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Saint Paul University Philippines

Tuguegarao City, 3500 Cagayan North

SCHOOL OF HEALTH SCIENCES

RECTAL CANCER
Case Study

By:

EDWARD VICTOR B. BERMUDEZ, RN


MA. CLARRISE ANN SD. CRUZ, RN
LORA MAE O. MATUTE, RN
NIKA IRA M. ROPA, RN
RIZA M. RAMOS, RN, USRN
FREDERICK ALLAN D. RANA, RN
Graduate School Students

To:

JANNICE ANN B. BUNSOY, RN, MAN


JULIUS T. FLORES, RN, MAN
Clinical Preceptors
Chapter I: CASE OVERVIEW

Patient Database and Clinical History

Patient is 58 years old, Filipino, female, married, Roman Catholic who was
diagnosed with Rectal Cancer Stage IV with metastasis on the liver, lung and bone.

Risk and Predisposing Factors

According to the patient, she has been hypertensive and was taking Amlodepine
10 mg/tab once a day, as maintenance medication. Both of her parents died due to
stroke. Patient stressed that her mother has symptom such as difficulty in defecating. No
known familial history of cancer. However, some of her siblings have hypertension.
It was noted during the interview that she had difficulty in defecating and whenever
she’s constipated, she took Dulcolax 5mg 1 tab as needed at home.

Analysis of Clinical Health Problems

History of Present Illness:


The patient is a known case of Rectal Adenocarcinoma Stage IV with bone, liver
and lung metastasis. She was diagnosed last July 2018 and immediately treated since
August 2018 S/P N1 cycle of chemotherapy (5 FU). Since discharge, the patient had
frequent episodes of rectal pain, burning in character graded 5-6/10 without
defecating. Noted occasional nausea, no vomiting, occasional black tarry stool and
decreased appetite, no abdominal pain.
On the other hand, she is also a known hypertensive and taking Amlodepine 10
mg/tab once a day as maintenance medication.
Patient was then admitted for 2nd cycle of chemotherapy.
Chapter II: REVIEW OF RELATED LITERATURE

Overview

Rectal cancer was usually associated with colon cancer, it was known as
Colorectal Cancer (CRC). It became the third most commonly diagnosed cancer in male
and second in female in the world. The American Cancer Society identified that there are
approximately 140,250 new diagnosed cases of large bowel cancer; 43, 030 new cases of
rectal cancer and the remaining were colon cancer. It is expected to cause death for
about 50,630 in the United States for as of this writing [1]. In the Philippines, colorectal
cancer became the number 1 gastrointestinal cancer surpassing liver cancer. Over 3,000
of new cases annually among Filipino were reported and over 2,000 of which die [2].

Anatomy and Physiology[3]

Figure 1: Human Anus Anatomy Rectum Anatomy and Rectum Function. Differentiate Anus Vs Rectum -
Anatomy Sciences. (2018). Retrieved from http://anatomysciences.com/human-anus-anatomy/human-
anus-anatomy-rectum-anatomy-and-rectum-function-differentiate-anus-vs-rectum/

The rectum is the concluding part of the large intestine, immediately following the
sigmoid colon, and ends the anus. The average length of the human rectum may range
between 10 and 15 cm. Its diameter can be linked to that of the sigmoid colon at its
beginning. Though, it becomes bigger near the anus, where it forms the rectal ampulla.
Rectal ampulla acts as a temporary storehouse of feces. The expansion of the rectal walls
causes the stretch receptors within the walls to stimulate the urge to defecate. When the
storage site becomes full, the intra-rectal pressure causes the anal canal walls to dilate
and expand. This results in the feces entering the canal.

Evidenced-based predisposing factors on colorectal cancer

Age is a major risk factor for sporadic CRC, more than 90% of the people
diagnosed with the disease are older than 50.

Approximately 20% to 25% of cases who have family history of the disease
suggesting a hereditary disposition. Actually, 85% of the CRCs coin from adenocarcinoma,
which accounts for adenomatous polyps [4]. Common variations of adenomatous
polyposis syndromes are familial adenomatous polyposis (FAP), MUTYH-associated
polyposis (MAP) and Lynch syndrome or Hereditary Non-Polyposis Colorectal Cancer.

Patients with continuing inflammatory bowel disease (IBD) have a higher possibility of
CRC. In fact, CRC accounts for 1/6th of ulcerative colitis (UC)-related deaths and 1/12th of all
deaths in patients with Crohn's disease [5].

Numerous studies shown that diabetes has a direct relationship between CRC
incidences. The increase of insulin concentration and insulin-like growth factor (IGF)-1
levels, increase of glucose (hyperglycemia), and prolonged exposure of the colorectal
mucosa to fecal bile acids (due to constipation) all play an important role in colorectal
carcinogenesis [6]. A meta-analysis study also exhibited that there is a higher possibility of
CRC in people who have DM in non-DM subjects by 35% [7,8].

According to the research, low socioeconomic plays a vital role as risk for having
CRC as there is an approximately 30 percent compared to people with high SES quintile.
Potentially variable behaviors such as physical inactivity, unhealthy diet, smoking, alcohol
and obesity are believed to account for a considerable proportion [9].

Recommendations of the related literature give emphasis on prevention of the


illness through early screening. Many studies suggest that a significant form of evidence
supports a defensive effect of aspirin and other nonsteroidal anti-inflammatory drugs
(NSAID) on the development of colonic adenomas and cancer. Aspirin can be considered
in selected patients with Lynch syndrome for chemoprevention of Lynch syndrome-
associated cancers.

A lot of epidemiologic studies have shown an association between the intake of a


diet high in fruits and vegetables and protection from CRC. The relative risk of CRC is
approximately 0.5 comparing groups with the highest intake to those with the lowest.
Several observational studies have reported a correlation between intake of a high-fiber
diet and reduced risk of CRC [10].

Regular physical activity is advise based on significant observational data, either


occupational or leisure time, is associated with protection from CRC [11]. In a meta-analysis
of 21 studies, there was a significant 27% reduced risk of proximal colon cancer when
comparing the most versus the least active individuals [12].

Based on National Cancer Institute’s SEER database, looking at people diagnosed


with rectal cancer between 2004 and 2010, the survival rate of rectal cancer per stage are
as follows [13]: the 5-year relative survival rate for people with stage 1 rectal cancer is 88%;
for people with stage IIA rectal cancer, the 5-year relative survival rate is about 81% while
for stage IIB cancer, the survival rate is about 50%. Meanwhile, the 5-year relative survival
rate for stage IIIA rectal cancers is about 83%; or stage IIIB cancers the survival rate is
about 72%, and for stage IIIC cancers the survival rate is about 58%. Lastly, rectal cancers
that have spread to other parts of the body are often harder to treat and tend to have a
poorer outlook. Metastatic, or stage IV rectal cancers, have a 5-year relative survival rate
of about 13%. Still, there are often many treatment options available for people with this
stage of cancer.
Chapter III: METHODOLOGY
Patient Care Approach
Gordon’s Functional Health Assessment (September 18, 2018 1:00 PM)

List of Functional Health Patterns Before Hospitalization During Hospitalization

1. Health Perception-Health Management Pattern


a) In general, how is your and “It’s okay except having
“It's okay”, as verbalized.
your family’s health? the illness”, as verbalized.
Since she was diagnosed,
the patient verbalized that
b) What do you do to stay “By doing households she can’t do the usual
healthy? chores”, as verbalized. households chores
because she’s
recuperating

c) Do you have regular check-ups


with your physician and/or “No. The family visits the
specialists (Pediatrician, Ob/Gyn, doctor once we felt
“Every 2 weeks because of
Cardiologist, etc.)? Describe how something’s wrong with
chemotherapy”, as
frequent is your check-up? Do you our body or health, or
listen to and follow any verbalized.
when symptoms manifest”,
suggestions made by your health as verbalized.
care providers?

e) Do you drink alcohol or use


No. No.
tobacco products?

2. Nutritional-Metabolic Pattern
“Eats more vegetables and
a) Describe your typical daily food fish. 0-2 times a week red
“No raw foods”, as
intake? Do you consider yourself a meat, twice a week
healthy eaters? verbalized.
processed food for
breakfast”, as verbalized.
b) Describe your typical daily fluid “I am fond of drinking “Same as before”, as
intake? water”, as verbalized. verbalized.

c) Do you consider yourself over


or under weight? Is there any No. None.
unexplained weight gain or loss?
Describe.
d) Do you drink alcohol? Kindly
No. No.
write the amount and frequency
3. Elimination Pattern
“Difficulty on defecating
sometimes constipated.
Narrowing in size was Rectal pain.
a) Describe your regular bowel
noted, rectal pain. Based on Input and Ouput
elimination pattern? Frequency?
Whenever constipated, I Record, no stool was
Character? Discomfort? Difficulty?
took Dulcolax 5mg 1 tab as recorded.
needed at home”, as
verbalized.
b) Describe your regular urinary
There’s a blood in her urine
elimination pattern? Frequency? “I have no problem on
yesterday as she said, but
Discomfort? Problems with urinating”, as verbalized.
control? it stopped now.
4. Activity-Exercise Pattern
Since she was diagnosed,
the patient verbalized that
“By doing household
she can’t do the usual
a) Do you exercise? What type? chores and taking care of
households chores
How often? If not, why? my grandchildren”, as
because she’s
verbalized.
recuperating

Since she was diagnosed,


the patient verbalized that
b) What do you like to do in your “No sports. I’m taking care she can’t do the usual
spare time? What sports do you of my grandchildren”, as households chores and
participate in? verbalized. taking care of her
grandchildren because
she’s recuperating
5. Sleep-Rest Pattern
a) Do you feel that you
“No, because of pain in
are generally well rested and able Yes
to perform your daily activities? rectal area”, as verbalized.
“No, I don't use anything to
b) How well do you fall asleep? “There are times that I
help me sleep. I sleep
Stay asleep? Do you use any aids wake up because of pain”,
to help you sleep? whenever I’m sleepy”, as
as verbalized.
verbalized.
c) Do you awaken feeling rested
Yes “Not really”, as claimed.
and ready to take on the day?
6. Cognitive-Perceptual Pattern
a) Do yo have any difficulty
No. No.
hearing others?

b) Do you have difficulty seeing?


No. No
Do you have routine eye exams?
c) How do you learn best?
“No difficulty”, as “Nothing's changed”, as
Preference for visual or audio
aids? Do you have difficulty
verbalized. verbalized.
learning?

7. Self-Perception - Self-Concept Pattern


“Yes especially when I
a) Most of the time, do you
Yes accomplished something”,
feel good about yourself?
as verbalized.

When she was diagnosed,


b) Do you ever feel that you have she said she lost hope and
No.
lost hope? asked God why He gave
her that.

8. Roles-Relationships Pattern
“With my family. My
a) Who do you live with? Alone,
siblings and I were close “With my family”, as
family, others? What was the
structure in which you grew up?
since we grew up verbalized.
together”, as verbalized.

b) Do you belong to social


“Yes, in the community”, as “Yes, but now limited
groups? Do you interact with
others outside of work or school?
claimed. because she’s recovering”,
as claimed.

9. Sexuality-Reproductive Pattern
a) How would you describe your No problem. She tried pills
sexual relationship? Satisfying? for a month when they No sexual activity/contact
Changes? Problems? were younger.
b) Describe menstruation cycle. Menarche – 12 years old
Problems? Last menstrual period? Menopause – 55 years old Menopause
Para? Gravida? G6P6
10. Coping-Stress Tolerance Pattern
Yes, adjusting to the
a) Any big changes in the past “Yes, when I knew about therapy. She shared that
year or two? my illness “, as claimed. she skipped a cycle due to
anxiety.
b) Who is most helpful in talking
“My husband and God”, as
things over? Are the frequently “My family”, as claimed.
available to you?
claimed.

c) Do you use any medications,


“Amlodepine for “Yes, plus prescribed home
drugs, or alcohol? If yes, kindly
enumerate.
Hypertension”, as claimed. medications as claimed.
11. Values-Beliefs Pattern
“Yes, there’s just this one
a) Is religion important in your incident that I asked God
“Yes, our family is Roman
life? Does this help when you are why He gave me the illness.
faced with difficult situations? Catholic”, as claimed.
But I always lift everything
to God”, as claimed.
b) Describe your plans for the “To be treated and recover
”To take care of my
future. Do you generally get what from my illness”, as
you want from life? grandchildren”, as claimed.
claimed.
Chapter IV: DISCUSSION OF FINDINGS
Conceptual Framework/Pathophysiology (Concept Map)

58 y/o, Female, diagnosed with Rectal Cancer


LEGEND:

Patient Database Aging, Family History -mother side, difficulty on defecating


Risk Factors
Adenocarcinomas: Tumor
Pathophysiology that arise from the glandular
epithelial tissue of the colon
Diagnostic Test

Signs and symptoms Loss of key tumor suppressor


genes and activation of
Management certain oncogenes
Side Effects
Activation of certain
Nursing Care Plan
oncogenes that alter colonic
mucosa cell division

Increase proliferation of Colonoscopy,


colonic mucosa forms polyps Biopsy,
that can be transformed into Endoscopy
malignant tumors

Fecal Occult
Blood Test
Early stage Late Stage
Usually NO S/Sx Manifestations

Chemotherapy
Black streaked and
Rectal Pain Constipation narrowed stool
Loss of and rectal bleeding
Nausea
appetite
Dolcet 37.5
Dulcolax 5mg Hemostan
mg/325mg/tab
Collaborate Plasil 2 tabs OD 500mg/cap PO q8h
with 10mg/tab 1 tab PO TID
dietician PO TID

• Acute pain related to rectal cancer as evidenced by pain scale of 9/10


• Ineffective elimination pattern related to change in normal bowel habits
characterized by a decrease frequency in stool
Chapter V: CONCLUSION AND RECOMMENDATIONS
• Risk for imbalance nutrition: less than body requirements related to lack of
appetite
Chapter V: CONCLUSIONS AND RECOMMENDATIONS

The nursing profession recognizes colon and rectal cancer as an altered life
process that affects the regulation, perception, and cognition of the client. Colon cancer
is categorized from stage I through stage IV, depending on how far the cancer
penetrates the mucosal layer and whether it spreads into surrounding organs. There are
a number of treatment options for colon cancer: surgery, chemotherapy, and radiation
therapy, all of which have unpleasant side effects. In line with the theory of unpleasant
symptoms which states that patients perceive illnesses and challenging treatments as
clusters of noxious symptoms that both individually and jointly impact their experience
of illness, their emotional distress, and their functional abilities, this patient’s case can be
related to this theory due to the number of symptoms the patient experiences between
the disease and the treatment options. There are a number of ways to aesthetically
describe the experience of colon cancer and how it affects her physically, emotionally,
spiritually and psychologically.

By definition of World Health Organization (WHO, 2016), palliative care improves


the quality of life of patients and families who promotes psychological, social and
spiritual quality of life Metastatic or locally advanced disease often leads to symptoms
such as abdominal and pelvic pain, muscle wasting, abdominal mass and distention,
Hospice care provides palliative care for people who are close to the end of life. Hospice
services are not intended to speed up or prolong the dying process. They focus instead in
relieving pain and other symptoms.

Worldwide, the majority of cancer patients are in advanced stages of cancer when
first seen by a medical professional. For them, the only realistic treatment option is pain
relief and palliative care. Effective approaches to palliative care are available to improve
the quality of life for cancer patients. Effective public health strategies, comprising of
community and home-based care are essential to provide pain relief and palliative care
for patients and their families in low-resource settings. There are great differences in
availability and development of palliative care around the world.
Palliative care focuses on improving the quality of patients’ lives by solving
problems caused by disease progression including addressing the physical complications
and symptoms it causes, pain relief, psychological support to patients and their families
and caregivers. It is carried out by a multidisciplinary team that includes physicians,
pharmacists, nurses, chaplains, social workers, psychologists, etc. Focus is instead on
relieving pain and other symptoms.
APPENDICES
a. Physical Examination and Health History Forms Used

General Appearance Awake, not in distress


Skin No active dermatoses
Head, Eyes, Ears, Nose, Anicteric sclerae, pink palpebral conjunctivae, pupil
Throat response 12 equal in size and reactive
Chest / Lungs Symmetrical chest expansion, clear breath sounds
Heart Adynamic precordium, normal rate and regular rhythm
Abdomen Abdomen flabby, soft, nontender, no organomegaly
Rectum and Genitalia
Extremities Full equal pulse, no cyanosis, no edema
Neurologic and Mental No neurologic deficit, no barriers in learning
Status GCS 15/15 Motor 5/5 Sensory 5/5

KATZ INDEX OF INDEPENDENCE IN ACTIVITIES OF DAILY LIVING:


Feeding – 1 Bathing – 1 Dressing – 1
Toileting – 1 Transferring – 1 Continence – 1
TOTAL: 6 – Patient is independent
b. LABORATORY EXAMS / DIAGNOSTIC EXAMS

Patient is receiving chemotherapy, and the doctor ordered complete


blood count to monitor if the cancer has spread to the bone marrow
and determine how the body of patient is handling cancer treatment,
as some of the body’s normal cells may be damaged by the treatment.

Laboratory Test Result Female Normal Values


Hemoglobin 13.5 12 - 16
Hematocrit 0.41 0.37 - 0.47
RBC 6.3 4 - 5.20
WBC 5,000 - 10,000
11,500
Segmenters 0.72 0.51 - 0.66
Lymphocytes 0.22 0.2 - 0.4
Monocytes 0.06 0.02 - 0.08
Platelet Count 150,000 - 450,000
147,000
Creatinine 0.89 .5 - 0.9
ALT 19.6 0 - 41
Sodium 135.4 135 - 148
Potassium 4.2 3.4 - 5.3

Purpose: Prior to chemotherapy, complete blood count is ordered by


attending physician to check the baseline levels of different blood
cells, including white blood cells, for this may indicate presence of
higher or lower risk for infection.

Result: Based on the results, patient may undergo chemotherapy


since her WBC is increased. This count may drop as chemotherapy
goes on, that’s why monitoring this blood test is necessary.
c. Sample Nurse Charting

Date/Shift/Time Focus NURSES NOTES


(Data, Action and Response)
September 17, 2018
6:00 am – 6:00 pm

9:20 am Admission D-Received from ER an 85 year old


female patient under the service of
Dr. X
D-Assisted by ER nurse on duty
together with porter via wheelchair
D-With patent IV line inserted at left
metacarpal, gauge 24 cannula used
D-With on-going IV medication of
oxaliplatin 150mg incorporated in
D5W 200ml in 250ml D5W to run for 2
hours
A-Patient assisted to designated
room
A-Oriented to unit regulations
A-Instructed to use call light for
10:00 am Chemotherapy immediate needs
A-Endorsed to room nurse on duty

D-Patient scheduled for


chemotherapy
12:00 pm A-Re-assessed IV line for patency
R-Consent for scheduled procedure
instructed and signed by patient

D-Oxaliplatin 150mg incorporated in


2:00 pm Bleeding D5W 500cc to run for 90 minutes as
chemotherapy medication started
A-Monitored IV line for extravasation

D-Patient reported blood in urine


A-Re-assessed vital signs and other
2:15 pm signs of bleeding
A-Assessed amount and character of
urine output
A-Instructed patient to increase fluid
intake
A-Referred to MROD with new orders
given
A-Instructed patient of medication
3:00 pm Dizziness for bleeding
A-Hemostan 500mg tab given
A-Instructed patient and relative of
patient to report further signs of
bleeding
A-Monitored for any further bleeding

D-Patient experienced of being light


headed while on bed
A-Adjusted patient’s position to semi
3:10 pm Vomiting fowler’s
A-Assessed and recorded BP
A-Instructed patient to minimize
sudden movements
A-Dimmed room lights
A-Raised and secured side rails
D-Patient felt upset stomach and
vomited
20ml of clear, non-foul smelling liquid
A-Assisted patient to right side lying
position
A-Informed MROD; with new orders
A-Assessed patient if able to swallow
A-Metoclopromide 10mg tablet given
d. Nursing Care Plans

Assessment Nursing Planning Intervention Rationale Evaluation


Diagnosis

Subjective: Acute pain At the end 1. Obtained full  Pain is a Goal


- “Masakit related to of the description of subjective partially
yung pwet Rectal cancer shift, the pain from experience met at the
ko” as as evidenced patient patient and must be end of the
verbalized by by pain scale will be including described by shift, the
the patient of 9/10 able to location, the patient. patient
- Pain scale of verbalize intensity (0- Assist patient verbalized
9/10 relief of 10), duration; to quantify partial
pain from quality pain by relief of
Objective: 9/10 to (dull/crushing); comparing it pain from
- facial 2/10 and radiation to other 9/10 to
grimace experiences. 4/10, PR:
- irritable 87, BP: 120
- PR: 105 /80
- BP: 140/100 2. Instructed  Delay in
patient to reporting
report pain pain hinders
immediately pain relief/
may require
increased
dosage of
medication to
achieve relief.
In

3. Provided  Decreases
quiet external
environment, stimuli, which
calm activities, may
and comfort aggravate
measures anxiety and
(e.g., dry/ cardiac strain
wrinkle—free and limit
linens, coping
backrub). abilities and
Approach the adjustment
patient calmly to current
and situation.
confidently

 Helpful in
4. Assisted and decreasing
instructed in perception
relaxation of/ response
techniques, to pain.
e.g, deep/ slow Provides a
breathing, sense of
distraction having some
behaviors, control over
visualization, the situation,
guided increase in
imagery. positive
attitude.

 Research
5. Evaluated shows that
the the most
effectiveness common
of the pain reason for
control unrelieved
measures pain is failure
through to routinely
ongoing assess pain
assessment. and pain
relief.

 Dolcet is
6. As ordered, used for
Administered moderate to
Dolcet 1 tab severe pain.
PO Q8 PRN for It works by
pain works in the
brain to
change how
the body
feels and
responds to
pain,
increasing
the pain
threshold and
increases the
blood flow
across the
skin.
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Subjective: Constipation At the end 1. Determined  Assists in Goal met.


- related to of the stool color, identifying At the end
““Nahihirapan change in shift, the consistency, 
causative or of the
ako dumumi” normal patient frequency, and contributing shift, the
as verbalized bowel habits will be amount. factors and patient
by the patient characterized able to appropriate was able
by a decrease establish interventions. to
Objective: frequency in bowel defecate
-Abdominal stool movement
distention 2. Auscultated  Bowel
- Guarding at bowel 
sounds sounds are
the abdomen generally
- Hypoactive decreased in
bowel sound constipation.
- Presence of 

black streaks 3. Encouraged  Assists in
on stool fluid intake of improving
2500- 3000 stool
ml/day within consistency.
cardiac 

tolerance.

4. Avoiding
gas-  Decreases

forming gastric
foods was distress and
recommend abdominal
er. distention.

5. Encouraged
 To enhance
to eat high-
easy
fiber rich
defecation.
foods.

6. As ordered,
 Dulcolax is a
administered
known
dulcolax tab
stimulant
PO as ordered
laxative. It
works by
increasing
the
movement of
the
intestines,
helping the
stool to come
out.

7. Consulted
 Fiber resists
with dietitian
enzymatic
to provide
digestion and
well- balanced
absorbs liquid
diet high in
in its passage
fiber and bulk. along the
intestinal
tract and
thereby
produces
bulk, which
acts as a
stimulant to
defecation.
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis

Subjective: Risk for At the end of 1. Ascertained  To Goal met. At


- ““ Wala imbalance the shift, the understanding determine the end of
ako ganang nutrition: less patient will be of individual informational the shift, the
kumain” as than body able to nutritional needs of patient was
verbalized requirements verbalize needs. client able to
by the related to understanding demonstrate
patient ” as lack of of causative behavior,
verbalized appetite factors and 2. Assessed  To establish lifestyle
by the necessary weight, baseline changes to
patient interventions measure or parameters. regain
to promote calculate body appropriate
optimum fat and muscle weight.
nutrition. mass and other
anthropometric
measurements.

3. Observed for  It indicates


absence of protein
subcutaneous energy
fat and muscle malnutrition
wasting, hair
loss, fissuring
of nail, delayed
healing of
wounds, gum
bleeding or
swollen
abdomen
4. Evaluated  Reveals
total daily food caloric intake
intake of patient
that can lead
to
malnutrition

5. Weigh at  Monitors
regular effectiveness
intervals and of dietary
document plan.
results.

6. Collaborate  To have an
with dietitian accurate
and nutritional dietary
support team intake for
long term
needs.
Commented [n1]: Tables are too compressed. Hard to read and
e. Drug Study understand.
DRUG DRUG ACTION INDICATI SIDE EFFECTS NURSING
NAME CLASS ON MANAGEMENT
RELATED TO
PT.’S DISEASE
5 FU Antineoplas Antimetabo Usually Common: Patient is
FLUOROUR tic; lites are cell- used for - Diarrhe diagnosed
ACIL 500mg Cytotoxic specific. The the a having Rectal
IV and Chemothera basic work treatmen - Nausea Cancer Stage III.
1000mg IV py drug; of this drug t of - Vomitin She was
in D5 W 1L x Antimetabo is to tumors g administered
22H lites damage the and - Mouth with
RNA and different sores Fluorouracil as a
DNA that kinds of - Poor chemotherapy
tells the cell cancer appetit drug currently
how to such as e on her 2nd
copy itself Colon - Metallic session.
in the and taste Management
division Rectal - Vein are as follows:
phase. It is cancer discolor - Instructe
classified as which is ation d the
pyrimidine specifical on IV patient
analog due ly site to
to its diagnose - Low increase
interference d in the blood fluid
with the patient. counts intake as
DNA and Delayed the drug
RNA effects: may
synthesis - Hair cause
done by thinnin dehydrat
mimicking g ion due
the building - Nail to
blocks discolor diarrhea,
necessary ation nausea
for - Hand- and
synthesis. foot vomiting
syndro .
me - Advised
- Skin the
reactio patient
ns to
(peelin consume
g, ice chips
rashes, prior IV
dry, treatme
crackin nt to
g) prevent
mouth
sores
and after
to
prevent
nausea
and
vomiting
.
- Instructe
d patient
to get
plenty of
rest,
maintain
good
nutrition
as
prescrib
ed by
the
dietician
and try
to do
simple
exercise
s to
boost
the
energy
and
immune
system.
- Instructe
d patient
to limit
crowded
areas to
prevent
accumul
ation of
infection
.
DRUG DRUG ACTION INDICATION SIDE EFFECTS NURSING
NAME CLASS MANAGEMENT
RELATED TO PT.’S
DISEASE
LEUCOVOR Reduced It is a folic -It is used in Its side effects Patient is
IN 300mg folic acid with combination are oftentimes diagnosed having
in D5 W x acid; added with attributable to Rectal Cancer
2H Chemo- vitamin Fluoruracil that of Stage III. She was
protecta which to treat Fluorouracil or administered with
nt enhances cancers any other Leucovorin
the such as; chemo drug combined with
binding of colon and when used in Fluorouracil as a
Fluoroura rectal combination. chemotherapy.
cil to an cancer. Common: Management are
enzyme -As an - Allergic as follows:
inside of antidote to reaction - Instructed
the effects of s the patient
cancer certain (rashes, to increase
cells. As a chemothera itchines fluid intake
result py drugs s, facial as the
fluoroura such as flushing drug may
cil may Methotrexa ) cause
stay in the te. - Nausea dehydratio
cancer -Treatment and n due to
cell of vomitin diarrhea,
longer megaloblast g nausea
and exert ic anemia and
its when folic vomiting.
anticance acid - Instructed
r effect deficiency is patient to
on the present. get plenty
cells. of rest,
maintain
good
nutrition
as
prescribed
by the
dietician
and try to
do simple
exercises
to boost
the energy
and
immune
system.

DRUG DRUG ACTION INDICATIO SIDE EFFECTS NURSING


NAME CLASS N MANAGEMENT
RELATED TO
PT.’S DISEASE
OXILALIP Antineopla Alkylating -It is used Infusion related: Patient is
TIN stic; agents are to treat - Shortnes diagnosed
150mg in Cytotoxic most colon or s of having Rectal
D5W Chemother active in rectal breath Cancer Stage III.
250cc apy drug; the resting cancer that - Abnormal She undergoes
Alkylating phase of has spread tongue scheduled
agent the cell. (metastasiz sensation administration of
These ed), it is - Chest Oxilaliptin.
drugs are often given heaviness Management are
cell-cycle in Common: as follows:
non- combinatio - Periphera - Instructe
specific. n with l d the
The basic other neuropat patient to
work of anticancer hy always
this drug is drugs - Nausea keep
to damage (Fluorourac and body
the RNA il and vomiting warm and
and DNA Leucovorin - Diarrhea in a warm
that tells ). - Mouth place to
the cell sores prevent
how to - Fatigue periphera
copy itself - Loss of l
in the appetite neuropat
division - Low hy and
phase. blood hypother
Fast- counts mia.
dividing - Generaliz - Instructe
cells are ed pain d patient
more likely - Allergic to
to be killed reactions increase
by - Fever oral fluid
chemother intake in
apy lukewarm
causing temperat
the tumor ure to
to shrink. prevent
dehydrati
on.
- Instructe
d to
maintain
good
nutrition
and get
plenty of
rest to
boost the
immune
system.
- Advised
patient to
void
crowded
areas to
prevent
accumula
tion of
infection.
- Encourag
ed
patient to
take
meds
prescribe
d for
nausea as
needed.
DRUG NAME DRUG ACTION INDICATION SIDE EFFECTS NURSING
CLASS MANAGEMENT
RELATED TO
PT.’S DISEASE
METOCLOPR Gastro- Dopamin - For Common: For the
AMIDE 10mg intestin e the - Constipat management of
tab PO TID al antagoni treat ion GI
stimula st that ment - Diarrhea complications,
nt; acts by of - Drowsine patient was
Antiem increasin Gastr ss administered
etic g o- - Fatigue with
sensitivit esop - Involunta Metoclopramid
y to hage ry e. Management
acetylch al moveme are as follows:
oline Reflu nts of - Assessed
resulting x limbs and abdomin
to Disea eyes al
increase se - restlessn sounds
d motility (GER ess distentio
of the D) n and
upper GI - For note for
tract and the nausea
relaxatio treat and
n of ment vomiting
pyloric of prior to
sphincter nause medicati
and a and on
duodenal vomit administ
bulb. ing ration.
for - Instructe
patie d patient
nts to
under increase
going oral fluid
chem intake to
other prevent
apy complica
treat tion of
ment constipa
tion and
diarrhea.
- Instructe
d to
maintain
good
nutrition
and get
plenty of
rest to
boost
the
immune
system.
- Encoura
ged
patient
to take
the
medicati
on only
as
prescrib
ed by
the
doctor.

DRUG NAME DRUG ACTION INDICATIO SIDE EFFECTS NURSING


CLASS N MANAGEMENT
RELATED TO
PT.’S DISEASE
ONDANSETR Gastro- It works This Common: For the
ON 8mg tab intestina by medication - Headache management of
PO BID l blocking is usually - Light- GI complications,
stimulan one of used for headednes patient was
t; the prevention s administered
Antieme body's of nausea - Dizziness with
tic natural and - Drowsines Metoclopramide
substanc vomiting s . Management
es such caused by - Allergic are as follows:
as chemother reactions - Assessed
serotoni apy and - Stomach abdomina
n that radiation pain l sounds
causes therapy. - Chest pain distentio
vomiting n and
. note for
nausea
and
vomiting
prior to
medicatio
n
administr
ation.
- Instructe
d patient
to
increase
oral fluid
intake to
prevent
complicat
ion of
constipati
on and
diarrhea.
- Instructe
d to
maintain
good
nutrition
and get
plenty of
rest to
boost the
immune
system.
- Advised
to take
the
medicatio
n with
correct
dosage
and
frequenc
y only as
prescribe
d by the
doctor.

DRUG DRUG ACTION INDICATIO SIDE EFFECTS NURSING


NAME CLASS N MANAGEMENT
RELATED TO
PT.’S DISEASE
BISACOD Stimula Stimulates This Common: Patient has
YL 5mg 2 nt peristalsis medicatio - Abdominal difficulty in
tabs PO laxative by directly n is cramps defecating due to
OD irritating commonly - Nausea the diagnosis.
the used for - Diarrhea She was
smooth the - Rectal administered
muscles of treatment burning with Bisacodyl as
the of patients Rare cases due to part of the
intestine, with chronic use: treatment.
such as constipati - Hypokalemi Management are
colonic on. It is a as follows:
intramural also used a - Muscle - Assessed
plexus. It laxative to weakness abdominal
also alters clean the - Tetany sounds
water and colon prior - Protein- distention
electrolyte undergoin losing , bowel
secretion g surgery enteropathy sounds
producing or - Electrolyte and usual
net examinati imbalance pattern of
intestinal on for bowel
fluid patients. function.
accumulati - Instructed
on and patient to
laxation. take
medicatio
n at
bedtime
to prevent
episodes
of bowel
movemen
t and
provide
enough
sleep for
the
patient.
- Advised
patient to
take
medicatio
ns only as
prescribed
by the
doctor
and to
prevent
chronic
consumpti
on.
- Instructed
the
patient to
increase
oral fluid
intake to
prevent
dehydrati
on and
promote
easy
defecatio
n.
- Instructed
patient to
maintain
good
nutrition
for as
alternativ
e
managem
ent for
constipati
on.

DRUG NAME DRUG ACTION INDICATIO SIDE EFFECTS NURSING


CLASS N MANAGEMENT
RELATED TO
PT.’S DISEASE
DIPHENHYDRA Antihista It has It is used Common: For the
MINE HCL mine: h-1 significa for - Dizziness chemotherapy
25mg cap PO receptor nt anti- temporary - Drowsine course of the
OD HS antagonist choliner symptoma ss patient, she
gic tic relief of - Dry was prescribed
effects. various mouth, and
It allergic nose and administered
compet conditions throat with
es for or as - Headache Diphenhydrami
H-1 prophylaxi - Nausea ne as pre-
recepto s for BT - Diarrhea medication as
r sites reactions - Restlessn prophylaxis for
on or ess allergic
effector chemothe - Sleeping reactions.
cells, rapy problems Management
thus, reactions - Loss of are as follows:
blockin prior the appetite - Instruct
g procedure - Muscle ed the
histami . Also used weakness patient
ne for - Hypotensi that
release. treatment on first
or - Allergic signs of
preventio reactions medicat
n of ion
motion effectivi
sickness, ty is
and dizzines
vertigo. It s and
is also drowsin
used as a ess,
sedative- thus,
hypnotic patient
drug. safety
was
secured
thru
proper
bed
position
ing and
keeping
the bed
side-
rails up
to avoid
fall.
- Advised
the
patient
to avoid
tasks
that
require
alertnes
s and
motor
skills as
it may
cause
sedative
effects.
- Strictly
monitor
ed the
patient’
s vital
signs
especial
ly BP
and HR.

DRUG DRUG ACTION INDICATION SIDE EFFECTS NURSING


NAME CLASS MANAGEMENT
RELATED TO
PT.’S DISEASE
AMLODIPI Calcium It blocks It is used for Common: Patient is also
NE 10mg Channel the the - Headache known as
tab PO OD Blocker; transport treatment - Edema hypertensive,
anti- of and (swelling hence the
hypertensi calcium prevention of the administration
ve agent into the of chest lower of Amlodipine.
smooth pain extremities Management
muscle (angina) ) are as follows:
cells that results - Dizziness - Strictly
lining the from - Flushing monitor
coronary coronary - Nausea ed the
arteries artery - Fatigue blood
and spasm. In - Palpitation pressure
other addition to s results
arteries this, it is also of the
of the used for the patient
body. treatment to
Calcium and prevent
is prevention complic
importan of high ations
t in blood such as
muscle pressure postural
contracti (hypertensi hypoten
on and on). sion.
by - Strictly
blocking monitor
this, ed the
artery patient
muscles for signs
relax and of fluid
coronary accumul
arteries ation or
and edema
other on lower
arteries extremit
dilate, ies and
thus, signs
better in and
preventi sympto
ng chest ms for
pain dose-
(angina) related
that peripher
results al or
from facial
coronary edema
artery unacco
spasm. mpanied
With this, by
there will weight
be gain.
decrease - Strictly
d blood monitor
pressure, ed the
reducing patient’s
the vital
workload signs
of the especiall
heart to y BP and
pump HR.
blood for
the
whole
body.

DRUG DRUG ACTION INDICATI SIDE EFFECTS NURSING


NAME CLASS ON MANAGEMENT
RELATED TO
PT.’S DISEASE
PARACETA Non- Produces It used Common: Due to Rectal CA,
MOL 500mg narcotic analgesia for the - Allergic patient is
tab PO Q6H analgesi by relief, reactions developing pain,
PRN for c and blocking treatmen - Rashes hence the
pain antipyre generatio t and - Liver administration of
tic n of pain preventio damage Paracetamol.
impulses n of mild - Jaundice Management are
by pain and - Neutropeni as follows:
inhibiting fever. a - Thorough
prostaglan - Pancytopen ly
din ia assessed
synthesis - Hypoglyce patient’s
in the CNS mia pain thru
that pain
sensitize scale,
pain location,
receptors intensity,
to duration,
mechanica temperat
l or ure and
chemical diaphores
stimulatio is for
n. It proper
relieves managem
fever by ent and
central dosing of
action in medicatio
the n.
hypothala - Advised
mic heat- patient to
regulating verbalize
center. improvem
ent or
progressi
on of pain
and fever
for
proper
referral to
the
doctor.
- Instructe
d patient
to take
meds only
as
prescribe
d by the
doctor
and not
to be
overly
consume
d.

DRUG DRUG ACTION INDICATI SIDE EFFECTS NURSING


NAME CLASS ON MANAGEMENT
RELATED TO
PT.’S DISEASE
TRAMADOL Analge Inhibition It used Common: Due to Rectal
+ sic reuptake of for the - Nausea CA, patient is
PARACETA norepineph relief, - Dizziness developing pain,
MOL rine and treatmen - Fatigue hence the
37.5mg/325 serotonin is t and - Somnolenc administration of
mg tab PO caused due preventi e Paracetamol.
TID PRN for to binding on of - Fatigue Management are
pain of pain and - Asthenia as follows:
Tramadol µ- fever. - Allergic - Thorough
opiate reactions ly
receptors. - Rashes assessed
- Liver patient’s
damage pain thru
- Jaundice pain
- Neutropeni scale,
a location,
- Pancytopen intensity,
ia duration,
- Hypoglyce temperat
mia ure and
diaphores
is for
proper
managem
ent and
dosing of
medicatio
n.
- Advised
patient to
verbalize
improve
ment or
progressi
on of pain
and fever
for
proper
referral to
the
doctor.
- Instructe
d patient
to take
meds only
as
prescribe
d by the
doctor
and not
to be
overly
consume
d.

DRUG DRUG ACTION INDICATI SIDE EFFECTS NURSING


NAME CLASS ON MANAGEMENT
RELATED TO
PT.’S DISEASE
TRANEXA Anti- Inhibits It used for Common: Due to Rectal
MIC ACID fibrinol activation the - Hypotension CA, patient
500mg ytic of treatment - Thromboembol developed
cap PO plasmino of ism bleeding in the
Q8H gen thru excessive - Thrombosis rectal area,
binding bleeding - Dizziness hence the
to kringle due to - Visual administration
domain, systemic abnormalities of Hemostan.
thus, or local - Diarrhea Management
reducing hyper- - Nausea are as follows:
conversio fibrinolysi - Vomiting - Confirm
n of s. Also ed to
plasmino used as patient if
gen to prophylax she has
enzyme is for history
plasmin coagulopa of
that thy for stroke,
degrades patients blood
fibrin undergoin clot or
clots and g surgery. bleeding
other in brain.
pro- - Advised
coagulan patient
t factors to
V and verbalize
VIII. improve
ment
progress
ion or
changes
in
bleeding
pattern
for
proper
referral
to the
doctor.
- Instructe
d patient
to take
meds
only as
prescrib
ed by
the
doctor
and not
to be
overly
consume
d.
- Instructe
d patient
to
immedia
tely
report
any
allergic
reaction
s such as
rashes,
urticarial
,
dyspnea
or chest
tightnes
s.
References:
1. Cancer.org. (2018). Key Statistics for Colorectal Cancer. [online] Available at:
https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html
[Accessed 26 Sep. 2018].

2. Afinidad-Bernardo, D. (2018). Colorectal cancer now Philippines' number 1 cancer.


Retrieved from http://www.pchrd.dost.gov.ph/index.php/news/library-health-
news/6126-colorectal-cancer-now-philippines-number-1-cancer

3. Rectum Anatomy, Diagram & Function | Body Maps. (2018). Retrieved from
https://www.healthline.com/human-body-maps/rectum#1

4. Dove-Edwin, I., Sasieni, P., Adams, J., & Thomas, H. (2005). Prevention of
colorectal cancer by colonoscopic surveillance in individuals with a family history
of colorectal cancer: 16 year, prospective, follow-up study. BMJ, 331(7524), 1047.
doi: 10.1136/bmj.38606.794560.eb

5. Jess, T., Rungoe, C., & Peyrin–Biroulet, L. (2012). Risk of Colorectal Cancer in
Patients With Ulcerative Colitis: A Meta-analysis of Population-Based Cohort
Studies. Clinical Gastroenterology And Hepatology, 10(6), 639-645. doi:
10.1016/j.cgh.2012.01.010

6. Luo, S., Li, J., Zhao, L., Yu, T., Zhong, W., & Xia, Z. et al. (2016). Diabetes mellitus
increases the risk of colorectal neoplasia: An updated meta-analysis. Clinics And
Research In Hepatology And Gastroenterology, 40(1), 110-123. doi:
10.1016/j.clinre.2015.05.021

7. Airley, R., & Mobasheri, A. (2007). Hypoxic Regulation of Glucose Transport,


Anaerobic Metabolism and Angiogenesis in Cancer: Novel Pathways and Targets
for Anticancer Therapeutics. Chemotherapy, 53(4), 233-256. doi:
10.1159/000104457
8. He, J., Stram, D., Kolonel, L., Henderson, B., Le Marchand, L., & Haiman, C. (2010).
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British Journal Of Cancer, 103(1), 120-126. doi: 10.1038/sj.bjc.6605721

9. Doubeni, C., Laiyemo, A., Major, J., Schootman, M., Lian, M., & Park, Y. et al.
(2012). Socioeconomic status and the risk of colorectal cancer. Cancer, 118(14),
3636-3644. doi: 10.1002/cncr.26677

10. Larsson, S., Giovannucci, E., Bergkvist, L., & Wolk, A. (2005). Whole grain
consumption and risk of colorectal cancer: a population-based cohort of 60 000
women. British Journal Of Cancer, 92(9), 1803-1807. doi: 10.1038/sj.bjc.6602543

11. Wolin, K., Yan, Y., Colditz, G., & Lee, I. (2009). Physical activity and colon cancer
prevention: a meta-analysis. British Journal Of Cancer, 100(4), 611-616. doi:
10.1038/sj.bjc.6604917

12. Boyle, T., Keegel, T., Bull, F., Heyworth, J., & Fritschi, L. (2012). Physical Activity
and Risks of Proximal and Distal Colon Cancers: A Systematic Review and Meta-
analysis. JNCI: Journal Of The National Cancer Institute, 104(20), 1548-1561. doi:
10.1093/jnci/djs354

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https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-
staging/survival-rates.html

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