I. INTRODUCTION A.

Overview of the study

Colon cancer ranks 6th overall leading cause of cancer-related deaths, 5th among males and 7th among females. An estimated 2,963 new cases, 1,548 in males 1,415 in females, together with 1,567 deaths will be seen in 1998. Colon cancer increases markedly after age 50. A malignancy in the colon can be referred to as colorectal cancer. Strictly speaking, a malignancy in the colon is colon cancer and a malignancy in the rectum is rectal cancer. Most colon cancers occur on the left side in the sigmoid region. The colon is a muscular tube approximately 6 feet long connecting the small intestine to the rectum. The right side of your body has the ascending colon which receives waste from the small intestine. This ascends upward to the transverse colon which crosses over the small intestines and descends on the left side of the body as the descending colon. At the bottom the colon again crosses the belly toward the rectum as the sigmoid colon. Finally, the sigmoid colon empties into the 8-inch rectum. When the cells that line the colon or rectum start to proliferate in an uncontrolled manner it is called a tumor. It is common to find a benign type of growth called polyps. These are small and produce few, if any, symptoms. However, over time these polyps can grow and develop into cancer.

B. Objectives and Purpose of the Study As a student nurse, it is indeed my vocation to adjoined hands with the health care team for the promotion of wellness of our clients. My main goals for this study are the following: To establish rapport To identify chief complaints of clients to give its specific interventions To determine the family and personal history of the client that many affect clients present condition To identify the cause and effect the main problem through the correct analysis of the pathophysiology of the case To determine the medical management given through identifying doctors order and its rationale To make nursing care plans for the different health problems encountered by the client To evaluate the effectiveness of the actual nursing care plan that was established C. Scope and Limitation of the Study Specifically this study is more concerned with the care of one patient in PGH , Medical Ward. I performed physical assessment to the patient to properly identify the nursing problems, which requires necessary and direct interventions and medical regimen. I had 2 days duty or 16 hours care for the patient and some limited informants.. Thus this care study focuses on the particular case of the patient. The study of the medications and doctors order are limited to our chosen patient, a case of Colon Cancer.

II. HEALTH HISTORY A. Patients Profile Name of Patient: RF Sex: Male Age: 73 Birthday: May 31, 1938 Birthplace: Misamis Oriental Religion: PIC Civil Status: Married Educational Attainment: CollegeLevel Occupation: OFW Number of Siblings: 5 Nationality: Filipino Date Admitted: July 5, 2011 Time Admitted: 5:15 pm Informant: Daughter Blood Pressure: 110/60 mmHg Temperature: 36.7O C Pulse Rate: 82 bpm Respiration: 21 cpm Allergy: No known allergy Attending Physician: Dr. O Admitting Diagnosis: T/C Colon Cancer

B. Past Health History and Family history Mr. RF verbalized he has been confined due to gastritis but he already forgot about the date he was admitted. He has no allergy to any foods or other stuffs. The paternal side of the patient had a heredity of cardiovascular disease while at the maternal side, the patient cant trace any diseases.

C. Chief Complains and History of Present Illness Patient RF, 83 years old, from Lapasan, CDOC, few days prior to admission he already experienced poor appetite and severe generalized body weakness and due to this instance,he was brought to PGH by his daughter last July 5, 2011 with the admitting diagnosis of T/C Colonic cancer. the initial vital signs of: temperature- 36.7 C, respiratory rate- 21 cpm, and a pulse rate of 82 bpm.

III. DEVELOPMENT DATA A. Erik Eriksons Stages of Psychosocial Development Theory Erikson describes eight developmental stages through which a healthily developing human should pass from infancy to late adulthood. In each stage the person confronts, and hopefully masters, new challenges. Each stage builds on the successful completion of earlier stages. The challenges of stages not successfully completed may be expected to reappear as problems in the future. Each of Erikson's stages of psychosocial development are marked by a conflict, for which successful resolution will result in a favourable outcome and by an important event that this conflict resolves itself around. In the Eriksons 8th stage of psychosocial Development theory which is Senior: Integrity vs. Despair (65 years onwards). Integrity means moral soundness, whole or completeness of a person, Despair means being hopeless. When it comes to my patient he was loosing hope that his illness will be cure, it is because he feels that he was really old and he dont have the capabilities of living the way it should be. But still, because of the support of the family little by little he was trying to understand his situation tried to think on positive side and for himr to live longer for his family that still need him as a father, as a grandfather and as a husband. B. Sigmund Freuds Psychosexual Development Theory According to Freud, people enter the world as unbridled pleasure seekers. Specifically, people seek pleasure through from a series of

erogenous zones. These erogenous zones are only part of the story, as the social relations learned when focused on each of the zones are also important. Freud's theory of development has 2 primary ideas: One, everything you become is determined by your first few years - indeed, the adult is exclusively determined by the child's experiences, because whatever actions occur in adulthood are based on a blueprint laid down in the earliest years of life (childhood solutions to problems are perpetuated) Two, the story of development is the story of how to handle anti-social impulses in socially acceptable ways. My patient belongs to the genital stage which begins at puberty involves the development of the genitals, and libido begins to be used in its sexual role. However, those feelings for the opposite sex are a source of anxiety, because they are reminders of the feelings for the parents and the trauma that resulted from all that. C.Robert J. Havighursts Developmental Task Theory Havighurst categorized the tasks, in first category are the tasks, which has to be completed in certain period, and the second are the tasks that continue for a long, sometimes for a lifetime.So what happens if the task is not completed in that stage or completed in a later date? Havighurst reply to that it is critical that the tasks should be completed during the appropriate stage, otherwise result will be the failure to achieve success in future tasks. D. Jean Piagets Theory of Development According to Piaget, development is driven by the process of equilibration. Equilibration encompasses assimilation (i.e., people transform incoming information so that it fits within their existing schemes or thought patterns) and accommodation (i.e., people adapt their schemes to include incoming information). My patient belongs to the formal operational stage. In this stage, individuals move beyond concrete experiences and begin to think abstractly, reason logically and draw conclusions from the information available, as well as apply all these processes to hypothetical situations. The abstract quality of the adolescent's thought at the formal operational level is evident in the adolescent's verbal problem solving ability. The logical quality of

the adolescent's thought is when children are more likely to solve problems in a trial-and-error fashion. Adolescents begin to think more as a scientist thinks, devising plans to solve problems and systematically testing solutions. They use hypothetical-deductive reasoning, which means that they develop hypotheses or best guesses, and systematically deduce, or conclude, which is the best path to follow in solving the problem.

IV. MEDICAL MANAGEMENT A. DOCTORS ORDER

Order 7/5/11 Please admit under the service of Dr. O Secure Consent to care Monitor or V/S q 4 Start venodysis w/ D5NSS IL @ 15 gtts/min LABS: -CBC -Urinalysis -Chest x-ray PA -Serum Na+, K+ creatinine MEDS - Vamin 500 cc for 12 hours I & O q shift Refer accordingly 7/6/11 NaCl 1 tab TID Iterax tramal 7/7/11 hold iterax Morphine 10g 1 tab q 8o D/C tramal once Morphine is started 7/8/11 continue meds 7/9/11 Paracetamol 500g 1 tab q 4 PRN for fever D/C vamin when consumed Flanax 275 g 1 tab BID IVF to ff D5NSS1L @ 15 gtts/min

7/10/11 d/c flanax refer to Dr. RY for colonoscopy & Biopsy - if for colonoscopy pls. do 1. CXR 2. ECG 12 leads 7/11/11 may change FBC in AM per request 7/12/11 follow up CXR result for possible colo this am depending on response of bowel prep give morphine 10 mg 1 tab now increase IVF rate to 25 gtts/min 7/13/11 give flanax 1 tab sched for colo @ 9 am tomorrow - do the routine bowel prep - refer to Dr. G 7/14/11 suggest surgical consult colostomy schedule noted resume previous diet resume vamin 500 cc to run for 12 hours refer to Cr. RY for evaluation if ok w/ family plan : Diverting loop colostomy ?& debarment of perineal abcess 7/15/11 request CBC, serum Nat, Kt, Crea, SGPT secure unit of PRBC for possible transfusion pls. facilitate hot sitz bath for 15 min 3 x a day for 2 -3 days provide bedside commode pls. transfuse 2 units of PRBCof blod type @ 20 gtts/min please close main IVF line once BT is ongoing 7/16/11 secure another units of FWB for possible BT repeat CC result 7/17/11 absolute NPO once vamin glucose is consumed; start kabiverl 2,000 kcal to run for 24 hours decrease IVF rate to 10 gtts/ min when kabivern is started repeat CBC result request for ECG 12 leads for possible sigmoid coop colostomy @ 1 pm 7/18/11 hold all meds transfuse: 1 unit of available FWB @ 20 gtts/min start O2 @ 2 L/min check 02 sat

 proceed scheduled sigmoid loop colostomy @ 1 pm 7/19/11 monitor V/S q 15 min I & O q shift Incorporate 20 meq kCl to ongoing IVF of D5NSS 1L regulated @ 20 gtts/min 7/20/11 d/c tramadol decrease O2 inhalation to 2 L/min soft diet sinecoid forte 1 tab TID terminate D5NSS line 7/21/11 full diet 7/22/11 off O2 inhalation fluimucil 2m/sachet 7/23/11 repeat CBC 7/24/11 start tsenam 500mg IV drip q 8 h encourage deep breathing exercise d/c fluimucil 7/25/11 follow up biopsy result 7/26/11 continue tsenam 7/31/11 V/S monitoring q 4 Transfer in ICU Increase Dopa to 3cc.hr 8/1/11 decrease ivf rate to 15 ggts/min 8/2/11 decrease O2 inhaltion to 2 l/min 8/3/11 start dopamine via syringe pump meds FeSO4 1 tab OD 8/4/11 full diet continue vital signs 8/5/11 v/s q hourly I & O q shift 8/7/11 decrease dopamine rate to 9cc/hr decrease IV rate into 15 ggts/min 8/8/11 decrease dopamine rate to 5cc/hr

 encourage deep breathing exercises 8/9/11 > decrease dopa to 4 cc/hr > consume stock tsenam

B. LABORATORY TEST

CHEST XRAY IMPRESSION 1. Consider atelectasis versus pneumothorax, right lung 2. Pneumonia, bilateral 3. Consider cardimegally 4. Atherosclerotic aorta 5. Minimal pleural effusion and or/ thicking, bilateral

Laboratory Result URINALYSIS To detect metabolic disease. To diagnose many specific disorders. Color: pale yellow yellow Negative Glucose: negative clear Turbidity: clear Negative WBC: negative or rare RBC: negative or rare Negative pH: 4.5 -8.0 6.5 Speciy gravity:1.o15-1.025 1.020 Creatinine: 53-120 umol/L BLOOD CHEMISTRY Ordered prior to surgery or a procedure to examine the general health of the patient. HEMATOLOGY Detect blood forming organs and blood diseases 181.4 umol/L High level of creatinine because it was produced by the body during the process of normal muscle breakdown (colorectal cancer)

Hemoglobin mass concentration: 140-170 Lymphocytes: 0.25-0.35

95g/dl 0.38

Indicates cancer Indicates an active viral infection.

Potassuim

3.50-5.10

4.41 mmol/L

Normal

10

V. PATHOPHYSIOLOGY & ANATOMY AND PHYSIOLOGY A. PATHOPHYSIOLOGY COLON CANCER Colorectal cancers arise from dysplastic adenomatous polyps in the majority of cases. There is a multistep process involving the inactivation of a variety of tumour-suppressor and DNA repair genes, along with simultaneous activation of oncogenes. This confers a selective growth advantage to the colonic epithelial cell and drives the transformation from normal colonic epithelium to adenomatous polyp to invasive colorectal cancer. Germline mutations underlie the well-described inherited colon cancer syndromes, whereas sporadic cancers arise from a step-wise accumulation of somatic genetic mutations. A single germline mutation in the adenomatous polyposis coli (APC) tumour suppressor gene is responsible for the dominantly inherited syndrome that bears the same name. Clinical expression of the disease is seen when the inherited mutation of one APC allele is followed by a second hit mutation or deletion of the second allele. Ulcerative colitis and Crohn's colitis are associated with an increased risk of colorectal cancer with an interim step of dysplastic epithelium. Spread of colorectal cancer is to local lymph nodes and via the vasculature to liver and lungs and, less commonly, to bone and brain. However, as survival improves with systemic chemotherapy, bone and brain metastases have been increasingly reported.

11

B. ANATOMY AND PHYSIOLOGY COLON

The colon is also called the large intestine. The ileum (last part of the small intestine) connects to the cecum (first part of the colon) in the lower right abdomen. The rest of the colon is divided into four parts: The ascending colon travels up the right side of the abdomen. The The transverse descending colon colon runs travels across down the the left abdomen. abdomen.

The sigmoid colon is a short curving of the colon, just before the rectum. The colon removes water, salt, and some nutrients forming stool. Muscles line the colon's walls, squeezing its contents along. Billions of bacteria coat the colon and its contents, living in a healthy balance with the body.

12

VI. NURSING REVIEW CHART IV. PHYSICAL ASSESSMENT NURSING SYSTEM REVIEW CHART Name: RF Date: August 8, 2011 Vital Signs: Pulse: 82 bpm BP: 110/60

Temp:

36.7

Respi: 20 cpm

EENT [X] impaired vision [] blind [] pain reddened [] drainage [] gums [] hard of hearing [] deaf [] burning [] edema [] lesion teeth [] asses eyes, ears, nose [] throat for abnormality [] no problem RESPIRATION [] asymmetric [] tachypnea [] barrel chest [] apnea [] rales [] cough [] bradypnea [] shallow [] rhonchi [] sputum [] diminished [] dyspnea [] orthopnea [] labored [] wheezing [] pain [] cyanotic [] assess resp rate, rhythm, depth, pattern [] breath sounds, comfort [X]no problem GASTRO INTESTINAL TRACT [] obese [] distention [] mass [] dysphagia [] rigidly [X] pain [] asses abdomen, bowel habits, swallowing [] bowel sounds, comfort []no problem GENITO-URINARY and GYNE [] pain [] urine color [] vaginal bleeding [] hematuria [] discharge [] nocturia [] assess urine freq., control, color, odor, comfort [] grip, gait, coordination, speech, []no problem NEURO [] paralysis [] stuporous [] unsteady [] seizure [] lethargic [] comatose [] vertigo [] tremors [] confused [] vision [] grip [X] assess motor function, sensation, LOC, strength [] grip, gait, coordination, speech, [X]no problem 2 MUSCULOSKELETAL and SKIN [] appliance [] stiffness [] itching [] petechiae [] hot [] drainage [] prosthesis [] swelling [] lesion [X] poor turgor [] cool [] deformity [] atrophy [] pain [] ecchymosis [] diaphoretic [] assess mobility, motion, gait, alignment, joint function [X] skin color, texture, turgor, integrity [] no problem

Blurry vision

With pitting edema

Abdominal pain noted with the scale of 5/10

Generalized weakness

13

VII. NURSING MANAGEMENT A. IDEAL NURSING MANAGEMENT PATIENT: RF

ASSESSMENT DIAGNOSIS OBJECTIVE INTERVENTIONS RATIONALE EVALUATION Subjective: Pain related to disease After 4-6 hours of -Determine the -To evaluate need The goal has been - Sakit akung tiyan process(inflammation) comprehensive location for effectiveness partially met as verbalized by the secondary to colon nursing intervention, -To promote patient. cancer as evidenced by the patient will be -Provide basic relaxation and health Objective: patient facial able to verbalized a comfort measure like refocus attention - facial grimace appearance of pain minimal reduction of repositioning -Enable patient to -gurading sign noted pain from score of 7 -Encourage use of participate actively - pain scale of 5/10 to 5 (at the pain stress management and enhance sense scale of 10 where 1 like relaxation o control is the lowest and 10 techniques like is the highest) music. -To relieve the pain -Give medication as -To detect whether ordered the patient has fever -Monitor temperature

14

ASSESSMENT
Subjective: -wa koy gana mo kaon as verbalized by the patient -coherent Objective: -sagging of skin -w/ on going IVF of D5 LR 1L @ 30 infusing well at the right arm -FBC attached to UB colostomy noted -sunken eyeballs -thin

DIAGNOSIS
Imbalance nutrition less than body requirements related to pain secondary to colon cancer sensation as evidenced by patient sagging of the skin

OBJECTIVES INTERVENTI ONS

After 4-6 hrs. of comprehensive nursing interventions, the patient will be encouraged to eat even just a little in order to have something or the stomach to digest without triggering nausea and vomiting. -Monitor daily food intake -Encourage patient to eat high calorie, nutrient-rich w/ adequate fluid intake

RATIONALE

ACTUAL EVALUATION

-Metabolic tissue needs as increases as will as fluid supplement can play on important rule in maintaining adequate calorie and protein intake -Can trigger nausea/vomiting -Control response environmental -May prevent onset or factor -Encourage use reduce severity of nausea, decrease of relaxation anorexia and enable techniques patient to increase oral intake -Often a source of emotional distress, especially for SO who -Encourage want to feed open communication rejected/frustrated -Help identify to regarding degree of biochemical anorexia imbalance/malnutrition problem and influence choice of dietary

-Identifies nutritional The goal has been partially strength / deficiencies met

-Review laboratory studies as indicated

interventions

15

ASSESSMENT

DIAGNOSIS

OBJECTIVES INTERVENTIONS

RATIONALE

ACTUAL EVALUATION

16

SUBJECTIVE: kanunay ko kapoy

Fatigue related to altered bodyAfter 4-6 hrs of-Have patient rate fatigue, using a-Help in developing a plan for managing fatigue. as and other medications. interventions, day when it is most severe.

The

goal

has

nagluya ko, paminaw nako chemistry, side effects of painnursing. verbalized by the patient. OBJECTIVE: -Disinterest surrounding -lethargy -seen pt. lying on bed -poor ROM noted in the

numeric scale, If possible, the time of-Frequent rest periods or naps are needed to restore orbeen conserve energy. Planning will allow pt. to be activemet

partially

the patient will-Plan care to allow rest periods.during times when energy. Planning will allow patient to report improveSchedule activities for periods whenbe active during times when energy level is higher, which sense energy. ofpatient has most energy may restore feeling of well being and a sense of control. -Assist patient with self-care needs.-Weakness may make activities of daily living and Keep bed in low position and assistambulation difficult, further assistance is needed. with ambulation. -Enhances strength and enables patient to become more -Encourage patient to do whateveractive without undue fatigue possible and increase activity level as-Poorly managed cancer pain can contribute to fatigue tolerated. -Perform pain assessment provide pain mgt. as prescribed. -Encourage nutritional intake. Collaborative: -Refer for physical therapy. -Adequate intake o nutrient is necessary to meet energy andreserves for activity. -Programmed daily exercises and activities help patient maintain or increase strength and muscle tone which enhances sense of well being.

17

B. ACTUAL NURSING MANAGEMENT PATIENT: RF

S -wa koy gana mo kaon as verbalized by the patient

-sagging of skin -sunken eyeballs -thin

Imbalance nutrition less than body requirements related to pain

After

4-6

hrs.

of

comprehensive

nursing

interventions, the patient will be encouraged to eat even just a little in order to have something I or the stomach to digest -Monitored daily food intake -Encouraged patient to eat high calorie, nutrientrich w/ adequate fluid intake -Controled environmental factor -Encourage use of relaxation techniques -Encouraged open communication regarding anorexia problem -Reviewed laboratory studies as indicated

The patient have eaten a little without vomiting.

18

sakit akong tiyan As verbalized by the patient

>C pain scale of 7/10 >grimace noted >irritable >weakness noted Pain related cancer

to

disease

process(inflammation) secondary to colon

At the end of 30 mins the patient will be able to demonstrate relief from pain

Independent: >monitored v/s >Instructed tondeep breathing excersise >Encouraged to have Diversional activities like watching t.v. >Placed patient in a comfortable position >Encouraged to have adequate bed rest >Provided therapeutic touch Dependent: >Administered Ranitidine as ordered

> goal partially met, patient demonstrate relief from pain

19

nagluya ko, paminaw nako kanunay ko kapoy as verbalized by the patient.

-Disinterest in the surrounding -lethargy -seen pt. lying on bed -poor ROM noted

Fatigue related to altered body chemistry, side effects of pain and other medications.

After 4-6 hrs of nursing. interventions, the patient will report improve sense of energy.

-Have patient rate fatigue, using a numeric scale, If possible, the time of day when it is most severe. -Planned care to allow rest periods. Schedule activities for periods when patient has most energy -Assisedt patient with self-care needs. Keep bed in low position and assist with ambulation. -Encouraged patient to do whatever possible and increase activity level as tolerated. -Perform edpain assessment and provide pain mgt. as prescribed. -Encouraged nutritional intake. Collaborative: -Referred for physical therapy . The goal has been partially met

20

C. DRUG STUDY
DRUG/MEDICATION CLASSIFICATION ACTION INDICATION SIDE EFFECTS NSG. IMPLICATION Tramadol Dose: 150mg Frequency: q 8 route: P.O. Analgesics- relieve painUnknown. A centrally actingModerate without loss ofsynthetic analgesicsevere pain consciousness Anti-depressantssymptoms depressions compound not chemically related to opiates. Drug ofreceptors and serotonin. and inhibit toCNS: Dizziness, CV: Vasodilation EENT: Visual disturbances GI TRACT: Nausea, vomiting,dyspepsia, mouth, and diarrhea. SKIN: Pruritus, and rash. headache, and anxiety.
-use consciously in pt. risk for

vertigo,seizures or respiratory depression;

increased intracranial pressure or head injury, or and acute in abdominal, heptic physical condition impairment; renalor

prevent or relieve thethrough to mind to opiola reuptate of norepinephrine

dependence on opiodes. -monitor bowel and bladder fxn. Anticipate need for laxative.

constipation,- for better analgesic effect give drug drybefore onset of intense pain.
-monitor pt. at risk for seizure. Drug may reduce threshold. -monitor pt. for drug dependence. Drug similar can to produce that of dependence codeine or

dextropropoxyphene and thus has potential for abuse.

21

DRUGS/MEDICATION Paracetamol (biogesic) Route: P.O Dose: 500mg

CLASSIFICATION Antipyretic

ACTION Antipyretic:

INDICATION

SIDE EFFECTS

NSG. IMPLICATION >observed the rights of pain,giving needs >do not exceed the >d/c drug if

reduces>common colds , otherCNS: headache, and bacterialCV: chest

fever by acting directlyviral heat-regulating centerfever. to cause vasodilation and sweating w/c helps discipate heat.

Frequency: P.R.N forAnalgesic fever

on the hypothalamicinfection with pain anddyspnea failure, jaundice.

GI: hepatic toxicity andrecommended dosage. hypersensitivity reaction occurs. >assess allergy >advice patient that paracetamol is only for short-term use.

22

DRUG/MEDICATION Tramal Dose:30 mg Route: IVTT Frequency: q 8

CLASSICATION

ACTION

INDICATION Short-term management o moderately severe, acute pain singledose treatment.

SIDE EFFECTS CNS: drowsiness, sedation, dizziness, headache. CV: edema, hypertension, palpitations. GI: nausea, dyspepsia, GI pain, diarrhea, peptic ulceration, vomiting, constipation, flatulence, stomatitis. HEMATOLOGIC: prolonged bleeding time SKIN: rash, diaphoresis.

NSG.IMPLICATION >use cautiously in patients with hepatic or renal impairment >carefUlly observed patients with coagulopathies and those taking coagulant. >dont give drug epidurally or intrathecally because of alcohol content. >correct hypovolemia before giving.

Non-steroidal anti- Unknwon. Though inflammatory drugs to inhibit =prevent prostaglandin inflammation, pain synthesis and fever support Route: IV the blood clotting Onset: immediate function of platelets, Peak: 1 to 3min. and protect the Duration: 6 to 8 hrs. lining of the stomach from the damaging effects of acid

23

VIII. REFERRAL AND FOLLOW UP HEALTH TEACHINGS => Encourage the patients family to wash hands with an antibacterial soap and maintain good hygiene. => Instruct the family to inform the health care providers if symptoms persist beyond 3 days discharged from the hospital. ANTICIPATORY S/S => Upon instructing the patient to take his medicines ordered by his doctor, the patient will be able to lessen the pain at his incision sites. => After recommending the patient with his diet/nutrition he will be able to gain weight and recover from undesired weight loss/cachexia SPIRITUALITY => Encourage the patients family members to pray for the patients fast recovery and encourage also the patient to have a strengthen faith to GOD. MEDICATION => Instruct the patients daughter to continue medication as what his doctor has ordered for the patient and not to discontinue even If the patient feels better. => Instruct also the patients family member to take home the medication and follow the frequency ordered by the doctor. INCISION CARE => Instruct the family members to clean and dressed with bandage the incision site of the patient. => Instruct the Family members to use sterile materials in assessing/cleaning the incision sites of the patient. NUTRITION => Recommend patient to increase fluid intake and eat foods thats more on fiber. ENVIRONMENT => Encourage the patient and his family members to maintain clean surroundings (especially patients room). IX. EVALUATION AND IMPLICATION At the end of our hospital duty, I was able to render care to our patient to help him resolve his health condition. Through observing the patients status, I was able to identify priority problems related to his health. The patient was willing to pursue the medical therapy just to promote health and wellness for the betterment of his condition. I have also made the patients daughter realize the importance of completing the course of therapy by taking the medicines prescribed or ordered for him by his physician. In addition, eating healthy or nutritious foods that were prescribed to him by the health providers was further been explained to the benefits he will gain in eating those foods. Moreover, this several intervention to him as given to the patient made his body conditioning normal and I can say that our patient has somehow recovered from his illness.

24

X. BIBLIOGRAPHY BOOKS Suzzanne C. Smeltzer, EdD, RN,FAAN,et.al Medical Surgical Nursing 11th Edition, Lippincott Williams and Wilkins Manual of Nursing Practice 7th Edition c 2001 by Lippincott Williams and Wilkins WEBSITES www.nursingcrib.com www.scribd.com www.wikipedia.com/coloncancer

25