COLEGIO DE SAN JUAN DE LETRAN CALAMBA School of Nursing Brgy. Buc l!

C l "# Ci$y

C s% S$u&y On

COLON CANCER
Su#"i$$%& #y' PANGANIBAN, DANICA D.

Su#"i$$%& $o' Ms. C rol Alc n$ r RN! MAN

I. INTRODUCTION BACKGROUND OF THE STUDY: Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they're often referred to as colorectal cancers. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. ver time some of these polyps become colon cancers. !olyps may be small and produce few, if any, symptoms. "or this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying polyps before they become colon cancer. SIGNS AND SYMPTOMS: # change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool Rectal bleeding or blood in your stool !ersistent abdominal discomfort, such as cramps, gas or pain # feeling that your bowel doesn't empty completely $ea%ness or fatigue &ne'plained weight loss

CAUSES: Precancerous gro !"s #n !"e co$on Colon cancer most often begins as clumps of precancerous cells (polyps) on the inside lining of the colon. !olyps can appear mushroom(shaped, or they can be flat or recessed into the wall of the colon. Removing polyps before they become cancerous can prevent colon cancer. In"er#!e% gene &u!a!#ons !"a! #ncrease !"e r#s' o( co$on cancer )nherited gene mutations that increase the ris% of colon cancer can be passed through families, but these inherited genes are lin%ed to only a small percentage of colon cancers. )nherited gene mutations don't ma%e cancer inevitable, but they can increase an individual's ris% of cancer significantly.

RISK FACTORS:

lder age # personal history of colorectal cancer or polyps )nflammatory intestinal conditions "amily history of colon cancer and colon polyps *ow(fiber, high(fat diet # sedentary lifestyle +iabetes besity ,mo%ing #lcohol Radiation therapy for cancer

DIAGNOSTIC TEST: Colonoscopy CT ,can STAGES OF CO)ON CANCER: S!age I. -our cancer has grown through the superficial lining (mucosa) of the colon or rectum but hasn't spread beyond the colon wall or rectum. S!age II. -our cancer has grown into or through the wall of the colon or rectum but hasn't spread to nearby lymph nodes. S!age III. -our cancer has invaded nearby lymph nodes but isn't affecting other parts of your body yet. S!age I*. -our cancer has spread to distant sites, such as other organs . for instance to your liver or lung.

TREATMENT: Chemotherapy Radiation Therapy +rug Therapy

RATIONA)E FOR CHOOSING THE CASE: ( ) chose this study to promote awareness to the people who had this %ind of disease by giving them information about the actions to be done and those contributing factors that made the treatment more seriously. ) also want to determine management that can be done to help them to relieve some of the signs and symptoms of the disease as well as to teach them to prevent further complications.

SIGNIFICANCE OF THE STUDY: ( The importance of this study is to have information about the proper management and care for those clients who have this %ind of illness. $e can also educate people on how they can prevent and reduce the complication of the disease even if they already have the disease or not. )t can also promote awareness and consciousness.

SCOPE AND )IMITATION OF THE STUDY: ( ) will be focused on the nursing aspect of care, to give a basic %nowledge about Colon Cancer.

II. C)INICA) SUMMARY: A. PERSONA) DATA Na&e: !atient C Age: /0 Se+: Male A%%ress: 112 !ulo, Cabuyao, *aguna B#r!" Da!e: Ma, -./ 0120 Re$#g#on: Roman Catholic Da!e o( A%&#ss#on: +ecember 3, 0214, 11542 am D#agnos#s: Caloric Mass T6C Colon Cancer B. CHIEF COMP)AINT *oss of #ppetite C. HISTORY OF PRESENT I))NESS: 1 wee% prior to confinement patient have mass on the abdomen D. PAST MEDICA) HISTORY: (7) #cute 8astritis (7) 9epa #

III. PHYSICA) E3AMINATION AREA

body built, height and weight in relation to client:s age !osture while sitting .body and breath odor signs of distress in posture or facial e'pression signs of health and illness client:s attitude client:s affect6 mood= appropriateness of client:s responses >uantity of speech, >uality and organi?ation

TECHNI4UE
)nspection )nspection )nspection (tal%ing with the patient) )nspection )nspection )nspection )nspection )nspection

NORMS
!roportionate, varies with lifestyle Rela'ed, erect, posture, coordinated movement <o body odor or minor odor relative to wor%, or e'ercise= no breath odor <o distress noted 9ealthy appearance Cooperative, able to follow instructions #ppropriate to the situation &nderstandable, moderate pace, clear tone, e'hibits thought association

FINDINGS
,mall body built, height and weight was not ta%en The patient can:t sit <o body odor and breath odor The patient loo%s wea% The client appears wea% The patient was cooperative The patient answers >uestions coherently without assistance &nderstandable, moderate and clear

ANA)YSIS AND INTERPRETATION

#;< RM#* +ue to his present condition #;< RM#* +ue to his present condition < RM#* #;< RM#* +ue to his present condition #;< RM#* +ue to his present condition < RM#* < RM#* < RM#*

relevance and organi?ation of thoughts

)nspection

*ogical se>uence, ma%es sense, has sense of reality

Ma%es sense and has sense of reality

< RM#*

I.

SKIN AREA

TECHNI4UE )nspection

NORMS @aries from light to deep brown= from yellow overtones to olive

FINDINGS &niform s%in color

s%in color

ANA)YSIS AND INTERPRETATION < RM#*

. uniformity of s%in color assess edema s%in lesions s%in moisture II. HAIR AREA

)nspection

)nspection )nspection )nspection

8enerally uniform e'cept in areas e'posed to the sun= areas lighter pigmentation (palms, lips, nailbeds) in dar% s%inned <o edema "rec%les, some birthmar%s, no abrasions or other lesions Moisture in s%in folds and a'illae NORMS Avenly distributed and covers the whole scalp ,il%y, resilient hair <o infection and infestation @ariable

&niform in s%in color

< RM#*

<o edema <o lesions ,%in is dry

< RM#* < RM#* #;< RM#* +ue to dehydration. ANA)YSIS AND INTERPRETATION < RM#* < RM#* < RM#* < RM#*

TECHNI4UE )nspection )nspection )nspection )nspection

FINDINGS Avenly distributed and covers the whole scalp ,il%y resilient hair <o )nfection and )nfestation @ariable. <o abnormal hairiness

evenness of the growth, thic%ness or thinness of hair te'ture and oiliness over the scalp presence of infection and infestation amount of body hair

III.

NAI)S AREA

TECHNI4UE )nspection )nspection )nspection

NORMS Conve', curvature= angle of nail plate ,mooth te'ture 9ighly vascular and pin% in light s%inned clients= dar% s%inned clients may have brown or blac% Conve'

FINDINGS

fingernail plate shape fingernail and toenail te'ture fingernail and toenail bed color

ANA)YIS AND INTERPRETATION < RM#* < RM#* #;< RM#* +ue to anemia

,mooth te'ture !ale in color

tissues surrounding nails blanch test of capillary refill

)nspection )nspection, palpation

pigmentation in longitudinal strea%s )ntact epidermis !romptly return of pin% or usual color (generally less than 3 seconds)

)ntact epidermis *ess than 3 seconds

< RM#* #;< RM#* +ue to low hemoglobin or anemia

I*.

HEAD AREA

TECHNI4UE )nspection

NORMS Round (normocephalic with symmetrical frontal, parietal, and occipital prominences) smooth s%ull contour ,mooth uniform consistence= absence of nodules, or masses <o edema and hollowness

FINDINGS The client:s head is round, normocephalic with symmetrical frontal, parietal, and occipital prominences ,mooth, absence of nodules or masses <o edema or hollowness

si?e, shape and symmetry of the s%ull presence of nodules, masses and depressions presence of edema and hollowness in the eye *. EYES AREA

ANA)YSIS AND INTERPRETATION < RM#*

)nspection and palpation )nspection and palpation TECHNI4UE )nspection

< RM#* < RM#*

NORMS !in%ish in color with presence of small capillaries= moist, no foreign bodies $hite in color= clear, no yellowish discoloration, some capillaries may be visible #nterior chamber is transparent= no noted visible materials, color depends on the person:s race

FINDINGS !ale in color

color, te'ture and presence of lesions in the palpebral conBunctiva sclera5 color and clarity iris5 shape and color

ANA)YSIS AND INTERPRETATION #;< RM#* +ue to low hemoglobin #;< RM#* +ue to past medical history of 9A!# # < RM#*

)nspection )nspection

-ellowish in color #nterior chamber is transparent= no noted visible materials, blac% in color

cornea5 clarity and te'ture pupils5 color, shape and symmetry of si?e light reaction and accommodation visual acuity5 near vision lacrimal gland5 palpability and tenderness of lacrimal gland e'traocular muscles eye alignment visual fields5 peripheral visual fields *I. EARS AREA

)nspection )nspection )nspection )nspection !alpation

<o irregularities on the surface, loo%s smooth, clear or transparent Color depends on person:s race= si?e ranges from 4( / mm= and are e>ual in si?e= e>ually round Constrict bris%ly6 sluggish Can detect light and dar% <o edema or tenderness over lacrimal gland ;oth eyes coordinated, moved in unison with parallel alignment $hen loo%ing straight ahead the client can see obBects in the periphery NORMS Color same as facial s%in= symmetric= auricle aligned with outer canthus of the eye= about 12 degrees from vertical Mobile, firm and not tender, pinna recoils after it is folded <ormal voice tones audible

<o irregularities on the surface= clear ;lac%, e>ual in si?e= e>ually round= 3mm in si?e Constricts bris%ly Can detect light and dar% <o edema or tenderness

< RM#* < RM#* < RM#* < RM#* < RM#*

)nspection )nspection

;oth eyes are coordinated in movement= parallel alignment !atient sees obBects in periphery

< RM#* < RM#*

TECHNI4UE )nspection

FINDINGS #ligned with outer canthus of the eye, same color as facial s%in, both auricle are symmetrical Mobile firm and not tender= pinna recoils after folded The client can hear whispered voices

auricles5 color, symmetry of si?e and position te'ture, elasticity and areas of tenderness hearing acuity test5 client response to normal voice tones *II. NOSE

ANA)YSIS AND INTERPRETATION < RM#*

)nspection and palpation )nspection6 rinne test

< RM#* < RM#*

AREAS any deviation in shape, si?e or color and flaring or discharge from nares nasal septum (between the nasal chambers) patency of both nasal cavities tenderness, masses and displacement of the bones and cartilage sinuses5 identification of the sinuses for tenderness *III. MOUTH AREA lips5 symmetry and contour, control and te'ture buccal mucosa gums5 color and condition tongue6 floor of the mouth5 color and te'ture of the mouth and frenulum

TECHNI4UES )nspection

NORMS ,ymmetric and straight= no discharge= uniform in color <asal septum intact and in midline #ir moves freely as the client breathes through the nares <ot tender= no lesions not tender

FINDINGS ,ymmetric and straight= no discharge= uniform in color= not flaring and has no discharge <asal septum is in midline and intact #ir moves freely in both nares <o lesions, not tender <ot tender

ANA)YSIS AND INTERPRETATION < RM#*

)nspection )nspection !alpation !alpation

< RM#* < RM#* < RM#* < RM#*

TECHNI4UE )nspection )nspection )nspection )nspection

NORMS &niform pin% color, soft, moist, smooth te'ture, symmetry of contour, ability to purse lips !in% color, moist, smooth, soft glistening and classic te'ture !in% gums= no retraction !in% color= moist, slightly rough= thin= whitish coating= moves freely= no tenderness

FINDINGS !ale in Color !ale in color !ale in color !in% color= moist, slightly rough= thin= whitish coating= moves freely= no tenderness

ANA)YSIS AND INTERPRETATION #;< RM#* +ue to low hemoglobin or anemia #;< RM#* +ue to low hemoglobin or anemia #;< RM#* +ue to low hemoglobin or anemia < RM#*

position, color, and te'ture, movement and base of the tongue any nodules, lymph nodes or e'ocrated areas plates and uvula5 color shape te'ture and presence of bony prominences position of the uvula and mobility (while e'aming the palates) oropharyn' and tonsil5 color and te'ture si?e, color and discharge of tonsils gag refle'

)nspection )nspection )nspection and palpation )nspection )nspection )nspection )nspection

Central position, pin% in color, smooth tongue, base with prominent veins ,mooth with no palpable nodules lumps or e'coriated areas *ight pin%, smooth, soft palate, lighter, pin% hard palate, move irregular te'ture !ositioned in midline of soft palates !in%, smooth posterior wall !in% and smooth posterior wall !resent

!in% in color= smooth tongue= base with prominent veins ,mooth with no palpable nodules ,oft palate, lighter pin% hard palate !ositioned in midline ,mooth posterior wall ,mooth posterior wall !resent

< RM#* < RM#* < RM#*

< RM#* < RM#* < RM#* < RM#*

I3.

THORA3 AREA

TECHNI4UES )nspection !alpation #uscultation

NORMS Cuiet, rhythmic, and effortless respiration ,%in intact, uniform temperature, chest wall intact= no tenderness= no masses ;ronchovesicular and vesicular breath sounds

FINDINGS Affortless respiration &niform temperature= no tenderness or masses ;ronchovesicular

anterior thora'5 breathing patterns temperature, tenderness and masses anterior thora' auscultation

ANA)YSIS AND INTERPRETATION < RM#* < RM#* < RM#*

posterior thora'5 shape, symmetry and comparison of anteroposterior thora' to transverse diameter spinal alignment temperature, tenderness and masses posterior thora' auscultation 3. ABDOMEN AREA

)nspection

#nteroposterior to transverse diameter in ration 1=0 chest symmetric ,pine vertically aligned

#nteroposterior to transverse diameter= symmetric

< RM#*

)nspection and palpation !alpation #uscultation

,pine aligned vertically

< RM#* < RM#* < RM#*

,%in intact, uniform temperature= <o tenderness or masses= chest wall intact, no tenderness intact no masses ;ronchovesicular and vesicular ;ronchovesicular breath sounds NORMS FINDINGS

TECHNI4UE )nspection )nspection

s%in integrity abdominal contour

&nblemished s%in, uniform color &niform color, unblemished s%in "lat, rounded (conve'), scaphoid !resence of abdominal mass (concave) <o evidence of enlargement of liver or spleen ,ymmetric contour ,ymmetric movements caused by respiration= visible peristalsis in very lean people= aortic pulsations in thin persons at epigastric area <o visible vascular patter <o evidence of enlargement of spleen or liver ,ymmetric contour ,ymmetric movement

ANA)YSIS AND INTERPRETATION < RM#* #;< RM#* +ue to his present condition (colon cancer) < RM#* < RM#* < RM#*

enlargement of liver or spleen symmetry of contour abdominal movements associated with respiration, peristalsis or aortic pulsations vascular pattern

palpation )nspection #uscultation

)nspection

<o visible vascular pattern

< RM#*

3I.

MUSCU)OSKE)ETA) SYSTEM AREAS TECHNI4UE )nspection )nspection )nspection )nspection

NORMS

FINDINGS !roportionate to body, e>ual strength on both sides <o fasciculation and tremors Aven and firm in muscle tone 9as e>ual strengths

ANA)YSIS AND INTERPRETATION < RM#* < RM#* < RM#* < RM#*

muscle si?e and comparison on the other side fasciculation and tremors in muscle muscle tonicity muscle strength

!roportionte to body= even in both sides <o fasciculation and tremors Aven and firm in muscle tone 9as e>ual strength on both sides

3II.

5OINTS AREA

TECHNI4UE )nspection and palpation )nspection and palpation

NORMS <o swelling= no warmth, no redness, no pain, no crepitus <o swelling, no warmth, no redness, no pain

FINDINGS <o swelling, redness, pain or crepitus <o swelling, warmth or redness

Boint swelling A'tremities

ANA)YSIS AND INTERPRETATION < RM#* < RM#*

I*. GORDON6s 00 FUNCTIONA) HEA)TH PATTERN OF ASSESSMENT

GORDON6S FUNCTIONA) HEA)TH PATTERNS 9ealth !erception and 9ealth Management <utritional( Metabolic

PRIOR TO HOSPITA)I7ATION The client thin%s that health is a state of being well.

DURING HOSPITA)I7ATION The client thin%s that it is important to consult to the doctor when he doesn:t feel well.

He eats 3 times a day and drinks 8 glasses of water a day.

The client said he defecates 1(0 times daily and urinates 4(3 times a day

He cant eat everything he wants because of some restrictions on foods.

The client can defecate and urinate.

Alimination

#ctivity and A'ercise Cognitive( !erceptual ,leep and Rest Role Relationship

The client said he is not doing any exercise.

The client said he is a positive thin%er. The client said the he always have D hours of sleep every day The client is a responsible father.

He is unable to perform any exercise at all.

The client is still positive thin%er. The client said that he can:t sleep well

He is being dependent to everyone because of his condition.

+uring hospitali?ation the client copes to stress by means of sleeping. The client thin%s the same.

Coping ,tress

The client said he is coping to stress by means of rest.

@alue ;elief

The client said she is a Roman Catholic. 8od serves as a guide to his family.

*. ACTI*ITIES OF DAI)Y )I*ING

ASPECT 1. NUTRITION PRIOR TO HOSPITALIZATION L ! "##$T%T$ DURING HOSPITALIZATION L ! "##$T%T$ ANALYSIS AND INTERPRETATION &ue to hospitali'ation the patient has low appetite because she doesnt feel well. &ue to hospitali'ation the patient can eliminate properly. &ue to hospitali'ation the patient cannot do his daily routine because of his condition. &ue to hospitali'ation the patient cannot go to -. to take a bath and need relative to assist him in doing his personal hygiene &ue to hospitali'ation the patient have altered sleeping pattern because he doesnt feel comfortable.

2. ELIMINATION

(rinates 3)* times a day and defecates +), times a day. The patient cannot exercise

(rinates ,)3 times a day and defecates once a day The patient cannot exercise

3. EXERCISE

4. HYGIENE

#roper hygiene

The patient cannot go to -. to take a bath.

5. SLEEP AND REST

8 hours of sleep and take a naps during the afternoon

9e can:t sleep well because he feels uncomfortable.

*I. ANATOMY AND PHYSIO)OGY The large intestine is a hollow tube that ma%es up the last E feet of the digestive tract. )t is often referred to as the large bowel or colon (which is technically Bust one part of the large intestine). The large intestine consists of the cecum (a pouch(li%e structure at beginning of the large intestine), colon, rectum and anus. The colon and rectum are ne't to other organs, including the spleen, liver, pancreas, and reproductive and urinary organs. Aach of these organs can be affected if colorectal cancer spreads beyond the large intestine.

STRUCTURE: The colon begins at the cecum, where it Boins the end of the small intestine (ileum). The colon changes to rectal tissue in its last E inches. ;ecause there is not a clear border between the colon and rectum, colon and rectal cancers are grouped together as colorectal cancer. The colon is divided into 3 parts5 ascending colon F begins at the cecum, where it Boins the end of the small intestine, and travels upward along the right side of the body to the transverse colon transverse colon F connects the ascending colon to the descending colon and lies across the upper abdomen descending colon F connects the transverse colon and the sigmoid colon and lies along the left side of the body sigmoid colon F connects the descending colon and the rectum

FUNCTION: The main functions of the colon and rectum are to absorb water and nutrients from what we eat and to move food waste out of our body. The colon receives partially digested food, in a li>uid form, from the small intestine. ;acteria (bowel flora) in the colon brea% down some materials into smaller parts. The epithelium absorbs water and nutrients. )t forms the remaining waste into semi(solid material (feces or stool).

 The epithelium also produces mucus at the end of the digestive tract, which ma%es it easier for stool to pass through the colon and rectum. ,ections of the colon tighten and rela' (peristalsis) to move the stool to the rectum. The rectum is a holding area for the stool. $hen it is full, it signals the brain to move the bowels and push the stool from the !recipitating "actors5 body through the anus. GAnvironment G@iruses *II. PATHOPHYSIO)OGY G+iet GTobacco &se !redisposing "actors5 Cellular +<# G*ifestyle G8enetics mutation G&@ e'posure G ther carcinogens Malignant Cellular !roliferation )mmune system failure to destroy cancer cells Malignant Cellular ,urvival Malignant Cellular +eprivation of <ormal Cells of <utrition and other substances for sustenance Malignant Cellular Compression of <ormal Cells

<ormal Cell +eath

C(hanges in bladder or bowel habits A(sore that doesn:t heal U(nusual bleeding or discharges T(hic%ening or lumps I(ndigestion ordiffuclty swallowing O(bvious changes in warts, moles, or the s%in N(agging cough or hoarseness of voice U(ne'plained anemia S(udden loss of weight

*III. )ABORATORY RESU)T

HEMATO)OGY

RESU)TS
98; H.E

NORMA) *A)UE
14(1/

ANA)YSIS
ABNORMA) +ecreased in hemoglobin can cause anemia ABNORMA) +ecreased in hemoglobin can cause anemia

9CT

0H

32(I3

R;C

4.0

3(E

ABNORMA) +ecreased in hemoglobin can cause anemia

$;C

11,H22

I222(12222

,A8MA<TAR,

D4J

42(/2

*-M!9 C-TA,

13J

02(32

ABNORMA) There is an increase in $;C this means that the patient has infection. )ncrease in wbc may lead to leu%ocytosis, this can result from bacterial infection.. ABNORMA) )ncreased in segmenters means that there is infection. ABNORMA) )ncreased in lymphocytes means that there is infection.

I3. DRUG STUDY NAME OF DRUG #ppetite !lus 1 cap ;)+ C)ASSIFICATION #ppetite Anhancers MECHANISM OF ACTION ,timulates appetite K enhances weight gain SIDE EFFECTS 9eadache <ausea Constipation &pset stomach CONTRAINDICATION 9ypersensitivity NURSING RESPONSIBI)ITY ,hould be ta%en with food. Monitor vital signs Monitor )nta%e and utput

9eraclene "orte 1 tab +

#ppetite Anhancers

&sed for ta%ing care of <ausea and vomiting weight loss, )t also +iarrhea may be used for #cidity treating tuberculosis

9ypersensitivity !regnancy *actation

Monitor vital signs Monitor ) K

and additional 9eadache persistent diseases, 8) disorders recuperating from severe surgery or infection and defective nutrition in elderly patients.

3. FDAR

FOCUS

DATA R%c%i)%& * $i%n$ + ,%! lying on #%& +i$h ongoing D-NM .L / 011 cc L%)%l.

ACTION I4 flui&s " in$ in%& n& r%gul $%& Encour g%& $o consu"% high5 c loric &i%$ +i$h &%:u $% flui& in$ ,% 3ro)i&%& h% l$h $% ching r%g r&ing h% l$hy nu$ri$ious foo& Moni$or%& in$ ,% n& ou$*u$ A&"inis$%r%& *r%scri#%

IMBALANCED NUTRITION Bo&y M l is% 2%igh$ Loss 3oor "uscl% $on% 4S $ ,%n s follo+s' B35 .11671 T5 87.8 3597

R5 ;7

"%&ic $ion RESPONSE: S$ill for Con$inui$y of c r%

3II. DISCHARGE P)ANNING Medications 2ri$% $h% %< c$ $i"% n& ins$ruc$ion +h%n $o $ ,% $h% "%&ic $ion n& ho+ $o $ ,% $h% "%&ic $ion. E"*h si=% *ro*%r &os g% of "%&ic $ion $o #% $ ,%n for $h% *ro*%r con$inui$y of c r%.

Exe cise T eat!ent "ea#t$ Teac$in%s O&t '(atient Diet

Ins$ruc$ cli%n$ $o h )% ligh$ %<%rcis%s. Con$inu% "%&ic $ion s or&%r%& #y $h% *hysici n Ins$ruc$ $h% cli%n$>s r%l $i)% $o *ro)i&% &%:u $% r%s$ ?ollo+ u* ch%c, u* A&)is% cli%n$>s r%l $i)% $o *ro)i&% incr% s%& in$ ,% of flui& A&)is% cli%n$>s r%l $i)% $o *ro)i&% high5 c lori% n& foo& $h $ rich in *ro$%in

S(i it&a#)sex&a# acti*it+

Encour g% * $i%n$ $o 3r y l+ ys