Casepre Coloncancer2

THE COLLEGE OF MAASIN
“Nisi Dominus Frustra”
College of Nursing & Allied Health Sciences
Maasin City, Southern Leyte
Case Study – Colon Cancer
In Partial Fulfillment of the Requirements in NCM-106
RLE
Semester A.Y. 2020-2021
SUBMITTED TO:
Ms. Hannah Mae Plateros, RN
Clinical Instructor
SUBMITTED BY:
Cabales, Mico Vecris E.
Dacup, Jobeth L.
Delposo, Jodelyn L.
November 2021
Scenario
B.T. is a 68-year-old man who went to his primary care provider's office for a yearly
examination. He initially reported having no new health problems; however, on further
questioning, he admitted to having developed some fatigue, abdominal bloating, and
intermittent constipation. His physical examination was normal except for a stool positive for
guaiac. A CBC with differential, BMP, and carcinoembryonic antigen (CEA) were ordered. B.T.
was referred to a gastroenterologist for a colonoscopy. A 5-cm mass found in the sigmoid
colon was diagnosed as an adenocarcinoma of the colon. The pathology report described the
tumor as a Dukes’ stage B, meaning the cancer extends into the muscle or connective tissue
and invades adjacent organs and lymph nodes. A distant metastatic workup is negative, and
B.T. is being referred for surgery.
CASE STUDY PROGRESS
After surgery, B.T. is admitted to the surgical intensive care unit (SICU) with a large
abdominal dressing. The nurse rolls B.T. side to side to remove the soiled surgical linen, and
the dressing becomes saturated with a large amount of serosanguineous drainage.
CASE STUDY PROGRESS
Four weeks after surgery, B.T. is scheduled to begin chemotherapy
INTRODUCTION
Cancer that begins in the colon is called a colon cancer, while cancer in the rectum is
known as a rectal cancer. Cancers that affect either of these organs may be called colorectal
cancer. Though not true in all cases, the majority of colorectal cancers generally develop over
time from adenomatous (precancerous) polyps. Polyps (growths) can change after a series of
mutations (abnormalities) arise in their cellular DNA. Some of the risk factors for colorectal
cancer involve a family history of colon or rectal cancer, diet, alcohol intake, smoking and
inflammatory bowel disease.
Colorectal cancer begins when healthy cells in the lining of the colon or rectum change
and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign.
A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body.
A benign tumor means the tumor can grow but will not spread. These changes usually take
years to develop. Both genetic and environmental factors can cause the changes. However,
when a person has an uncommon inherited syndrome (see Risk Factors and Prevention),
changes can occur in months or years.
The large intestine is part of the body's gastrointestinal (GI) tract or digestive system.
The colon and rectum make up the large intestine, which plays an important role in the body's
ability to process waste. The colon makes up the first 5 to 6 feet of the large intestine, and the
rectum makes up the last 6 inches, ending at the anus. The colon and rectum have 5 sections.
The ascending colon is the portion that extends from a pouch called the cecum to the portion
of the colon that is near the liver. The cecum is the beginning of the large intestine into which
the small intestine empties; it’s on the right side of the abdomen. The transverse colon crosses
the top of the abdomen. The descending colon takes waste down the left side. Finally, the
sigmoid colon at the bottom takes waste a few more inches, down to the rectum. Waste leaves
the body through the anus.
What if I have polyps? There are a variety of colorectal polyps, but cancer is thought
to arise mainly from adenomas and sessile serrated lesions, which are precancerous polyps.
If a polyp is found during a colonoscopy it is usually removed, if possible. Polyps removed
during colonoscopies are then examined by a pathologist and evaluated to determine if they
contain cancerous or precancerous cells. Based on the number, size, and type of
precancerous polyps found during colonoscopy, your healthcare provider will recommend a
future colonoscopy for monitoring (surveillance). There are several forms of polyps.
Adenomatous polyps, or adenomas, are growths that may become cancerous. They can be
found with a colonoscopy (see Risk Factors and Prevention). Polyps are most easily found
during a colonoscopy because they usually bulge into the colon, forming a mound on the
wall of the colon that can be found by the doctor. About 10% of colon polyps are flat and
hard to find with a colonoscopy unless a dye is used to highlight them. These flat polyps
have a high risk of becoming cancerous, regardless of their size. Hyperplastic polyps may
also develop in the colon and rectum. They are not considered precancerous.
Colorectal cancer can begin in either the colon or the rectum. Cancer that begins in
the colon is called colon cancer. Cancer that begins in the rectum is called rectal cancer.
Most colon and rectal cancers are a type of tumor called adenocarcinoma, which is cancer
of the cells that line the inside tissue of the colon and rectum. This section specifically covers
adenocarcinoma. Other types of cancer that occur far less often but can begin in the colon
or rectum include neuroendocrine tumor of the gastrointestinal tract, gastrointestinal stromal
tumor (GIST), small cell carcinoma, and lymphoma.
GENERAL OBJECTIVE
After 2-3 hours of case presentation, the BSN III students shall gain knowledge, develop
basic skills, manifest positive attitude, apply acquired knowledge and formulate nursing
management in caring for a client with Colon Cancer.
SPECIFIC OBJECTIVES:
After the thorough discussion of this case presentation, the nursing students shall be able to:
• To ascertain the client’s past and present history

• Perform physical assessment to obtain comprehensive baseline data
• Trace client’s developmental data
• Discuss and share thoughts regarding spontaneous delivery
• Trace the pathophysiology of Colon Cancer.
• Decisively analyze the different laboratory and diagnostic procedures and relate the
results to the condition
• State and identify the appropriate nursing diagnosis and make essential interventions
• To enhance knowledge regarding Colon Cancer.
NURSING HEALTH HISTORY
DEMOGRAPHIC PROFILE:
• Name: B.T.
• Age: 68
• Gender: Male
• Address: N/A
• Marital Status: N/A
• Occupation: N/A
• Religious Orientation: N/A
• Health Care Financing: N/A
• Informant: N/A
Chief Complaint:
He initially reported having no new health problems; however, on furthis questioning,

he admitted to having developed some fatigue, abdominal bloating, and intermittent
constipation. His physical examination was normal except for a stool positive for
guaiac
History of Present Illness:
A CBC with differential, BMP, and carcinoembryonic antigen (CEA) were ordered.
B.T. was referred to a gastroenterologist for a colonoscopy. A 5-cm mass found in
the sigmoid colon was diagnosed as an adenocarcinoma of the colon.
Past History
The patient's medical history included chronic hypertension at age 25 years,

controlled with antihypertensive medications, a body mass index of 22, history of
regular exercise, and conception of a twin gestation without any fertility assistance.
The patient began prenatal care at 8 weeks. A twin pregnancy was diagnosed at the
first obstetrical appointment. Because of the patient's history of hypertension, he was
referred to a perinatalogist and was comanaged by his obstetrician. He maintained
all appointments (every 2 weeks), laboratory tests, and reduced his work schedule.
His pregnancy course included blood pressure testing biweekly, antihypertensive
medication, monitoring of twins, and ultrasound data that demonstrated normal fetal
growth for both twins.
Family History of Illness
His fathis was diagnosed before age 50 with colorectal cancer.
PHYSICAL ASSESSMENT
Vital Signs
T- 37.1°C
PR- 92 bpm
RR- 19 cpm
BP- 130/90 mmHg

General Survey
The pathology report described the tumor as a Dukes’ stage B, meaning

the cancer extends into the muscle or connective tissue and invades adjacent organs
and lymph nodes. A distant metastatic workup is negative, and B.T. is being referred
for surgery.
Head: Head is round in shape. Hair is gray in color, long, thin, straight and evenly
distributed. Scalp is smooth and white in color; minimal lesions were noted. Dandruff
and lice weren’t observed. The patient stated that he had frequent headaches.
Skin: Patient has dark-brown complexion in color. Has presence few scars and
marks notes. No lesions or abrasions were observed. Skin is slightly dry, intact and
warm to touch. Has good skin turgor.
Eyes: Eyes are symmetrical, black in color, almond shape. The pupils are black and
equal in size, pupils equally round and respond to light accommodation. The bulbar
conjunctiva appeared transparent with few capillaries evident. The sclera is white.
Cornea is transparent and smooth. Unusual discharges from the lacrimal ducts noted
upon palpation.
Ears: The auricles are symmetrical and has the same color with his facial skin.
Auricles are aligned with the outer canthus of eyes. When palpating for texture,
auricles are movable and not tender. The pinna recoils when folded. Dry earwax was
noted.
Nose: Nose has uniform color and symmetrical in shape. Nasal hairs are very
evident when light is fluhed through the nasal passageway. No nasal flaring
observed upon respiration. Nasal septum is straight and in midline. No lesions and
discharges noted. Patient was able to sniff easily on both nostrils.
Mouth: Patient’s lips are uniformly pink; slightly dry. He uses false teeth with minimal
dental caries noted on the last permanent teeth. Oral mucosa and gingival are pink
in color, moist and thise were no lesions nor inflammation observed. Tongue is
pinkish and is free of swelling and lesions.
Neck: Lymph nodes are notes. Neck has strength that allows movement back and
forth, left and right. Patient is able to freely move his neck.
Pharynx: N/A
Chest & Lungs: No reports of pain during the inhalation and exhalation. Absence of
adventitious sounds upon auscultation. Respiratory rate 24 cycles per minute from
the normal range of 16-20 cpm
Breast & Axillae: The patient has no problems with breast and his axillae
Heart: Patient has an audible heart sound. PMI is heard between 4th – 5th
intercostals space. Heart is pumping well with a pulse rate of 92 bpm from the
normal range of 100 bpm.
Abdomen: The patient stated that he had right lower quadrant discomfort.
Back & Extremities: 3+ edematous feet and ankles
Genito Urinary: Patient stated that he has no problem with urinating.
GORDON’S FUNCTIONAL HEALTH PATTERNS
A. Health Perception and Health Maintenance Management Pattern:
Before Hospitalization
The patient lived normally with his family everyday since moving in the town,
until he experiences discomfort in the abdomen and in defecating.
During Hospitalization
Upon arrival to the hospital, the patient was placed in bed, hir abdomen was
palpated for tenderness, and the patient stated that he had right lower quadrant
discomfort and a headache. His lower abdomen was soft and nontender. Vital signs
were temperature of 37.1, pulse of 92, respirations of 19, and blood pressure of
130/90.
B. Nutritional- Metabolic Patterns:
Before Hospitalization:
The patient began prenatal care at 8 weeks. A twin pregnancy was diagnosed
at the first obstetrical appointment. Because of the patient's history of hypertension,
he was referred to a perinatalogist and was comanaged by his obstetrician.
During Hospitalization.
Patient seldom eats at the hospital. he does not have the appetite for eating.
he also drinks water more often than before. The patient remained on
antihypertensive medications.
C. Elimination Pattern:
.patient has discomfort and difficulty in defecating
During Hospitalization:
Defecation pain was slightly managed
D. Activity/Exercise Pattern:
The patient do his regular exercise every day
Most of the patient’s time was spent for resting and sleeping due to fatigue
and discomfort upon doing a medication.
E. Sleep/Rest Pattern:
Patient usually sleeps at 9 PM in the evening and usually gets up at 5:30 AM

in the morning. Patient do his regular exercise before cooking breakfast. And he has
straight undisturbed sleep at night.
Patient sleeps early but has sleep disturbances when the nurses take his vital
signs, administer medicines and discomfort due to abdominal pain.
F. Cognitive and Perceptual Pattern:
Patient is normal in terms of his cognitive abilities and he has no problem with
his senses.
Patient was still able to cooperate and responds to the nurses despite the
pain and discomfort he felt.
G. Self-Perception and Self-Concept Pattern:
H. Roles, self-concept & social supports:
The patient has a close relationship with his family. He is also friends to his
perinatalogist and his obstetrician.
Thise were no changes on patient’s closeness towards his family during his
confinement.
I. Sexually-Reproductive Pattern:
Prior to admission, patient was inactive to sexual activities.
J. Coping Stress Pattern:
According to his wife, when the patient has problems or stress is he always
approach her.
Patient feels uncomfortable when his wife is not insight.

K. Value-belief Pattern:
The patient’s wife reported that he brought his to the health facility because
he was sick due to an evil spirit and they had unsuccessfully tried spiritual treatment
at their locality.
Patient together with his wife prayed to God for his fast recovery and safety
during his hospitalization
PATIENT’S DEVELOPMENTAL TASKS
• Erick Erickson’s Psychosocial Development
The Psychosocial Stage of Development developed by Erickson enumerates the eight stages though which is healthy
developing human should pass from infancy to the late adulthood. Each stage describes a task to be accomplished of the earlier
stages. Successful resolution of these crisis supports a healthy- development. The failure to resolve the crises damages the ego
and maybe the expected to reappear as the future problems.
AGE STAGE BASIC ACTUAL

Middle Generativity vs Adults need to create or nurture things that Patient is married to his wife for almost 26
Adulthood Stagnation will outlast them, often by having children or year and she has a strong, intimate loving
(40 to 65 creating a positive change that benefits relationship with his wife.
years) other people.
During adulthood, we continue to build our

lives, focusing on our career and family.
Those who are successful during this
phase will feel that they are contributing to
the world by being active in their home and
community.2 Those who fail to attain this
skill will feel unproductive and uninvolved in
the world.
• KOHLBERG’S MORAL DEVELOPMENT THEORY
This theory specifically addresses the moral development in children and adults. The morality of an individual’s decision’s
was not Kohlberg’s concern; rather he focused on the reasons of an individual makes a decision.
AGE STAGE BASIC ACCTUAL

Older children, Conventional During this time, adolescents and adults
Adolescents, Morality internalize the moral standards they have
and Most Adults learned from their role models and from
society.
This period also focuses on the
acceptance of authority and conforming to
the norms of the group.
There is an emphasis on conformity, being

"nice," and consideration of how choices
influence relationships.
Stage 3: Good The patient is interactive and engage in

Interpersonal social interaction. He is kind towards other
Relationships people.
Stage 4: People begin to consider society as a The patient is aware with the rules and
Maintaining whole when making judgments. The focus regulations, and he obeys it to maintain the
Social Order is on maintaining law and order by peace and to help maintaining a
following the rules, doing one’s duty, and functioning society.
respecting authority.
• HAVIGHURT’S DEVELOPMENTAL TASK

Havighurt’s (1972) defines a development tasks as one that arises at a certain period in our lives, the successful
achievement of which leads to happiness and success with later tasks; while leads to unhappiness, social disapproval
and difficulty with later tasks. He identifies three sources of developmental tasks (Havighurt, 1972).
Tasks that arise from physical maturation
Tasks that arise from personal values
Tasks that have their source in the pressures of society.
Havighurt’s also identified Six Major Stages in Human life covering birth to old age which are the following:
Infancy and early childhood (Birth until 6 years old)

Middle childhood (6-12 years old)
Adolescence (13-18 years old)
Early Adulthood (19 -30 years old)
Middle age (30-60 years old)
Later maturity (60 years old and over)
DEVELOPMETAL TASK ACHIEVED OR NOT AVHIEVED
Adjusting to decreasing physical strength and health Achieved
Adjusting to retirement and reduced income Achieved

Adjusting to death of a spouse Achieved
Establishing an explicit affiliation with one’s age group

Achieved
Meeting social and civil obligations Achieved
Establishing satisfactory physical living arrangement Achieved

• FREUD’S PSYCHOSEXUAL DEVELOPMENT
Freud believed that personality developed through a series of childhood stages in which the pleasure-seeking energies of
the id become focused on certain erogenous areas. An erogenous zone is characterized as an area of the body that is particularly
sensitive to stimulation.
STAGE BASIC ACTUAL

The Genital Stage During the final stage of psychosexual He is a 68-year-old, married and they
development, the individual develops a had two children.
(Puberty to Death) strong sexual interest in the opposite
sex. This stage begins during puberty
but last throughout the rest of a person's
life.
Unlike the many of the earlier stages of
development, Freud believed that the
ego and superego were fully formed and
functioning at this point. Younger
children are ruled by the id, which
demands immediate satisfaction of the
most basic needs and wants.
PATHOPHYSIOLOGY OF COLORECTAL CANCER
CRC usually does not produce symptoms in early stages of the disease. If symptoms are present, they usually depend on
the site of the primary tumor. Cancers of the proximal colon tend to grow larger before symptoms appear than those in the
left colon and rectum. The first symptoms of colon cancer may be iron-deficiency anemia and bleeding due to abnormal
vasculature in the tumor and trauma from the fecal stream. The bleeding is usually occult in early stages. Tumor of the
anus, sigmoid colon, and rectum may lead to hematochezia.
Late stages of the disease may be associated with obstruction of the colonic lumen, abdominal distention, pain, nausea
and vomiting. Obstruction of the gastrointestinal (GI) tract suggests a larger tumor and poorer prognosis. If the tumor was
invaded the muscularis propria and adjacent tissue, pain and site-specific symptoms may be present. This may include
tenesmus from rectal invasion, pneumaturia from bladder penetration or perineal or sacral pain from pelvic invasion.
Cachexia is also common in patients with advanced GI malignancies.
ANATOMY OF COLON
The large intestine is part of the body's gastrointestinal (GI) tract or digestive system. The colon and rectum make up the large
intestine, which plays an important role in the body's ability to process waste. The colon makes up the first 5 to 6 feet of the large
intestine, and the rectum makes up the last 6 inches, ending at the anus
The colon and rectum have 5 sections. The ascending colon is the portion that extends from a pouch called the cecum to the portion
of the colon that is near the liver. The cecum is the beginning of the large intestine into which the small intestine empties; it’s on the
right side of the abdomen. The transverse colon crosses the top of the abdomen. The descending colon takes waste down the left
side. Finally, the sigmoid colon at the bottom takes waste a few more inches, down to the rectum. Waste leaves the body through the
anus.
PHYSIOLOGY
Colorectal cancer begins when healthy cells in the lining of the colon or rectum change and grow out of control, forming a mass
called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts
of the body.
DEFINITION
• Colorectal carcinoma is a cancer, or malignant tumor, of the large intestine, which may affect the colon or rectum. Many colon
cancers develop over a long period of time, often arising from pre-cancerous colon polyps that gradually grow and can turn into
cancer. Many early stage colon cancers do not cause any symptoms at all. Therefore, various methods of colon cancer screening
are currently recommended in the hope of finding the polyp or cancer at a time when it can be removed and cured. You should talk
to your physician about if and when colon cancer screening would be appropriate.
Source: Copyright © 2021 Radiological Society of North America, Inc. (RSNA).
https://www.radiologyinfo.org/en/info/colocarcinoma
• Colon cancer is one of the leading tumours in the world and it is considered among the big killers, together with lung, prostate and
breast cancer. In the recent years very important advances occurred in the field of treatment of this frequent disease: adjuvant
chemotherapy was demonstrated to be effective, chiefly in stage III patients, and surgery was optimized in order to achieve the
best results with a low morbidity. Several new target-oriented drugs are under evaluation and some of them (cetuximab and
bevacizumab) have already exhibited a good activity/efficacy, mainly in combination with chemotherapy. The development of
updated recommendations for the best management of these patients is crucial in order to obtain the best results, not only in clinical
research but also in every-day practice.
Source: Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
https://www.sciencedirect.com/science/article/abs/pii/S1040842810000119
• Cancer that begins in the colon is called a colon cancer, while cancer in the rectum is known as a rectal cancer. Cancers that
affect either of these organs may be called colorectal cancer. Though not true in all cases, the majority of colorectal cancers
generally develop over time from adenomatous (precancerous) polyps. Polyps (growths) can change after a series of mutations
(abnormalities) arise in their cellular DNA. Some of the risk factors for colorectal cancer involve a family history of colon or rectal
cancer, diet, alcohol intake, smoking and inflammatory bowel disease.
Source: 9500 Euclid Avenue, Cleveland, Ohio 44195 | 800.223.2273 | © 2021 Cleveland Clinic. All Rights Reserved.
https://my.clevelandclinic.org/health/diseases/14501-colorectal-colon-cancer
ETIOLOGY
PREDISPOSING
RATIONALE ACTUAL JUSTIFICATION
FACTORS
Age Cases are increasing in people younger The patient is a 68-year-old
than age 64, and increasing even faster male.
for those younger than 50, so education
and prevention remain critical.
History of polyps or The risk is higher for those who’ve
cancer previously had colorectal polyps,
especially if these were large, copious or
had abnormal-but-noncancerous cells
(dysplasia). The risk is also higher for a
patient who’s had colorectal cancer
before.
Certain health conditions Inflammatory bowel disease (IBD,
including ulcerative colitis or Crohn's
disease) or type 2 diabetes may raise
the risk of developing colorectal cancer.
Irritable bowel syndrome (IBS) doesn’t
seem to be linked to a higher risk.
Family health history If other family members have had
colorectal cancer or polyps, the risk of
developing colorectal cancer is higher.
PRICIPIATTING FACTORS RATIONAALE ACTUAL JUSTIFICATION
The risk is higher for those who eat a
The patient usually ate meat
high-fat diet, a lot of processed meat or
Diet and food that is rich in fat or
red meat. Aim for a diet rich in fruits,
cholesterol.
vegetables and fiber.
Being overweight or having obesity
Weight increases a person’s risk of developing
or dying from colon cancer.
People who drink heavily or regularly
may also be putting themselves at
Alcohol used greater risk of colon cancer. Men
should limit their drinking to no more
than two drinks per day
People who smoke are more likely to
develop or die from colon cancer than
Smoking those who do not. Smoking
cigarettes also increases the risk of
many other types of cancer.
Being physically inactive increases
the risk of developing colon cancer. Patient verbalized that he
Inactivity Staying active by doing even light was not physically active
workouts each day may help reduce due to his age felt weak.
this risk.
SYMPTOMATOLOGY
SYMTPOMS RATIONALE ACTUAL JUSTIFICATION

Blood in the stool, bleeding Patient who experience bloody The patients stool is positive
from the rectum and/or stools or change in color, for guaiac after some
change in the appearance of darkened or tarry this could this laboratory test.
the stool. could also be an indication of
changes inside the colon.
Constipation Constipation is defined as The patient complained an
having less than three bowel intermittent constipation when
movements in a week, and it is asked.
one of the most common
gastrointestinal complaints.
Having constipation, however,
does not mean you have colon
cancer. A change in your diet,
poor nutritional habits, stress,
dehydration or lack of physical
activity can also cause
constipation.
Unexplained Fatigue or People with colon cancer may Patient reported he developed
Weakness feel constant fatigue or some fatigue or feeling tired.
weakness, possibly due to the
cancer cells using extra energy
and the stress of bowel
symptoms. Although feeling
tired now and then is normal,
chronic fatigue does not go
away with rest.
Bloated abdomen Occasional cramps or bloating Patient reported that he
are common digestive issues experienced abdominal
that can occur due to an upset bloating.
stomach, gas, or eating certain
foods.
Experiencing frequent,
unexplained cramps and
bloating can be a sign of colon
cancer, though these
symptoms are more often the
result of other health issues.
Feeling as though the If a growth turns into a
bowels are not empty blockage in the colon, it may
cause the person to feel as
though they can never empty
their bowels.
Even if their bowels are empty,

they will still feel the need to
use the restroom again.
MEDICAL /SURGICAL MANAGEMEMT
A bowel resection is performed to surgically remove a disease part of the bowel. Common indications for the surgery are blockage of
the bowel (intestinal obstruction) due to scar tissue or tumours, bleeding or infection due to diverticulosis, inflammatory bowel disease
such as Crohn’s disease or Ulcerative Colitis, injuries, cancer, and precancerous polyps. A segmental small bowel resection is the
removal of a piece of small bowel. Removal of some or all, of the colon is called a colectomy.
You will be given a general anesthetic. An incision is made in the abdomen. The amount of bowel removed depends on the reason for
the surgery. For example, a partial colectomy is performed to remove a section of diseased bowel. A right hemicolectomy, a left
hemicolectomy or transverse colectomy may be performed to remove half of your colon. A low anterior resection may be necessary to
remove the sigmoid colon and upper part of the rectum. the following diagrams illustrate these procedures.
Sigmoidectomy surgery removes all or part of the sigmoid colon - the S-shaped part of the large intestine just before the rectum. Where
possible the two healthy ends of the intestinal tract are then rejoined. If this is not possible then a stoma may be formed. It is also
known as a sigmoid colectomy or sigmoid colon resection.
PRE-OPERATIVE NURSING CONSIDERATIONS
1. Provide routine preoperative care for the surgical client as outlined in Chapter 7.
2. Arrange for consultation with enterostomal therapy (ET) specialist if appropriate. The ET nurse is trained to identify and mark an
appropriate stoma location, taking into consideration the level of ostomy, skinfolds, and the client’s clothing preferences. Initial
ostomy care teaching also is provided by the ET nurse during the preoperative visit.
3. Insert a nasogastric tube if ordered. Although it is often inserted in the surgical suite just prior to surgery, the nasogastric tube may
be placed preoperatively to remove secretions and empty stomach contents.
4. Perform bowel preparation procedures as ordered. Oral and parenteral antibiotics as well as cathartics and enemas may be
prescribed preoperatively to clean the bowel and reduce the risk of peritoneal contamination by bowel contents during surgery
INTRA-OPERATIVE NURSING CONSIDERATIONS
• Education
The nurse will explain the recovery process and goals for today. Items you will have during your recovery:
✓ IV. You will have an IV placed in your hand or arm to give you fluids and medication. It will remain in place until you are able
to drink liquids.
✓ Catheter. A catheter will be inserted into your bladder during surgery, to drain urine. It will be removed when you are able
to walk to the bathroom.
✓ Leg sleeves. These will be on while you are in bed. The leg sleeves are to help with circulation and prevent blood clots.
Items you may or may not have, depending on your physician:
✓ Tri-flow. This is an instrument used for breathing exercises. The nurse will show you how to use it. You will use it during
your entire stay.
✓ NG tube. The NG tube assists with relieving abdominal discomfort.
✓ Patient-controlled analgesia (PCA) machine. It is one way to give you pain medication. The nurse will show you how to
use it.
• Diagnostic Tests
Blood pressure and temperature will be checked frequently. A nurse will check your abdomen for sounds, swelling and pain.
• Medication
You will receive pain medication via a PCA machine or shots. Tell your nurse if your pain score is greater than 4 (scale 0-10) or if you:
✓ Cannot sleep
✓ Are nauseous
✓ Feel itchy
✓ Feel restless or nervous
• Nutrition
No food or drink today. The IV will deliver nutrition to your body.
• Treatments
You will be assisted with changing your position every few hours to provide comfort and to prevent skin problems. If a tri-flow has been
ordered, use it 10 times every hour.
• Activities
Today you will:
✓ Stay in bed and rest

✓ Wiggle your toes and move your feet and legs 10 times every hour
✓ Do deep breathing and coughing exercises 10 times every hour
✓ Daily Goals
✓ We hope that by the end of the day:
✓ Your pain is under control
✓ You have no nausea
POST-OPERATIVE NURSING CONSIDERATIONS
1. Provide routine care for the surgical client.
2. Monitor bowel sounds and degree of abdominal distention. Surgical manipulation of the bowel disrupts peristalsis, resulting in
an initial ileus. Bowel sounds and the passage of flatus indicate a return of peristalsis.
3. Assess the position and patency of the nasogastric tube, connecting it to low suction. If the tube becomes clogged, gently
irrigate with sterile normal saline. A nasogastric or gastrostomy tube is used postoperatively to provide gastrointestinal
decompression and facilitate healing of the anastomosis. Ensuring its patency is important for comfort and healing.
4. Assess color, amount, and odor of drainage from surgical drains and the colostomy (if present), noting any changes or the
presence of clots or bright bleeding. Initial, drainage may be bright red and then become dark and finally clear or greenish
yellow over the first 2 to 3 days. A change in the color, amount or odor of the drainage may indicate a complication such as
hemorrhage, intestinal obstruction, or infection.
5. Alert all personnel caring for the client with an abdominoperineal resection to avoid rectal temperatures, suppositories, or other
rectal procedures. These procedures could disrupt the anal suture line, causing bleeding, infection, or impaired healing.
6. Maintain intravenous fluids while nasogastric suction is in place. The client on nasogastric suction is unable to take oral food
and fluids and, moreover, is losing electrolyte-rich fluid through the nasogastric tube. If replacement fluid and electrolytes are
not maintained, the client is at risk for dehydration; sodium, potassium, and chloride imbalance; and metabolic alkalosis.
7. Provide antacids, histamine2-receptor antagonists, and antibiotic therapy as ordered. The above medications may be ordered
for the postoperative client, depending on the procedure performed. Antibiotic therapy is a common measure to prevent infection
resulting from contamination of the abdominal cavity with gastric contents.
8. Resume oral food and fluids as ordered. Initial feedings may be clear liquids, progressing to full liquids, and then frequent small
feedings of regular foods. Monitor bowel sounds and monitor for abdominal distention frequently during this period. Oral
feedings are reintroduced slowly to minimize abdominal distention and trauma to the suture lines.
9. Begin discharge planning and teaching. Consult with a dietitian for instructions and menu planning; reinforce teaching. Teach
about potential postoperative complications, such as abdominal abscess, or bowel obstruction, their signs and symptoms, and
preventive measures.
NURSING CARE PLAN
NURSING CARE
NURSING DESIRED GOALS/ NURSING
PLAN CUES/ RATIONALE EVALUATION
DIAGNOSIS OUTCOME INTERVENTIONS
DATA
Subjective data: Risk for infection r/t GOAL: 1. Established 1. Helps build After 1 week of
“Maam init lagi invasive procedures After 1 week of rapport. cooperation with nursing
ahung paminaw, di or surgery. nursing the patient and interventions, the
ni tungod sa ahung interventions, the obtain effective patient may able to
opera” as patient patient may able to nurse-client gain comfort.
asked. gain comfort. relationship.
OBJECTIVE
OBJECTIVE: 2. Adhere to facility 2. Established - Maintained safe
- Maintain safe infection control, mechanisms aseptic
aseptic sterilization, and designed to environment.
Objective data: environment. aseptic policies prevent - Identified
Vital signs: - Identify individual and procedures. infection. individual risk
T: 37.6 C risk factors and factors and
P: 87 bpm interventions to 3. Examine skin for interventions to
R: 17 cpm reduce potential for breaks or 3. Disruptions of reduce potential for
BP: 110/80 mmHg infection. irritation, signs skin integrity at infection.
- Drainage in the of infection. or near the
incision site operative site
- Warm to touch are sources of
contamination to
the wound.
Careful shaving
or clipping is
imperative to
prevent
abrasions and
nicks in the skin.
4. Maintain 4. Prevents stasis

dependent and reflux of
gravity drainage body fluids.
of indwelling
catheters,
tubes, and/or
positive
pressure of
parenteral or
irrigation lines.
5. Contamination
5. Identify breaks
by
in aseptic
technique and environmental
resolve or personnel
immediately on contact renders
occurrence. the sterile field
unsterile,
thereby
increasing the
risk of infection.
6. Apply sterile 6. Prevents

dressing. environmental
contamination of
fresh wound.
7. Provide copious 7. May be used

wound irrigation, intraoperatively
e.g., saline, to reduce
water, antibiotic, bacterial counts
or antiseptic. at the site and
cleanse the
wound of debris,
e.g., bone,
ischemic tissue,
bowel
contaminants,
toxins.
8. Administer
antibiotics as 8. May be given
indicated. prophylactically
for suspected
infection or
contamination.
NURSING CARE PLAN
NURSING CARE
DATA
Subjective data: Grieving related to GOAL: 1. Expect initial 1. Few patients are After 1 week of
“Samokas kinabuhi anticipated loss of shock and fully prepared for nursing
After 1 week of
physiological well- disbelief the reality of the
uy, nganu ako nursing interventions, interventions, the
being (e.g., loss of following changes that can
paman sa tanan sa the patient may able goal was partially
body part; change in diagnosis of occur. Few
to:
among pamilya?” as body function); cancer patients are fully met.
change in lifestyle. and traumatizing prepared for the
patient asked.
Evidenced by procedure. reality of the
Changes in eating • Identify and changes that can The patient was
express feelings 2. Assess patient
habits, alterations occur. able to identify and
appropriately. and SO for stage
in sleep patterns, 2. Knowledge about
• Continue normal of grief currently express feelings
activity levels, and the grieving proc
life activities, being appropriately.
communication ess reinforces the
looking experienced.
Objective data: patterns normality of
toward/planning Explain process
feelings and
Vital signs: for the future, as appropriate. The patient wasn’t
reactions being
T: 37.6 C one day at a 3. Encourage experienced and able to continue
P: 87 bpm time. verbalization of can help patient normal life activities,
• Verbalize thoughts or deal more
R: 17 cpm looking
understanding of concerns and effectively with
BP: 110/80 mmHg the dying process accept them. toward/planning for
- Drainage in the and feelings of expressions of 3. Patient may feel the future, one day
being supported sadness, anger, supported in
incision site at a time.
in grief work. rejection. expression of
- Warm to touch Acknowledge feelings by the The patient was
normality of understanding able to verbalize
these feelings. that deep and
understanding of
4. Be aware of often conflicting
mood swings, emotions are the dying process
hostility, and normal and and feelings of
other acting-out experienced by
being supported in
behavior. Set others in this
difficult situation. grief work.
limits on
inappropriate 4. Indicators
behavior, redirect of ineffective
negative thinking. coping and need
for additional
interventions.
Preventing
destructive
actions enables
patient to
maintain control
and sense of self-
esteem.
NURSING CARE PLAN
NURSING CARE
DATA
Subjective data: Acute Pain related to GOAL: 1. Determine pain 1. Information After 1 week of
“Daghana nakog Side effects of various After 1 week of
history (location provides baseline nursing
cancer therapy agents of pain, data to evaluate
gipaminaw nga nursing interventions, interventions, the
evidenced by Reports frequency, effectiveness of
dimao, ganahan of pain the patient will be goal was met.
duration, and interventions.
able to:
nako mamatay” as intensity using Pain of more than Patient was able to :
• Report maximal numeric rating 6 mo duration
patient asked.
pain scale (0–10 constitutes chron
relief/control scale), or verbal ic pain, which • Report maximal
with minimal rating scale (“no may affect pain
interference with pain” to therapeutic relief/control
ADLs. “excruciating choices. with minimal
• Follow prescribed pain”) and relief Recurrent interference with
Objective data: pharmacological measures used. episodes of acute ADLs.
regimen. Believe patient’s pain can occur • Follow prescribed
Vital signs:
• Demonstrate use report. within chronic pharmacological
T: 37.6 C 2. Provide pain, requiring regimen.
of relaxation skills
P: 87 bpm and diversional nonpharmacologi increased level of • Demonstrate use
R: 17 cpm activities as cal comfort intervention. of relaxation skills
indicated for measures Note: The pain and diversional
BP: 110/80 mmHg (massage, experience is an activities as
individual
- Drainage in the situation. repositioning, individualized indicated for
incision site backrub) and one composed of individual
diversional both physical and situation.
- Warm to touch
activities (music, emotional
television) responses.
3. Provide
cutaneous
stimulation (heat 2. Promotes
or cold, relaxation and
massage). helps refocus
4. Determine attention.
timing or 3. May decrease
precipitants of inflammation,
“breakthrough” muscle spasms,
pain when using reducing
around-the-clock associated pain.
agents, whether 4. Pain may occur
oral, IV, or patch near the end of
medications. the dose interval,
indicating need
for higher dose or
shorter dose
interval. Pain may
be precipitated
by identifiable
triggers, or occur
spontaneously,
requiring use of
short half-life
agents for rescue
or supplemental
doses.
CUES/DATA NURSING NSG GOAL NURSING RATIONALE EVALUATION

DIAGNOSIS AND INTERVENTIONS
OBJECTIVES
SUBJECTIVE Fatigue related to After 8 hours Have patient rate Help in developing a plan form an aging After 8 hours of
DATA: altered body of nursing fatigue, using a fatigue. nursing
“Gikapoy ko chemistry, side interventions, numeric scale, If interventions, the
feel nahu ky effects of pain the patient will possible, the time of patient was able to
murag permi and other report improved day when it is most report improved
ko gi kapoy” as medications, sense of energy. severe. sense of energy.
chemotherapy
verbalized by Frequent rest periods or naps are
patient Plan care to allow needed to restore or conserve energy.
rest periods. Planning will allow patient to be active
Scheduled activities during times when energy level is
OBJECTIVE for periods when higher, which may restore feeling of
DATA: patient has most wellbeing and a sense of control,
Disinterest in the energy.
surrounding.
Weakness may make activities of daily
Lethargy living and ambulation difficult, further
assistance is needed.
V/S taken as
follows: T: 37.3 Enhances strength and stamina
P: 90R: 22 and enables patient to become
Assist patient more active without undue fatigue.
BP: 120/80
with self-care
needs. Keep bed in Tolerance varies greatly
low position and depending on the stage of the
assist with disease process, nutrition state,
ambulation. fluid balance, and reaction to
therapeutic regimen.
Encourage Poorly managed cancer pain can
patient to do contribute to fatigue.
whatever
possible (self- Presence
bathing, sitting of anemia and hypoxemia reduces
up in chair, O2available for cellular uptake and
walking). contributes to fatigue.
Increase activity
level as Programmed daily exercises and
individual is activities help patient maintain and
increase strength and muscle
able.
tone, enhance sense of well-
being. Use of adaptive devices
Monitor may help conserve energy.
physiological
response to
activity.
Perform pain
assessment and
provide pain
management.
Provide
supplemental
oxygen as
indicated.
Refer to physical
or occupational
therapy.
CUES/DATA NURSING NSG GOAL AND NURSING RATIONALE EVALUATION

DIAGNOSIS OBJECTIVES INTERVENTIONS
SUBJECTIVE Self-Concept Verbalize Discuss with patient Aids in defining At the end of the
DATA: “lain man Disturbance understanding of and SO how the concerns to begin nurse-patient
tan.awon nga nay : low self-esteem body changes, diagnosis and problem-solving interaction the
tahi ahung tijan” associated with acceptance of self treatment are process. patient was able to
verbalized by dysfunctional grieving in situation. affecting the Show adaptation
patient patient’s personal and verbalize
Begin to develop life, home and work acceptance of self
OBJECTIVE coping activities. in situation.
DATA: mechanisms to
Clients looked more deal effectively with Anticipatory
like himself, confused problems. guidance can help
when asked to choose Review anticipated patient and SO
an alternative action, Demonstrate side effects begin the process
want to injure himself / adaptation to associated with a of adaptation to
want to end life. changes/events particular treatment, new state and to
that have occurred including possible prepare for some
as evidenced by effects on sexual side effects (buy a
setting of realistic activity and sense of wig before
goals and active attractiveness and radiation, schedule
participation in desirability time off from work
work/play/personal (alopecia, disfiguring as indicated).
relationships as surgery). Tell patient
appropriate. that not all side May help reduce
effects occur, and problems that
others may be interfere with
minimized or acceptance of
controlled. treatment or
stimulate
Encourage progression of
discussion of disease.
concerns about
effects of cancer Validates reality of
and treatments on patient’s feelings
role as homemaker, and gives
wage earner, permission to take
parent, and so forth. whatever measures
are necessary to
Acknowledge cope with what is
difficulties patient happening.
may be
experiencing. Give
information that Helps with planning
counseling is often for care while
necessary and hospitalized and
important in the after discharge.
adaptation process.
Although some
patients adapt or
adjust to cancer
effects or side
effects of therapy,
many need
additional support
during this period.
Evaluate support Affirmation of
structures available individuality and
to and used by acceptance is
patient and SO. important in
reducing patient’s
feelings of
insecurity and self-
Provide emotional doubt.
support for patient
and SO during
diagnostic tests and May be necessary
treatment phase. to regain and
maintain a positive
psychosocial
structure if patient
and SO support
systems are
deteriorating.
Use touch during

interactions, if
acceptable to
patient, and
maintain eye contact
.
Refer for
professional
counseling as
indicated
JOURNAL
• Comprehensive Review Of Targeted Therapy For Colorectal Cancer

• Date published: 20 March 2020
• By: Yuan-Hong Xie, Ying-Xuan Chen & Jing-Yuan Fang
• https://www.nature.com/articles/s41392-020-0116-z
Colorectal cancer (CRC) is among the most lethal and prevalent malignancies in the world and was responsible for nearly 881,000
cancer-related deaths in 2018. Surgery and chemotherapy have long been the first choices for cancer patients. However, the prognosis
of CRC has never been satisfying, especially for patients with metastatic lesions.
Targeted therapy is a new optional approach that has successfully prolonged overall survival for CRC patients. Following successes
with the anti-EGFR (epidermal growth factor receptor) agent cetuximab and the anti-angiogenesis agent bevacizumab, new agents
blocking different critical pathways as well as immune checkpoints are emerging at an unprecedented rate.
EVALUATION AND IMPLICATION TO:
Nursing Practice
Knowledge, skills and attitude should always be present on the practice of nursing profession. In carrying out the nursing actions and
interventions the underlying principles and standards must always be observed to provide total patient care. The nursing care plans in
the presentation will aid the learners in the care of the patient.
Nursing Education –
The presentation will help future students gain knowledge about the case–Colon Cancer and provide them insight on how to care and
manage patients with this case. This case presentation will also encourage health teaching to care givers and significant others.

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THE COLLEGE OF MAASIN

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

Case Study – Colon Cancer

In Partial Fulfillment of the Requirements in NCM-106

Semester A.Y. 2020-2021

Ms. Hannah Mae Plateros, RN

Cabales, Mico Vecris E.

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

CASE STUDY PROGRESS

CASE STUDY PROGRESS

Four weeks after surgery, B.T. is scheduled to begin chemotherapy

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

• To ascertain the client’s past and present history

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

NURSING HEALTH HISTORY

He initially reported having no new health problems; however, on furthis questioning,

History of Present Illness:

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

The patient's medical history included chronic hypertension at age 25 years,

Family History of Illness

His fathis was diagnosed before age 50 with colorectal cancer.

BP- 130/90 mmHg

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

The pathology report described the tumor as a Dukes’ stage B, meaning

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

Back & Extremities: 3+ edematous feet and ankles

Genito Urinary: Patient stated that he has no problem with urinating.

GORDON’S FUNCTIONAL HEALTH PATTERNS

A. Health Perception and Health Maintenance Management Pattern:

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

B. Nutritional- Metabolic Patterns:

.patient has discomfort and difficulty in defecating

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences

Maasin City, Southern Leyte

Defecation pain was slightly managed

The patient do his regular exercise every day

Patient usually sleeps at 9 PM in the evening and usually gets up at 5:30 AM

F. Cognitive and Perceptual Pattern:

“Nisi Dominus Frustra”

College of Nursing & Allied Health Sciences