PALAWAN POLYTECHNIC COLLEGE INC.

Brgy. Milagrosa, Manalo Ext., Puerto Princesa City

Bachelor of Science in Nursing

An Individual Case Study

A Treatment to Live
(Chemotherapy for Colon CA)

Submitted by:
Jaileen Triesh A. Batiancila, SN

Submitted to:
Hannah Joy Lobaton RN, MAN

October 20,2018

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TABLE OF CONTENTS

I. Title Page--------------------------------------------------------------------------------1

II. Introduction----------------------------------------------------------------------------3

III. Patient’s Profile----------------------------------------------------------------------5-6

A. Personal data----------------------------------------------------------------------5
B. Present health history------------------------------------------------------------6
C. Past health history----------------------------------------------------------------6

IV. Physical Assessment------------------------------------------------------------------7

V. Laboratory------------------------------------------------------------------------------13

VI. Drug Study-----------------------------------------------------------------------------15

VII. Anatomy & Physiology--------------------------------------------------------------17

VIII. Pathophysiology---------------------------------------------------------------------21

IX. Summary of Nursing Care Plan------------------------------------------------------22

X. Nursing Care Plan-----------------------------------------------------------------------23

XI. Discharge Plan--------------------------------------------------------------------------29

XII. Bibliography---------------------------------------------------------------------------31

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INTRODUCTION

This case is an individual case study which is entitled A Treatment to Live which
my 64-year-old patient is undergoing chemotherapy for being diagnosed of colon cancer.

Colon cancer is cancer of the large intestine (colon), which is the final part of
your digestive tract. Most cases of colon cancer begin as small, noncancerous (benign)
clumps of cells called adenomatous polyps. Over time some of these polyps can become
colon cancers. Polyps may be small and produce few, if any, symptoms. For this reason,
doctors recommend regular screening tests to help prevent colon cancer by identifying
and removing polyps before they turn into cancer.

Signs and symptoms of colon cancer include: a change in your bowel habits,
including diarrhea or constipation or a change in the consistency of your stool, that lasts
longer than four weeks; rectal bleeding or blood in your stool; persistent abdominal
discomfort, such as cramps, gas or pain; a feeling that your bowel doesn't empty
completely; weakness or fatigue; and unexplained weight loss. Many people with colon
cancer experience no symptoms in the early stages of the disease. When symptoms
appear, they'll likely vary, depending on the cancer's size and location in your large
intestine.

If you notice any symptoms of colon cancer, such as blood in your stool or an
ongoing change in bowel habits, do not hesitate to make an appointment with your
doctor. Talk to your doctor about when you should begin screening for colon cancer.
Guidelines generally recommend that colon cancer screenings begin at age 50. Your
doctor may recommend more frequent or earlier screening if you have other risk factors,
such as a family history of the disease.

In most cases, it's not clear what causes colon cancer. Doctors know that colon
cancer occurs when healthy cells in the colon develop errors in their genetic blueprint, the
DNA. Healthy cells grow and divide in an orderly way to keep your body functioning
normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to
divide — even when new cells aren't needed. As the cells accumulate, they form a tumor.
With time, the cancer cells can grow to invade and destroy normal tissue nearby. And
cancerous cells can travel to other parts of the body to form deposits there (metastasis).

Inherited gene mutations that increase the risk of colon cancer can be passed
through families, but these inherited genes are linked to only a small percentage of colon
cancers. Inherited gene mutations don't make cancer inevitable, but they can increase an
individual's risk of cancer significantly.

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 Studies of large groups of people have shown an association between a typical
Western diet and an increased risk of colon cancer. A typical Western diet is high in fat
and low in fiber. When people move from areas where the typical diet is low in fat and
high in fiber to areas where the typical Western diet is most common, the risk of colon
cancer in these people increases significantly. It's not clear why this occurs, but
researchers are studying whether a high-fat, low-fiber diet affects the microbes that live
in the colon or causes underlying inflammation that may contribute to cancer risk. This is
an area of active investigation and research is ongoing.

Factors that may increase your risk of colon cancer include: older age; African-
American race. African-Americans have a greater risk of colon cancer than do people of
other races; a personal history of colorectal cancer or polyps; inflammatory intestinal
conditions; chronic inflammatory diseases of the colon, such as ulcerative colitis and
Crohn's disease, can increase your risk of colon cancer; inherited syndromes that increase
colon cancer risk; family history of colon cancer; low-fiber, high-fat diet; a sedentary
lifestyle; Diabetes; obesity; smoking; alcohol; and radiation therapy for cancer.

People with an average risk of colon cancer can consider screening beginning at
age 50. But people with an increased risk, such as those with a family history of colon
cancer, should consider screening sooner. Several screening options exist — each with its
own benefits and drawbacks. Talk about your options with your doctor, and together you
can decide which tests are appropriate for you.

You can take steps to reduce your risk of colon cancer by making changes in your
everyday life. Take steps to: eat a variety of fruits, vegetables and whole grains; drink
alcohol in moderation, if at all (if you choose to drink alcohol, limit the amount of
alcohol you drink to no more than one drink a day for women and two for men); stop
smoking; exercise most days of the week; and maintain a healthy weight.

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PATIENT’S PROFILE

Personal Data

Patient name:

Address: UHOS, Tiniguiban, P.P.C., Palawan

Sex: Male

Civil Status: Married

Age: 64

Birthday: February 28, 1954

Nationality: Filipino

Religion: Roman Catholic

Special Procedure: Resection (colon), Colostomy bag LLQ

Chief Complaints: For chemotherapy session

Admission time: 05:19 pm

Admission day: October 12, 2018

Admission Diagnosis: For chemotherapy

Attending Physician: Dr. Joseph M. Tovera, MD

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Present Health History

Prior to admission, the patient stated that he got colds for 3 days and has been

diagnosed for chemotherapy also. He has been scheduled chemotherapy every three

weeks for his treatment in colon cancer. And has been undergoing chemotherapy

treatment since the month of August.

Past Health History

As the patient stated, he undergone a surgery (resection, colostomy bag LLQ)

last week of July and been undergoing a chemotherapy since the month of August up

until now for his cancer treatment and its scheduled every 3 weeks. He has a history

of colon cancer in his father side and he has been a party people in his teen age life

but he stopped smoking and drinking alcohol now. He doesn’t know if he completed

vaccinations when he was young.

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PHYSICAL ASSESSMENT

 HEAD
Hair
-short hair, black in color with graying hair
-evenly distributed covers the whole scalp
-no evidences of alopecia noted
-thin, and smooth to touch
-neither brittle nor dry
Scalp
-lighter in color than the complexion.
-oily to touch
-no scars noted
-no lice, nits and dandruff noted
-no lesions noted
-no tenderness or masses noted upon palpation.

Skull
-Generally round, with prominences in the frontal and occipital area
-normocephalic and symmetrical
-no tenderness noted upon palpation.
Face
- he has a semi-rounded shape of face
-facial features were symmetrical
-cranial nerves are functioning well
- no involuntary muscle movements
-can move facial muscles at will
-no scars noted
-no lesions noted
-no masses noted
-no rashes noted
-no discoloration
-light brown in complexion

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 EYES
Eyebrows
-symmetrical and in line with each other
-black in color
-evenly distributed
Eyelashes
-black in color
-evenly distributed
-turned outward
Eyes
-evenly placed and in line with each other.
-none protruding
-equal palpebral fissure
- upper eyelids cover the small portion of the iris, cornea, and sclera when
eyes are open.
-no ptosis noted (drooping of upper eyelids)
-both eyelid meets completely when eyes are closed
-eyelids are symmetrical
-palpebral conjunctiva is pink in color
-sclera is white in color
- moist noted
-no ulcers noted
-no foreign objects noted
-PERRLA
-can clearly see and recognized an object from across the room

 EARS
- the ear lobes are bean shaped, parallel, and symmetrical
-the upper connection of the ear lobe is parallel with the outer canthus of
the eye
-skin is same in color as in the complexion
-no lesions and no discharges noted on inspection
-the auricles are has a firm cartilage on palpation
-the pinna recoils when folded
-there is no pain or tenderness noted on the palpation of the auricles

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 -his ear canal has normally some cerumen on inspection
-both ears are able to hear clearly

 NOSE
- nose in the midline noted
-no discharges noted
-no flaring alae nasi noted
-both nares are patent
-no bone and cartilage deviation noted on palpation
-no tenderness noted on palpation
-nasal septum in the mid line and not perforated

 MOUTH
Lips
- with visible margin
-symmetrical in appearance and movement
-slightly pinkish in color
-no edema noted
Temporomandibular
-moves smoothly, no crepitus noted
-no deviations noted
-no pain or tenderness on palpation and jaw movement.
Gums
-pinkish in color
-no gum bleeding noted
-no receding gums noted
Teeth
-yellowish in color
-no halitosis (bad breath) noted
Tongue
- pinkish with white taste buds on the surface
-no lesions noted
-no varicosities on ventral surface noted
-gag reflex is present
-able to move the tongue freely and with strength

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 -he can speak loud and clear

 NECK
-the neck is straight
-no visible mass or lumps
-symmetrical
-no jugular venous distension (suggestive of cardiac congestion) noted

 THROAT
- the thyroid is non palpable.
-no nodules are palpable.

 CHEST and LUNGS

Inspection
-the chest walls are intact and symmetrical
-no rashes noted
-no lesions noted
-no scars noted
-no discoloration noted
-nipples are seen
-spine is at the midline
- effortless respirations noted
-no difficulty in breathing noted
-no dyspnea noted
Palpation
-apical pulsation can be felt
-no abnormal heaves noted
-thrills felt over the apex
-no masses noted
Percussion
-normal sounds at specific areas are heard
Auscultation
-bilaterally clear
- no abnormal heart and lung sounds is heard (e.g.
murmurs, adventitious sounds).

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 -cardiac rate 72 bpm
- manifested quiet, rhythmic and effortless respirations

 ABDOMEN
Inspection
-presence of excess fats noted
-symmetric contour is noted
-no rashes noted
-no discoloration noted
-no venous engorgement.
-colostomy bag in LLQ
- symmetrical movements cause by respirations noted
-navel is inverted
Auscultation
-normal active bowel sounds are heard
Palpation
- no tenderness noted.
-with smooth and consistent tension noted
-no muscles guarding
-no masses noted
Percussion
- normal sounds at specific areas are heard

 GENITO URINARY
-he has a penis
-he is urinating well

 SKIN EXTREMITIES
Upper:
-symmetrical
-brown in color noted
-have the same contour with prominences of joints noted
-no involuntary movements noted
-no edema noted
-no rashes noted

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 -discoloration noted (darker shade of color in arms)
-warm to touch
-no masses or lesions noted
-can move muscles at own will
-can perform complete range of motion
-skin turgor is normal
-capillary refill is normal

Lower:
-symmetrical
-he has the same contour with prominences of joints
-no involuntary movements noted
-no edema noted
-no rashes noted
-small scattered scars are noted
- warm to touch
-no masses or lesions noted
-can perform complete range of motion
-ambulatory
-skin turgor is normal
-capillary refill is normal

 GENERAL CONDITION- a 64-years-old man, who undergone resection (colon) and

colostomy in LLQ, with a pulse rate of 68 beats per minute; respiratory rate of 22
cardiac per minute; a result of 110/80 mmHg for his blood pressure with a 35.8OC of
temperature; PaO2 of 97%, and he has a GCS of 15

 NURSING IMPRESSION- cooperative to the medical staff and answers coherently

when asks.

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LABORATORY
Procedure Result Normal Values Clinical Significance Nursing Implications

Platelet Count  76 x 10g/L  150-450 x 10g/L  Indicates decrease in  Advised to eat nutritious fruits
clotting time most special those fruits that can
 Below normal make your platelet higher like
papaya, pomegranate, etc. and
also advised him to drink milks.

Hemoglobin  123g/L  140-175 g/L  Advised to eat nutritious food,

 Indicates occurrence of
anemia especially rich in vitamin C
(citruses and oranges, cashews,
 Below normal guavas) and iron (malunggay
and green leafy vegetables,
spinach, beans, and sea foods)

Hematocrit  0.37%  0.41-0.50%  Indicates hyper

coagulation  Advised patient to eat rich in
iron (green leafy vegetables)
 Below normal and vitamin C (oranges,
citruses, etc.)

 Indicates invasion of  Should eat nutritious food,

Monocytes  10%  0-7% microbes. especially rich in vitamin C
 Above normal (citruses and oranges) and
fishes.

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 Creatinine  1.45 mg/dL  0.7-1.2 mg/dL  Indicates that the  Advised to eat protein rich food
kidney is not working (monggo, beans) and adequate
properly intake of water.
 Above normal

Sodium  145.6 mEq/L  136-145 mEq/L  Indicates dehydration

 Instructed patient to minimized
 Above normal
or avoid sodium intake and
increase fluid intake.
o Indicates small average
Mean Corpuscular o 72.2 o 80-96 fL o Advised patient to increase iron
of red blood cell size
Volume (MCV) diet foods like malunggay and
(microcytic)
green leafy vegetables, spinach,
o Below normal
beans, and sea foods

Mean corpuscular  Indicates microcytic

 24.2  27.5-33.2 pg  Instructed patient to eat foods
Hemoglobin (MCH) anemia
rich in irons like malunggay and
 Below normal
green leafy vegetables, spinach,
beans, and sea foods

 20.8  11.6-14.6%  May indicates anemia  Advised patient to eat nutritious

RDW-CV
 Above normal foods

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 DRUG STUDY
Name of Drug Classification Dose/Freq/Route Mechanism of Indications Contraindications Side Effects Nursing
Action Implications
Generic:  Vitamin 500 ml x 10 hrs -  Hemoglobin  Vitamin B12  Contraindicated  headache  Implement the
B12 OD - IV Synthesis deficiency in patients  itching 10 R’s (right
Alamine
from hypersensitive to  swelling patient, time,
 Gene
Brand: inadequate drugs.  nervousness dose, route,
Methylation
diet, subtotal  anxiousness medication,
 Myelin gastrectomy,  involuntary or education, to
Production or other uncontrollable refuse,
condition, or movements assessment,
 Consuming disease, except  low levels of evaluation, and
Enough B12 malabsorption, potassium in the documentation).
related to blood
Before:
pernicious  clots in the arms
anemia or and legs  Inform the
other GI  life-threatening patient about the
disease. allergic reaction, drug, why is it
in which you necessary and
 Pernicious
may have how the client
anemia or
trouble can cooperate.
vitamin B12
breathing, your
malabsorption After:
tongue swells
 Maintenance and/or throat  Advise patient to
therapy for closes up, and seek medical
remission of your skin breaks attention
pernicious out into hives immediately if

15
 anemia after  fluid building up adverse reactions
I.M. vitamin in the lungs occur.
B12 therapy in
patients
without
nervous
system
involvement;
dietary
deficiency,
malabsorption
disorders, and
inadequate
secretion of
intrinsic factor
 Cyanide
poioning

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ANATOMY and PHYSIOLOGY

The intestine is part of the digestive system. It is made up of the small intestine
and the large intestine. The colon and rectum are parts of the large intestine. The colon is
a U-shaped tube made of muscle and found below the stomach. The rectum is a shorter
tube connected to the colon. Together, the colon and rectum are about 2 metres (6 feet)
long. They are surrounded by other organs including the spleen, liver, pancreas, bladder
and reproductive organs.

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Parts of the large intestine
The large intestine is made up of the cecum, colon, rectum and anus. The colon
and rectum are held in the abdomen by folds of tissue called mesenteries.
Cecum
The cecum is a pouch-like passage that connects the colon to the ileum (the last
part of the small intestine). If cancer develops in the cecum, it is treated like colon cancer.
Colon
The colon is the longest part of the large intestine. It receives almost completely
digested food from the cecum, absorbs water and nutrients, and passes waste (stool or
feces) to the rectum. The colon is divided into 4 parts.
The ascending colon is the start of the colon. It is on the right side of the
abdomen. It continues upward to a bend in the colon called the hepatic flexure.
The transverse colon follows the ascending colon and hepatic flexure. It lies
across the upper part of the abdomen. It ends with a bend in the colon called the splenic
flexure.
The descending colon follows the transverse colon and splenic flexure. It is on the
left side of the abdomen.
The sigmoid colon is the last part of the colon that connects to the rectum.
Rectum
The rectum is the lower part of the large intestine that connects to the sigmoid
colon. It is about 15 cm (6 in) long. It receives waste (stool or feces) from the colon and
stores it until it passes out of the body through the anus.
Anus
The anus is the opening at the lower end of the rectum through which waste (stool
or feces) is passed from the body. Cancer in the anal canal or anus is treated differently
from colorectal cancer. Find out more about anal cancer.

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Mesentery
Mesentery is made of fatty connective tissue that contains blood vessels, nerves,
lymph nodes and lymph vessels. The mesocolon is a mesentery that attaches the colon to
the wall of the abdomen. The rectum is surrounded by a mesentery called the
mesorectum.
When part of the colon or rectum is removed to treat cancer, nearby mesentery is also
removed. The lymph nodes within the mesentery are examined to see if they contain
cancer cells.

Layers of the colon and rectum

The colon and rectum are made up of different layers of tissues.
Mucosa
The mucosa is the inner lining of the colon and rectum. It is made up of:
 a thin layer of epithelial cells (called the epithelium)
 a layer of connective tissue (called the lamina propria)
 a thin layer of muscle (called the muscularis mucosa)
Submucosa
The submucosa is a layer of connective tissue that surrounds the mucosa. It
contains mucous glands, blood vessels, lymph vessels and nerves.
Muscularis propria
The muscularis propria lies outside the submucosa. It is a thick layer of muscle. It
has an inner ring of circular muscle fibres and an outer ring of long muscle fibres that
surround the wall of the colon and rectum.
Serosa
The serosa is the outer layer of the colon. It is not found on most of the rectum.

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Function
The colon and rectum:
 absorb water and some nutrients from what we eat and drink
 form and store waste (stool or feces)
 move waste out of the body
Partly broken down or digested food moves from the small intestine into the colon.
Sections of the colon tighten and relax to move the food through the colon and rectum.
This movement is called peristalsis.
In the colon, bacteria break down food into smaller pieces. The inner layer of the mucosa
(called the epithelium) absorbs, or takes up, water and some nutrients. The liquid waste
remaining in the colon is formed into semi-solid stool (also called feces).
The mucosa also makes mucus that helps stool move easily through the colon and
rectum. As stool moves through the colon, more water is absorbed from it and it becomes
more solid.
Stool leaves the colon and moves into the rectum. The rectum is a holding area for the
stool. When the rectum is full, it pushes the stool out of the body through the anus.

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 PATHOPHYSIOLOGY

Predisposing Factors Precipitating Factors Contributing Factors

-64 years’ old Multiple gene interactions -high consumption of

meat
-Familial polyposis
(father side) -cigarette smoking
-alcohol consumption
Formation of -sedentary life (low level
adenomatous polyps in of physical activity)
the descending colon

Clinical
Manifestations: Formation of
malignant adenoma
-progressive
abdominal distention
-pain
-vomiting Surgical removal

-constipation (resection [colon])

-need for laxatives

-abdominal cramps
-change in bowel
habits
-obstruction Chemotherapy
treatment

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SUMMARY OF NURSING CARE PLAN

Date Nursing Diagnosis

October 13, 2018 Risk for infection related to lowered immune system
secondary to chemotherapy for colon cancer
October 13, 2018  Risk for injury related to impaired primary
defense mechanism secondary to colostomy in
LLQ
October 13, 2018  Fear related to situational crisis secondary to
chemotherapy treatment for colon cancer

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 NURSING CARE PLAN
Assessment Diagnosis Planning Intervention Rationale Evaluation
S:  Risk for infection  After 8 hours of INDEPENDENT:  Goal’s met.
related to nursing
None  Monitor temperature.  An elevation of  Patient remain
lowered immune interventions
temperature may afebrile as
system patient will remain
indicate invasion of evidenced by vital
secondary to afebrile.
O: infections/microbes. signs taking of
chemotherapy
temperature 35.8 0C
 colon cancer for colon cancer
 Keep linens dry and  Reduces pressure and
patient wrinkle-free. Ensure irritation to tissues and
 undergone clean and may prevent skin
colostomy in comfortable clothing breakdown (potential
LLQ to the client. site for bacterial
 undergone growth)
resection
(colon)  Limits fatigue, yet
 Promote adequate
 history of three encourages sufficient
rest periods.
days cold movement to prevent
complications.

 Will decrease chances

 Stress importance of of invasion of
good and proper microbes
hygiene

23
  Provide a quiet  Excessive stimulation
environment. of the environment
will aggravate
negative emotions.

 Limit the visiting  Will decrease chances

hours and person to of cross-
visit. contaminating the
patient

DEPENDENT:
 Administer  To reduce risk of
medications as invasion of microbes.
ordered by the
physician.

COLLABORATION:
 Provide infection  To reduce risk of
control procedures cross-contamination.
with the other
members of the health
team

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 Assessment Diagnosis Planning Intervention Rationale Evaluation
S:  Risk for injury  After 6 hours of INDEPENDENT:  Goal’s met.
related to impaired nursing
None  Assist and advice the  By assisting the client’s  No harms done to
primary defense interventions the
client’s SO to always need will decrease chances the patient.
O: mechanism patient will be free
assist the client’s need in of having an injury.
secondary to of injury.
 Undergone colostomy in LLQ
daily living activities.
resection
(colon)  By having knowledge that
 Undergone  Instruct to always ask an she needed assistance will
colostomy in assistance whenever she decrease chances of
LLQ wants to stands, walks, having an injury.
 Altered clotting and moves.
factor platelet
count result of  It will reduce the chances
76 x 10g/L  Instruct the patient not of patient from having an
(150-450 x lift heavy objects. injury.
10g/L)
 Decrease
hemoglobin  Instruct patient to avoid  Having wound has a high
123g/L (140- sharp objects that can risk of having a longer
175 g/L) harm himself. time in healing because of
decrease in clotting factor
and low in hemoglobin.

25
  By having knowledge will
 Provide ascertain
decrease chances of
knowledge of safety
having an injury.
precautions and
motivation to prevent
injury.

26
 Assessment Diagnosis Planning Intervention Rationale Evaluation
S:  Fear related to  After 20 minutes of INDEPENDENT:  Goal’s met.
situational crisis nursing
“Tingin mo gagaling  Remain with the  Helps to reduce  “Gagaling ako” as
secondary to interventions the
pa kaya ako? as patient, and stay calm. interpersonal the positive
chemotherapy patient will display
verbalized by the
treatment for colon appropriate range Speak in a slow transmission anxiety, verbalization of the
patient.
cancer of feelings and manner and shows caring for patient.
lessened fear. the patient.

O:
 Hopelessness  To help the patient in
 Instructed patient to do
relax her muscles and
noted deep breathing
 Apprehension make her calm.
exercises.
noted  Focuses on likelihood of
 Eagerness to heal  Reinforce positive
desirable outcome and
noted aspects of his
helps to bring perceived
chemotherapy
or actual threat into
treatment.
perspective.

 Support or redirect
 Improves fundamental
expressed coping
and automatic coping
mechanisms.
mechanisms, increases
self-confidence and
acceptance, and reduces
anxiety.

27
  Encourage the patient  Supporting the client
that she can make it will give her positive
and support him. outlook.

 Encourage the patient  Will strengthen his

to ask guidance in our relationship to God and
Almighty Creator. encourage him to be
religious.

28
DISCHARGED PLAN

NURSING ORDERS RATIONALES

Medication

Exercise
 Provide exercise as tolerated  To not over exceed himself
 Instructed to take a walk every  Sunlight in this hour are nutritious you
morning when the sun is still healthy can absorb vitamin D and not
which is around 6 to 7:30 in the cancerous
morning
 Excessive exercise can may cause
 Instruct patient to do ROM exercises injury the client.

Treatment
 Closely monitor any signs of  Prevention from having
complications complications.
 Encourage adequate rest periods to  To have patient timely healing.
prevent fatigue

Health Teachings
 Proper care of self to help increase  To promote patient timely healing.
chances of fast recovery
 Instructed the patient to be always
 To promote positive emotions to the
calm and think only happy thoughts to
client that will help in his healing.
avoid stress and worsening her
condition.

Out Patient
 Follow up check-up as the physician  Will prevent having complications to
ordered (if there is). the client.
 Encourage family of the client to
follow checkup schedule to give the
physician right information about the
status of the client
Diet
 Soft diet, low fat diet and low salt diet.  It will make the patient recover faster.
 Instructed the client to eat nutritious
food and proper meal in every serving
with a variety of fruits and vegetables.

29
  Instructed the client to eat in proper
time 7am -8am for breakfast, 11am-
12pm for lunch, and 6:30pm-7:30pm
for dinner.
 Instructed the client to minimize or
avoid salt intake, avoid fatty foods
and rich in cholesterol such as oil
cooked foods, meats, burgers, and etc.
 Advised to eat nutritious fruits most
special those fruits that can make your
platelet higher like papaya,
pomegranate, etc. and also advised
him to drink milks.
 Advised to eat nutritious food,
especially rich in vitamin C like
citruses and oranges, cashews,
guavas.
 Instructed patient to minimized or
avoid sodium intake and increase
fluid intake.

Spiritual  Strengthen the relationship of the

client to our Almighty Creator.
 Seeking the guidance of the Almighty
God in her journey to become a good
parent, wife, citizen and overcome
every challenges she’s going to face.

30
BIBLIOGRAPHY

 Nursing 2017 Drug Handbook-Wolters Kluwer

 Webster’s New Explorer Medical Dictionary

 http://www.cancer.ca/en/cancer-information/cancer-type/colorectal/colorectal-cancer/the-

colon-and-rectum/?region=on

 Understanding Pathophysiology- Huether and McCance

 Medical-Surgical-White

 Medical-Surgical 7th Edition-Lewis, Bucher, and etc.

 Nursing Understanding Diseases-Lippincott

 Nurse’s Pocket Guide 14th Edition- Doenges; Moorhouse; and Murr

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