Sigmoid Adenocarcinoma

Lyceum of the Philippines UniversityCapitol Site,
Batangas CityTel. 043 723-0706 loc. 166
Lyceum of the Philippines University –

Batangas
College of Nursing
Medical Ward Clinical Duty at

Batangas Medical Center
Case Analysis
of
Chronic Kidney Disease
By:
Advincula, Erryl Justine O.
BSN 4-1 Group A
September 14, 2023

TABLE OF CONTENTS
I. Introduction
II. Patient`s Profile
III. Clinical History
IV. Physical Assessment
V. Anatomy and Physiology
VI. Pathophysiology
VII. Laboratory and Diagnostic Examinations
VIII. Drug Study
IX. Nursing Care Plan (FDAR)
X. Prognosis
XI. Discharge Planning
XII. Conclusion
XIII. Proposed Actions and Recommendations

GENERAL OBJECTIVES
The study was conducted in order to develop the necessary skills needed to
provide quality, efficient, and to the extent of the caliber of excellence in nursing care,
through the application of critical thinking, ability to conceptualize a condition from both
objective and subjective standpoint, and to cater the proliferation of the body of
knowledge that we, student nurses must possess and hone to its sharpest condition.
This study focuses on developing and rendering nursing care toward a 22-year-old
patient diagnosed with Chronic Kidney disease. Connected to this is the analysis of the
condition, how it came to be, its pathophysiology. With all this taken into perspective, all
this compels the student nurses to develop a comprehensive plan of action and
intervention of care in order to provide quality nursing care and ensure optimal health
and well-being.
SPECIFIC OBJECTIVES
● Define Chronic Kidney Disease and its causes, risk factors, signs and symptoms,
the pattern of development, and foreseeable management
● Identify the drugs of choice and their mode of action, specific to the client
● Formulate possible health care plans and intervention of care that extends
outside the hospital
● Provide health teaching and guidance towards care of patient after provision of
institutional care
● Provide an evidenced-based nursing care practice and perform nursing
responsibilities
● Apply theoretical knowledge in performing nursing responsibilities
● Exhibit positive approach and attitude towards the provision of nursing care
I. INTRODUCTION
CKD is a condition in which the kidneys are damaged and cannot filter blood as well as
they should. Because of this, excess fluid and waste from blood remain in the body and may
cause other health problems, such as heart disease and stroke.
II. PATIENT’S PROFILE

Name: Patient JG
Address: Taal, Batangas
Age: 22 years old
Gender: Female
Phone Number: —
Religion: Roman Catholic
Status: Single
Birthdate: June 9, 2001
Place of birth: Taal, batangas
Ethnic Background: Filipino
Educational level: —--
Occupation:
Primary or Secondary Language: Tagalog
Support Person: Sister
Provider of History: Patient and sister

Hospital Number: —--
Diagnosis: Admitting Diagnosis: Chronic Kidney Disease
Physician:
Reason for Admission / Seeking Health For hemodialysis. Patient reported a
Care:
shortness of breath, body weakness and

dizziness.
III. CLINICAL HISTORY
HISTORY OF PRESENT HEALTH CONCERN

The patient is a 22-year-old female, with chief complaints of shortness of breath,
body weakness and dizziness. The patient is also scheduled for Chronic Kidney
Disease.
PAST HEALTH HISTORY

Past Medical/Surgical History
The patient had no surgical history. The patient claimed that she first
started feeling weak and lightheaded when she was still a teenager.
Family History
The patient stated that their family have a history of diabetes.
Lifestyle and Health Practices

The patient admitted that

she puts a lot of sugar in his
drinks and she was used to
eating junk foods and processed
food. She also stated that she is not physically active.
IV. PHYSICAL ASSESSMENT
GENERAL SURVEY
The patient is in a sitting position, was

awake, responsive, and aware of time and environment
PHYSICAL ASSESSMENT
Date September 13, 2023
Vital Signs BP: 130/90 mmHg
CR: 88 bpm
RR: 20 bpm
T: 36.4°C
O2 Sat: 95%
Body Parts Methods Findings Analysis
HEENT Inspection Lips do not appear Pinkish and smooth

dehydrated and lips indicate good
patient is not pale in hydration.
appearance
Neck Inspection Thyroid glands are not Normal

enlarged. There are
no palpable lymph
nodes
Chest and Lungs Inspection Symmetrical and Normal

normal. No scar, no
precordial bulging no
visible apex beat, and
no prominent dilated
vein
Abdomen Inspection Abdomen was not Normal

distended. Incision
scar was noted.
V. ANATOMY AND PHYSIOLOGY
Chronic kidney disease is a result of a number

of pathological processes causing irreversible damage
to kidney tissue. There is a mass destruction of
nephrons, so that the kidneys are unable to maintain
fluid and electrolyte balance and excrete waste
products from the body.
A kidney contains over 1 million functioning

units called nephrons. Each nephron is composed of a glomerulus and tubule. The glomerulus
acts to filter the blood free of cells and large proteins, producing an ultrafiltrate composed of the
other smaller circulating elements. The ultrafiltrate enters the tubule, which is highly specialized
at various segments, to produce the final urine by removing substances from the tubular fluid
(reabsorption) or adding substances to the tubular fluid (secretion). Filtration, reabsorption, and
secretion keep the organism in balance in terms of water, minerals, electrolytes, and hydrogen
ion concentration and eliminate the toxic substances produced by the body. The major known
hormonal functions of the kidney influence blood pressure, calcium metabolism, and red blood
cell production.
VI. PATHOPHYSIOLOGY
VII. LABORATORY AND

DIAGNOSTIC EXAMINATIONS
PROCEDURE PERFORMED: BLOOD CHEMISTRY
Blood chemistry tests are one of the most common tests performed to detect and
identify a wide variety of medical conditions, and these are also basic to complex
parameters that help doctors evaluate how well organ systems are functioning during
general physicals and in-depth examinations. A blood chemistry test is a test with a
blood specimen that measures the concentration of certain chemicals in a blood. Blood
chemistry tests provide important information about how well your kidneys, liver and
other organs are working. Abnormal levels of substances in your blood can be a sign of
disease or a side effect of treatment. sick. Blood chemistry tests are used to help
diagnose and monitor many medical conditions before, during, and after treatment.
Test Result Normal Significance

Values
BLOOD UREA NITROGEN 42.8 mmol/L 2.1 – 7.1 High. A high BUN level
means your kidneys aren’t
working well. But elevated
BUN can also be due to:
Dehydration, resulting from
not drinking enough fluids or
for other reasons
Creatinine 2043 46-92 A higher than normal level

may be due to: Blocked
urinary tract. Kidney
problems, such as kidney
damage or failure, infection,
or reduced blood flow.
Blood uric acid 791.4 149-369 High levels of uric acid can
sometimes cause gout or
kidney disease. You may
have this test if you have had
or are about to have certain
types of chemotherapy.
Phosphorus 4.2 0.41-1.85 High phosphorus, also called
hyperphosphatemia, means
you have extra phosphorus in
your blood. High phosphorus
is often a sign of kidney
damage.
PROCEDURE PERFORMED: HEMATOLOGY – COMPLETE BLOOD COUNT

A complete blood count (CBC) is a test that count the cells that make up the
blood such as red blood cells (RBC) which deliver oxygen to the tissues in the body,
white blood cells (WBC) that protects body from infection, hemoglobin wherein it
transports oxygen from the lungs into the tissues, the hematocrit which measures red
blood cells in the blood, and platelets that prevent and stops the bleeding.
A complete blood count that reveals abnormal results may suggest that the
patient may have anemia, iron deficiency, heart disease or underlying medical condition
that requires further assessment. The various reasons why physicians suggest this kind
of procedure is to review the overall health of the patient, to diagnose and monitor the
patient’s medical condition, and to identify and begin medical treatment.
HEMATOLOGY
Laboratory Exams Normal Values Result Significance
Hemoglobin 140 – 180 128 Abnormal. May indicate anemia.
Anemia is a warning sign of
colon cancer.
HEMATOLOGY
colon cancer.
HEMATOLOGY
colon cancer.
DIAGNOSTIC EXAMS
Examination Results Analysis
Chest X-RAY Lungs: There are minimal linear Lungs: Minimal fibrosis, left upper
densities at the apicoposterior and left lower lobes
segment of the left and upper and
anteromedial segment. Billae, left upper lobe
The lower aspect of the major fissure Fissural thickening, left lower
is thickened hemithorax
Heart and great vessel: Mildly
Few small bullae are

noted at the lingular
segment of the left
upper lobe
atherosclerotic thoracic aorta
Heart and great vessel: The heart is Bones: Osteodegenerative changes,

normal in size. The thoracic aorta is thoracic spine
mildly atherosclerotic
Bones: There are osteophytes in the

thoracic spine
Whole Gallbladder: The gallbladder is Diffuse nodular wall thickening as

abdomen CT physiologically distended described, proximal sigmoid colon.
scan with IV
Kidney: The right kidney is enlarged Few prominent mesenteric lymph
rectal contrast with normal configuration and good nodes, left lower quadrant
parenchymal opacification. Left
kidney is surgically absent Compensatory hypertrophy, right
kidney
GI tract/Lymph nodes: There is
diffuse nodular wall thickening of the S/P Left nephrectomy
proximal sigmoid colon, approx 3.7cm
in length causing mild luminal
narrowing, minimal pericolic fat and
few prominent mesenteric lymph
nodes
Histopathology Microscopic examination shows Adenocarcinoma, well to moderately

colonic mucosal fragments differentiated (sigmoid mass)
involved by a malignant tumor
composed of well to moderately
defined malignant glandular
patterns lined by stratified
columnar epithelium with loss of
nuclear polarity, with nuclear
hyperchromatism, and
pleomorphism and increase in
mitotic figures.
Some glands are filled with
cribriform pattern of growth of
tumor cells, associated with acute
inflammatory reaction
and stromal
desmoplasia
Colonoscopy A fungating mass obstructing the Indicates sigmoid mass, with internal
with biopsy of lumen was noted in the sigmoid colon hemorrhoids grade 1
sigmoid mass (20 cm).
In the anal area engorged internal
hemorrhoidal vessels were noted
Colectomy Colon resection: Stage III Sigmoid Adenocarcinoma

Adenocarcinoma, poorly
differentiated, tumor size, 5 cms in
widest tumor dimension
Tumor extends to the serosa and
pericolic adipose tissues
Presence of lymphovascular space
invasion
13/19 lymph nodes, positive for tumor
VIII. Drug Study

IX. NURSING CARE PLAN (FDAR)

NURSE’S NOTES
Date/Shift Time Nurse’s Notes

Feb 20, 2023 3pm to 11pm F: Elevated Blood pressure
D:
VS: HR - 75, BP - 140/90, PR - 16, Temp - 36.5, O2Sat - 99%
Patient is diagnosed with sigmoid adenocarcinoma
Patient reported stool with blood
A: Vital signs taken and recorded

Measured intake and output
Encouraged patient to increase fluid intake and fiber intake
Advised patient to refrain from drinking alcohol, coffee, or tea
due to their diuretic effect
Assist the patient in doing physical activity and exercise.
Encourage bowel elimination at the same time each day.
However, reiterate to patient to not strain during defecation
R: Patient was able to report relief from discomfort of
constipation
Acha, Marinella Salve B.

BSN III-1 Group A
Date/Shift Time Nurse’s Notes

Feb 21, 2023 3pm to 11pm F: Increased blood pressure
D: > V/S: BP - 140/100, RR - 19, PR - 75
Fatigue
Nausea
noted
A: >
Seen
patient on sitting position
Vital signs taken and recorded
Scheduled uninterrupted rest period
Educated patient on stress management such as relaxation
technique
Advised patient to avoid food that could increase BP such as
junk food and processed food
Measured intake and output
R: Latest BP: 140/90
Acha, Marinella Salve B.

BSN III-1 Group A
Feb 22, 2023 3-11pm F: Pain on incision site

D: Pain scale of 4/10
Facial grimace
A: Monitored vital sign
Advised patient to have adequate rest period
Advised patient to avoid sudden rapid change or any
aggressive movement
Encouraged patient to ambulate as tolerated
Instructed patient to avoid straining during defecation and to
avoid lifting heavy materials
R: The patient was able to verbalize control of pain as
evidenced by decreased in pain scale from 4 to 1 out of 10
Acha, Marinella Salve B

BSN III-1 Group A
X. PROGNOSIS
The prognosis of chronic kidney

disease depends on a number of
factors, and for some people, it can
progress to kidney failure. For some
though, it never causes any problems. One of the major factors relating to the overall
prognosis will relate to the underlying cause of the patient’s chronic kidney disease. The
life expectancy for a person receiving dialysis is around 5–10 years, though many live
for 20–30 years. People who receive a donor kidney from a living donor tend to go 15–
20 years before needing a new kidney. Donor kidneys from deceased donors tend to
last 10–15 years before needing to be replaced..
XI. DISCHARGE PLANNING

Medications:
● Continue oral medications as prescribed.
Environment:
● Advised patient and partner to have a clean and sleep-conducive environment,
comfortable room temperature, and appropriate ventilation and lighting.
● Inform the significant other to pay attention to the patient's safety at home in
order to speed up recovery, minimize potential infection sources, and ensure that
family members are aware of the patient's need for assistance.
● Encourage the patient to do light stretching exercises and walk daily to relieve
tension in the body.
● Advised patient to take a break from exhausting work and promote a relaxing
environment.
Treatment:
● Advise the patient to have an adequate rest for faster recovery.
● Instructed the patient to increase her oral fluid intake.
● Informed patient to avoid lifting heavy object
Hygiene:
● Instructed the patient to wash his

hands before and after eating.
● Reiterated the importance of
hand washing to avoid infection
Outpatient:
● Instructed patient and significant other to do a follow-up check-up or contact the
physician if recurrences and other issues occur.
Diet:
● Instructed significant other to give support to the patient by giving her the best
option of healthy foods that will make her motivated to eat and enjoy them at the
same time.
● Advised patient to avoid salty and sodium rich foods as it causes the body to
retain fluids.m
● Suggested to patient to reduce or limit alcohol intake.
Spiritual:
● Advised patient to continue spiritual practices, so long as it does not put the
patient’s health into compromise.
XII. CONCLUSION
If left untreated, CKD can progress to kidney failure and early cardiovascular
disease. When the kidneys stop working, dialysis or kidney transplant is needed for
survival. Kidney failure treated with dialysis or kidney transplant is called end-stage
renal disease (ESRD).
XIII. PROPOSED ACTIONS AND

RECOMMENDATIONS
The most important step you can take to treat kidney disease is to control your
blood pressure. High blood pressure can damage your kidneys. You can protect your
kidneys by keeping your blood pressure at or less than the goal set by your health care
provider. For most people, the blood pressure goal is less than 140/90 mm Hg.
Work with your health care provider to develop a plan to meet your blood
pressure goals. Steps you can take to meet your blood pressure goals may include
eating heart-healthy and low-sodium meals, quitting smoking, being active, getting
enough sleep, and taking your medicines as prescribed.

Sigmoid Adenocarcinoma

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Lyceum of the Philippines UniversityCapitol Site,

Batangas CityTel. 043 723-0706 loc. 166

Lyceum of the Philippines University –

Medical Ward Clinical Duty at

Chronic Kidney Disease

September 14, 2023

II. Patient`s Profile

III. Clinical History

IV. Physical Assessment

V. Anatomy and Physiology

VII. Laboratory and Diagnostic Examinations

VIII. Drug Study

IX. Nursing Care Plan (FDAR)

XI. Discharge Planning

XIII. Proposed Actions and Recommendations

II. PATIENT’S PROFILE

Provider of History: Patient and sister

shortness of breath, body weakness and

III. CLINICAL HISTORY

HISTORY OF PRESENT HEALTH CONCERN

PAST HEALTH HISTORY

Lifestyle and Health Practices

The patient admitted that

IV. PHYSICAL ASSESSMENT

The patient is in a sitting position, was

Date September 13, 2023

Vital Signs BP: 130/90 mmHg

Body Parts Methods Findings Analysis

HEENT Inspection Lips do not appear Pinkish and smooth

Neck Inspection Thyroid glands are not Normal

Chest and Lungs Inspection Symmetrical and Normal

Abdomen Inspection Abdomen was not Normal

V. ANATOMY AND PHYSIOLOGY

Chronic kidney disease is a result of a number

A kidney contains over 1 million functioning

VII. LABORATORY AND

Test Result Normal Significance

Creatinine 2043 46-92 A higher than normal level

PROCEDURE PERFORMED: HEMATOLOGY – COMPLETE BLOOD COUNT

Examination Results Analysis

Few small bullae are

Heart and great vessel: The heart is Bones: Osteodegenerative changes,

Bones: There are osteophytes in the

Whole Gallbladder: The gallbladder is Diffuse nodular wall thickening as

Histopathology Microscopic examination shows Adenocarcinoma, well to moderately

Colectomy Colon resection: Stage III Sigmoid Adenocarcinoma

VIII. Drug Study

IX. NURSING CARE PLAN (FDAR)

Date/Shift Time Nurse’s Notes

A: Vital signs taken and recorded

Acha, Marinella Salve B.

Date/Shift Time Nurse’s Notes

Acha, Marinella Salve B.

Feb 22, 2023 3-11pm F: Pain on incision site

Acha, Marinella Salve B

The prognosis of chronic kidney

XI. DISCHARGE PLANNING

● Instructed the patient to wash his

XIII. PROPOSED ACTIONS AND

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