Professional Documents
Culture Documents
I. INTRODUCTION
Rectal cancer may be of the adenocarcinoma type and usually arise from the
epithelium (the layer of cells) which lines the large intestine. The colon is part of the
large bowel. The large bowel starts at the end of the small bowel (the ileum), at the
caecum. The caecum has the appendix running off it. The start of the colon is the
ascending colon and where this rises to meet the liver (the hepatic flexure) it becomes
the transverse colon. The transverse colon goes across the upper abdomen until it
becomes adjacent to the spleen (the splenic flexure) and at this point it becomes the
descending colon. The large bowel at this point goes down the abdomen to the pelvis at
which point it becomes the sigmoid colon (because it curves in an "S" shape, sigma
being the Greek for "S"). The sigmoid colon terminates at the rectum, which acts as a
storage pouch for feces before it is evacuated through the anus.
Overall, the function of the large bowel is to absorb water from stools. When the
ileum enters its contents into the caecum, they are extremely liquid and gradually
solidify as the contents progress around the large bowel.
Rectal cancer is common but occurs very rarely in young adults. Rectal cancer
becomes more common as age increases. People in their 50s, 60s and 70s are most at
risk with sex incidence being slightly more common in females. Geographically, the
rectal cancer tumor is found worldwide, but rectal cancer is most common in areas
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A Case Study on Rectal Adenocarcinoma
which have low fiber diets. Areas of the world with high fat consumption and low fiber
consumption such as Europe, USA and Australia.
Furthermore, in the Philippines, 75% of all cancers occur after age 50 years, and
only about 3% occur at age 14 years and below. If the current low cancer prevention
consciousness persists, it is estimated that for every 1800 Filipinos, one will develop
cancer annually. At present, most Filipino cancer patients seek medical advice only
when symptomatic or at advanced stages: for every two new cancer cases diagnosed
annually, one will die within the year. It is estimated that 3050% of cancer patients in
all stages of the disease will experience pain and 7095% with advanced disease will
have significant pain, but only a fraction of these patients receive adequate treatment. In
a study on cancer pain among Filipino patients, 73% had pain related to their disease,
60% of which was persistent (43).
Causative Factors:
Hereditary Conditions: At particularly high risk of Rectal cancer are people with
hereditary conditions such as Familial Adenomatous Polyposis or Hereditary Non
Polyposis Colorectal Cancer. In these conditions, it can occur even in young
adults, e.g. late teens and early 20s.
Family History of Rectal Cancer: First degree relatives of patients with rectal
cancer have an increased risk, particularly if the relative develops rectal cancer
at a young age.
Polyps: Certain types of polyps, notably villous adenomas have a potential to
become malignant. Rectal cancer patients who have previously had a polyp in
the large bowel should undergo regular colonoscopy (ask your doctor how often).
Inflammatory Bowel Disease: Patients who suffer from ulcerative colitis, have
approximately a tenfold risk of developing the disease and should have a
colonoscopy carried out regularly.
Diet: A high fat, low fibre diet, especially if high in red meat, is the worst diet that
predisposes people to rectal cancer. People who suffer from obesity are also at
an increased risk.
The rectal cancer tumor spreads by invading the bowel wall. Once it crosses through
the muscle layer within the bowel wall, it enters the lymphatic vessels, spreading to local
and then regional lymph nodes. Sometimes rectal cancer spread via the blood stream to
the liver, which is the most common area of metastasis from this tumour. Other organs
that may be affected by blood borne spread are the lungs, less often the bones, and
even less often the brain. If a lot of tumor cells get through the bowel wall, they tend to
float around as a small amount of fluid within the abdomen and can seed the covering of
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A Case Study on Rectal Adenocarcinoma
the bowel (peritoneum). This type of seeding produces small nodules throughout the
abdomen which irritates tissues and causes the production of large amounts of ascites
(fluid). Direct spread from the rectum may attach the tumor to the bladder in males and
cause fistulas. In females it may invade the vagina or adjacent pelvic organs.
Virtually all adenocarcinomas develop from adenomas. In general, the bigger the
adenoma, the more likely it is to become cancerous. For example, polyps larger than
two centimeters (about the diameter of a nickel) have a 30-50 percent chance of being
cancerous. You can learn more about polyp size and colon cancer risk by viewing the
Polyp Size Gallery.
By the time colorectal cancer is diagnosed, it has often been growing for several
years, first as a non-cancerous polyp (adenoma) and later as cancer. Research
indicates that by age 50, one in four people has polyps.
General investigations into rectal cancer may show anaemia or an abnormal liver
function test. The blood albumin level may be low (Albumin is produced mainly in the
liver. It helps to keep the blood from leaking out of blood vessels. When albumin levels
drop, fluid may collect in the ankles, lungs, or abdomen). If liver involvement is severe
the clotting profile will be abnormal with a raised INR.
The rectal cancer symptoms that may require attention are fatigue from anaemia
and the feeling of tenesmus (wanting to open the bowels when there is no stool there
can be particularly distressing, especially when it is painful). Rectal cancer patients may
require treatment for visceral pain from liver metastases and less commonly for somatic
pain from bone metastases. If lung metastases are present there may be pleural
effusions causing breathlessness. Effusions may require drainage.
The scope and limitation of this case study was only during the hospitalization of the
patient right after his surgery, which was during our first week of duty on September 17-
18, 2010. We then gather the necessary information for this case study possible.
Furthermore, the group decided to choose this case to be presented in our clinical
instructor for this is new and interesting problem, as far as we were exposed to the
clinical area. In addition to that, our kind clinical instructor also suggests having this as
our case.
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A Case Study on Rectal Adenocarcinoma
General Objectives:
To provide the students a guide line in caring for people with Rectal
Adenocarcinoma using the nursing process appropriately and effectively. To give
information on the readers about the nature and the extent of well differentiated
adenocarcinoma rectum disease. Lastly, to provide the general public of the new
developments in nursing care in regards of treating the disease condition.
Specific Objectives:
At the end of this study, we, the student nurses of this institution, will able to:
1. Define and identify the probable causative factors of adenocarcinoma
rectum
2. Trace the anatomy and physiology.
3. Assess the nursing history of the patient.
4. Identify the signs and symptoms of the underlying disease.
5. Formulate the nursing care plan, to achieve the maximum wellness of the
patients well as awareness on the part of the significant others.
6. To provide health teaching to the patient and significant others to improved
the former condition and prevents complication.
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A Case Study on Rectal Adenocarcinoma
A. Socio-demographic data
Patient X is a 26 year old male, Roman Catholic; a resident of Damilag,
Manolo Fortich, Bukidnon. Patient X worked at Del Monte Philippines as a
harvester. Patient X was admitted for the first time at Northern Mindanao
Medical Center last August 22, 2010 at 10am due to rectal pain and
weakness. He arrived at the hospital awake conscious and coherent, but
irritable.
B. Vital Signs
The patients vital signs are essential because it provides a baseline data
in determining alteration in the patient's body that may suggest underlying
disease. Any changes from the normal are considered to be an indication of
the person's state of health and provide clues to physiological functioning of
the client.
The patient had the following vital signs: Blood pressure: 130/90mmHg,
pulse rate: 110 bpm, respiratory rate: 28cpm, temperature:38.3 degrees
Celsius .He currently weighs 48 kilograms and stands 55.
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A Case Study on Rectal Adenocarcinoma
is a tobacco user for 13 years and can consume 10 sticks of cigarette per
day. He is also an alcoholic drinker for 13 years and can consume 5
bottles of drinking beverages twice a day. Patient X also drinks
coffee/cola/tea for 15 years and can consume 8 bottles twice a day.
Patient X also had taken recreational drugs such as marijuana for
sometimes. He has no known food and drug allergies. Patient X appears
to be weak and irritable.
2. Nutrition
During pre -hospitalization, the client is used to eat spicy foods as
well as fruits and vegetable. He drinks five liters of water a day.
During hospitalization, Patient X was on a general liquid diet, he
consumed 1/2 of share with fair appetite. The client seldom drinks water
amounting to 680 ml for 8 hours and was taking Enervon C 500mg once
daily as a vitamin supplement. He was hooked with 1 liter D5LR regulated
at 30gtts/min. Patient X has Jackson Pratt drainage and with colostomy
bag attached.
3. Elimination Pattern
Pre-hospitalization, Patient X defecates 2 times daily with formed
brown stool and soft in consistency until patient felt discomfort during
defecation, he has hemorrhoids hence patient sought medical advice, but
during hospitalization after the surgery patient has a colostomy bag
attached.
Pre-hospitalization, Patient X urinates five times a day with yellow
colored urine with no problem in control but during hospitalization after the
surgery patient has a distended bladder thats why he was catheterized
with a straight catheter with a urine output of 200 ml for 8 hours.
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A Case Study on Rectal Adenocarcinoma
5. Cognitive-Perceptual Pattern
Patient X understands and speaks Visayan language without
speech deficit. Patient X finished his secondary education at St. Jude
Academy but failed to pursue to college due to financial constraint. He has
no learning difficulties and change in memory. Patient has a pain felt in his
rectum, pre- hospitalization. Post-operatively Patient X has a pain felt at
the right lower quadrant area of the abdomen (where colostomy bag is
placed) with a pain scale of 8/10 lasting for 30 minutes from the onset
during passage of fecal material and upon movement. He is taking his
pain medication (tramadol) to relieve such pain.
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A Case Study on Rectal Adenocarcinoma
D. Physical Assessment
1. Neurologic Assessment
Orientation Oriented
2. Head
Head Normocephalic
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A Case Study on Rectal Adenocarcinoma
Fontanels Closed
Hair Fine
Scalp Clean
3. Eyes
Lids Symmetrical
Conjunctiva pink
Sclera Anicteric
4. Ears
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A Case Study on Rectal Adenocarcinoma
5. Nose
Mucosa Pinkish
6. Mouth
Lips Pallor
Mucosa Pinkish
Tongue Midline
Gums pinkish
7. Pharynx
Uvula Midline
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8. Neck
Trachea Midline
Thyroids non-palpable
9. Skin
Texture Rough
Turgor Firm
Tempareture warm
10. Abdomen
Configuration Symmetrical
Percussion Tympanitic
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A Case Study on Rectal Adenocarcinoma
Percussion Resonant
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A Case Study on Rectal Adenocarcinoma
The colon is made up of 6 parts all working collectively for a single purpose.
Their purpose is ridding the body of toxins that have entered the body from food
sources, environmental poisons, or toxins produced within the body. The colons role is
to transfer nutrients into the bloodstream through the absorbent walls of the large
intestine while pushing waste out of the body. In this process, digestive enzymes are
released, water is absorbed by the stool, and a host of muscle groups and beneficial
microorganisms work to maintain the digestive system.
The colon is approximately 4.5 feet long, 2.5 inches wide, and is a muscular tube
composed of lymphatic tissue, blood vessels, connective tissue, and specialized
muscles for carrying out the tasks of water absorption and waste removal. The tough
outer covering of the colon protects the inner layer of the colon with circular muscles for
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A Case Study on Rectal Adenocarcinoma
propelling waste out of the body in an action called peristalsis. Under the outer muscular
layer is a sub-mucous coat containing the lymphatic tissue, blood vessels, and
connective tissue. The innermost lining is highly moist and sensitive, and contains the
villi- or tiny structures providing blood to the colon.
The colon is actually just another name for the large intestine. The shorter of the
two intestinal groups, the large intestine, consists of parts with various responsibilities.
The names of these parts are: the transverse colon, ascending colon, appendix,
descending colon, sigmoid colon, and the rectum and anus.
The transverse, ascending, and descending colons are named for their physical
locations within the digestive tract, and corresponding to the direction food takes as it
encounters those sections. Within these parts of the colon, contractions from smooth
muscle groups work food material back and forth to move waste through the colon and
eventually, out of the body. The intestinal walls secrete alkaline mucus for lubricating
the colon walls to ensure continued movement of the waste.
The ascending colon travels up along the right side of the body. Due to waste
being forced upwards, the muscular contractions working against gravity are essential
to keep the system running smoothly. The next section of the colon is termed the
transverse colon due to it running across the body horizontally. Then, the descending
colon turns downward and becomes the sigmoid colon, followed by the rectum and
anus.
The ileocecal valve is located where the small and large intestines meet. This
valve is an opening between the small intestine and large intestine allowing contents to
be transferred to the colon. The cecum follows this valve and is an opening to the large
intestine.
The rectum is essentially a storage place for waste and is the final stop before
elimination occurs. The "tone" of the muscles of the anal sphincter and a persons ability
to control this skeletal-muscular system are vital for regulating bowel movement urges.
When elastic receptors within the rectum are stimulated, these nerves signal that
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A Case Study on Rectal Adenocarcinoma
defecation needs to occur. In other words, these muscle and nerve groups convey when
a bowel movement is necessary but allow a person to control when waste will actually
be removed, as the final step in the digestive process. The anus is the last portion of the
colon, and is a specialized opening bound with elastic membranes, sensitive tissues,
and muscles and nerves allowing it to stretch for removing bowel movements of varying
sizes. If, for example, you suffer from constipation, these tissues can become damaged
and lose their ability to function normally if waste has to be forced out or remains in the
body for prolonged periods. So its definitely good practice to keep things moving along
at a regular pace. Ideally, you should have two bowel movements per day but at least
once a day is pretty good; anything less than that could spell trouble for not only your
digestive health but general health as well.
The colon and rectum perform vital functions in the last phases of digestion.
Digestion first begins in the mouth where food is chewed into smaller pieces and
swallowed. The food travels down the esophagus to the stomach where it is further
broken down by gastric juices and sent to the small intestine. The small intestine
continues to break down the contents in addition to absorbing most of the nutrients,
including carbohydrates, proteins and vitamins. Once the contents have passed through
the small intestine, the material has become mostly liquid and is moved into the colon,
which measures about 5 feet long. The main function of the colon is to absorb water
and dehydrate the leftover material, forming semi-solid matter, or stool. The colon
moves the stool into the approximately 6-inch long rectum, which acts as a holding
chamber, until it is ready to be expelled through the anus.
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A Case Study on Rectal Adenocarcinoma
V. PATHOPHYSIOLOGY
Predisposing Factors:
Precipitating Factors: LEGEND:
Smoking for 13 years
Predisposing Factors
Alcohol consumption for Presence of non-
13 years malignant mass Precipitating Factors
Sedentary lifestyle Changes in the bowel
Internal hemorrhoids habit Disease Process
Treatment (either through
medication or surgery)
Alteration in the normal cell
Diagnostic Examination
Surgery effects
Negatively affects the DNA repair Tumor suppressor genes is turned off inactivation of the adenomatous
Polyposis coli gene
Proliferation of affected cell Quick abnormal cell growth and division Allows unchecked cellular
replication at the crypt surface
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A Case Study on Rectal Adenocarcinoma
Inability to control proliferation DNA repair genes is inactivated Increased cell division causing further mutations
of affected cells
Increases survival and proliferation of cancer cells Activation of the k-ras oncogene
mucosa in the large intestine regenerates Forms epithelium composed of genetically Transformation takes place among the stem
altered cells located in the superficial cell population at the crypt base
portions of the mucosa
crypt cells migrate from the base to the surface
Transformed stem cell replicated
abnormal cells spreads laterally and
undergoes differentiation and maturation downward to form new crypts
Abdomino-peritoneal subsection
Formation of malignant tumor in epithelial tissue
surgery (Miles procedure)
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A Case Study on Rectal Adenocarcinoma
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A Case Study on Rectal Adenocarcinoma
1. Bladder
distention
1. Increase BP of
Loss of blood 2. oliguria
130/90 mmHg
2. increase in RR 1. abdominal
of 28 cpm distention.
2. Changes in
3. increase in HR bowel
of 110bpm movement catheterization
1. Body weakness
2. Abnormal
decrease of hgb Decrease cardiac output
11.7 and hct 34.0
3. Pallor Colostomy is
Decrease tissue perfusion performed
going to the GI
1 unit of PRBC
Acid production within the GI lining
given
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A. Hematology Report
September 16, 2010
Test Results Reference Values Interpretation
Differential count:
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indicate infection.
Differential count:
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A Case Study on Rectal Adenocarcinoma
B. Ultrasound Report
September 3, 2010
Finding: liver is normal in size and echopattern, no mass, nor calcification seen.
Intrahepatic bile ducts are not dilated. Gall bladder is 4.20 cm x1.40cm. No intraluminal
changes noted. Pancreas and spleen are unremarkable right and left kidneys measures
9.31 cm x 3.92 cm and 4.98 cm x 4.65 cm, with parenchymal thickness of 1.3 cm and
1.5 cm respectively. Central echocomplex are intact with well define sinus parenchymal
junctions. Urinary bladder is moderately distended and defines of intraluminal echoes.
Prostatic gland is unremarkable.
There is on ill define hypoechoic mass posterior to the urinary bladder measure 5.6 cm
x 2.7cm.
Diagnose: Hypoechoic mass posterior to the urinary bladder may be rectal mass
severe fecal matter. No remarkable ultrasound findings in the liver, spleen, gallbladder,
pancreas, kidneys, urinary bladder and prostate.
Description microscopic:
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A Case Study on Rectal Adenocarcinoma
E. Urinalysis
Bacteria: few
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
FREQUENCY: every 6
hours
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
FREQUENCY: every 6
hours
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
5. Advise patient to
FREQUENCY: every 8
immediately report bleeding
hours
tendencies.
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
5. Discontinue if
FREQUENCY: every 6
hypersensitivity occurs.
hours
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
antibacterial 3. Discontinue if
hypersensitivity occur
DOSAGE: 7g
4. Report if side effects
ROUTE:IVTT
worsens
FREQUENCY: every 8
hours
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
4. Provide concurrent
DOSAGE:500mg
antacid therapy to relieve
ROUTE:IVTT pain.
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
GENERIC NAME: Reduces total acid load Constipation. Prep. > Ileus, intestinal Abdominal discomfort, 1. Advise patients to take
dulcolax in the GI tract, elevates for hemorrhoids obstruction, acute diarrhea. plenty of water to prevent
gastric pH, strengthens and anal fissures. surgical abdominal constipation
the gastric, mucosal conditions, severe
2. Be alert for adverse
BRAND NAME: barrier, and increases dehydration.
reactions of the drug.
Bisacodyl esophageal sphincter
tone. 3. Monitor and evaluate
CLASSIFICATION:
drug effectiveness.
laxatives
4. Warn patients to avoid
hazardous tasks that
DOSAGE: 20g require alertness.
ROUTE: IVTT
FREQUENCY: TID
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
GENERIC NAME: Normalizes metabolic Prevention and Hypocalcaemia, hypocalcaemia 1. Instruct patients to have
ketosteril process, promotes therapy of damages disturbed amino acid proper hygiene
recycling product due to faulty or metabolism
BRAND NAME: 2. Monitor serum Ca level
exchange. Reduces ion deficient protein
Ketoanalogues and
concentration of metabolism in 3. Always assess for
amino acids
potassium, magnesium chronic renal bleeding tendencies
CLASSIFICATION: and phosphate. insufficiency.
4. Monitor BP and RR
Hemostatic
DOSAGE: 1 cap
ROUTE: PO
FREQUENCY: BID
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
GENERIC NAME: Causes the Relief of painful Not recommended for None significant 1. Assess pt. for abdominal
Simethicone coalescence of gas symptoms of infant colic. Use pain, distention and bowel
bubbles. Does not excess gas in the cautiously in abdominal sounds prior to and
BRAND NAME: Degas
prevent the formation of GI tract that may pain. periodically throughout
CLASSIFICATION: gas. occur course of therapy.
Antiflatulents postoperatively or
2. Assess frequency of
as a consequence
DOSAGE: 1 tab 500mg belching and passage of
of: Air swallowing
flatus.
ROUTE: PO
FREQUENCY: TID
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
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A Case Study on Rectal Adenocarcinoma
DRUG ORDER
(Generic name, brand
MECHANISM OF CONTRAINDICATIONS ADVERSE EFFECTS NURSING
name, classification, INDICATIONS
ACTION OF THE DRUG RESPONSIBILITIES/
dosage, route,
PRECAUTIONS
frequency)
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A Case Study on Rectal Adenocarcinoma
ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
INDEPENDENT:
Subjective: Ineffective breathing Short Term Goals: 1. Assist client on semi-fowlers Short Term Goals:
kapoyan ko,.. murag pattern related to After 15 minutes of position. Goals met. After 15 minutes of
mag.apas ko ug ginhawa alterations of clients thorough nursing R To promote proper lung thorough nursing intervention,
usahay as verbalized by the normal oxygen supply intervention, the client will expansion. the client was able to establish
patient. and demand ration be able to: normal breathing pattern from
Establish normal 2. Instruct client and/or clients 28cpm to 24 cpm, and
Objective: breathing pattern SO to avoid wearing of tight demonstrated different kinds
Abnormal increase of from 28cpm to 24 clothes. of techniques to relief
RR of 28cpm cpm R To avoid compromising restlessness and feeling of
Restless Demonstrate the lungs to expand to its breathless.
Abnormal decrease of different kinds of maximum level.
hemoglobin of 11.5 techniques to relief Long Term Goals:
Abnormal decrease of restlessness and 3. Allow client bed rest in Goals met. After 8 hours of
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A Case Study on Rectal Adenocarcinoma
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A Case Study on Rectal Adenocarcinoma
ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
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A Case Study on Rectal Adenocarcinoma
5. Encourage client in
diversional activities like
listening music to his
cellphone.
R To divert the clients
attention to the activity
rather to the pain felt.
DEPENDENT:
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A Case Study on Rectal Adenocarcinoma
ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
INDEPENDENT:
Subjective: Impaired Physical Short Term Goals: 1. Instruct client and/or clients Short Term Goals:
Galisod ko og lihok ky sakit Mobility related to After 1 hour of thorough SO in the use of side rails or Goals met. After 1 hour of
akong samad, as verbalized presence of surgical nursing interventions, the pillows. nursing interventions the
by the patient. wound. patient will be able to: R - for position changes/ patient was able to verbalized
Verbalize transfers. understanding of situation and
Objective: understanding of individual treatment regimen
Limited range of situation and 2. Support the affected parts. and safety measures and
motion individual treatment R: to maintain position of demonstrated techniques that
Slowed movement regimen and safety function and reduce risk of enable resumption of
Difficulty turning to measures. pressure ulcers. activities.
sides Demonstrate
techniques that 3. Schedule activities with
enable resumption adequate rest periods during
of activities. the day.
R: to reduce fatigue.
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A Case Study on Rectal Adenocarcinoma
ambulation.
R To gradually promote
physical mobility.
DEPENDENT:
1. Administer medications prior
to activity as needed for pain
relief. (tramadol 500mg via
IVTT every 6 hours and
ketorolac 30mg via IVTT
every 8 hours, celecoxib
1.5mg via IVTT every 6
hours), as ordered.
R: To permit maximal
effort/involvement in
activity.
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A Case Study on Rectal Adenocarcinoma
ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
RATIONALE
(Subjective and Objective) (Problem and Etiology)
INDEPENDENT:
Subjective: Short Term Goals:
Impaired Skin Integrity 1. Keep area clean and dry. Short term Goals:
katol dapit diri sa akong At the end of 8 hours of
related to surgical R - To assist bodys natural
samad, as verbalized by the nursing care, the patient
incision secondary to Goals partially met. After 8
process of repair and
patient. will be able to:
colostomy. hours of nursing intervention,
preventing proliferation of
the patient was able to be free
Achieved and microorganisms.
from any complications such
maintain timely
Objective: as dehiscence and
wound healing. 2. Assist client in turning to sides
evisceration but failed to
Presence of surgical Be free from any R - to prevent further skin
achieved and maintain timely
complications such breakdown and promote
wound at the abdomen
wound healing.
as dehiscence and comfort.
Rashes
Redness on site evisceration.
3. Stretch wrinkled linens
promptly to avoid moisture.
R Moisture potentiates
skin breakdown.
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DEPENDENT:
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A Case Study on Rectal Adenocarcinoma
ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
INDEPENDENT:
Risk Factors: Risk for infection Short Term Goals: 1. Perform/promote meticulous Short-Term Goals:
Presence of surgical related to tissue After 30 minutes of nursing hand washing by caregivers
wound at the abdomen destruction as interventions the patient and client. Goals met. After 30 minutes of
Environmental evidenced by the will be able to: R: Prevents cross nursing interventions, the
Exposure presence of surgical Verbalize contamination/bacterial patient was able to verbalize
Poor personal hygiene wound at the abdomen. understanding of colonization. understanding of individual
individual causative/risk causative/risk factor, identified
factor. 2. Maintain strict aseptic interventions to
Identify interventions o technique with prevent/reduce risk of
prevent/reduce risk of procedures/wound care. infection, and demonstrated
infection. R: Reduces risk of bacterial techniques, lifestyle changes
Demonstrate infection to promote safe environment.
techniques/lifestyle
changes to promote 3. Provide health teachings
safe environment. about the risk of developing
infection within the course of
treatment.
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DEPENDENT:
1. Administer cefuroxime,
paracetamol, ceroxitin,
ciprofloxacin, metronidazole
in its appropriate time and
dosage, as ordered.
R Act as prophylaxis
against infection.
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ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
INDEPENDENT:
Subjective: Activity Intolerance Short Term Goals: 1. Increase exercise/activity Short Term Goals:
Luya gyod ko karon daun (Level III) related to After 45 minutes of levels gradually; teach Goals met. After 45 minutes of
mas ganahan ko naa sa imbalance between thorough nursing methods like stopping to rest thorough nursing intervention
higdaanan, as verbalized by oxygen supply and intervention, the client will for 3 minutes. the client was able to
the patient. demand. be able to: R To conserve energy and Verbalize the willingness to
Verbalize the gradually enhance activity participate in necessary
Objective: willingness to tolerance activities, demonstrated
Weakness or body participate in different identified techniques
malaise necessary activities 2. Assist client in early to enhance activity tolerance
Abnormal decrease of Demonstrate ambulation. and demonstrated a decrease
hemoglobin of 11.5 different identified R To help client in in physiologic signs of
Abnormal decrease of techniques to developing activity intolerance as evidenced by
hematocrit of 32.4 enhance activity tolerance. normal heart rate (100pbm)
Pallor skin tolerance and normal blood
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DEPENDENT:
1. Perform blood transfusion 1
unit of PRBC 450 ml.
R To replace loss of blood
within the body.
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A Case Study on Rectal Adenocarcinoma
ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
INDEPENDENT:
Subjective: Hyperthermia related to Short- Term Goals: 1. Promote surface cooling by Short Term Goals:
Init kaayu aq paminaw increase metabolic rate After 45 minutes of means of tepid sponge bath. Goals met. After 35 minutes of
maam, as verbalized by teh secondary to rectal thorough nursing R Heat loss by thorough nursing interventions
patient. adenocarcinoma interventions, the patient evaporation and , the patient manifested a
will manifest: conduction. decreased in surface
temperature from 38.3 to 37.5.
Objective: Decreased surface 2. Maintain bedrest. And demonstrated behaviour
Increased in body temperature from R - To reduce metabolic to promote normothermia such
temperature above 38.3 to 37.5 demands/oxygen as promoting surface colling
normal range of 38.3C Demonstrate consumption. by means of tepid sponge
Warm to touch behaviour to bath.
Flushed skin promote 3. Discuss importance of
normothermia such adequate fluid intake. Long Term Goals:
as promoting R - To replace fluid from Goals met. After 8 hours of
surface cooling by insensible loss thorough nursing intervention,
means of tepid the client was able to maintain
sponge bath. 4. Promote cool and well- body temperature within the
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ASESSMENT DATA NURSING DIAGNOSIS GOAL AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
(Subjective and Objective) (Problem and Etiology) RATIONALE
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A Case Study on Rectal Adenocarcinoma
behavioral changes. 4. Encourage rest after meals. pressure on its normal range
R to maximize blood flow (120/80mmHg) and improved
Long term Goals: to stomach, enhancing bowel sounds from 3 clicks.
After 16 hours of thorough digestion.
nursing intervention, the
client will be able to: 5. Elevate the lower extremities
Maintain blood within the cardiac reserve.
pressure on its R To promote effective
normal range venous return.
(90/60
120/80mmHg) INDEPENDENT:
Improve bowel 1. Administer Ferrous Sulfate
sounds from 3 clicks 20mg PO every 6 hours.
to 5 clicks. R - Iron supplements in the
production and maturation
of RBC.
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Medications
1. Advice patient to continue taking medications needed to maintain a normal
functioning of the body and maintain homeostasis. The treatment regimen
ordered by the doctors must be followed strictly and should not be stopped to
prevent the aggravation of the condition. The full course of antibiotics should be
followed.
2. Advice the patient to observe the any reaction towards the given medications and
signs that needs to call the attention of the physician.
Exercise
1. Encourage patient to have an active and passive ROM because it will promote
blood circulation and to improve muscle strength in order to promote total range
of motion.
Treatment:
1. Instruct patient to consult the physician first if what activities must he/she avoid
or put into limits.
2. Encourage patient to compliance of medication regimen to promote optimal
health.
Health Teachings:
1. Importance of personal hygiene to prevent infection.
2. Intake of nutritious foods like vegetables and fruits and intake of foods that is rich
in fiber such as green leafy vegetables and pineapple, also increased fluid intake
to prevent constipation.
3. Strict compliance of medication regimen to promote wellness.
4. Immediate report to the physician if unusualities occur.
Out-Patient:
1. Return to OPD for further check-up if whether it is improving or not. Also, for
early diagnosis of any other underlying conditions.
Diet:
1. Encourage client to eat nutritious or healthy foods such as fruits and vegetables
and foods that are high in fiber such as green leafy vegetables, wheat, cereal
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and pineapple. Suggest client also to consult to a dietary physician to know what
the correct dietary intake he must maintain are.
Spiritual:
1. Advise client to pray and have faith in God always because God is the most
powerful of all He knows what happened and He will never leave us.
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In our first duty in Surgical ward we committed so many kinds of errors and we
are all guilty for that but for that errors weve learn a lot and gradually we are learning to
improve our work in order to follow the mission of the nursing profession, which is to
give care to the patient. Weve learn that not at all the times we will be perfect on what
we will be doing, weve learn that the patients admitted in the Surgical Ward are mostly
confined due to vehicular accident. Other cases were those required for surgery. thus,
they need more attention and we need to be more careful in the provision of the care
they needed. Ideally, we must have referred the patient to registered advisers so that
there will be a comprehensive advise to the client and to the significant others as well
but because due to the institutional policies and time constraints, we failed to do it as
well and have done modification through giving him ample information.
In our skills, weve improve the common procedures and common work for what
we are doing like calculating the drops of the IVF either it is micro drops or macro drops
that is being administered in our patients and also monitoring the intake and output to
our patients, monitoring patient during blood transfusion and doing correctly
administration of medication via IVTT.
In making this case study, it strengthens us and really proves that in everything that we
do, learning is always there for us, waiting to be grasped and to be well-digested. I know
for the fact that this study requires a lot of sacrifices and fortunately we did survive all
the things we have done. My great felicitation and commemoration to my Clinical
Instructor, Ma. Liwayway Salcedo,RN, MN who gave us the motivation to be serious in
the clinical area in order to promote the proper and appropriate care towards our
patient. It was truly enjoyable because we have a clinical instructor who is very much
approachable and mindful. Though we have life threatening patient, she still there to
make some inspiring words and cheer us. She makes us calm when we get nervous.
She treats us like her own daughters and son.
We extend our thanks to our PCI, Ms. Arnie Echaves, who taught and gave us
the inspiration to do things well. She just not do things to comply with the requirements
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but has done it with passion and whole heartedly. We also appreciate to the nursing
staff for attending to our question properly whenever we have some clarifications.
Furthermore, we have all learned new procedures and know more the apparatus
used by the clinical area. We also appreciate the peri-operative care in the ward and
dealing patiently to our patients needs.
And last we learn the real value of being a student nurse that we should control
our temper, our emotion while we are on our patients side, we have to adjust the in
environment where we belong it is because we didnt know the feelings of the watchers
and more importantly our patient. Patient must not be only a patient but he/she should
be my/our patient. Thank you
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XI. REFERENCE
BOOKS:
WEB:
http://coloncancer.about.com/od/typesofcancer/a/Adenocarcinoma.htm
http://jjco.oxfordjournals.org/content/32/suppl_1/S52.full
http://www.alpharubicon.com/med/vitalssn.htm
http://www.google.com/images?hl=en&biw=1128&bih=721&gbv=2&tbs=isch%3A1&sa=
1&q=Abdomino-
perineal+subsection+surgery+procedure&aq=f&aqi=&aql=&oq=&gs_rfai=
http://answers.yahoo.com/question/index?qid=20081221030633AAVfM7o
http://www.wikipedia.com
http://www.scribd.com
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