Modifiable Non-Modifiable

 Overweight or Obesity 7  Family history of colon cancer

 High consumption of alcohol  History of type 2 diabetes
 Cigarette smoking  Gender (Male)
 History of inflammatory bowel disease
 History of cancer

Modifiable Non-Modifiable
Sporadic Mutation Mutations in DNA Repair Gene  Overweight or Obesity  Family history of CKD
 High consumption of alcohol  Age
 Cigarette smoking
 Diabetes Mellitus
Cell line mutation  Hypertension

Apoptosis

Non-enzyme glycation
Uncontrolled cell division in the colon
Legends:
Stiffness/narrowing of efferent arteriole
Polyps Risk Factors (Hyaline Arteriosclerosis)

Disease Process
Tubular Adenomas
Difficult for blood to leave Increase pressure within
Disease glomerulus the glomerulus
More Mutations
Signs and Symptoms

Surgical Intervention Hyperfiltration

Might become malignant
Complication
Invades tissues Secretions of more
Nursing Diagnosis structural matrix

Abdominal Pain Adenocarcinoma of the Colon Medical Device

(Colorectal Cancer) Expansion of glomerulus

Local growth of tumor Glomerulosclerosis

Tumor in Descending Colon Diminish nephron’s ability to

filter blood

Colostomy Bag Left Hemicolectomy

Decrease Glomerular Filtration Rate

Disturbed sleep pattern related Anastomosis

to required colostomy care and Chronic Kidney Disease
effluent (CKD)
Anastomotic Failure
Elevated White Blood Count
Exploratory laparotomy Poor blood and oxygen supply Decreased renal excretion of Decreased Bicarbonate Reduced filtration capability
Infection on the entire body electrolytes and water production, borderline pH, and that leads increase organic
Anastomotic Leak decreased PCO2 anions remaining in the blood
Impaired/lessening healing
Altered electrolyte
Minimal Abdominal factors of organs and cells
imbalance related to renal Metabolic Acidosis
Ascites dysfunction
Ischemia
Jackson-Pratt (JP) Drain Increased extracellular fluid
Impaired tissue Integrity
related to Impaired Systemic volume overload
circulation

Hypertension Grade 2 Edema on

upper extremities
Most colorectal carcinomas are adenocarcinoma meaning that they are arise from the cells lining of the intestinal
glands.
Most cases of colorectal
 Most cases are due to sporadic mutations - a sporadic genetic disease is not inherited from parents, but
arises via a mutation. However, a sporadic genetic disease becomes inheritable to children of the person
who has acquired the genetic disease via mutation.
 Some due to known mutations from person’s family.
o Examples; Adenomatous Polyposis Coli Gene Mutation (APC) - is a rare, inherited condition
caused by a defect in the adenomatous polyposis coli (APC) gene. APC is a tumor suppressor
gene.
 APC proteins identifies when the cells a lot of mutation and forces to undergo apoptosis –
program cell death. Note; mutated bowel cells don’t die, instead it starts dividing
uncontrollably.
 If APC is mutated it can allow uncontrolled division (in the colon and rectum) which can
form polyps that we can also called as tubular adenomas which is a precancerous polyp.
 As a (more) mutations it might become a malignant tumor that can invades neighboring tissues and
because it develops over time it forms as malignant form of polyps - Adenocarcinoma of the Colon which
also called as Colorectal Cancer.
o One of the mechanisms of Colorectal Cancer is Local growth of the Tumor is also referred as
neoplasm that is defined as abnormal or excessively growth of the tissue in the localized area. To
be more precise the tumor grows at the descending colon of the patient.
 That leads to our patient to undergo Anastomosis a surgical connection between two structures.

Before we proceed to the main diagnosis of the patient, we must proceed first to the other disease that
patient has that can contribute to the diagnosis of the patient.

Risk Factors of the CKD

The most common cause of CKD is Diabetes, excess glucose in the blood start sticking to protein in the
blood (- a process called non-enzymatic glycation) because there is no enzymes are involve. This kind of
process affect the efferent arteriole and causes it to go stiff and narrow (-a process called hyaline
arteriosclerosis). It creates an obstruction that makes it difficult for the blood to leave the glomerulus,
and it increases pressure within the glomerulus leading to hyperfiltration (pushing more fluid through).
In response to high pressure state, the supportive mesangial cells secrete more and more structural
matrix which expands the size of the glomerulus. Over the time, the process of Glomerulosclerosis (eh
kasi nga nasisira dahil sa pressure) diminishes the nephron’s ability to filter the blood and leads to
Chronic Kidney Disease (CKD)

These risk factors can or may damage the glomerular of the kidney, so once the glomerular of the kidney
has been damaged it may cause Glomerulosclerosis (is scarring in the tiny blood vessels in the kidneys
called the glomeruli) so since it is glomerulosclerosis occur The Nephron’s ability to filter the blood is
diminished and over the time this leads to Decreased Glomerular Filtration Rate and leads to Chronic
Kidney Disease (CKD).

So CKD has mechanisms that may contribute to what our patient is manifesting. In individuals with
Chronic Kidney Disease (CKD), metabolic acidosis can develop due to the kidneys' reduced ability to
excrete excess acid and maintain proper acid-base balance. This condition is reflected in arterial blood
gas (ABG) readings, which typically show a lower pH, decreased bicarbonate levels, and increased pCO2
levels. These findings indicate acidemia (excess acid in the blood) and respiratory compensation
(increased breathing to eliminate carbon dioxide) due to reduced bicarbonate production. Reduced
Filtration Capability: In individuals with reduced kidney function, such as those with chronic kidney
disease (CKD), the filtration capacity of the glomeruli (the tiny filtering units in the kidneys) is
compromised. As a result, the kidneys may struggle to effectively filter the blood and excrete waste
products, including ammonium. Increased Organic Anions: In CKD and related conditions, the kidneys
may have difficulty filtering and excreting organic anions, which are negatively charged molecules like
citrate or oxalate. These organic anions are normally excreted in the urine, helping to regulate acid-base
balance. When kidney function is impaired, these organic anions can accumulate in the blood. The
combination of decreased renal excretion of ammonium and the accumulation of organic anions in the
blood can result in an increased acid load in the body. This excess acid, if not effectively eliminated, can
lead to a decrease in blood pH and the development of metabolic acidosis.

Decreased renal excretion of electrolytes and water: In CKD, the kidneys become less effective at
regulating the balance of salt and water in the body. Increased extracellular fluid: As a result, there's an
accumulation of salt and water in the extracellular fluid (outside the cells), which increases the volume
of fluid in the body. Systemic volume overload: The increased extracellular fluid leads to systemic
volume overload, affecting various body systems. Hypertension: The excess fluid and volume overload
can contribute to high blood pressure (hypertension), as the heart has to work harder to circulate the
increased blood volume. Edema: Excess fluid can also accumulate in tissues, leading to edema, which is
the swelling of various parts of the body. In CKD, the inability of the kidneys to properly manage salt and
water balance can contribute to systemic volume overload, hypertension, and edema, all of which can
have significant health consequences.
Chronic Kidney Disease (CKD) can lead to poor blood and oxygen supply throughout the body. This
reduced supply can impair the healing abilities of organs and cells, making the body less effective at
repairing and regenerating damaged tissue. An impaired healing factor in the body may contribute to
complications like anastomotic failure after surgery. Anastomotic failure is when a surgical connection
between two structures, such as blood vessels or intestines, doesn't heal properly, leading to issues like
leakage or other complications. In CKD, the overall health of the body is compromised, which can make it
more challenging for tissues to heal and recover after surgical procedures, potentially increasing the risk
of complications like anastomotic failure. [and due to anastomotic failure patient experienced abdominal
pain and diagnosed by the Doctors as (Acute Abdomen Secondary to Anastomotic Failure)]