A CASE STUDY PRESENTED TO THE HEADS OF

NURSINF IN SOCSARGEN COUNTY HOSPITAL

Nursing Management
of a patient with
Ascending Cecal
Colonic Mass
In Partial Fulfillment for the requirement for Related Learning Experience in NCM 112: Care of Clients with Problems
in Infectious Inflammatory & Immunologic Response, Fluids & Electrolytes, Oxygenation, Cellular Aberation, Acute &
Chronic
 TABLE OF CONTENTS
I. INTRODUCTION
II. OBJECTIVES
III. PATIENT’S PROFILE
IV. ANATOMY & PHYSIOLOGY
V. PATHOPHYSIOLOGY
VI. COURSE IN THE HOSPITAL
VII. LABORATORY STUDY
VIII. DRUG STUDY
IX. NURSING CARE PLAN
X. MEDICAL MANAGEMENT
XI. SURGICAL MANAGEMENT
XII. PROGNOSIS
XIII. DISCHARGE PLANNING
XIV. CONCLUSIONS
XV. REFERENCES
I. INTRODUCTION
I. INTRODUCTION
The diagnosis of an ascending cecal colonic mass refers to the presence of a tumor or
abnormal growth in the ascending colon, particularly at the cecum, which is causing
obstruction or blockage of the colonic passage. This condition is a significant
concern as it may lead to various complications such as bowel obstruction,
perforation, or even malignancy. The ascending colon is the part of the large
intestine that extends from the cecum, located in the right abdomen, to the hepatic
flexure near the liver. When a mass develops in this region, it can impede the normal
flow of stool and gas through the colon, resulting in symptoms such as abdominal pain
in the right quadrant, bloating, nausea, vomiting, and changes in bowel habits.
The etiology of ascending cecal colonic masses can vary, including both benign and
malignant causes. Some common benign causes include colonic polyps,
diverticulosis, or inflammatory conditions like Crohn's disease. On the other hand,
malignant causes include colorectal cancer, which is a leading cause of cancer- related
I. INTRODUCTION
Early detection and accurate diagnosis of an ascending cecal colonic mass are crucial for
effective management and better patient outcomes to prevent also the growth of other
malignant tumors. Diagnostic modalities such as colonoscopy, computed tomography
(CT) scan, and biopsy are commonly employed to evaluate the location, size, and
nature of the mass, enabling clinicians to determine the appropriate treatment
approach.

Our case is a 36-year-old female with a chief complaint of abdominal pain in the right
upper quadrant. Ascending cecal colonic masses as the final diagnosis. This case study
thoroughly examines the complexities of the final diagnosis, from its diverse causes to its
effect on the health of the patient. We aim to highlight the difficulties and
accomplishments by investigating real-life situations, therapeutic methods, and the most
recent medical findings. Our reason for conducting this study is to better understand
the disorder and improve the lives of patients with Ascending Cecal Colonic mass and
II. OBJECTIVES
GENERAL OBJECTIVES
Our case is a 36-year-old female with a chief complaint of abdominal pain
in the right upper quadrant. Ascending cecal colonic masses as the final
diagnosis. This case study thoroughly examines the complexities of the
final diagnosis, from its diverse causes to its effect on the health of the
patient. We aim to highlight the difficulties and accomplishments by
investigating real-life situations, therapeutic methods, and the most
recent medical findings. Our reason for conducting this study is to better
understand the disorder and improve the lives of patients with Ascending
Cecal Colonic mass and this case study takes us on a trip through the
complicated area of diagnosis, treatment, and patient care.
SPECIFIC OBJECTIVES
In this case study, we specifically aim to gain the following:
To understand the state of the disease and associate it with the patient
through the introduction of the case.
To know the nursing history, personal data, health history and physical
assessment of the patient.
To explain to you the anatomy and physiology of the organ affected, as
well as its pathophysiology.
To consider and determine the symptoms and complications.
To strengthen the competence of nursing management with this disease.
To provide the client a nursing care plan and discharge plan to assure the
client's total wellness during her hospitalization up to the time of her
hospital discharge.
III. PATIENT’S PROFILE
I. BIOGRAPHIC DATA
Name: Patient A
Age: 36 years old
Birthday: August 5, 1987
Address: Purok Rose, Talnya, Glan, Saranggani
Province
Gender: Female
Occupation: Housekeeper
 II. CLINICAL DATA

Vital signs

Chief Complaint: Abdominal Pain Temperature: 36 Degree Celsius per axilla

Admitting Diagnosis: Ascending Colon Pulse Rate: 80 bpm
Mass Respiratory Rate: 20 cpm
Final Diagnosis: Ascending Cecal Colonic Blood Pressure: 110/80 mmHg
Mass Height: 157 cm
Date of Admission: October 05, 2023 Weight: 43 kg
Time of Admission: 4:20 PM
Hospital: Socsargen County Hospital
III. GENERAL PHYSICAL DATA

Date and Time Assessed: November 13, 2023/ 12:30 PM

Date of admission: October 05, 2023, upon admission,

the patient appears to be awake, coherent, and
responsive.
III. GENERAL PHYSICAL DATA
Health Assessment
General Appearance

A comprehensive physical examination of the head

and neck was performed. When assessed, the patient
was awake, attentive, and coherent, wearing home
clothing, lying in bed in supine position.
PATIENT'S ASSESSMENT (INITIAL/ FOCUS/ GENERAL

SKIN The patient’s color is brown. Skin is warm to touch with

a body temperature of 36 C.

HEENT The head of the patient is round and symmetrical. It

has no masses, lumps, and lesions. Hair is color black
and evenly distributed. Eyebrows are symmetrical,
black in color. Pupils are equally round and reactive to
light and accommodation, none protruding. The right
and left ears are normal and there is no problem in
hearing. The nose is normal and no presence of any
discharges, not tender and no lesions upon palpation.
The patient has no problem swallowing and gag reflex.
PATIENT'S ASSESSMENT (INITIAL/ FOCUS/ GENERAL

NECK Neck of the patient is symmetrical with head centered

and without palpable masses.

CHEST Appears symmetrical

BREAST No mass or lumps noted.

ABDOMEN The abdomen of the patient appears to have some

deviation from the normal structure and shape specially
on the right quadrant side.
PSYCHIATRIC The patient is coherent and responsive to verbal
commands and oriented with its environment.
IV. GORDON’S HEALTH ASSESSMENT
DEMOGRAPHIC DATA

Date of Admission: October 05, 2023

Time: 4:20 PM
Name: Patient A
Date of Birth: August 05, 1987
Age: 36 years old
Sex: Female Primary
Significant other: Husband of Patient A
Name of primary information source: Husband of Patient A
Admitting medical diagnosis: Ascending Colon Mass
IV. GORDON’S HEALTH ASSESSMENT
VITAL SIGNS

Temperature: 36°C ; oral__ rectal _ axillary: √ tympanic___

Pulse Rate: 80 bpm; radial √ apical regular irregular __
Respiratory Rate: 20 cpm; abdominal _ diaphragmatic √
Weight: 43 kg
Height: 157 cm

Do you have any allergies? No √ Yes__ What?__

(Check reactions to medications, foods, cosmetics, insect bites, etc.)
HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN
OBJECTIVE

1. Mental Status (indicate assessment with a √)

a. Oriented √ Disoriented__ ​Time: √; Place: √; Person: Yes √ No__;
b. Sensorium Alert √ Drowsy _ Lethargic__ Stuporous__ Comatose_ Cooperative
Combative__ Delusional__

2. Vision Visual acuity:

Both eyes__; Right _; Left_; Not assessed: √
Pupil size: 3 mm

Pupil reaction:
Right: Normal √ Abnormal__;
Left: Normal √ Abnormal___
HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN
3. Hearing Not assessed__ Right ear: WNL √
Impaired__ Deaf__; Left ear: WNL √
Impaired__ Deaf__
1. Hearing aid: Yes__ No √
2. Reflexes: Normal: √ Abnormal__
Describe: ________________

3. Any enlarged lymph nodes in the neck? No √ Yes__

Location and size:_________

4. General appearance:
Hair: Black, curly, and evenly distributed hair with slight notable hair fall.
Skin: Skin warm to touch, evenly distributed skin hair.
Nails: Normal in shape with no nail clubbing, and normal capillary refill.
HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN

7. Touch ​Blunt: Normal _ Abnormal__ Describe: (not assessed) ​

Sharp: Normal _ Abnormal_ Describe: ​​​(not assessed) ​
Light touch sensation: Normal √ Abnormal__ Describe: ​​
Proprioception: Normal √ Abnormal__ Describe: ​​​​
Heat: Normal_√_ Abnormal__ Describe: ​Cold: Normal_√_ Abnormal__ Describe:
​Any numbness? No √ Yes__ Describe: ​​
Any tingling? No √ Yes__ Describe:

8. Reflexes: Normal √ Abnormal__ Describe:

9. Any enlarged lymph nodes in the neck? No √ Yes__ Location and size: ​___
NUTRITIONAL-METABOLIC PATTERN OBJECTIVE
1. Skin examination Warm_√_ Cool Moist__ Dry__
Lesions: No √ Yes__Describe:____________
Rash: No √ Yes__ Describe: __________
Turgor: Firm √ Supple__ Dehydrated__ Fragile__
Color: Pale Pink__ Dusky__ Cyanotic___ Jaundiced__ Mottled__ ​Other: __Brown_

2. a. Eyes
I. Moist √ Dry__
II. Color of conjunctiva: Pale__ Pink_√_ Jaundiced__
III. Lesions: No √ Yes__ Describe: _____

3. Edema
a. General: No √ Yes__ Describe: ______
Abdominal girth: slight deviation from the normal range.

4. Gag reflex: Present √ Absent__ Not Assessed ____­­

5. Can patient move easily (Move head from L to R, Flapping)? Yes_√ _ No Describe limitations: ___________________
NUTRITIONAL-METABOLIC PATTERN OBJECTIVE
SUBJECTIVE:

1. Any weight gain in the last 2 months? No ✔ Yes _ Amount: __

2. Any weight loss in the last 2 months? No Yes Amount: 6 kg__

3. Would you like to: Gain weight?_ Lose weight? √ Neither

4. Any problems with:

a. Nausea: No √ Yes__
b. Vomiting: No √ Yes__
c. Swallowing: No √ Yes__
d. Indigestion: No √ Yes__
ELIMINATION PATTERN
OBJECTIVE
1. Ostomy present: No √ Yes__

SUBJECTIVE
1. What is your usual frequency of bowel movements?
“isa o kaduha sa isa ka adlaw” as verbalized by the patient.
a. Have to strain to have a bowel movement? No √ Yes__
b. Same time each day? No √ Yes__
2. Has the number of bowel movements changed in the past week? No√ Yes__ Increased?__
Decreased? _
3. Character of stool
a. Consistency: Hard__ Soft √ Liquid__
b. Color: Brown_√_Black__ Yellow _ Clay-colored_
c. Bleeding with bowel movements: No √ Yes__
4. History of constipation: No_√ _ Yes__
How often? Do you use bowel movement aids (laxatives, suppositories, diet)? No√ Yes__
ELIMINATION PATTERN
5. History of diarrhea: No √ Yes___When? _________________
6. History of incontinence: No √ Yes__
Related to increased abdominal pressure (coughing, laughing, sneezing)? No__ Yes__
7. History of travel? No_√ _ Yes__ Where:______
a. Usual voiding pattern:
b. Color: Yellow √​­Smokey__ Dark__
c. Incontinence: No√ Yes__
Difficulty voiding when urge to void develops? No √ Yes__
Have time to get to bathroom: Yes √ No_ _
Patient is catheterized: No
d. Retention: No √ Yes__ e. Pain/burning: No √ Yes__
f. Sensation of bladder spasms: No √ Yes _ When? ____
ACTIVITY-EXERCISE PATTERN

OBJECTIVE

1.Cardiovascular
a. Cyanosis: No √ Yes__ Where?
b. Extremities:
i. Temperature: Cold__ Cool Warm_√ _ Hot__
ii. Capillary refill: _normal (2 seconds)
iii. Nails: Normal √ Abnormal__
iv. Hair distribution: Normal √ Abnormal__
ACTIVITY-EXERCISE PATTERN
2. Respiratory
a. Rate: 22cpm Depth: Regular √ Shallow__ Deep_ Abdominal__ Diaphragmatic _
b. Have patient cough. Any sputum? No√ Yes__ Describe: _________

3. Musculoskeletal
a. Postural: Normal √ Kyphosis__ Lordosis____
b. Deformities: No √ Yes_ _ Describe: _______________
c. Missing limbs: No √ Yes__ Where? _____________
d. Uses mobility aids (walker, crutches, etc)? No √ Yes__ Describe:
e. Tremors: No √ Yes__ Describe: ________

4. Spinal cord injury: No √ Yes__ Level: __________________

5. Paralysis present: No√ Yes__ Where? ___________________

ACTIVITY-EXERCISE PATTERN
SUBJECTIVE

Have patient rate each area of self-care on a scale of 0 to 4. (Scale has been adapted by NANDA from
E. Jones, ET. Al., Patient Classification for Long Term Care; User’s Manual. HEW Publication No. HRA-
74-3107, November 1974.)

0 – Completely independent
1 – Requires use of equipment or device
2 – Requires help from another person for assistance, supervision or teaching
3 – Requires help from another person and equipment device
4 – Dependent; does not participate in activity

Feeding - 0; Bathing/hygiene - 2; Dressing/grooming - 2; Toileting - 2; Ambulation - 2; Care of home –

not applicable; Shopping - not applicable; Meal preparation - not applicable; Laundry - not applicable;
Transportation – not applicable
SELF-PERCEPTION AND SELF-CONCEPT PATTERN OBJECTIVE

1. During this assessment, does patient appear: Calm√ Anxious__ Irritable__

Withdrawn__ Restless__

2. Did any physiologic parameters change?

Face reddened: No √ Yes__;
Voice volume changed: No √ Yes__ Louder__ Softer__;
Voice quality changed: No √​Yes__ Quavering__ Hesitation__ Other: __

3. Body language observed: Composed and relaxed.

4. Is current admission going to result in a body structure or function change for the
patient? No_√_Yes _ Unsure at this time__
SELF-PERCEPTION AND SELF-CONCEPT PATTERN OBJECTIVE
OBJECTIVE

1. During this assessment, does patient appear: Calm√ Anxious__ Irritable__ Withdrawn__
Restless__

2. Did any physiologic parameters change?

Face reddened: No √ Yes__;
Voice volume changed: No √ Yes__ Louder__ Softer__;
Voice quality changed: No √​Yes__ Quavering__ Hesitation__ Other: __

3. Body language observed: Composed and relaxed.

4. Is current admission going to result in a body structure or function change for the
patient? No_√_Yes _ Unsure at this time__
ROLE-RELATIONSHIP PATTERN OBJECTIVE
ROLE-RELATIONSHIP PATTERN OBJECTIVEROLE-RELATIONSHIP PATTERN OBJECTIVE

OBJECTIVE

1. Speech Pattern

a. Is English the patient’s native language? Yes__ No √

Native language is: Bisaya
Interpreter needed? No √ Yes__
b. During interview have you noted any speech problems? No√ Yes__ Describe:__________

2. Family Interaction
a. During interview have you observed any dysfunctional family interactions? No √_ Yes
_Describe: b. If patient is a child, is there any physical or emotional evidence of physical
or psychosocial abuse? No √_Yes__ Describe: ​​
ROLE-RELATIONSHIP PATTERN OBJECTIVE
ROLE-RELATIONSHIP PATTERN OBJECTIVEROLE-RELATIONSHIP PATTERN OBJECTIVE

OBJECTIVE

1. Speech Pattern

a. Is English the patient’s native language? Yes__ No √

Native language is: Bisaya
Interpreter needed? No √ Yes__
b. During interview have you noted any speech problems? No√ Yes__ Describe:__________

2. Family Interaction
a. During interview have you observed any dysfunctional family interactions? No √_ Yes
_Describe: b. If patient is a child, is there any physical or emotional evidence of physical
or psychosocial abuse? No √_Yes__ Describe: ​​
ROLE-RELATIONSHIP PATTERN OBJECTIVE
ROLE-RELATIONSHIP PATTERN OBJECTIVEROLE-RELATIONSHIP PATTERN OBJECTIVE

SUBJECTIVE

1. Does patient live alone? Yes__ No √ With whom? Husband

2. Is patient married? Yes_√_ No _ Children? No Yes _√
3. How would you rate your parenting skills? Not applicable No difficulty √_ ​
Average__ Some difficulty__ Describe:
COPING-STRESS TOLERANCE PATTERN
OBJECTIVE

1. Observe behaviour: Are there any overt signs of stress (crying, mood swings,
depression, restlessness, etc.)? Describe: none observed.

SUBJECTIVE

1. Have you experienced any stressful or traumatic events in the past year in addition to
this admission? No √ Yes__ Describe:_______________-

2. How would you rate your usual handling of stress? Good √_ Average__ Poor__
V. PAST HEALTH HISTORY

Patient A stated to have abdominal pain 3 months

prior to admission. Patient is a domestic helper
outside the country diagnosed with possible
appendicitis, given meds for pain. Additionally, the
patient underwent surgery for an ovarian mass, but
the operation was discontinued due to a
misdiagnosis.
VI. PRESENT HEALTH HISTORY

Patient A pain persisted but tolerable until she decided to

come back home 2 months ago. Ultrasound procedure done,
Ultrasound revealed ongoing right Exploratory Laparotomy
13 days after but noted with ascending Colon mass hence
operation was ended. Thus, the patient has a final
histopathologic diagnosis of ileum ascending colon and
transverse colon and gallbladder; right hemicolectomy and
cholecystectomy. Computed Tomography scan done and
patient for consultation, with Attending Physician advised for
this.
IV. ANATOMY AND
PHYSIOLOGY
IV. ANATOMY AND PHYSIOLOGY

The Digestive System

AFFECTED ORGAN OR PART:

1. THE ASCENDING COLON

2. THE COLON
3. THE INTESTINAL GLAND
V. PATHOPHYSIOLOGY
 I. DEFINITION
OF DIAGNOSIS
 According to the National Cancer Institute
(2021), cancer is not one disease, but a collection
of related diseases that can occur almost
anywhere in the body. At its most basic, cancer is
a disease of the genes in the cells of our body.
Genes control the way our cells work. But,
changes to these genes can cause cells to
malfunction, causing them to grow and divide
when they should not—or preventing them from
I. DEFINITION OF dying when they should. These abnormal cells
DIAGNOSIS can become cancer.
 Colon (colorectal) cancer starts in your colon
(large intestine), the long tube that helps carry
digested food to your rectum and out of your body.
Colon cancer develops from certain polyps or
growths in the inner lining of your colon (Cleveland
Clinic, 2022). An ascending cecal colonic mass is a
tumor that arises in the cecum and ascending colon.
The cecum is the pouch-like beginning of the large
intestine, and the ascending colon is the part of the
large intestine that travels up the right side of the
I. DEFINITION OF abdomen. Ascending cecal colonic masses can be
benign (non-cancerous) or malignant (cancerous).
DIAGNOSIS
 An ascending cecal colonic mass is
typically diagnosed through a colonoscopy. A
colonoscopy is a procedure in which a thin,
flexible tube with a camera on the end is
inserted into the colon to look for
abnormalities. If a tumor is found, a biopsy can
be taken to confirm the diagnosis (Mayo Clinic,
2023).
I. DEFINITION OF
DIAGNOSIS
II. ETIOLOGY
 PREDISPOSING FACTORS

1. AGE
2. DIETARY FACTORS
3. OBESITY
4. INFLAMMATORY BOWEL DISEASE
5. FAMILY HISTORY
6. GENETICS
7. LIFESTYLE

II. ETIOLOGY
 PRECIPITATING FACTORS

1. CHRONIC INFLAMMATION
2. CHANGES IN IMMUNE FUNCTION
3. ENVIRONMENTAL FACTORS
4. SMOKING
5. ALCOHOL USE

II. ETIOLOGY
 SYMPTOMS

1. ABDOMINAL PAIN
2. CONSTIPATION
3. NAUSEA AND VOMITING
4. PALPABLE ABDOMINAL MASS (PRE-
OPERATIVE)
5. RIGHT QUADRANTS PAIN (UPPER AND
LOWER)
6. WEIGHT LOSS
7. JAUNDICE

III. SYMPTOMATOLOGY
NARRATIVE
The development of colon cancer does not have a clear cause, however, its
explanation is that imagine the large intestine as a long, winding tube that absorbs water
and nutrients from food waste and eliminates the remaining solid waste from the body.
The ascending colon is the first part of the large intestine, located on the right side of the
abdomen. It's connected to the cecum, a pouch-like structure that receives digested food
from the small intestine. Ascending cecal colonic masses are abnormal growths that
develop in the lining of the ascending colon or cecum. These masses can be benign,
meaning they are not cancerous, or malignant, meaning they are cancerous. The
development of ascending cecal colonic masses is a complex process involving sporadic
mutations and environmental factors. Sporadic mutations can alter the growth and
division of cells in the lining of the colon, leading to the formation of polyps. Polyps are
small, benign growths that can protrude into the colon lumen. Over time, some polyps
can transform into malignant tumors. Environmental factors, such as diet and lifestyle,
also play a role in the development of ascending cecal colonic masses. A diet high in red
meat, processed foods, and saturated fats, and low in fiber-rich fruits and vegetables,
NARRATIVE
The growth of an ascending cecal colonic mass can cause a variety of symptoms
including: Abdominal pain, Change in bowel habits, such as constipation or diarrhea; Blood in
stool; Unexplained weight loss; Fatigue. In some cases, the mass may not cause any symptoms
until it has grown larger and advanced, hence, the patient becomes asymptomatic, which results
in healthcare providers having difficulty in diagnosis. The complications arise as the tumor
progresses, including metastasis in liver, results to invasion of hepatocyte, then, bile build up as
liver gradually being affected, solid particles or stones are formed in the gallbladder, which then
result to pus or empyema of the gallbladder. If still not treated with surgery, it causes sepsis,
whereas the patient will have multiorgan dysfunction and failure, which then result in death.
Diagnosis of ascending cecal colonic masses typically involves a colonoscopy, a procedure where
a long, thin tube with a camera is inserted into the colon to examine its lining. Other diagnostic
tests may include CT scans and MRI scans, which provide detailed images of the colon and
surrounding organs. Treatment for ascending cecal colonic masses depends on the type of mass,
its size, and its location. Benign masses may not require treatment, but they will be monitored
regularly to ensure they do not become cancerous. Malignant masses typically require surgical
removal, followed by chemotherapy or radiation therapy to eliminate any remaining cancer cells.
Early detection and treatment of ascending cecal colonic masses are crucial for a favorable
VI. COURSE IN THE
HOSPITAL
I. DOCTOR’S ORDER

DATE ORDERED PROGRESS NOTES DOCTOR’S ORDER RATIONALE

CBC provide information about
10-05-2023 Wt.: 47.3kg Kindly admit the number and types of blood

Temp: 36.3 C under my cells, including RBC, WBC,

3:50 PM Platelet. Abnormalities in these
PR:113bpm supervision count indicate various health
CBC serum FBS/ condition, including anemia,
RR: 20cpm infection, or clotting disorder.
creatinine Na-K
BP:120/80mmHg FBS measures glucose levels in
CXR PA view the blood after overnight fast.
O2: 100% Attach CT-scan Creatinine assesses kidney
function by measuring the levels
result of creatinine, a waste product
IVF D5LR 1Lx30cc from muscle metabolism.
Elevated creatinine indicated
Niacinamide forte
kidney dysfunction
TID tabs Intended to identify current
inform me after infection in individuals and is
performed when a person has
admission signs or symptoms consistent
for SARS-COV 2 with COVID-19, or is
asymptomatic, but has recent
test
known or suspected exposure to
D5LR 1L @60cc/ someone with suspected or
confirmed SARS-CoV-2 infection.
II. VITAL SIGNS MONITORING SHEET

DATE SHIFT BP TEMP. CR RR O2 SAT

10/15/2023 8am 100/60 mmHg 36 *C 81 bpm 20 cpm 93%

12pm 110/70mmHg 36*C 74 bpm 20 cpm 98%

4pm 100/60mmHg 36*C 81 bpm 20cpm 98%

8pm 120/80mmHg 36*C 87 bpm 20cpm 96%

12am 120/80mmHg 36*C 75 bpm 20cpm 97%

4am 110/80mmHg 36.2*C 84 bpm 20cpm 95%

8am 110/60mmHg 36.5*C 68 bpm 20cpm 95%

VII. LABORATORY
CHEMICAL SECTION
Name of Patient: Patient A
Age/Sex: 36/Female
Dx: Ascending Cecal Colonic Mass
10-20-23 @7:25PM

REFERRENCE REFERRENCE
SI UNIT CONVENTIONAL UNIT
RANGE RANGE

Sodium L 133.74 mmol/L 136-145 L 133.74 mEq/L 136-145

Serum 64-104 0.48

L 42.53 mmol/L L mEq/L 0.72-1.18
Creatinine

Potassium 3.67 mmol/L 3.5-5.1 3.67 mEq/L 3.5-5.1

HEMATOLOGY SECTION
Name of Patient: Patient A
Age/Sex: 36/Female
Dx: Ascending Cecal Colonic Mass

CBC RANGE INTERPRETATION

Platelet H 429 10^9/L 125-350 Too few platelets can be a sign

of cancer, infections or other
health problems. Too many
platelets put you at risk for
blood clots or stroke. There are
tens of thousands of platelets
in a single drop of blood.
HEMATOLOGY SECTION

CBC RANGE INTERPRETATION

MPV L 7.30 fL 6.5-12.0 an MPV result that's higher

than normal may be a sign of:
Thrombocytopenia, not having
enough platelets.
Myeloproliferative diseases,
blood cancers in which the
bone marrow makes too many
platelets or other blood cells.
HEMATOLOGY SECTION

CBC RANGE INTERPRETATION

hemogl L 112 g/L 115-175 If a hemoglobin test reveals

obin that your hemoglobin level is
lower than normal. it means
you have a low red blood cell
hemat L 0.34 g/L 0.35-0.50 count (anemia)
A hematocrit level below the
ocrit
normal range, meaning the
person has too few red blood
cells, is called anemia.
HEMATOLOGY SECTION

CBC RANGE INTERPRETATION

RBC An RBC count can be used to help

4.36 10^12/L 3.80-5.80 diagnose blood-related conditions, such
as iron deficiency anaemia (where there
are less red blood cells than normal). A
low RBC count could also indicate a
vitamin B6, B12 or folate deficiency.
MCV L 77.0 fL 82.0-100.0 An MCV test may also be used with other
tests to help diagnose or monitor certain
blood disorders, including anemia. There
are many types of anemia. An MCV test
can help diagnose which type of anemia
you have.
HEMATOLOGY SECTION

CBC RANGE INTERPRETATION

MCH MCH is one measurement of your red

L 25.60 pg 27.0-34.0 blood cells' health that is recorded during
a complete blood count. Anything above
or below that may indicate an underlying
condition, usually a type of anemia.

MCHC 333 g/L 316-354 an MCHC test is to evaluate whether RBC

are carrying an appropriate amount of
hemoglobin. MCHC is one of several
measurements used to assess the
function and health of RBC to check for
signs of anemia and other blood
disorders.
HEMATOLOGY SECTION

CBC RANGE INTERPRETATION

RDW f RDW is too high, it could be an indication

H 0.171 0.110- of a nutrient deficiency, such as a
0.160 deficiency of iron, folate, or vitamin B-12.
If low RDW level is macrocytic anemia

WBC 9.47 10^9/L 3.50-9.50 For men, a normal white blood cell count
COUNT is anywhere between 5,000 and 10,000
white blood cells per ul of blood. For
women, it is a reading of between 4,500
and 11,000 per ul, and for children
between 5,000 and 10,000.
HEMATOLOGY SECTION

CBC RANGE INTERPRETATION

Neutrophils are a type of white blood cell.
Neutro 0.60 0.40-0.75 More specifically, they form the most
phils abundant type of granulocytes and make up
40% to 70% of all white blood cells in
humans. They form an essential part of the
innate immune system, with their functions
Lymph L 0.11 0.20-0.50 varying in immune
A type of different cell
animals.
that is made in the
ocyte bone marrow and is found in the blood
and in lymph tissue. The two main types
of lymphocytes are B lymphocytes and T
lymphocytes.
HEMATOLOGY SECTION

CBC RANGE INTERPRETATION

Monoc A type of immune cell that is made in

0.08 0.05-0.10
yte the bone marrow and travels
through the blood to tissues in the
body where it becomes a
macrophage or a dendritic cell.
Eosino H 0.21 0.004- Eosinophils are a type of white blood
phils
0.008 cell that protect your body from
parasites, allergens, foreign bacteria and
outside organisms.
a type of white blood cell that works closely with your immune
Basophils 0.00 0.00-0.010 system to defend your body from allergens, pathogens and
parasites
VIII. DRUG STUDY
VIII. DRUG STUDY

1. Metronidazole Hydrochloride
2. Ketorolac Tromethamine
3. Tramadol Hydrochloride
4. Ranitidine Hydrochloride
5. Mefencamic Acid
6. Ceftriaxone
IX. NURSING CARE PLAN
IX. Nursing Care Plan

ACTUAL NCP
Imbalance nutrition: less than body
requirements related to intrinsic biological ill
effect of food secondary to colonic mass
disease process
Readiness for enhanced health literacy related
to inadequate knowledge of health
resources/facility available.
IX. Nursing Care Plan

POTENTIAL NCP
Risk for infection related to surgical incision
secondary to exploratory laparotomy.

ACTUAL NCP (Pre-op)

Acute pain related to pressure to build up in
the abdomen secondary to colonic mass as
evidenced by pain scale of 7/10 and decrease
physical activity.
X. MEDICAL MANAGEMENT
 1. Ceftriaxone 2grams OD IVTT
2. Metronidazole 50mg @8h-IVTT
3. Ranitidine 50 @8h IVTT x 6 dose
4. Tranexamic acid 500mg IV @ x5d
5. Paracetamol 30mg @ 6hr
6. Ketorolac 15mg IV @ 6h x 6 doses
7. Ketorolac 30mgTIV q8h
8. Nubain 5mg @ 6H
9. Tramadol 50mg q8h
10. Tramadol 500 mg PRN q8
11. Metronidazole 500mg Tab TID
12. Mefenamic acid 500mg per tab TID
13. KCL 2 tab TID x 6 doses
14. Omeprazole 40 mg IV OD 1
15. Metoclopromide 1 Amp q8h IV x 3d
16. Dulcolax 5mg/tab 2 tabs
lifestyle RE FR A IN FROM
E N G A GING IN
SM O K ING AND THE
modificatio C O N S UMPTION OF
A D V I CE LOW FAT,
LO W CALORIE DIET
E XCE S SIVE
ns A M O U NTS OF
A L C O HOL.

RE DU CE THE PROM OTE

IN T A KE OF RED E N G A GEMENT IN
M E A T AND PH Y S ICAL
PROC ESSED MEAT A C T I VITIES, SUCH
TO A MINIMUM. A S E XERCISE.
Follow up
A S S E SS VITAL
monitoring SIGN S , BOWEL
IM A G ING STUDIES
FO R INTESTINAL
FU N C TION, AND I/O B L E E DING
C O N C ERNS

C O L L A B O R A TE WI TH
P R O C T O L O G I ST AN D
O T H E R S P E C I A L I ST
FOR FURTHER
REFERRAL.
 INSTRUCT THE PATIENT
Patient TO RECOGNIZE
MODIFIABLE RISK
PROMOTE ADHERENCE TO
MEDICAL

Monitoring FACTORS, AS WELL AS

WARNING SIGNS AND
RECOMMENDATIONS,
INCLUDING MEDICATION
SYMPTOMS, REGIMEN, SCREENINGS,
PROMPTING TIMELY AND DAILY SUPPLEMENT
MEDICAL ATTENTION. INTAKE.

H I G H L I G H T TH E FACILITATE PATIENT
COMPREHENSION OF THE
IMPORTANCE OF
INTRICACIES OF THEIR
LIFESTYLE MEDICAL STATUS AND
A D J U S T M E N TS TO ADVOCATE FOR
P R O M O T E O PTI MAL COLLABORATIVE
H E A L T H A N D WE L L - ENGAGEMENT WITH
BEING HEALTHCARE PROVIDERS
XI. SURGICAL MANAGEMENT
SURGICAL PROCEDURE
medical interventions involving an
incision with instruments usually
performed in an operating theatre and
normally involving anaesthesia and/or
respiratory assistance.

NURSING MANAGEMENT
It includes processes common to all
management like planning,
organizing, staffing, directing and
controlling.
 NURSING MANAGEMENT FOR PRE-PROCEDURE

EXPLORATORY Assessment:
LAPAROTOMY Conduct a thorough pre-operative assessment, including the
Exploratory laparotomy patient's medical history, allergies, medications, and current
is surgery to open up health status.
the belly area
Assess the patient's emotional and psychological state,
(abdomen). This surgery
is done to find the cause providing support and addressing any concerns or anxiety.
of problems (such as Evaluate vital signs, laboratory results, and diagnostic tests to
pain or bleeding) that
testing could not
identify potential risks.
diagnose. It's also used
when an abdominal
Patient Education:
injury needs emergency
medical care. This Provide detailed information about the procedure, including
surgery uses one large its purpose, risks, benefits, and potential outcomes.
cut (incision).
Result: Ascending Cecal
Colonic Mass; Obstructing
Explain the pre-operative and post-operative processes to
help alleviate anxiety and promote patient cooperation.
NURSING MANAGEMENT FOR PRE-PROCEDURE

Informed Consent:
Ensure that the patient has signed a valid informed consent form after
receiving comprehensive information about the surgery

Preparation:
Administer pre-operative medications as ordered, including antibiotics and
prophylactic medications to prevent complications.
Ensure the patient follows fasting guidelines to prevent aspiration during
anesthesia.
Administer pre-operative enemas or bowel preparations as prescribed.

Skin Preparation:
Instruct the patient to shower with an antimicrobial soap before the surgery.
Ensure proper skin preparation at the surgical site, following hospital
NURSING MANAGEMENT FOR PRE-PROCEDURE
IV Access:
Establish intravenous (IV) access for fluid and medication administration.
Administer IV fluids as prescribed, ensuring the patient is adequately
hydrated.

Monitoring:
Continuously monitor and document vital signs.
Monitor intake and output to assess fluid balance.
Assess and document the patient's pain level and administer pain
medication as ordered.

Psychosocial Support:
Provide emotional support and reassurance to alleviate anxiety.
Involve family members in the support process, if appropriate.
NURSING MANAGEMENT FOR PRE-PROCEDURE
Pre-operative Checklist:
Complete a pre-operative checklist, ensuring all necessary pre-operative tasks are
completed.
Confirm that the surgical site is correctly marked and matches the consent form.

Collaboration with the Surgical Team:

Communicate effectively with the surgical team, ensuring all necessary preparations
are in place.
Verify the availability of required equipment and supplies for the surgery.

Documentation:
Document all assessments, interventions, and communications accurately in the
patient's medical record.

Handoff Communication:
Provide a thorough and accurate handoff to the surgical team, including pertinent
 NURSING MANAGEMENT FOR INTRA-PROCEDURE
Patient Positioning:
Assist with proper positioning of the patient on the operating table to provide
optimal exposure
Ensure adequate padding and support to prevent pressure injuries.

Monitoring:
Continuously monitor vital signs, including heart rate, blood pressure, respiratory
rate, and oxygen saturation.
Monitor electrocardiogram (ECG) and end-tidal carbon dioxide (ETCO2) if
applicable.

Maintaining asepsis:
Collaborate with the surgical team to maintain a sterile field.
Monitor and enforce aseptic techniques to prevent surgical site infections.
 NURSING MANAGEMENT FOR INTRA-PROCEDURE
Assisting with Induction:
Collaborate with the anesthesia team during the induction of anesthesia.
Assist in positioning the patient's airway and securing the endotracheal
tube.

Instrument and Supply Management:

Anticipate the needs of the surgical team by providing the necessary
instruments and supplies.
Maintain a correct count of surgical instruments and sponges throughout
the procedure.

Communication:
Facilitate effective communication between the surgical team members.
Relay important information between the surgical team and other
 NURSING MANAGEMENT FOR INTRA-PROCEDURE
Medication Administration:
Administer medications as prescribed, including anesthesia and other
intraoperative medications.
Monitor the patient for any adverse reactions to medications.

Fluid and Blood Administration:

Administer intravenous fluids as prescribed to maintain adequate
hydration.
Assist with blood transfusions if necessary and monitor the patient's
response.

Temperature Regulation:
Monitor and regulate the patient's body temperature to prevent
 NURSING MANAGEMENT FOR INTRA-PROCEDURE
Wound Care:
Assist with the preparation of the surgical site, ensuring proper draping.
Monitor the wound for any signs of bleeding and report to the surgical
team.

Documentation:
Document intraoperative events, interventions, and any unexpected
findings.
Maintain accurate records of fluid input and output.

Patient Advocacy:
Advocate for the patient's safety and well-being throughout the
procedure.
 NURSING MANAGEMENT FOR INTRA-PROCEDURE

Preparing for Closure:

Anticipate the needs for wound closure and collaborate with the
surgical team during this phase.
Ensure that all sponges and instruments are accounted for before
closure.

Handoff Communication:
Provide a thorough handoff report to the post-anesthesia care unit
(PACU) or the designated receiving area, including key
intraoperative events and the patient's status.
 NURSING MANAGEMENT FOR POST-PROCEDURE

Immediate Postoperative Care:

Transfer the patient to the post-anesthesia care unit (PACU) or
recovery area.
Monitor vital signs frequently, ensuring stability as the patient
emerges from anesthesia.

Airway Management:
Assess and maintain the patient's airway, ensuring proper
oxygenation and ventilation.
Administer supplemental oxygen as needed.
 NURSING MANAGEMENT FOR POST-PROCEDURE

Pain Management:
Assess and manage postoperative pain using a combination of
pharmacological and non-pharmacological interventions.
Administer pain medications as prescribed and evaluate their
effectiveness.

Fluid and Electrolyte Balance:

Monitor and manage fluid balance, assessing for signs of
dehydration or fluid overload.
Monitor electrolyte levels and address any imbalances.
NURSING MANAGEMENT FOR POST-PROCEDURE
Wound Care:
Monitor the surgical site for signs of infection, hematoma, or
dehiscence.
Follow the surgeon's instructions for wound care and dressing
changes.

Mobility and Ambulation:

Encourage early mobilization and ambulation to prevent
complications such as deep vein thrombosis (DVT) and atelectasis.
Provide support and assistance as needed.

Gastrointestinal Function:
Assess bowel sounds and monitor for the return of bowel function.
 NURSING MANAGEMENT FOR POST-PROCEDURE
Urinary Function:
Monitor urinary output and assess for signs of urinary retention or
complications.
Ensure proper functioning of urinary catheters if in place.

Nutritional Support:
Initiate and advance the patient's diet as prescribed, considering any
dietary restrictions.
Monitor nutritional intake and address any concerns.

Pulmonary Care:
Encourage deep breathing exercises and incentive spirometry to prevent
respiratory complications.
Monitor for signs of respiratory distress and intervene as necessary.
 NURSING MANAGEMENT FOR POST-PROCEDURE

Discharge Planning:
Collaborate with the healthcare team to plan for the patient's
discharge.
Provide education on postoperative care, medication management,
and signs of potential complications.

Follow-up:
Schedule follow-up appointments with the surgical team to assess the
progress of recovery.
Provide contact information for any questions or concerns after
discharge.
XII. PROGNOSIS
The prognosis of ascending cecal colonic mass, or colon cancer in general, depends on
several factors, including the stage at which the cancer is diagnosed, the extent of
spread, the individual's overall health, and the effectiveness of treatment. Prognosis is
typically categorized into stages:

1. Early Stages (I and II): If the cancer is diagnosed at an early stage when it is localized
to the colon, the prognosis is generally more favorable. Surgical removal of the tumor is
often curative in these cases.

2. Intermediate Stage (III): In stage III, the cancer has spread to nearby lymph nodes
but has not reached distant organs. Treatment usually involves surgery to remove the
tumor along with chemotherapy. Prognosis can vary, and the five-year survival rate is
lower compared to early stages.

3. Advanced Stage (IV): Stage IV colon cancer indicates that the cancer has metastasized
to distant organs, such as the liver or lungs. Treatment may involve surgery,
XII. DISCHARGE PLANNING
 METHODS RATIONALE
How to Know if Nursing is For You
Medication
Patient should be instructed about his/her Instructing patients about the correct dosage
medication at home prescribed by his/her and timing of medications ensures they take
physician. them as prescribed. Emphasize the
importance of adhering to the prescribed
Here are some of medication that is related to schedule to achieve the best therapeutic
patient condition effect.
Ferrous sulfate + folic acid 1 Tab OD PO 3
weeks before breakfast.

General home medication:

Silgram 750 mg TID
Metronidazole 500 mg TID
Celecoxib 200 mg/ capsule BID
 METHODS
How to Know if Nursing is For You
Follow up
The patient should follow up with their
doctor in 1 week to assess their recovery.
At that time, the doctor will check for any
signs of infection and determine if the
patient needs any further treatment.
Diet
Offer dietary recommendations to manage
symptoms, considering the conditions. For
example, a low-fiber diet might be
recommended
RATIONALE
A one-week follow-up allows the doctor to
evaluate the patient’s progress in recovering
from conditions such as an ascending colonic
mass and obstructive empyema of the
gallbladder with multiple stones. This
assessment helps determine if the prescribed
treatment is effective.
The patient should be instructed to eat a
healthy diet that is low in fat and easy to
digest. They should avoid foods that are high
in fat, such as fried foods, fatty meats, and full-
fat dairy products. They should also avoid
foods that are spicy or difficult to digest, such
as raw vegetables and fruits, and processed
 METHODS
How to Know if Nursing is For You
Activity
The patient should be instructed to avoid
strenuous activity for 2-4 weeks after being
discharged from the hospital. This will
allow their body to heal properly. They
should also avoid lifting anything heavier
than 10 pounds.
Patient Education:
Ensure the patient understands the nature
of their conditions, the importance of
medication adherence, and the
significance of follow-up appointments.
RATIONALE
Strenuous physical activity, including heavy
lifting, can strain the body and impede the
healing process for conditions such as an
ascending colonic mass or obstructive
empyema of the gallbladder with multiple
stones. By limiting physical exertion, the body
can focus its energy on healing and recovery.
Understanding the conditions fosters a sense
of control and engagement in their own
healthcare.
 METHODS RATIONALE
How to Know if Nursing is For You
Psychosocial Support:
Address any emotional or psychological Diagnosis of conditions such as an ascending
concerns related to the conditions and colonic mass or obstructive empyema of the
provide information on available gallbladder with multiple stones can have a
counseling or support services. significant emotional toll on individuals.
Anxiety, depression, fear, and stress are
common reactions that can affect a patient’s
mental well-being.
Spiritual:
Encourage the patient to find solace in her Spiritual support can provide emotional
faith by praying for strength, health, and resilience and comfort during challenging
hope from God. times, fostering a positive outlook on health
and recovery.
XIV. CONCLUSIONS
 The case of the patient with an ascending cecal colonic mass,
presenting initially with abdominal pain, underscores the
complexity and challenges inherent in diagnosing and managing
abdominal conditions especially in colon. The patient's journey,
marked by a misdiagnosis of possible appendicitis and an
interrupted ovarian mass surgery, reflects how the disease is
complex, whereas the patient become asymptomatic, and in some
cases, manifestation of symptoms-like appendicitis occurs. As the
mass or cancer advanced, the nearby tissues and/or organs
become affected and precipitated by the mass through
inflammation, the liver for instance, which result to cholecystitis
and multiple stones in the gallbladder. Furthermore, this
misdiagnosis case, adds up how the importance of thorough
The delayed identification of the ascending colon mass, discovered
during an exploratory laparotomy, highlights the necessity for
advanced diagnostic modalities, as evidenced by the subsequent
Computed Tomography scan. The collaborative efforts between
the medical team and the attending physician further exemplify
the significance of communication and expert consultation in
arriving at a conclusive diagnosis and treatment like surgeries,
right hemicolectomy, and cholecystectomy.

As the patient's pain persisted, her decision to return home

facilitated a more comprehensive evaluation, ultimately leading to
a more accurate diagnosis. This case underscores the importance
of persistence in seeking medical attention, as well as the need for
a holistic approach to healthcare that considers a patient's entire
Moving forward, the insights gained from this case emphasize the
importance of continuous medical education, diagnostic vigilance,
and patient advocacy. By learning from experiences such as these,
we enhance our ability to provide timely and accurate diagnoses,
improving patient outcomes and fostering a culture of patient-
centered care. This case serves as a reminder that each patient's
journey is unique, and comprehensive collaboration among
healthcare professionals is paramount in navigating the
complexities of medical conditions.
RECOMMENDATIONS

This case study aims to provide a detailed analysis of a patient presenting with an
ascending cecal colonic mass. The investigation encompasses the patient's medical
history, signs and symptoms, factors and etiology, pathophysiology, diagnostic
procedures, treatment options, and overall outcomes. By delving into the complexities
of this case. Our group would recommend the following:

o the Patient, Family and Friends To the patient, we would like to express our sincere
admiration for the resilience and courage you have displayed throughout your journey
with the ascending cecal colonic mass. Your commitment to your health and the
collaborative spirit you demonstrated with the healthcare team have left a lasting
impression. Thus, with proper care and follow-up, you can manage your condition and
maintain a good quality of life. Here are some specific recommendations for you:
Follow your treatment plan carefully. This includes taking your medications as
prescribed and attending all of your appointments. Make lifestyle changes to improve
your overall health. This includes eating a healthy diet, exercising regularly, and
maintaining a healthy weight.
To our patient's family and friends, in witnessing the unwavering support and
care provided by you, the family and friends, we are compelled to acknowledge
the vital role you played in the patient's recovery. Your emotional strength and
commitment to their well-being significantly contributed to a positive healing
environment. May you continuously offer your unwavering emotional support to
the patient. She may be feeling anxious or scared about their diagnosis. Let the
patient know that you are there for her and that you will help her in any way that
you can.

To the Nursing Practice We want to commend the Socsargen County Hospital

nursing practice team involved in the care of the patient. Your professionalism,
compassion, and attention to detail were evident in every aspect of the case. The
collaborative efforts and commitment to patient-centered care have set a
commendable standard for nursing practice. This case serves as a testament to
the importance of a holistic approach to patient care, where the synergy between
healthcare professionals, patients, and their support networks plays a pivotal
XV. REFERENCES
 Aubrey-Jones, D. (2023, October 3). The Cecum - Position - Vasculature
- TeachMeAnatomy. TeachMeAnatomy.
https://teachmeanatomy.info/abdomen/gi-tract/cecum/

Azzouz, L. L., & Sharma, S. (2023, July 31). Physiology, large intestine.
StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK507857/

Tresca, A. J. (2023, July 3). The anatomy of the ascending colon.

Verywell Health. https://www.verywellhealth.com/ascending-colon-
anatomy-5184808

Young, B., Lowe, J. S., Stevens, A., Heath, J. W., & Deakin, P. J. (2006).
Wheater’s functional histology. Elsevier Health Sciences. Raghavan R,
Cohen S. Cecal volvulus. [Updated 2021 May 22]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK459349/

XV. REFERENCES Gollub MJ, Aryaie AH. Cecal Masses. In: Blumetti J, editor. StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK431073/ Kahi
THANK YOU!

BANDIOLA, JAPHETH JABRAIN T.

ABANDO, KESHIA ANGELINE S.
ALABADO, ATHENA SHYLA M.
AGCAOILI, RIAN MIGUEL M.
ABDULLATIP, JOHANNA Z.
TULADTEG, MUHAINA K.
AMBAG, LED HAYRAH S.
BAYOG, LENNY JOY S.
AKMAD, SERHANA A.
ASIS, JADE DYLL C.