COLON

CANCER
With

Multiple
Pulmonary and
Hepatic Metastasis

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 INTRODUCTION

Colon cancer (also called colorectal cancer) is the third most commonly

diagnosed cancer and the second leading cause of cancer death in men and women

combined in the United States. On average, the lifetime risk of developing Colon

Cancer is 1 in 20. In 2011, According to WHO,

 135,260 people in the United States were diagnosed with colorectal cancer,

including 70,099 men and 65,161 women.

 51,783 people in the United States died from colorectal cancer, including

26,804 men and 24,979 women.

 Incidence Rates by Race/Ethnicity and Sex

"Incidence rate" means how many people out of a given number get the

disease each year. The year 2011 is the most recent year for which numbers

have been reported. The colorectal cancer incidence rate is grouped by race

and ethnicity. Colon cancer is the third most commonly diagnosed cancer and

the second leading cause of cancer death in men and women combined in the

US. The American Cancer Society estimates 136,830 people will be diagnosed

in 2014 and 50,310 will die from colon cancer in the United States.

About 72% of cases arise in the colon and about 28% in the rectum.

In the Philippines

Colon, Rectum, Prostate, and Others are the #6 leading Cancer

It showed that the lack of knowledge about a healthy diet was not a

problem among Filipinos: the gap was between knowledge and practice. The

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 majority assessed their current dietary practice as satisfactory to poor, with a

good number unsure of giving up unhealthy practices. The age group 14–21

years had the least mean knowledge scores on a healthy diet (5.3 on a scale of

10), but the most favorable mean attitude score towards a healthy diet (3.3 on

a scale of 4).

Early Detection

With regular screening, colon cancer can be found early, when treatment is

most effective. In many cases, screening can prevent colon cancer by finding

and removing polyps before they become cancer. And if cancer is present,

earlier detection means a chance at a longer life - generally, five-year survival

rates for colon cancer are lower the further advanced the disease is at

detection:

 Over 90% of those diagnosed when the cancer is found at a local stage

(confined to colon or rectum) survive more than five years.

 Once the cancer is diagnosed at a regional stage (spread to surrounding tissue)

that rate drops to 70%.

 When cancer has also spread to distant sites, only 13% of those diagnosed will

reach the five-year survival milestone.

Stage at Diagnosis

Unfortunately, the majority of colon cancers are not found early (before it has

spread):

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 40% of colon cancers are found while the cancer is found at a local stage

(confined to the colon or rectum).

 36% of colon cancers are found after the cancer is diagnosed at a regional

stage (spread to surrounding tissue).

 20% of colon cancers are found after the disease has spread to distant organs.

Colon Cancer and Age

 90% of new cases and 95% of deaths from colon cancer occur in people 50 or

older. However, colon cancer does not discriminate and can happen to men

and women at any age.

 While rates for colon cancer in adults 50 and older have been declining,

incidence rates in adults younger than 50 years has been increasing.

Colon Cancer and Family History

 People with a first-degree relative (parent, sibling, or children) who has colon

cancer are between two and three times the risk of developing cancer than

those without a family history.

Causes

Most colorectal cancers arise from adenomatous polyps-clusters of abnormal

cells in the glands covering the inner wall of the colon.

 familial adenomatous polyposis (FAP).

 hereditary nonpolyposis colorectal cancer (HNPCC)

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Also, at high risk for developing colon cancers are people with any of the

following:

a.) Ulcerative colitis or Crohn colitis (Crohn disease)

b.) Breast, uterine, or ovarian cancer now or in the past

c.) A family history of colon cancer

Other factors that may affect your risk of developing a colon cancer:

Diet, Obesity, Smoking, Sedentary Lifestyle

Symptoms

Blood in the stool, Abdominal distension ,Abdominal pain, persistent nausea or

vomiting,

Unexplained weight loss, Change in frequency or character of stool (bowel

movements),

Small-caliber (narrow) or ribbon-like stools, Sensation of incomplete evacuation after

a bowel movement, Rectal pain

Colon Cancer Stages

Stage 0 (Carcinoma in Situ)

This is the earliest stage of colorectal cancer. The cancer only involves the lining, or

mucosa, of the colon or rectum and is confined to polyp(s). When the polyps are

removed during a colonoscopy, the chance of them progressing to later stages of

cancer is eliminated.

Stage I (Dukes A Colon Cancer)

Stage I colon cancer involves more than just the inner lining of the colon. The polyp

has progressed to a tumor, and extends into the wall of the colon or rectum. Treatment

can include surgery to remove the section of the colon that is cancerous. This type of

surgery is called a resection.

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Stage II (Dukes B Colon Cancer)

Stage II colorectal cancer is when the cancer has spread beyond the colon to the tissue

that surrounds the colon but has not spread to lymph nodes. Cancer spreading in this

manner from one part of the body to another is called metastasis.

Stage III (Duke C Colon Cancer)

Cancer that has spread outside the colon and on to the lymph nodes in the area

surrounding the colon. In this stage, the cancer has not spread to other organs in the

body, and treatment is more aggressive. Surgical resection of the colon,

chemotherapy, and other medical therapies may be necessary. The five-year survival

rate is 35 to 60 percent. Stage III colon cancer is divided into stage IIIA, stage IIIB,

and stage IIIC.

Stage IIIA: Cancer has spread from the innermost tissue layer of the colon

wall to the middle layers and has spread to as many as 3 lymph nodes.

Stage IIIB: Cancer has spread to as many as 3 nearby lymph nodes and has

spread:

Stage IIIC: Cancer has spread to 4 or more nearby lymph nodes and has

spread:

Stage IV (Dukes D Colon Cancer)

In this stage, the cancer had spread to other organs in the body such as the lungs or

liver. In addition to a surgical resection and chemotherapy, radiation treatment and

surgery to remove other affected parts of the body may be necessary. At this stage,

there is only a 3 percent chance of reaching the five-year survival time. Cancer may

have spread to nearby lymph nodes and has spread to other parts of the body, such as

the liver or lungs.

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Exams and Tests

Digital Rectal Exam, Colonoscopy, Barium X-ray, Hemoccult Test (Guaiac), CT

scan, Chest X-Ray

Treatment

Medical Treatment: Chemotherapy and Radiation Surgery: Colostomy,

Colonoscopy, Biopsy

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 PATIENT’S PROFILE

Name: C. C.
Address: Sto. Nino, Cagayan
Age: 62 years old
Date of Birth: January 5, 1959
Place of birth: Sto. Nino, Cagayan
Height: 4’11’’ (149.89cm)
Weight: 45 kg
BMI: 17.78kg/m2
Educational Attainment: College Graduate
Occupation: Housewife
Nationality: Filipino
Civil Status: Married
Religion: Jehovah’s Witness
Date of Admission: August 25, 2022
Chief Complaint: Fever, Cough and Body Weakness
Admitting Diagnosis: Colon cancer s/p Colostomy
Final diagnosis: Colon Cancer Stage IV with Multiple Pulmonary and Liver
Metastasis
Attending Physician: Dr. S.M.

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 BRIEF DISCUSSION OF THE CASE

Nursing Health History

History of Past Illness

Patient C. O. reported that she was never diagnosed of hypertension, asthma, or
Diabetes Mellitus. “Wala akong high blood or Diabetes, pero yong tatay ko cancer sa
baga daw ang ikinamatay” as stated by the patient.
The patient was admitted to Philippine General Hospital (PGH) with a chief
complaint of abdominal pain for three days without passing out of stools dated August
03, 2020 and undergone Explore Laparotomy, Resection with colostomy
According to the patient, she has no known allergies to drugs, foods nor dust.
She mentioned that she experienced common illnesses such as Fever and Headache
with over-the-counter medication.

History of Present illness

The patient was initially diagnosed of Colon cancer last year in Philippine
General Hospital (PGH). The patient reported that she passed out a hard stool last July
30, three days prior to admission in the said hospital. “Parang bloated akong lagi saka
medyo sumasakit ang tyan ko,” as verbalized by the patient. July 31, “hindi nako
makatae, pati pag utot,” the patient added. The patient described the characteristic of
the stool as dark brown and hard. The patient mentioned that she ate tinola, pakbet, 3
bananas and rice for lunch last July 31 and started experiencing epigastric pain since
then. The patient was brought to the said hospital August 25, 2022 by her son together
with her daughter in law. The patient was admitted in the morning the said day. She
was handled by Dr. Perez. The patient was then ordered to have X-ray and
colonoscopy. She was also ordered to be given fleet enema the same day. “August 25
nung naorderan sya ng X-ray, colonoscopy at labatiba,” the S.O verbalized.
“Inoperahan siya nong August 26 as Emergency case,” the S.O. added.
After the surgery (resection of the sigmoid with colostomy), patient C.C.
already has a colostomy bag attached to her left lower abdomen as mentioned by the
S.O. Few months after the surgery patient C.C. was admitted at St. Paul Hospital with
the chief complaint of fever, cough and body weakness. She was given an admitting
diagnosis of colon cancer s/p colostomy.

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Personal and Social history
The patient has two sons. She lives with her youngest son. Her husband died at
the age of 58 due to Myocardial Infarction secondary to heart attack. The patient is a
member of the senior citizens. According to her, she is a plain housewife and have a
small sari-sari store. The patient mentioned that she smokes 3 folds of tobacco leaf
when she was at the age of 20-50 (32,850 folds).

Family history
Patient C.C. has no family history of colon cancer but her father died from
lung cancer. No history of hypertension, asthma or Diabetes mellitus were
documented in both parents.

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 GORDON’S 11 FUNCTIONAL NEEDS

1) Health Perception and Health Management Pattern

 Before Hospitalization
The patient perceived health in the state of good condition. “Feeling
ko malakas ako, saka malusog kasi bihira akong magkasakit”, the patient
verbalized. According to her, she manages her health by practicing proper
hygiene. “Body conscious ako kahit medyo matanda na”, she verbalized. In
addition, the patient stated that she uses advil if she experiences fever and
headache. The patient brushes her teeth 3 times a day and added that she
takes a bath daily.

 During hospitalization
The patient sees herself as no longer healthy. “When the doctor told
me that I have a cancer, feeling ko, bukas o makalawa wala na ako, kaya medyo
nadepress ako,” the patient verbalized. However, the patient stated that she is
still managing her health. “Noon, yong anak ko ang naglilinis sa aking
colostomy, pero ako nalang ngayon,” the patient verbalized. The patient
mentioned that she complies with the treatment regimens the doctor ordered her
to have. “Sa ngayon, lahat ng gamot na inirereseta ni doctor, binibili at iniiom
ko” she added.

2) Nutritional-Metabolic Pattern
 Before Hospitalization
The patient verbalized that she does not have any difficulty in
drinking and swallowing her food. However, she mentioned that she has
problems in regards to food preference “Andami ko ng ayaw na pagkain
ngayon, isa pa madaming bawal dahil sa colostomy ko,” she said.
The patient eats three times a day and drinks 6-8 glasses (210ml per
glass) of water. She doesn’t drink coffee and juice. She eats light snacks in
between meals. According to her, she eats a lot of meat when she was young.
“Grabe ako sa barbecue saka kahit anong inihaw,” she verbalized. “Ang mga

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 anak at asawa ko laging karne ang gusto ganon din sa frozen foods”, she
added.
After her sigmoid resection in PGH, the patient mentioned that she was
restricted to eat meat and fatty foods. “Gulay at prutas lang ang lagi naming
kinakain,” she verbalized. She eats three meals in a day and can drink 6-8
glasses of water. She does not have problems in drinking and swallowing.
According to her, prior to the surgery, the she weighs 46 kilos and has a
height of 4’11’’ having the BMI of 20kg/m ². After her surgery in PGH, the
weight of the patient decreased to about 41 kilos having the BMI of 17.78
kg/m².

 During Hospitalization

The patient was advised not to eat meat, and fatty foods. “Halos puro prutas
nalang kinakain ni mama ngayon, kumakain parin naman sya ng rice with
gulay pero konti-konti nalang, nabubusog sya sa prutas e,” as verbalized by
the S.O. According to the S.O. the patient eats approximately 3/4 cup of rice
per meal. The patient drinks 8-10 (210 ml per glass) glasses of water a day
maintaining a fluid intake of 2 liters or more. According to her, she has no
difficulty in drinking and swallowing but has difficulty in mastication.

3) Elimination Pattern
 Before Hospitalization
The patient empties her colostomy bag once a day every morning
after breakfast with a characteristic of semi-formed to formed stool from
light to dark yellow in color. According to the patient, initially, her daughters
are the ones emptying her colostomy bag. However, she mentioned that after
two months she is emptying the said bag herself already. She urinates for
about 4-5 times (210 ml per urination) a day with a color of yellow amber,
clear and aromatic in odor. According to her, she has no difficulty in
urinating, draining and cleaning her colostomy bag. There was no report of
pain in urinating and defecating.

 During Hospitalization

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 The patient empties her colostomy bag with the assistance of her
daughter in law in the morning at around 7-8:00. According her the color of
the stool is light yellow. The patient urinates 7-10 times (estimate 200 ml per
voiding) a day. There was no report of difficulty or pain in urinating and
draining her colostomy bag.

4) Activity-Exercise Pattern
 Before Hospitalization
The patient is a plain housewife. According to her, she stays at home and
managing her sari- sari store. She added that she helps accomplishing simple
household chores like washing dishes and sweeping the floor. She sees these
as her form of exercise.
The patient verbalized that after the surgery in PGH, she stays at
home and limits her work. According to her, she no longer helps in doing
simple household chores. However, she verbalized that she does walk around
the house as a form of her simple exercise. In addition, the other activities of
the patient include watching TV and reading.

 During Hospitalization
The patient’s activities are confined within her room (Holy Family
Unit). According to her, she usually talks with her SO’s and sleeps when she
feels sleepy.

5. Sleep-Rest Pattern
 Before Hospitalization
The patient has no difficulty in sleeping. According to her, she
usually sleeps with 2 pillows for 6-8 hours every night and naps
sometimes during the day time. The patient verbalized that she
usually sleeps at 9pm and wakes up 5-6 in the morning.

 During Hospitalization
The duration of sleep according to the patient is still the same. She
verbalized that she sleeps about 6-8 hours still but has difficulty in sleeping.

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 “Hindi ako masyadong makatulog dito, mas gusto ko sa bahay,” as
verbalized by the patient. In addition, the patient said that she sleeps at day
time for about two hours when she feels sleepy. According to her, she
usually sleeps at 1pm until 3pm.

6. Cognitive-Perceptual Pattern
 Before Hospitalization
According to the patient, she does not have deviation in the normal
functioning of her sense of touch, smell and taste. However, the patient
reported that she has problems with regards to her hearing and difficulty of
sight in both eyes due to aging. She verbalized that she uses eye glasses in
reading and watching.

 During Hospitalization
The patient does not have deviation in the normal functioning of her
sense of touch, smell and taste. She verbalized however that she has
difficulty of sight in her right eye. The patient also manifested hearing
problems. According to her, she has pain in the joints of her lower
extremities. “Sumusumpong kasi ang rayuma ko” verbalized by the patient.

7. Self-Perception and Self-Concept Pattern

 Before Hospitalization
The patient verbalized that she is a friendly type of person. According
to her, she remains happy with her family. She claimed that she’s a
responsible mother and wife.

 During Hospitalization
The patient sees herself as no longer healthy. When the doctor says
that she has a cancer, she considered herself as dying. However, the patient
mentioned that life does not stop there. She verbalized that she still has her
family with them and she is happy for it.

8. Role-Relationship Pattern

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  Before hospitalization
The patient is the eldest among 3 children in the family. She is
married but the husband died at the age of 58. She has two sons and a
grandson. She grew up happy and had a good relationship to others.

 During hospitalization
The patient said that she feels she is really loved by her family
because of their presence and support. “Napatunayan kong mahal ako ng
mga anak ko, mas inuuna nila ako kesa sa anupaman” as verbalized by the
patient.

9. Sexuality-Reproductive Pattern
The patient stated that she had her menarche at age 16 and had her first child
at age 30. She got married at the age of 27. The patient stated that she used
contraceptive for 5years and tried using withdrawal and rhythm method as a
means of family planning. She had her second son at the age of 32. She stated
that she had her menopause when she was 50 years old. Patient C.C. said that she
had her coitarche after she was married.

10. Coping-Stress Mechanism Pattern

 Before Hospitalization
The patient verbalized that when she has problem, she shares it to her family and
pray for God’s guidance. To cope up with stress she usually takes a rest and slept it
away. She believes that he can cope up with stress because of her faith. She manages
stress through seeking help from her family and through trusting herself that she can
cope with it.

 During Hospitalization
The patient verbalized “Malakas ang pananampalataya ko,”. She
mentioned that she believes that God will help her in her problems. She

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 follows the drug regimens the doctor orders her to have. According to the
patient, she copes with her condition through the help of her children.

11. Value-Belief Pattern

 Before Hospitalization
The patient is a Jehovah’s Witness. According to her, she reads the
Bible. For her, God serves as one of her strengths. According to her, she
prays before she goes to sleep and when she wakes up. She attends Sunday
masses before her surgery. After the surgery, she still attends mass. She
already tried going to “albularyos” and “manghihilots” before. She also
believes in “pamahiin” sometimes and practices them.

 During Hospitalization
The patient believes that God continually protects her. She still goes to
church and attend mass with wheelchair. She claimed that she feels complete
after seeking and praising Jehovah.

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 PHYSICAL ASSESSMENT

Date Assessed: August 25, 2022

Time Assessed: 10:30 AM
Initial Vital Signs:
T- 38.9 °C (febrile), RR- 28, PR- 108, BP-100/70

General Appearance: The patient is awake, sitting on bed conscious and coherent with
an ongoing IVF of #3 PLRS 1L x KVO @ 700 cc level infusing well at the right arm.
The patient can follow instructions and commands easily. She is well groomed and
dressed properly.

Area Assessed Techniques Normal Actual Findings Analysis

Used Findings
SKIN Inspection Light to deep Pale Due to anemia
Color brown secondary to
continues
minimal
bleeding from
cancer cell
detachment
from the
primary tumor
Texture Palpation Smooth, soft Coarse, Due to loss of
wrinkling and connective
sagging of skin tissue elasticity
and flexibility,
increased
dryness and
decreased
subcutaneous
fats related to
aging
Turgor Palpation Skin snaps Skin snaps back Due to loss of
back easily slowly skin elasticity
when pinched.
Temperature Palpation Warm to touch Warm to touch With fever
Moisture Palpation Dry, skin folds Dry Due to
are normally decreased
moist sebaceous
glands activity
and tissue fluid
NAILS Due to anemia
Color of nailbed Inspection Pink Pale secondary to

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 continues
minimal
bleeding from
cancer cell
detachment
from
the primary
tumor

HAIR
Color Inspection Black (Varies) Thinning and Due to
graying of hair progressive loss
of pigment cell
from hair bulbs
Distribution Inspection Evenly Evenly Normal
distributed distributed
Texture Inspection Silky, resilient coarse Due to
decreased
sebaceous
glands activity
Moisture Palpation Neither Dry Due to
excessively dry decreased
nor oily sebaceous
glands activity
CONJUNCTIVA
Color Inspection Transparent, Pale Due to anemia
smooth, pink secondary to
continues
minimal
bleeding from
cancer cell
detachment
from the
primary tumor
CORNEA Inspection Transparent, Opaque or Due to
Clarity smooth, and cloudy formation of
shiny appearance at cataract
the right eye.
Response to Whisper test Normal voice Normal voice Due to
normal voice tones audible tones are not decreased
tones audible hearing ability
MOUTH
LIPS Due to anemia
Color Inspection Pinkish Pale secondary to
continues
minimal
bleeding from
cancer cell
detachment
from the

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 primary tumor
Buccal mucosa Inspection Pinkish Pale
Due to anemia
secondary to
continues
minimal
bleeding from
cancer cell
detachment
from the
primary tumor
Gums
Color Inspection Pinkish Pale Due to anemia
secondary to
continues
minimal
bleeding from
cancer cell
detachment
from the
primary tumor
Number of teeth Inspection 32 20 decreased due to
aging
Presence of Inspection Without With retraction Due to increased
retraction retraction effort to
ventilate
secondary to
accumulation of
bronchial
secretions
Chest expansion Palpation Full and Use of Due to
symmetrical accessory consolidation in
muscles the lungs related
to the presence
of bronchial
secretions
secondary to
pneumonia
Tactile fremitus Palpation Bilateral Increased on Due to
symmetrical lower areas of consolidation in
the lungs the lungs related
to the presence
of bronchial
secretions
secondary to
pneumonia
Lung field Percussion Resonance Dullness Due to
consolidation in
the lungs related
to the presence

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 of bronchial
secretions
secondary to
pneumonia
Breath sounds Auscultation Vesicular, Crackles or Due to
broncho- rales with consolidation in
vesicular, bronchial the lungs related
bronchial breath sounds to the presence
of bronchial
secretions
secondary to
pneumonia
Anterior Thorax Due to
Breathing pattern Inspection Breathing is Tachypnea, consolidation in
automatic, with effort, the lungs related
regular and with noise to the presence
effortless, even of bronchial
and produces no secretions
noise. secondary to
pneumonia
Breath sounds Auscultation Vesicular, Crackles or Due to
broncho- rales with consolidation of
vesicular, bronchial secretions in the
bronchial breath sounds lungs.
ABDOMEN
Color Inspection Uniform with Pale Due to anemia
skin color secondary to
continued
minimal
bleeding from
cancer cell
detachment
from the
primary tumor
Contour Inspection Flat, rounded Flat Normal
Integrity Inspection No lesions, no Presence of Due to the
stoma stoma colostomy
Symmetry Inspection Symmetrical Symmetrical Normal
Frequency and Auscultation Audible, soft Hypoactive Due to
character gurgling sound bowel decreased
occur sound(<5/min) peristalsis
irregularly from
5-30 bowel
sound/minute
Abdomen field Percussion Tympanic Tympanic Normal
Texture Palpation Smooth Wrinkling and Due to loss of
sagging of skin skin elasticity,
increased
dryness and
decreased

4
subcutaneous
fats

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 LABORATORY EXAMS

ULTRASOUND OF THE LIVER

Date: August 25, 2022
Requesting Physician: Dr. S.M
IMPRESSION:
Multiple hyperechoic solid hepatic nodules. To consider metastases

SEROLOGY SPECIMEN EXAM REPORT

Date: August 20, 2022
Requesting Physician: Dr. S.M

Result Normal range Analysis

Carcinoembryonic 207.0 ng/ml 0-3 ng/ml High, due to
Antigen increased cancer
cells in the body

HEMATOLOGY
Date: August 25, 2022
Requesting Physician: Dr. S.M
ACTUAL NORMAL ANALYSIS SIGNIFICANCE
VALUES VALUES
INCREASED
d/t infection To determine the
5 – 10
WBC 15.95 secondary to presence of an
x10^9/L
depressed infection
immune system
To measure the
12 - 16 amount of oxygen-
HGB 10.9 DECREASED
g/dL carrying protein in
the blood
To measure the
percentage of red
HTC 39 37 - 48% NORMAL blood cells in a given
volume of whole
blood
Segmenters 0.96 0.60 - 0.70 INCREASED To measure the
since there is an ability of the
increase in immune system to
WBC due to fight against
infection infection 
Lymphocytes 0.17 0.20 - 0.30 DECREASED To measure the
since there is ability of the body to
already fight against
infection, the microbes
body’s ability to
defend against
microbes’
declines
1
Monocytes 0.04 0.02 - 0.06 NORMAL To measure the
ability of the
immune system to
fight against
infection 
Platelet 150 - 450 x  To confirm presence
317 NORMAL
Count 10^9/L of bleeding disorder
Up to 33  To evaluate kidney
SGPT 39.4 NORMAL
u/L function
 To determine
50 – 100
Crea 76 NORMAL normal functioning
umol/L
of the kidney

CHEST X-RAY

Date: August 25, 2022

Requesting Physician: Dr. S.M

IMPRESSION:

Pulmonary nodule

Right middle lung field

Atherosclerotic aorta

Suggest Left lateral view for further evaluation

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 PATHOPHYSIOLOGY OF COLON CANCER

Precipitating Factors:
Predisposing Factors: Etiology: Unknown -High fat intake
-Age (>40 years old) -Smoking
-Gender (female) -High intake of preserved
-Familial tendency foods
-Sedentary Lifestyle
-Low fiber Diet

Breakdown of smoking
contents swallowed Breakdown of preserved food Breakdown of fats Prolonged transit Time Decreased Peristalsis

Formation of cancer-causing chemicals

Exposure of colon wall to carcinogen

Carcinogens is deactivated Carcinogen acts on colon cell Excretion of carcinogen

A 1
 A

Chromosomal Damage

Cell mutation

Uncontrolled cell growth in the colon epithelium (Stage 0)

Mass of extra tissue Polypectomy

Benign Polyp Malignant Polyp

Further chromosomal damage

Malignant Polyp

Cytokine Stimulation

Immune system activation

Immune System cannot mount an Immune defenses do not recognize cancer cells Cytotoxic T cells, NK lymphocytes and
immune response macrophages destroy the unmasked cancer cells

Resection of the Apoptosis of cancer cells

Malignant Cells continue to multiply -Tumor (stage 1) diseased organ
2
 Increase in tumor size Compression of
Increase pressure from tumor Pain
the nerve endings
B
Cancer cells compete with the CELEBREX
normal cell growth

Detachment of cell from primary tumor Tumor blocks stool passing

through the colon
Damage to the basement membrane
Neoplastic cell invades Resection of the
surrounding tissue (Stage 2) diseased organ Obstruction
Minimal bleeding

Vascularization of the tumor

Change in bowel habit Incomplete
Blood in the Hemoglobin decreases feeling of
stool Penetration of the blood
Constipation evacuation
and lymph vessels (stage3) Diarrhea
Dark or bright
Anemia Decrease amount
red stool Loss of tumor cell cohesiveness
of energy Small,
Detachment of cancer cell from ribbon-
Weakness/fatigue like stool
primary tumor
Colostomy
Cancer cell emboli
FERRONERV
3
C
 C

Intravasation of cell emboli through the circulation

` Dissemination of the cancer cell through the circulation Increased CEA

Extravasation of cancer cell from the circulation system

Resection of the diseased organ

Cancer cells re-adhere to distant tissues

(Stage 4) Chemotherapy, radiation therapy

Cancer cell implantation to the fenestrated endothelium of the liver

Revascularization of the tumor

Hepatic nodule Secondary neoplasm growth in the Liver

(Metastatic colon cancer)

Cancer cell implantation in the lung tissues

Disruption of Secondary neoplasm growth in the Lungs Pulmonary nodule

respiratory (Metastatic colon cancer)
function

D 4
 D

PNEUMONI Increased
Fever
A WBC

CEPTROCIN
Difficulty in
PARACETAMOL
Excessive secretions breathing
in the bronchioles

COMBIVENT
Crackles

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 NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Objective: Acute pain r/t the At the end of 30 minutes, the Determined pain history, e.g., Information provides GOAL MET
inflammation of the patient will be able to report location of pain, frequency baseline data to evaluate
“masakit ang joints relief of pain as manifested by The patient was able to
kasukasuan ko” as duration, and intensity using need for or effectiveness of report relief of pain as
but not limited to:
verbalized by the numeric rating scale (0–10 interventions. manifested by but not
patient scale) or verbal rating scale limited to:

 Pain scale of No verbalizations of pain and (“no pain” to “excruciating No verbalizations of

5/10 discomfort pain”), and relief measures pain and discomfort
 irritability Appears relax Appeared relax
Participation in activities with used. Believe patient’s report. Participation in
ease activities appropriately
Demonstrate relaxation Demonstrated
Instructed to report pain as To determine the presence
techniques and diversional relaxation skills and
activities to control pain soon as felt and extent of pain diversional activities to
control pain

Provided a calm and quiet Environmental stimuli can

environment increase the level of pain

Encouraged rest periods To promote relaxation and

to control pain

Encouraged to assume To facilitate enough rest and

position of comfort relaxation

1
Provided diversional activities To refocus attention, to
like guided imagery reduce pain and may
enhance coping skills to pain

Provided comfort measures Promotes relaxation and

such as back rub comfort

Assisted to do deep-breathing Promotes relaxation and

exercises helps refocus attention

Administered analgesic as Effective in controlling pain

ordered specifically celebrex associated with Inflammatory

process

2
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Subjective: Altered At the end of 2 hours  Determined  To determine GOAL PARTIALLY
“ Andami ko ng ayaw na nutrition less the patient will be able nutritional intake the nutritional MET.
pagkain ngayon, isa pa than body to demonstrate status of the The patient was able to
madaming bawal dahil sa requirement r/t behaviors to regain and patient demonstrate behaviors to
colostomy ko”, loss of appetite maintain appropriate  Encouraged regain and maintain
verbalized by the weight as manifested by patient to eat low  Metabolic appropriate weight as
patient. but not limited to : residue diet that tissue manifested by but not
Objective:  Increased is high in CHON, needs are limited to:
 Weight loss appetite CHO and increased as  Increased
from 50 -45  Weight gain of 5 calories. well as fluids appetite
kilograms kg. (to  Weight gain of 2
 BMI= eliminate waste kg.
17.78kg/m2 products).
 Height= 4 11”  Emphasized the
 Anorexia need of  Supplements
supplemental can play an
vitamins such as important role
A,D,E,K in
maintaining
adequate

1
 caloric, CHO
and protein
intake.
 Encouraged
patient to  Makes
share meals with mealtime more
family/friends. enjoyable,
a which may
 Instructed patient enhance food
to take fluid intake
with a total of 2-
3 liters per day  Aids in better
 Instructed patient digestion and
to chew food absorption
slowly and  For more
properly efficient
(specifically 20- digestion and
25 chews for absorption of
each bite) foods

2
3
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Anxiety r/t prognosis of At the end of 1 hour, the  Identified  To determine the GOAL MET
the disease patient will be able to perception of the level of anxiety The patient was able to
“When the doctor told demonstrate controlled threat demonstrate controlled
me that I have a anxiety as manifested by  Assisted to do  For relaxation anxiety as manifested by
cancer, feeling ko, but not limited to: deep breathing techniques but not limited to:
bukas o makalawa  verbalization of exercises
feelings of anxiety  To encourage to  Verbalization of
wala na ako, kaya
 appearance of  Provided empathy identify the feelings of anxiety
medyo nadepress relaxed state problem and how  Appearance of
and unconditional
ako”as verbalized by the  reports of reduced to deal with it. relaxed state
positive regard
patient. anxiety  Reports of reduced
 Accurate anxiety
 Provided accurate information
information allows patient to
regarding the deal more
situation effectively with
reality of
situation, thereby
reducing anxiety
and fear of the
unknown.

 To relieve tension
 Encouraged to thus reducing
participate in anxiety
activities that can
displace and lower
the anxiety like
chatting with the
SO
 To reduce external
 Collaborated with stimuli and

1
the SO regarding promote relaxation
comfort measures
such as calm and
quiet environment

2
 ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Objective: Ineffective airway At the end of 2  Positioned the patient  To maximize lung Goal partially met.
 Cough clearance r/t retained hours, the patient will in HBR expansion thru the aid
 Crackles secretions in the be able to of gravity The patient was able to
upon bronchi secondary to demonstrate  Encouraged to manifest behaviors of
auscultation pneumonia. behaviors of effective increase fluid intake  To liquefy secretions effective airway as
 Presence of airway as manifested for at least 2-3 L/day manifested by but not
sputum by but not limited to: limited to:
 Demonstrated proper
RR of 12-20cpm deep breathing  To facilitate learning -RR of 19
(-) crackles upon exercises on proper deep -(+) crackles upon
auscultation breathing exercise auscultation
(-) presence of  Assisted to do deep- - (+) presence of
sputum breathing exercises  To facilitate proper sputum secretion
Pulse rate within deep breathing -Pulse rate of 70
normal range  Advised to cover the exercise for easier -report of effective
Report of effective mouth when expectoration of airway.
ventilation coughing, sneezing, sputum
and laughing.  To prevent
transmission of the
bacteria
 Emphasized proper
hand washing
technique.
 To avoid cross
contamination
 Emphasized proper
disposal of soiled
tissues
 To avoid cross-
contamination
 Administered
bronchodilators as
ordered such as
 To loosen the retained
salbutamol through
secretions

1
 nebulization.

 Provided chest
physiotherapy  To facilitate drainage
of mucus secretions in
the bronchial tree.
 Watched out for
untoward
manifestations  To prevent possible
complications

 Encouraged to have
adequate rest and  To avoid fatigue
sleep.

2
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective: Activity At the end of 2 hours, the  Determined  To know the GOAL MET.
“I have pain in intolerance patient will be able to patient’s duration ,ext The patient was able to
the joints of r/t pain in demonstrate behaviors of tolerability ent of the demonstrate behaviors of
my lower the lower increased activity of her activities increased activity tolerance

extremities extremities tolerance as manifested activities that she can as manifested by:

Sumusumpon by but not limited to: do

g kasi ang  To enhance  Report of increase

rayuma ko”  Report of  Encouraged her level of activity

verbalized by increase level of to engage in physiological  Participation in

the patient. activity activities well-being activities like

 Participation in according to ambulation, self care
activities like her interest  For and exercises

Objective: ambulation, self and relaxation, appropriate to

care and capability and for condition
 pain in the
exercises such as better blood
joints of her
appropriate to chatting with circulation
lower
condition her SO.  To add
extremities.
support
 Assisted to system
do passive
 Pain scale of 5/10
exercises like  Can increase

1
 deep- the patient’s
breathing ,le participation
g/plantar
exercises
 To prevent
 Collaborated fatigue
with the SO
to provide  To prevent
assistance to over
the patient’s exertion in
self-care, resuming her
activities
 Emphasized  monitor for
the any signs
importance and
of activity, symptoms of
rest, possible
appropriate complication
exercises s
and leisure  To prevent
activities. injury

2
 Encouraged
adequate
rest

 Advised to
resume her
activities
gradually

 Instructed to
report
untoward
incidents
immediately

 Ensured
safety

3
4
 DRUG STUDY

DRUG: 1.CELEBREX(CAP) 400 mg/ 1 cap OD After Breakfast

Classification: Analgesic(non-opiod) NSAID

Specific COX-2 Enzyme Inhibitor

Content: Celecoxib

INDICATION

 Acute and long term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis.

 Reduction of the number of colorectal polyps in familial adenomatous polyposis.

 Management of acute pain.

 Treatment of primary dysmenorrhea.

 Relief of signs and symptoms of ankylosing spondylitis.

 Relief of signs and symptoms of juvenile rheumatoid arthritis.

CONTRA- INDICATIONS

 Contraindicated with allergies to sulfonamides, colecoxib, NSAIDs, or aspirin, significant renal

impairment; pregnancy (third trimester); lactation.

 Use cautiously with impaired hearing, hepatic and CV conditions.

SIDE EFFECTS

Dizziness Drowsiness

ADVERSE EFFECTS

Central Nervous System

Headache, Dizziness, Somnolence, Insomnia, Fatigue, Tiredness, Dizziness, Tinnitus, Ophthalmologic

Effects
1
 Cardiovascular System

Myocardial Infarction, Dermatologic, Rash, Pruritus, Sweating, Dry mucous membranes, Stomatitis

Gastrointestinal

Nausea, Abdominal pain, Dyspepsia, Flatulence, GI Bleed

Hematologic

Neutropenia, Eosinophilia, Leucopenia, Pancytopenia, Thrombocytopenia, Agranulocytosis,

Granulocytopenia, Aplastic Anemia

NURSING RESPONSIBILITIES

• Administer drug with food or after meals if GI upset occurs.

• Establish measures if CNS or visual disturbances occur.

• Arrange for periodic ophthalmologic examination during long term therapy.

DRUGS: 2.CEPTROCIN 1 gram /IV Every 12 hours

Classification: Antibiotic

Cephalosporin (third generation)

Content: Ceftriaxone Sodium)

INDICATION:

Lower Respiratory Infections caused by Streptococcus Pneumoniae, Staphylococcus Aureus,

Klebsiella, Haemophilus Influenzae, Escherichia Coli, Proteus Mirabilis, Enterobacter Aerogenes,

Seratia Marcescens, Haemophilus Parainfluenzae, Streptococcus (excluding enterococci)

• UTIs caused by E. Coli, Klebsiella, Proteus Vulgaris, Morganella Morganii

• Gonorrhea caused by Neisseria Gonorrhoeae

2
 • Skin and skin structure infection caused by S. aureus, Klebsiella, Enterobacter Cloacae, P. Mirabilis,

Staphylococcus Epidermidis, Pseudomona Aeruginosa, Streptococcus (excluding Enterococci)

• Septicemia caused by E. coli, S, Pneumoniae, H. Influenzae, S. Aureus, K. Pneumoniae

• Bone and Joint Infection caused by S. Aureus, Streptococcus (excluding Enterococci), P. Mirabilis,

S. Pneumoniae, E. coli, K. Pneuminiae, Enterobacter

• Meningitis caused by S. Pneumoniae, H. Influenzae, Neisseria Meningitidis

• Perioperative prophylaxis for patients undergoing coronary artery bypass surgeryand in contaminated

or potentially contaminated surgical procedures (vaginal or abdominal hysterectomy)

DRUG: 3.COMBIVENT (NEB), 1 neb Every 8 hours

Classification: Anti asthmatic

COPD Preparations

Content:

Ipratropium Br anhydrous 500 mcg, salbutamol 2.5 mg

INDICATION

• Management of reversible bronchospasm associated w/ obstructive airway diseases in

patients who require more than a single bronchodilator.

• Treatment & prevention of vit & mineral deficiencies in adults ≥50 yrs

• Hypertrophic obstructive cardiomyopathy or tachyarrhythmia.

• History of hypersensitivity to soya lecithin or related food products.

SIDE EFFECTS

Drowsiness, Dizziness, Fine tremor of skeletal muscle, Palpitations, Headache, Dizziness,

Nervousness, Dryness of mouth, Throat irritation, Urinary retention.

NURSING RESPONSIBILITIES

• May be taken with or without food.

3
 • May be taken w/ meals for better absorption or if GI discomfort occurs.

DRUG 4.CENTRUM(TAB)/ OD

Classification: Vitamins and Minerals

Content: Per tab β carotene 4,000 iu, retinyl acetate 1,333 iu, cholecalciferol 200 iu, dl-alpha

tocopheryl acetate 17.9 iu, phytonadione 32 mcg, thiamine mononitrate 2.6 mg, riboflavin 2.4 mg,

nicotinamide 18 mg, pantothenic acid 6 mg, pyridoxine HCl 3.65 mg, biotin 150 mcg, folic acid

300 mcg, cyanocobalamin 3 mcg, ascorbic acid 120 mg, Ca 162 mg, chromium 60 mcg, copper 1

mg, iodine 100 mcg, Fe 3.5 mg, Mg 100 mg, manganese 1 mg, phosphorus 125 mg, K 40 mg,

selenium 25 mcg, Zn 5 mg

INDICATION

• Treatment & prevention of vit & mineral deficiencies in adults ≥50 yr.

DRUG: 5.FELDENE FLUSH (TAB)

Classification:NSAID (Oxicam Derivative) Content:

Piroxicam

Dosage: 1 tab

Frequency: OD (After supper)

INDICATION

• Relief of signs and symptoms of acute and chronic rheumatoid arthritis and osteoarthritis.

• Unlabeled uses: Dysmenorrhea, postoperative and postpartum pain.

CONTRA- INDICATIONS

4
 • Contraindicated with hypersensitivity to puroxicam and any other NSAID, for perioperative

pain in CABG surgery, lactation.

• Use cautiously in the elderly; and with renal, hepatic, CV, GI conditions, pregnancy; heart

failure.

SIDE EFFECTS

Drowsiness, Dizziness

Central Nervous System Headache, Dizziness, Somnolence, Insomnia, Fatigue, Tiredness,

Dizziness, Tinnitus, Ophthalmologic Effects

Dermatologic

Rash, Pruritus, Sweating, Dry mucous membranes, Stomatitis

Gastrointestinal

Nausea, Dyspepsia, GI pain, Diarrhea, Vomiting, Constipation, Flatulence

Hematologic

Bleeding, Granulocytopenia, Decreased Hgb or Hct,Bone Marrow Depression, Menorrhagia

Respiratory

Dyspnea, Hemoptysis, Pharyngitis, Bronchospasm, Rhinitis, Peripheral Edema

Anaphylactoid Reactions to Anaphylactic Shock