Management of Colorectal Cancer
Preoperative Care -
1. Maintaining Optimal Nutrition
2. Prevent Infection
3. Maintain fluid volume balance
4. Education
5. Emotional Support
Postoperative Care -
1. Maintaining Optimal Nutrition
2. Provide Wound Care
3. Monitor & manage complications
4. Educate self-care

7. Complications of Colorectal Cancer

- Intraperitoneal infection
- GI bleeding
- Complete large bowel obstruction
- Bowel perforation
- Peritonitis, abscess, and sepsis

8. Nursing Care Plan

Nursing Diagnosis
1. Acute pain related to persistent diarrhea as evidenced by verbal
complaints of abdominal pain.
Desired Outcome - Within hospitalization, patient will report relief from abdominal
pain with decrease in pain score level from 4/10 to 2/10.

2. Diarrhea related to colon tumor as evidenced by loose and watery stools.

Desired Outcome - Within hospitalization, patient will report a decrease in
frequency and urgency to less than three stools per day.

3. Risk for infection related to immunosuppression due to chemotherapy.

Desired Outcome - Within hospitalization, patient will remain free from infections.
STOMACH CANCER
1. Definition of stomach cancer
Stomach cancer is a disease where malignant (cancer) cells form in the lining of
the stomach. It is also known as gastric cancer.

2. Pathophysiology
Gastric cancer begins with a lesion involving cells on the top layer of the stomach
mucosa. → The lesion then penetrates cells in the deeper layers of the mucosa,
submucosa, and stomach wall. → Lesion infiltrates the stomach wall and extends
to organs or structures adjacent to the stomach. → Lymph node involvement and
metastasis tend to occur early due to the abundant lymphatic and vascular
networks of the stomach.
Common sites of metastasis include the liver, peritoneum, lungs, and brain.

3. Clinical Manifestations
- No specific symptoms are seen in early stages
- Nausea, Vomiting
- Ascites
- Liver Enlargement
- Abdominal Mass

4. Diagnostic Test & Assessment

Physical examination - not helpful in detecting early stages of cancer as most
early gastric tumors are not palpable. Advanced gastric cancer may be palpable
as a mass.
Esophagogastroduodenoscopy - for biopsy and cytologic washings
Barium X-ray examination of upper GI tract
Endoscopic ultrasound - to assess tumor depth and lymph node involvement
CT scan - to assess surgical resectability of tumor before surgery
CT scans of the chest, abdomen, and pelvis to stage gastric cancer.
Complete Blood Count (CBC) Test - to evaluate for the presence of anemia.
Assessment of tumor markers - Carcinoembryonic antigen (CEA),
Carbohydrate antigen (CA 19-9), and CA 50 are monitored to determine the
effectiveness of treatment(s).

5. Medical & Surgical Treatment

- Surgery
1. Subtotal gastrectomy with lymph node dissection
2. Total gastrectomy
- Chemotherapy (given before & after surgery to kill cancerous cells)
- Radiation Therapy (to kill cancerous cells in targeted area)
6. Nursing Care Plan

Nursing Management
1. Monitor patient’s nutritional intake and weight daily.
2. Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor
albumin and prealbumin levels to determine if protein supplementation is
needed.
3. Administer analgesics as prescribed.
4. Teach patient deep breathing exercise and non-pharmacologic measures
to manage pain.
5. Educate patient on the importance of consuming a balanced diet in order
to meet daily nutritional needs.
6. Educate patient and family regarding the treatment plan, to promote
compliance.

Nursing Diagnosis
1. Acute Pain related to stomach tumor as evidenced by verbalizations of
pain.
Desired Outcome - Within hospitalization, patient will achieve pain relief
and show a decrease in pain score level.

2. Imbalanced Nutrition: less than body requirements related to side effects

of chemotherapy as evidenced by nausea and frequent episodes of
vomiting.
Desired Outcome - Within hospitalization, patient will demonstrate stable
weight/progressive weight gain toward the goal with normalization of
laboratory values and be free of signs of malnutrition.

3. Risk for Infection related to malnutrition.

Desired Outcome - Within hospitalization, the patient will identify and
participate in interventions to prevent/reduce the risk of infection.
 ULCERATIVE COLITIS

1. Definition of Ulcerative Colitis

- Ulcerative colitis is a medical condition that involves the inflammation and ulcer
formation in the lining of the colon (large intestine) and rectum.

2. Causes, Signs and Symptoms

Sign and symptoms

- Diarrhea that could have blood or pus
- Abdominal pain and cramping
- Rectal bleeding and/or rectal pain
- Tenesmus – increased urgency to defecate but inability to move bowels;
accompanied by cramping rectal pain
- Inability to defecate despite urgency
- Weight loss
- Fatigue
- Fever

Causes
- Idiopathic
- Some research studies are focused on the nature of ulcerative colitis being an
autoimmune condition. The immune system is the body’s way to protect itself by
attacking foreign bodies like viruses and bacteria. This process sometimes fails
due to certain factors, making the body attack its own cells. Cells in the digestive
tract may be mistakenly attacked, causing ulcerative colitis.

- Heredity. Family history is apparent in some, but not all, people with ulcerative
colitis.

3. Diagnostic Tests
- Blood tests: Your blood can show signs of infection or anemia. Anemia is a low
level of iron in your blood. It can mean you have bleeding in your colon or rectum.
- Stool samples: Signs of infection, parasites (tiny organisms that can live in a
person’s body) and inflammation can show up in your poop (feces).
- Imaging tests: Your healthcare provider may need a picture of your colon and
rectum. You may have tests including a magnetic resonance imaging (MRI) scan
or computed tomography (CT) scan.
- Endoscopic tests: An endoscope is a thin, flexible tube with a tiny camera.
Specialized doctors can insert the endoscope through your anus to check the
health of your rectum and colon. Common endoscopic tests include colonoscopy
and sigmoidoscopy.
- X-ray. If you have severe symptoms, your provider may use a standard X-ray of
your abdominal area to rule out serious complications, such as a megacolon or a
perforated colon.
 - CT scan. A CT scan of your abdomen or pelvis may be performed if a
complication from ulcerative colitis is suspected. A CT scan may also reveal how
much of the colon is inflamed.
- Computerized tomography (CT) enterography and magnetic resonance
(MR) enterography. These types of noninvasive tests may be recommended to
exclude any inflammation in the small intestine. These tests are more sensitive
for finding inflammation in the bowel than are conventional imaging tests. MR
enterography is a radiation-free alternative.

4. Treatment

Medications
- Anti- inflammatory drug. These are the first line of treatment for people
with ulcerative colitis.
- 5-Aminosalicylates (Oral or Suppository). Anti-inflammatory agents to
reduce the severity of bowel symptoms in mild to moderate ulcerative
colitis
- Corticosteroid. To treat severe forms of ulcerative colitis, such as
prednisone or budesonide.
- Immunomodulators. These medicines include 6-mercaptopurine,
azathioprine or methotrexate. These medications help calm an overactive
immune system.
- Biologics. treat moderate to severe ulcerative colitis by targeting parts of
your immune system to quiet it down. Medications like infliximab,
adalimumab, golimumab, certolizumab pegol, vedolizumab and
ustekinumab are biologics.
- Janus kinase (JAK) inhibitors. To stop one of the body’s enzymes from
triggering inflammation.
- Anti- diarrheal medications (Loperamide).
- Pain relievers. For mild pain can use acetaminophen, but not ibuprofen
(Advil, Motrin IB, others), naproxen sodium (Aleve) and diclofenac
sodium, which can worsen symptoms and increase the severity of
disease.
- Antispasmodics. Sometimes health care providers will prescribe
antispasmodic therapies to help with cramps.
- Iron supplements. If you have chronic intestinal bleeding, you may
develop iron deficiency anemia and be given iron supplements.

Surgery
- Proctocolectomy and ileoanal pouch (also called J-pouch surgery) is the most
common procedure for ulcerative colitis. This procedure typically requires more
than one surgery, and there are several ways to do it. First, your surgeon does a
proctocolectomy, a procedure that removes your colon and rectum. Then, the
surgeon forms an ileoanal pouch to create a new rectum.
5. Nursing Care Plan

Nursing Management
1. Monitor patient’s vital signs such as blood pressure, temperature, respiration
rate, pulse rate and oxygen saturation levels.
2. Monitor patient’s intake and output chart. Review the patient's electrolyte levels.
3. Position patient comfortably. The left side of the abdomen or the rectum often
hurts in colitis. Certain positions can worsen ulcerative colitis pain depending on
which side of the intestinal tract is inflamed.
4. Teach patient deep breathing exercise and relaxation techniques for effective
pain management.
5. Administer analgesics & anti-diarrheals medications as prescribed.
6. Educate patient to avoid triggering factors by eating a healthy and balanced diet.

Nursing Diagnosis
1. Acute pain related to persistent diarrhea as evidenced by verbal complaints of
abdominal pain.
Desired Outcome - Within hospitalization, patient will report relief from abdominal
pain with decrease in pain score level from 4/10 to 2/10.

2. Diarrhea related to inflammation of colon as evidenced by loose and watery

stools.
Desired Outcome - Within hospitalization, patient will report a decrease in
frequency and urgency to less than three stools per day.

3. Risk for deficient fluid volume related to persistent diarrhea.

Desired Outcome - Within hospitalization, patient will maintain fluid and
electrolyte balance within normal limits.