COLON

CANCER
COLON CANCER

Colectomy

Personal History
Mr. Hebron
66 years old
July 20, 1949
American citizen
Waterstone Villa St. Maria 1 Balibago,
Pampanga
ADMISSION: June 20, 2016 (11:35 PM)

 In 2013, an estimated 1,777,556 people living

with colon cancer and rectal caner in the US.
It is also the 3rd most common type of cancer in
the US an estimated 95,270 new cases in 2016
In the Philippines it ranks 6th overall In the
Philippines, with an estimated 2,963 new
cases, with 1,567 deaths will be seen in 1998.
Colon cancer increases markedly after age 50

 CHIEF COMPLAINT: difficulty of breathing

(DOB)
DX: Pneumonia in the
Immunocompromised State; Colon
Cancer Stage IV
LIFESTYLE:
2-3 bottles of beer everyday
pack of cigaretttes a day (MIDDLE
SCHOOL)

History of Past Illness

Hypertension
DM

History of Present Illness

Hepatomegaly with multiple nodules/masses.
These nodules can be metastatic in origin.
Mild Splenomegaly without focal parenchymal
lesions.
Bilateral simple renal cysts.
Prostatomegaly
Colonic Diverticulosis
Thoraco-Lumbar Spondylosis
Small nodules in the right lung
Fusiform aneurysm in the infra-renal segment of
the ab aorta

ASSESSMENT (JUNE 28, 2016)

Confused with person, time, and place
With a GCS score of 11 (E4, V1, M6)
Pallor noted upon inspection
Lack of energy noted
Skin
Upon inspection, there is generalized pallor
noted upon inspection.
His skin was cool to touch.

Hair
The color of his hair is white and unevenly
distributed.
Nails
It has a capillary refill of 5 seconds.
The Nose and Sinuses
Difficulty of Breathing noted
The Mouth and Oropharynx
the lips and gums are dark in color
Pale and dry oral mucous membranes noted
Neck
Movements of the neck are uncoordinated, with
minimal discomfort observed.

The Thorax and Lungs

Crackles and Wheezes heard on both lung fields.
Use of accessory muscles when breathing noted.
Presence of non-productive cough
The Extremities
Limited mobility of upper and lower extremities
The Heart
There is weak heartbeat noted upon auscultation.
Bones and Joints
There are no deformities on the bones and the joints
can move but with minimal pain.

JUNE 28, 2016

Skin
Grade 1 decubitus ulcer located at
sacral region
The Extremities
Presence of (+) edema on lower
extremities

Diagnostic and
Laboratory Procedures

Diagnostic/La
boratory
Procedures

Date Order;
Date Result;

Hemoglobin

6/22/16
6/23/16

Hematocrit

Platelet

6/22/16
6/23/16

6/22/16
6/23/16

Diagnostic and
Procedure
Laboratory Procedures

A hemoglobin test measures the

amount of hemoglobin in the
blood.
Hemoglobin is a protein in your
red blood cells that carries
oxygen to your body's organs
and tissues and transports
carbon dioxide from your organs
and tissues back to your lungs.

Hematocrit is the proportion of

your total blood volume that is
composed of red blood cells. A
hematocrit (Hct) test indicates
whether you have too few or too
many red blood cells
conditions that can occur as the
result of certain diseases.
Platelets, which are also called
thrombocytes, are small diskshaped blood cells produced in
the bone marrow and involved in
the process of blood clotting.

Result

(N) 140-175
R: 111

(N) 0.410.50
R: 0.35

(N) 150
400
R: 266

Analysis

Clients hemoglobin level is at

low range, signifying he has a
problem with regards to the
oxygen supply to the cells
and tissues.

Low hematocrit may be

related to clients condition
which is Colon Cancer Stage
IV, due to bleeding can cause
destruction of the red blood
cells and decreased
production of RBC.

The patients platelet count is

within normal range.

Diagnostic/L
aboratory
Procedures

Monocytes

Neutrophils

Lymphocytes

Date
Order;
Date
Result;

06/22/16
06/23/16

06/22/16
06/23/16

06/22/16
06/23/16

Procedure

Monocytes can move

quickly to sites of
infection in the tissues
and divide/differentiate
into macrophages and
dendritic cells to elicit an
immune response.
Neutrophils are a type of
phagocyte and are
normally found in the
bloodstream. During the
beginning (acute) phase
of inflammation,
particularly as a result of
bacterial infection,
environmental exposure,
and some cancers.
Lymphocytes are used to
indicate immune
response of the body
Lymphocytes help to
protect the body against
tumors (tissues that grow
more rapidly than
normal).

Result

(N) 0
0.04
R: 0.05

(N) 0.18
0.70
R: 0.86

(N) 0.10
0.48
R: 0.09

Analysis

An increased production of
monocytes could indicate that the
blood cells are fighting against an
infection or it could be due to a
reaction to a drug that increases
white blood cell production to fight of
infection or a sign of inflammatory
response.

An increased production of
neutrophils is noted, signifying acute
stress due to infection. It could also
indicate that the blood cells are
fighting against an infection or it could
be due to a reaction to a drug that
increases white blood cell production
to fight of infection or a sign of
inflammatory response
Low Lymphocytes may be due to the
bodys ability to resist and fight off
infections is severely compromised
and its susceptibility to cancer.

Clinical
Chemistry

SODIUM

POTASSIUM

CREATININE

Date
Order;
Date
Result;

06/20/16
06/20/16

06/20/16
06/20/16

06/20/16
06/20/16

Procedure

Sodium is both an
electrolyte and mineral. It
helps keep the water (the
amount of fluid inside
and outside the body's
cells) and electrolyte
balance of the
body. Sodium is also
important in how nerves
and muscles work.
Potassium is crucial to
heart function and plays
a key role in skeletal and
smooth muscle
contraction, making it
important for normal
digestive and muscular
function.
Creatinine is a chemical
made by the body and is
used to supply energy
mainly to muscles. This
test is done to see how
well your kidneys work.

Result

Analysis

(N) 135145

Low sodium occurs when water and

sodium are out of balance; theres
either too much water or not enough
sodium. In the case of our patient
who is also diagnosed of Colon
Cancer Stage IV, is one of the most
common electrolyte disorders
associated with tumor-related
conditions.

R: 132.60

(N) 3.5-5.5
R: 4.99

(N) 71.00115.00
R: 55.77

Serum potassium is within normal

range. The client is not experiencing
potassium retention.

Low creatinine due to the condition of

the clients which can be related of his
diet and also because the kidneys
are damaged

Clinical
Chemistry

TROPONIN 1

Diagnostic/L
aboratory
Procedures

X-ray

Date
Order;
Date
Result;

6/20/16
6/20/16

Date
Order;
Date
Result;

6/20/16
6/21/16

Procedure

This test is performed on

patients with chest pain
to determine if the pain is
caused by cardiac
ischemia. It is a specific
indicator of cardiac
muscle injury. It is also
helpful in predicting the
possibility of future
cardiac events.

Result

Analysis

(N) 0.001.00

The troponin 1 level is within normal

means that there were no problems
in the cardiac muscles.

R: Less
than 0.50

Procedure

Result

Analysis

An x-ray film provides a

radiographic image of
the organs or tissues to
detect abnormalities
such as tumors,
perforations, abscesses,
infections, foreign
bodies, or fractures of
the bone.

Chest study
shows slight
increase in the
haziness in the
left lower lobe,
which may due to
pneumonia
and/or pleural
effusion.

The result of the Chest Xray

may be related to the chief
complaint of the patient
(Dyspnea).

Large Intestine

long, thick tube about 2 inches in diameter and about

5 feet long
inferior to the stomach and wraps around the superior
and lateral border of the small intestine
absorbs water and contains many symbiotic bacteria
that aid in the breaking down of wastes
Functions;
Absorb Water
Absorb Vitamins
Produce Antibodies
Reduce Acidity and Protect
from Infections

Colon

Ascending colon: uses muscle contractions to push up any

undigested food products
Transverse colon
Descending colon
Sigmoid colon

 Respiratory System
Functions;
Regulation of blood pH.
Voice production.
Olfaction.
Innate immunity.

Right Lung- three lobes, called;

superior, middle, inferior lobes.
Left Lung- two lobes called superior
and inferior lobes.
***The lobes of the lungs are separated by deep,
prominent fissures on the lung surface. Each lobe
is divided into bronchopulmonary segments
separated from one another by connective tissue
septa, but these separations are not visible as
surface fissures.

PLANNING (Nursing Care Plan)

Ineffective Airway Clearance r/t retained
secretions
Impaired gas exchange r/t alveolar-capillary
membrane changes
Imbalanced nutrition: Less than body
requirements
Impaired Skin Integrity
Activity Intolerance

VI. CLIENTS DAILY PROGRESS CHART

1. Clients Daily Progress Chart
DAYS

ADMISSIO

DAY 2

DAY 3

Day 4

07-21-

07-27-

07-28-

07-20-

2016

2016

2016

Nursing Problems
*

2016
1.Ineffective
Airway
Clearance

r/t

retained
secretions
2.Impaired gas
exchange

r/t

alveolarcapillary
membrane
changes
22

1. Clients Daily Progress Chart

DAYS

ADMISSIO

DAY 2

DAY 3

Day 4

07-21-

07-27-

07-28-

07-20-

2016

2016

2016

2016
Nursing Problems
3.Imbalanced

nutrition: Less
than

body

requirements
4.Impaired

skin integrity

5.Activity
intolerance

Vital Signs

Blood

110/70mmHg

Pressure

Temperature

36.4c

Pulse Rate

22cpm

Respiratory

96bpm

Rate

Laboratory Procedures
Hemoglobin

141

Hematocrit

0.44

Red Blood Cell 4.78

Count
MCV

92.1

MCH

29.5

MCHC

32.0

WBC

11.92

Neutrophils

0.84

Lymphocytes

0.13

Monocytes

0.03

Platelet Count

254

Medical

ADMISSIO

DAY 2

DAY 3

Day 4

Manageme

07-21-

07-27-

07-28-

nt

07-20-

2016

2016

2016

*
*

*
*

2016
IVF
D5NSS 1L
TPN

*
*

Drugs
Pantoprazole
40mg/IV

Omeprazole

40mg IV OD
Paracetamol

300mg/2ml IV
PRN
Piperacillin-

tazobactam
2.25mg/IV Q8
Acetylcysteine
600mg/tab
BID
Megestrol
Acetate
Ipatropium
salbuamol
Neb, Q4

Drugs
Hydrocortison
e

100mg/IV Q12
Nalbuphine
1/2 AMP for
restlessness

Meropenem

500mg/IV
Bisacodyl
10mg
/suppository

Diet
NPO

Soft Diet

Activity/exercise
Bed Rest

2. Discharge Planning
General Condition of patient after discharge

The patient was not seen during the discharge

b. METHOD
Medications:
Exercise:
Advise patient to do 10 minute walks.
Advise patient to have adequate rest periods between
walks

Treatment:
Advised patient to comply with the health teachings and
doctors instruction to promote well-being and life
Health Teachings:
Instructed patient to comply with the health teachings and
doctors orders
Encouraged patient to eat soft foods like mashed potato,
lugaw, sopas, bread, pasta, etc
Instructed patient to avoid spicy foods
Out-Patient Department:

Diet:
Soft diet

IV. Conclusion
Colon Cancer is a growth of a tumor on the
inner walls of the colon which may spread on
the different parts of the body and can be
treated with surgery (colectomy) and
chemotherapy.