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Level Ii Section 2 Group 6 Medical Forbes
Level Ii Section 2 Group 6 Medical Forbes
MEDICAL FORBES
I. Introduction
Cancer (medical term: malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits),
invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties
of cancers differentiate them from benign tumors, which are self-limited, and do not invade or metastasize. (http://en.wikipedia.org/wiki/Colorectal_cancer)
Colorectal cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. Tumors of the colon and rectum are
growths arising from the inner wall of the large intestine. Benign tumors of the large intestine are called polyps. Malignant tumors of the large intestine are called cancers. Benign
polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can be easily removed during colonoscopy and are not life-threatening. If benign polyps are
not removed from the large intestine, they can become malignant (cancerous) over time. Most of the cancers of the large intestine are believed to have developed from polyps.
Cancer of the colon and rectum (also referred to as colorectal cancer) can invade and damage adjacent tissues and organs. Cancer cells can also break away and spread to other
parts of the body (such as liver and lung) where new tumors form. The spread of colon cancer to distant organs is called metastasis of the colon cancer. Once metastasis has
occurred in colorectal cancer, a complete cure of the cancer is unlikely. Factors that increase a person's risk of colorectal cancer include high fat intake, a family history of
colorectal cancer and polyps, the presence of polyps in the large intestine, and chronic ulcerative colitis. (http://www.medicinenet.com/colon_cancer/article.htm)
Globally, cancer of the colon and rectum is the third leading cause of cancer in males and the fourth leading cause of cancer in females. The frequency of colorectal
cancer varies around the world. It is common in the Western world and is rare in Asia and Africa. In countries where the people have adopted western diets, the incidence of
colorectal cancer is increasing. Colorectal cancer ranks second to lung cancer as the overall most common cause of cancer mortality. In Asian 46.9 per 100,000 men and 34.6 per
100,000 women have incidence rates of colon cancer. The April 15th, 2009 release of the Cancer Statistics Review (1975-2006) does not include cancer mortality statistics because
the latest mortality file with 2006 deaths from the National Center for Health Statistics, Division of Vital Statistics has not been released.
(http://seer.cancer.gov/csr/1975_2006/index.html)
B. Rationale for the study
The researchers decided to choose this study because they wanted to know more about Colorectal Cancer and its cause. Why Colorectal cancer is rapidly growing not only
in the western population but also in the eastern population. They wanted to use the acquired knowledge in promoting awareness to the people especially to the poor in slum
because they are the most vulnerable. The researchers also wanted to focus on the preventive measure. Presently in our country Colon Cancer is rapidly gain momentum as one of
This study will help the nursing profession in providing information about the proper management and care of patients with colon cancer. It will also educate the people
especially those with colon cancer to seek medical care in order to prevent much more major complication. It will come to awareness the importance of healthy habits and lifestyle
to maintain wellbeing.
This study is the focus on the nursing aspects of care of patients diagnose with colon cancer. This study will also be used in the nursing profession. The researchers
only focus their attention on the medication, diagnosis, care plan, pathophysiology. This study will be limited for the colon cancer patients and for those who are interested in colon
cancer.
II. Clinical Summary
A. General Information
Age: 46 years old Gender: Female Civil Status: Married Nationality: Filipino
Religion: Roman Catholic Date of Birth: February 19, 1963 Place of Birth: Biñan
B. Chief Complaint
*Abdominal Pain
o Five days PTA, the patient complained continuous abdominal pain that was graded 6/10.
o Four days PTA, patient noted persistence of abdominal pain. And she also noted decrease urine output.
o Three days PTA, the patient still have persistence of abdominal pain. Patient had a paracentesis done on the same day. Patient now complained of the passage of
febrile, for which she self-medicated with Paracetamol, which lysed the fever.
o One day PTA, patient complained of the persistence of abdominal pain, loose watery stool, and uncontrolled passage of stool during urination. And she self-
o Persistence of symptoms prompted consultation the following days hence this admission.
Allergies: none
Illnesses: Colonic CA
Injuries: ----
G. Patterns of Functioning
The researchers utilized the Gordon’s typology in assessing the pattern of functioning of our patient in her life. How does she manages and takes care of herself
Activity and Exercise The human body was designed for motion, and regular exercise is necessary for its healthy
functioning. Individuals who choose inactive lifestyles or who are forced into inactivity by illness or injury
The patient has sedentary lifestyle.
placed themselves at high risk for serious health problems. (Fundamentals of Nursing 5th edition by Taylor,
The patient has no regular exercise.
page 1116)
According to her, cleaning the house and doing light
Vigorous physical activity is not always needed to achieve positive result. (Fundamentals of Nursing
activities like walking from house to market is her own
5th edition by Taylor, page 1117).
way of exercise.
Lack of exercise, inactivity, or immobility related to illness, or injury place a person at high risk for
The patient wasn’t aware that her activities weren’t
serious health problems. Immobility can affect the major body systems. Like the benefits, a person receives
enough to be considered good exercise because she
from exercise, complications resulting from immobility differ occurrence and severity based on the patients
believes that doing such activities like what she does is
age and overall health status. (Kozier et. Al, Fundamentals of Nursing 7th edition page 1118).
already good enough for her.
The wonderful tool of exercise can help teens become fit and healthy. Performing some form of
physical activity daily will significantly boost your “basal metabolic rate” – the number of calories your body
burns in order to keep you alive. By having a high metabolism, you burn calories 24 hours a day – even while
you sleep! You can literally turn your body into a fat-burning machine!
This has many benefits: with a strong metabolism comes a strong immune system. When you burn fat,
the toxins are released into the blood stream, and are quickly carried out of the body through sweat. This
inoculates you against the probability of developing cancerous and diseased cells. Therefore, hard exercise –
that makes you sweat – is very good for you.
Exercise also helps to regulate the mount of insulin released into the bloodstream. Insulin is
commonly referred to as “the fat-making hormone”. Its job is to metabolized blood sugar into energy. But too
much insulin in the bloodstream keeps your body from burning stored fat. Years of an overworked pancreas-
the organ that produces insulin – can lead to “onset (type2) diabetes”. However, if you use –burn-more
calories than you consume, you significantly reduce chances of developing this disease.
Exercise can also help control other problems, such as sleep apnea, moodiness, stress, decreased
energy, cardiovascular disease, high cholesterol and others. There are too many benefits to list here. But be
assured that this tool can help you become a fit, stronger, disease free, and overall healthier person. The main
goal of aerobic exercise is to keep the heart elevated for an extended period of time for the purpose of
strengthening the heart and lungs. The most common aerobic exercise is walking. Running is the quickest
way to lose weight because it burns many calories. It also tones your calves and thighs. However, to avoid
extreme muscle aches or injuries, do not begin a running routine until you have performed two to three
months of aerobic walking.
(http://www.thercg.org/youth/articles/0201-toie.html)
Cognitive-perceptual Cognition is greatly affected by education. Those who study and develop their skills have better
cognitive performances because they have been provided with different information nod chances to develop
The patient still has a good memory and was able to recall
their self. Perception is affected by the sensory diseases. Presence of any sensory abnormalities affects or
things that had happened in the past.
halters perception that would affect proper communication. (Black, Medical Surgical Nursing 7th edition, page
The patient is literate.
1880)
The patient can converse well.
Cognition involves a person’s intelligence, perceptual ability and ability to process information. It
The patient is aware about the happenings in her
represents a progression of mental abilities from illogical to thinking, from simple to complex problem
surroundings.
solving and from concrete to abstract ideas. (Kozier et. Al, Fundamentals of Nursing 7th edition page 359).
The patient is ill-tempered.
Sleep and Rest For no known reasons, 8 hours of sleep at night has been the accepted standard for adults despite
The patient’s usual time of sleep is around 10pm and obvious variation seen in the general population. It is important however that a person follows a pattern of
wakes up at around 7am. rest that maintains well-being. Many factors affect a person’s ability to rest. Illnesses and various life
The patient usually takes a nap in the afternoon after situations that causes physiological stress tends to disturb sleep. Sleep quality is also influenced by certain
eating her lunch, then, chats to her neighbors. drugs. Some decreases REM sleep (barbiturates, amphetamines and anti-depressants) and some are seen to
The patient considers sleeping as a necessary form of rest cause sleep problems (steroids, caffeine and asthma medications)
because it is when she regains her energy. The National Sleep Foundation in the United States maintains that eight to nine hours of sleep for adult
Whenever the patient feels tired, she sits on the sofa for humans is optimal and that sufficient sleep benefits alertness, memory and problem solving, and overall
few minutes and then goes back to what she’s doing. health, as well as reducing the risk of accidents. A widely publicized 2003 study performed at the University
of Pennsylvania School of Medicine demonstrated that cognitive performance declines with fewer than eight
hours of sleep.
It has also been shown that sleep deprivation affects the immune system and metabolism. In a study by
Zager et al in 2007, rats were deprived of sleep for 24 hours. When compared with a control group, the sleep-
deprived rats’ blood tests indicated 20% decrease in white blood cell count, a significant change I the immune
system.
Scientists have shown numerous ways in which sleep is related to memory. In a study conducted by
Turner, Drummond, Salamat and Brown working memory was shown to be affected by sleep deprivation.
Working memory is important because it keeps information active for further processing, and supports
higher-level cognitive functions such as decision making, reasoning, and episodic memory. Turner et al.
allowed 18 women and 22 men to sleep only 26 minutes per night over a 4-day period. Subjects were given
initial cognitive tests while well rested and then tested again twice a day during the 4 days of sleep
deprivation. On the final test the average working memory span of the sleep deprived group had dropped by
38% in comparison to the control group. (http://enwikipedia.org/wiki/sleep)
Self-perception Self concept is one’s mental image of oneself. A positive self concept is essential to a person’s mental
and physical health. Individuals with a positive self concept are better able to develop and maintain
The patient always senses that something is unusual with
interpersonal relationship and resist psychological and physical illness.
regards to her health condition.
The patient has low self-esteem since she cannot fulfill her Self concept involves all of these self perceptions, that is, appearance, values and beliefs that
responsibilities as a wife and mother. influences behaviors and that are referred to when using the words I or me. Body image is who the person
According to the patient, her family gives her the strength perceives the size, appearance and functioning of the body. If a person’s body image closely resembles one’s
and will-power to cope up with her condition. ideal body, the individual is more likely to think positively about the physical and non-physical concept of
The patient doesn’t have any traumatic experiences in her self.
entire life. Self concept is also affected by role-strains. People undergoing role-strains are frustrated because they
feel or made to feel inadequate or unsuited to a role.
Illness and trauma can also affect the self-concept. People responds to different stressors such as illness
and alterations in function related to aging in a variety of ways: acceptance, denial, withdrawal and
depression are common. . (Kozier et. Al, Fundamentals of Nursing 7th edition page 957-962).
Role-relationship Relationship to another person is a developed manner in which there is the sharing of self, showing care
and putting trust. A healthy relationship affects an individual’s emotional development; it will facilitate the
The client is the 3rd child among her 5 siblings.
channeling of the ideas, feeling of joy and others.
She’s happily married to her husband, Herman.
An interpersonal relationship is a relatively long-term association between two or more people. This
She’s a plain housewife.
association may be based on emotions like love and liking, regular business interactions, or some other type
She actively participates in the barangay activities.
of social commitment. Interpersonal relationships take place in a great variety of contexts, such as family,
friends, marriage, acquaintances, work, clubs, neighborhoods and churches. They may be regulated by law,
custom, or mutual agreement, and are the basis of social groups and society as a whole. A relationship is
normally viewed s a connection between two individuals, such as a romantic or intimate relationship, or a
parent-child relationship.
All relationships involved some level of interdependence. People in a relationship tend to influence
each other, share their thoughts and feelings, and engage in activities together. Because of this
interdependence, anything that changes or impacts one member of the relationship will have some level of
impact on the other member. Psychologists have suggested that all humans have a basic, motivational drive to
form and maintain caring interpersonal relationships.
According to attachment theory, relationships can be viewed in terms of attachment styles that develop
during early childhood. These patterns are believed to influence interactions throughout adulthood by shaping
the roles people adopt in relationships. (http://enwikipedia.org/wiki/intimate-relationship)
Sexuality-reproductive Sexuality is defined not only by a person’s genitalia but also by attitudes and feelings. It can also be
defined s learned behaviors in how a person reacts to his or her own sexuality and by how one behaves in
The patient is already menopause at age 45.
relationships with others. (Fundamentals of Nursing 5th edition by Taylor, page 931).
The patient has active sex life and engages herself to one
Sexuality is a crucial part of a person’s identity. Sex is central to who we are, to our emotional well-
sexual partner which is her husband.
being and to the quality of our lives. The world health organization defined sexual health as the integration of
She’s also able to express her feminine attitudes.
the somatic emotional, intellectual and social aspect of sexual beings in ways that are positively enriching and
that enhance personality, communication and love. (Kozier et. Al, Fundamentals of Nursing 7 th edition page
957-973).
During the middle adulthood both men and women experience decreased hormone production causing
the climacteric, usually called menopausal in women. These events often affect the individual’s self-concept,
body image and sexual identity.
Women through the menopausal period experiences hot flushes, vasomotor instability, sleep
disturbances, vaginal dryness, genital tract atrophy, mood changes and skin, hair changes. The incidence of
osteoporosis and cardiovascular lipid changes also increases. The climacteric in males is not as dramatic in
the females: changes are more gradual.
Sexual response love and ply involved people’s emotional, psychological, physical and spiritual make
up, which plays a significant role in the satisfaction. A sexual desire fluctuates within each person and varies
from person to person. If people suppresses or block out conscious sexual desires they may not experienced
any physiological response. (Kozier et. Al, Fundamentals of Nursing 7th edition page 975,980).
Coping stress Coping mechanisms which are behaviors used to decreased stress and anxiety. Many coping behaviors
are learned, based on ones family past experiences, and socio-cultural influences and expectations.
If the patient feels anxiety, she often watches movies or
(Fundamentals of Nursing 5th edition by Taylor, page 855).
telenovelas.
If the patient is angry, she talks a lot and becomes
uncontrollable.
She often sleeps or eats when she is stressed.
She chats to her neighbors when she feels bored.
She prefers to be alone on her room when she feels lonely.
Value-belief Spiritual well-being is the condition that exists when the universal spiritual needs for meaning and
purpose, love and belonging, and forgiveness are met. O’Briens conceptual model of spiritual well-being in
She is a Roman Catholic.
illness identified three empirical referents of spiritual well-being: personal faith, religious practice and
She attends mass every Sunday.
spiritual contentment. Spiritual beliefs are of special importance to nurses because of the many ways they can
She often prays the rosary.
influence a patient’s level of health and self-care behaviors. (Kozier et. Al, Fundamentals of Nursing 7 th
She believes in supernatural beings.
edition page 975,979).
She often seeks God’s grace and providence in times of
Spiritual well being is manifested by a generally feeling of being alive, purposeful and fulfilled. People
trouble.
nurture or enhance their spirituality in many ways. Some focus on development of the inner self or world;
others focus on the expression of their spiritual energy with others or outer world. Relating to one’s inner self
or soul may be achieved through conducting an inner dialogue with a higher power or with one’s self through
prayer or medications. The expression of a person’s spiritual energy to others is manifested in loving
relationship with and service to others, joy and laughter and participation in religious services and associated
fellow gatherings and activities and by expression of compassion. (Kozier et. Al, Fundamentals of Nursing 7 th
edition page 996).
H. Activities of Daily Living
1. Nutrition The patient shows no allergies to The patient receives soft diet as The patient’s diet is restricted only
any food or drugs. The patient’s ordered by her physician. to easily digestible foods that
include those that were mashed,
diet is tolerated and has no any
pureed, combined with sauce or
other precautions to eating habits. gravy, or cooked in soups.
2. Elimination The patient defecates at least 1 to 2 The patient defecates only twice The patient has irregular defecation
times daily and there was since her date of admission in the since she was not comfortable
uncontrolled passage of stool hospital and voids regularly using public toilets like in the
during urination. The stool of the everyday because of her diuretic hospital wards.
patient is dark brown in color and medications.
has soft consistency. The patient
voids 7 to 8 times daily.
3. Exercise The patient has sedentary lifestyle. The patient cannot even do light The patient cannot do her daily
According to her, cleaning the activities because she is always routine since she is always lethargic
house and doing light activities like lethargic from the time she was and weak.
walking from house to market is admitted to the hospital.
her own way of exercise.
4. Hygiene The patient has a habit of washing The patient cannot take a bath and The patient cannot take a bath
her hands before eating. The patient only receives TSB from her because she lacks energy and she is
takes a bath once daily and brushes attending nurse or relative. The very weak.
her teeth once daily. patient was not able to brush her
teeth from the time she was
admitted to the hospital.
5. Substance use The patient is non-smoker and The patient is non-smoker and The patient doesn’t smoke, drink,
doesn’t drink any alcoholic doesn’t drink any alcoholic or use any illicit drugs.
beverages. She doesn’t use or beverages. She doesn’t use or abuse
abuse any illicit drugs. any illicit drugs.
6. Sleep and Rest The patient’s usual time of sleep is The patient is restless even though The patient is having difficulty in
around 10pm and wakes up at she’s sleeping most of the time. sleeping since the environment is
around 7am. The patient usually She’s lethargic and often got not conducive for rest (loud noise
takes a nap in the afternoon after bothered by different interruptions from the outside, interruptions or
eating her lunch, then, chats to her to her sleep like medication time disturbances while trying to sleep).
neighbors. The patient considers and/or check up by her physician.
sleeping as a necessary form of rest
because it is when she regains her
energy. Whenever the patient feels
tired, she sits on the sofa for few
minutes and then goes back to what
she’s doing.
7. Sexual Activity The patient has active sex life and Not applicable Not applicable
engages herself to one sexual
partner which is her husband. She’s
also able to express her feminine
attitudes.
healthy is being fat and free from sickness. burdens her to do regular activities. certain disease is chronic and needs urgent cure.
- Health is defined as a state of complete physical, - Is disease, sickness or the condition of being in a - Placement of an individual in a hospital for
mental and social well-being and not merely the poor health, either physically or mentally. observation, diagnostic test, treatment for some
absence of disease or infirmity. WHO definition. (Blackwell’s Nursing Dictionary) diseases. (Blackwell’s Nursing Dictionary)
Monday, May 17, 2009 Compete Blood Count (CBC) HGB 74 g/L 120-170 Based on the CBC done to
RBC 2.69 x 10ˆ12/L 4.0-6.0 patient Pebenito, it shows that
HCT 0.21 0.37- 0.54 there are significant deviations
MCV 79.50 uˆ3 87+ - 5 to several blood components
MCH 27.40 pg 29+ - 2 and only few are considered
MCHC 34.50 g/d L 34+ - 2 inclusive within the normal
RDW 15.90 11.6- 14.6 range.
MPV 7.20 fL 7.4 – 10.4
Platelet 342 x 10ˆg/L 150- 450
WBC 16.19 x 10ˆ g/L 4.5 – 10.0
DIFFERENTIAL COUNT
Neutrophils 0.87 0.50- 0.70
Metamyelocytes
Bands 0.09 0.0-0.05
Segmented 0.78 0.50- 0.70
Lymphocytes 0.19 0.20- 0.40
Monocytes - 0.0-0.07
Eosinophils - 0.0-0.05
Basinophils - 0.0-0.01
Monday, May 18, 2009 Complete Blood Count (CBC) HGB 104 120- 170 Her HGB and HCT are below
HCT 0.31 0.37- 0. 54 from the normal range.
Monday, May 18, 2009 Clinical Microscopy Source : Ascitic Fluid Based on the clinical
Physical Characteristics microscopy of patient
Color: reddish Pebenito, it shows that there
Amount: 2mL were no noted changes in the
Transparency: Turbid physical characteristics and
Supernatant: reddish, clear red consistency of the ascites in the
precipitate peritoneal cavity.
The liver is enlarged. Solid nodules are again seen in both lobes of the liver, the largest at the left measures 6.3x5.1x5.8 cm (previous largest measurements were 3.7x4.9x3.9cm).
The boarder outlines of the most solid nodules are irregular. The intraheptic ducts are not dilated. There is increased parenchymal echopattern of the liver.
There s ascites.
The gallbladder measures 6.7x1.6cm. The intraluminal high level echo is again seen with acousting shadowing. The wall is not thickened.
The pancreas is normal in size and echopattern. Negative for mass in or at the region of the pancreas.
The right kidney measures 10.2x4.7cm w/a cortical thickness of 1.4cm. The cortico modullary echo is intact. Negative for hydronephrosis, mass lesion or calculi.
The left kidney measures 11.0x6.0cm w/a cortical thickness of 1.6cm. There is still dilation of the central echo complex to a slightly greater degree since the last examination.
The cystic nodule adjacent to the urinary bladder is again seen now measuring 9.7x7.2x7.9cm (previous measurement was 8.9x7.2x7.9cm). Still showing mural component and
appears to have increase in size. The other nodule adjacent to the cystic structure now measures 3.9x4.1x3.9cm, which s almost unchanged since the last examination.
K. Impression/Diagnosis
Progression in sizes in most of the solid nodules in both lobes of the liver.
Cholelithiasis
Grade II-III hydronephrosis, left but to a slightly greater degreethan the previous examination.
Increased in size of the retrovesical fluid mass as well as the neural nodules.
FUNCTION
M. Ecologic Model
May 18-23, 2009 -History Taking Upon admission: Vital signs and Physical assessment
must be taken to obtain a baseline
-Physical Assessment -GCS E3 V5 M5 data.
Hypothesis
-Neurological Assessment -Vital signs BP-110/80 mmhg, PR: Ultrasound must be done to detect if
there is abnormalities in the abdominal
-Ultrasound 78bpm RR;18 breaths/min portion
The patient developed colon cancer thru a process that begins when an abnormal cell is transformed by genetic mutation of the cellular of the
DNA. body.
This disease
-IVF
might be because of heredity, environment of PNSS 1the
surrounding liter 20 gtts/min
patient and her to rundiet.Temp:36.7 C
food Giving medications are important to
immediately treat the disease.
for 12 hours -IV insertion done at the left arm,
Diet therapy is necessary for the
-Medications infusing well. improvement of the health condition of
the patient.
Agent Metronidazole 500mg 1 tab TID -Due meds given
-Kept rested
Environment
The patient resides in a crowded community where street foods are usually sold. The environment where she resides is not polluted, however, people living
in this community are infected with various diseases that might contribute to infection.
WEB
Financial Insufficiency
Does not regularly take vitamins and minerals CAUSATION
Improper food preparations MODEL
Often eat street foods
Analysis
HOST
Lack of exercise
Exposure to low fiber and high fat diet Weakened immune
Doessystem
not eat food that is not cooked well.
Infected With Colon Cancer
Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. This abnormal cell forms a clone
Personal
Cancer of the colon can be prevented historywill
if people of colon cancerof their diet and their way of life. Considering precautions to the food we eat is necessary
be cautious
Cancer cells
II. Clinical Discussion of the Disease
DIGESTIVE SYSTEM
Made up of 30 feet of pipes and tubes and more than half a dozen organs, the digestive
system processes hundreds of pounds of food each year. As it moves food through the body,
the digestive system breaks down our meals into chemical compounds that can be absorbed
by the body’s cells. It also separates out unneeded materials and flashes them out of the
body.
Food travels through the body along the gastrointestinal (GI) tract, also called the alimentary canal. This 30-foot-long tube begins with the lips, where food
enters the body, and ends with the anus, where solid wastes are expelled.
Mouth
The digestive system begins here, where food is ground into pieces and prepped for delivery to the stomach. It then
enters the pharynx, or throat – muscular funnel that pushes the chewed food into the esophagus while simultaneously blocking
Stomach Area
This muscular, expandable J-
shaped pouch is responsible for
holding and digesting food, as well
as removing its nutrients. When
food enters the stomach, its
muscular walls contract and churn
the food with powerful gastric
acids that kills bacteria and break
down proteins. The result is creamy
substance called chime, which the stomach stores until it is ready for release into the small
intestine.
Intestine
The small intestine measure about 20 feet in length and 1 inch in diameter. Thousands of
folds and millions of fingerlike projection called villi increase the surface area of the small
intestine, which absorbs 90% of nutrients and water the body will received from the digested
food. The large intestine absorbs the last bit of nutrients and water from indigestible foods,
Duodenum – this is the first portion of the small intestine, where secretion from the liver and pancreas are received and most of the chemical digestion takes place.
Jejunum – this is the long, coiled middle portion of the small intestine that stretches from the duodenum to the ileum.
Ileum – this is the final portion of the small intestine, where remaining nutrients are absorbed and utilized.
Large intestine
Ascending colon – the large intestine surrounds the small intestine like an inverted U. the first
portion of the large intestine, the ascending colon, is suited vertically on the right side of the body. The
ascending colon extracts remaining moisture from food before its excretion.
Transverse colon – connecting the ascending and descending colons, this part of the large
Descending colon – found at the left side of the body, the descending, or left colon stores stool
Rectum – only 5 inches long, the rectum sits just above the anal canal. Feces are stored here
ACCESSORY ORGANS
Liver
Weighing in at 3 pounds, this wedge-shaped organ is the body’s largest gland. The liver is the accessory
organ of the digestive system. Among its many roles is detoxification of the blood. It also creates bile, which is
Gallbladder
This plum-size, green, muscular sac hangs from the liver. The gallbladder collects, stores, and concentrates bile from the liver.
Pancreas
This long organ, positioned behind the stomach, produces insulin and enzymes that aid digestion. The
Pancreatic enzymes help digest food in the small intestine, while insulin helps regulate the amount of sugar in the
blood.
DIGESTION
Digestion is the complex process of turning the food you eat into the energy you need to survive. The digestion process also involves creating waste to be eliminated.
Food's Journey
The mouth is the beginning of the digestive tract, and, in fact, digestion starts here before you even take the first bite of a meal. The smell of food triggers the salivary glands in
your mouth to secrete saliva, causing your mouth to water. When you actually taste the food, saliva increases.
Once you start chewing and breaking the food down into pieces small enough to be digested other mechanisms come into play. More saliva is produced to begin the process of
breaking down food into a form your body can absorb and use. In addition, "juices" are produced that will help to further break down food.
Also called the throat, the pharynx is the portion of the digestive tract that receives the food from your mouth. Branching off the pharynx is the esophagus, which carries food to
the stomach, and the trachea or windpipe, which carries air to the lungs.
The act of swallowing takes place in the pharynx partly as a reflex and partly under voluntary control. The tongue and soft palate -- the soft part of the roof of the mouth -- push
food into the pharynx, which closes off the trachea. The food then enters the esophagus.
The esophagus is a muscular tube extending from the pharynx and behind the trachea to the stomach. Food is pushed through the esophagus and into the stomach by means of a
closes to keep it there. If your LES doesn't work properly, you may suffer from a condition called GERD, which causes heartburn and regurgitation (the feeling of food coming
back up).
The stomach is a sac-like organ with strong muscular walls. In addition to holding food, it serves as the mixer and grinder of food. The stomach secretes acid and powerful
enzymes that continue the process of breaking the food down and changing it to a consistency of liquid or paste. From there, food moves to the small intestine. Between meals the
non-liquefiable remnants are released from the stomach and ushered through the rest of the intestines to be eliminated.
Made up of three segments -- the duodenum, jejunum and ileum -- the small intestine also breaks down food using enzymes released by the pancreas and bile from the liver.
Peristalsis is also at work in this organ, moving food through and mixing it up with the digestive secretions from the pancreas and liver, including bile. The duodenum is largely
responsible for the continuing breakdown process, with the jejunum and ileum being mainly responsible for absorption of nutrients into the bloodstream.
A more technical name for this part of the process is "motility" since it involves moving or emptying food particles from one part to the next. This process is highly dependent on
the activity of a large network of nerves, hormones and muscles. Problems with any of these components can cause a variety of conditions.
While in the small intestine nutrients from food are absorbed through the walls of the intestine and into the bloodstream. What's leftover (the waste) moves into the large intestine
Everything above the large intestine is called the upper GI tract. Everything below is the lower GI tract.
The colon (large intestine) is a five- to seven -foot -long muscular tube that connects the small intestine to the rectum. It is made up of the ascending (right) colon, the transverse
(across) colon, the descending (left) colon and the sigmoid colon, which connects to the rectum. The appendix is a small tube attached to the ascending colon. The large intestine is
a highly specialized organ that is responsible for processing waste so that defecation (excretion of waste) is easy and convenient.
Stool, or waste left over from the digestive process, passes through the colon by means of peristalsis, first in a liquid state and ultimately in solid form. As stool passes through the
colon, any remaining water is absorbed. Stool is stored in the sigmoid (S-shaped) colon until a "mass movement" empties it into the rectum, usually once or twice a day.
It normally takes about 36 hours for stool to get through the colon. The stool itself is mostly food debris and bacteria. These bacteria perform several useful functions, such as
synthesizing various vitamins, processing waste products and food particles, and protecting against harmful bacteria. When the descending colon becomes full of stool it empties
The rectum is an eight-inch chamber that connects the colon to the anus. The rectum:
When anything (gas or stool) comes into the rectum, sensors send a message to the brain. The brain then decides if the rectal contents can be released or not. If they can, the
sphincters relax and the rectum contracts, expelling its contents. If the contents cannot be expelled, the sphincters contract and the rectum accommodates so that the sensation
The anus is the last part of the digestive tract. It consists of the muscles that line the pelvis (pelvic floor muscles) and two other muscles called anal sphincters (internal and
external).
The pelvic floor muscle creates an angle between the rectum and the anus that stops stool from coming out when it is not supposed to. The anal sphincters provide fine control of
stool. The internal sphincter is always tight, except when stool enters the rectum. It keeps us continent (not releasing stool) when we are asleep or otherwise unaware of the
presence of stool. When we get an urge to defecate (go to the bathroom), we rely on our external sphincter to keep the stool in until we can get to the toilet.
B. Drug Study
Dulcolax Expands intestinal Gastrointestinal Constipation. Acute surgical abdomen, Rarely, abdominal Evaluate periodically
fluid volume by agent; laxative, Preparation for nausea, vomiting, discomfort and diarrhea patient's need for continued
increasing epithelial stimulant radiography; abdominal cramps, use of drug;
permeability antepartumand intestinal obstruction, Monitor patients receiving
post-partum care; fecal impaction; use of concomitant anticoagulants.
preparation for rectal suppository in Indiscriminate use of
sigmoidoscopy presence of anal or rectal laxatives results in decreased
or proctoscopy, fissures, ulcerated absorption of vitamin K.
colonoscopy. hemorrhoids, proctitis.
Add high-fiber foods slowly
to regular diet to avoid gas
and diarrhea. Adequate fluid
intake includes at least 6–8
glasses/d.
Do not breast feed while
taking this drug without
consulting physician.
Lactulose Reduces blood Gastrointestinal Constipation Low galactose diet; GI: Flatulence, In children if the initial dose
ammonia; appears to agent; laxative, associated with pregnancy (category C). borborygmi, belching, causes diarrhea, dosage is
involve metabolism hyperosmotic pediatric Safe use in lactation or abdominal cramps, pain, reduced immediately.
of lactose to organic problems, post- children is not established. and distention (initial Discontinue if diarrhea
acids by resident op; pregnancy dose); diarrhea persists.
intestinal bacteria. and post natal (excessive dose); nausea, Promote fluid intake (≥1500–
period; bedridden vomiting, colon 2000 mL/d) during drug
and geriatric accumulation of therapy for constipation;
patients; surgical hydrogen gas; older adults often self-limit
procedures; hypernatremia. liquids. Lactulose-induced
painful rectal osmotic changes in the bowel
&anal support intestinal water loss
conditions; and potential
laxative hypernatremia.
dependence; drug
Advice the patient and
induce
family that Laxative action is
constipation
not instituted until drug
reaches the colon; therefore,
about 24–48 h is needed.
Advise the patient and
family that do not self-
medicate with another
laxative due to slow onset of
drug action.
Advise the patient and
family tonotify physician if
diarrhea (i.e., more than 2 or
3 soft stools/d) persists more
than 24–48 h. Diarrhea is a
sign of overdosage. Dose
adjustment may be
indicated.
Metronidazo Synthetic compound Antiinfective; Acute intestinal Blood dyscrasias; active hypersensitivity (rash, Discontinue therapy
le
with direct antitrichomonal; amebiasis and CNS disease; first urticaria, pruritus, immediately if symptoms of
trichomonacidal and amebicide; antibiotic amebic liver trimester of pregnancy flushing), fever, fleeting CNS toxicity (see Appendix
amebicidal activity abscess. joint pains, overgrowth of F) develop. Monitor
as well as Symptoms and (category B), lactation. Candida. Vertigo, especially for seizures and
antibacterial activity asymptomatic headache, ataxia, peripheral neuropathy (e.g.,
against anaerobic trichomoniasis, confusion, irritability, numbness and paresthesia of
bacteria and some giardiasis depression, restlessness, extremities).
gram-negative weakness, fatigue, Lab tests: Obtain total and
bacteria. drowsiness, insomnia, differential WBC counts
paresthesias, sensory before, during, and after
neuropathy (rare). therapy, especially if a
Nausea, vomiting, second course is necessary.
anorexia, epigastric Monitor for S&S of sodium
distress, abdominal retention, especially in
cramps, diarrhea, patients on corticosteroid
constipation, dry mouth, therapy or with a history of
metallic or bitter taste, CHF.
proctitis. Polyuria, Monitor patients on lithium
dysuria, pyuria, for elevated lithium levels.
incontinence, cystitis, Report appearance of
decreased libido, candidiasis or its becoming
dyspareunia, dryness of more prominent with
vagina and vulva, sense therapy to physician
of pelvic pressure. Nasal promptly.
congestion. ECG changes Repeat feces examinations,
(flattening of T wave). usually up to 3 mo, to ensure
that amebae have been
eliminated.
KCl Principal Electrolytic balance Dryness of the Severe renal impairment; Nausea, vomiting, Monitor I&O ratio and
intracellular cation; and water balance mouth of any severe hemolytic diarrhea, abdominal pattern in patients receiving
essential for agents; replacement origin, reactions; untreated distension. Pain, mental the parenteral drug. If
maintenance of solution particularly in Addison's disease; crush confusion, irritability, oliguria occurs, stop infusion
intracellular radiogenic syndrome; early listlessness, paresthesias promptly and notify
isotonicity, sialadenitisand postoperative oliguria of extremities, muscle physician.
transmission of for the (except during GI weakness and heaviness Lab test: Frequent serum
nerve impulses, maintenance of drainage); adynamic ileus; of limbs, difficulty in electrolytes are warranted.
contraction of oral hygiene. acute dehydration; heat swallowing, flaccid Monitor for and report signs
cardiac, skeletal, and cramps, hyperkalemia, paralysis. Oliguria, of GI ulceration (esophageal
smooth muscles, patients receiving anuria. Hyperkalemia. or epigastric pain or
maintenance of potassium-sparing Respiratory distress. hematemesis).
normal kidney diuretics, digitalis Hypotension, Monitor patients receiving
function, and for intoxication with AV bradycardia; cardiac parenteral potassium closely
enzyme activity. conduction disturbance. depression, arrhythmias, with cardiac monitor.
Plays a prominent or arrest; altered Irregular heartbeat is
role in both sensitivity to digitalis usually the earliest clinical
formation and glycosides. ECG changes indication of hyperkalemia.
correction of in hyperkalemia: Tenting Be alert for potassium
imbalances in acid– (peaking) of T wave intoxication (hyperkalemia,
base metabolism. (especially in right see S&S, Appendix F); may
precordial leads), result from any therapeutic
lowering of R with dosage, and the patient may
deepening of S waves be asymptomatic.
and depression of RST;
prolonged P-R interval,
widened QRS complex,
decreased amplitude and
disappearance of P
waves, prolonged Q-T
interval, signs of right
and left bundle block,
deterioration of QRS
contour and finally
ventricular fibrillation
and death.
Tramadol Centrally acting Analgesics&antipyre Moderate to -Hypersensitivity to CNS: Drowsiness, Assess for level of pain relief
opiate receptor tics severe acute tramadol or other opioid dizziness, vertigo, and administer prn dose as
agonist that inhibits &chronic pain, analgesics fatigue, headache, needed but not to exceed the
the uptake of painful somnolence, restlessness, recommended total daily
-patients on MAO
norepinephrine and diagnostic euphoria, confusion, dose.
inhibitors
serotonin, suggesting procedures & anxiety, coordination Monitor vital signs and
both opioid and surgery disturbance, sleep assess for orthostatic
-patients acutely
nonopioid disturbances, seizures. hypotension or signs of CNS
intoxicated with alcohol,
mechanisms of pain CV: Palpitations, depression.
hypnotics, centrally acting
relief. May produce vasodilation. GI: Discontinue drug and notify
analgesics, opioids, or
opioid-like effects, Nausea, constipation, physician if S&S of
psychotropic drugs
but causes less vomiting, xerostomia, hypersensitivity occur.
respiratory -patients on obstetric dyspepsia, diarrhea, Assess bowel and bladder
depression than preoperative medication abdominal pain, anorexia, function; report urinary
morphine. flatulence. Body as a frequency or retention.
Whole: Sweating, Use seizure precautions for
-lactation.
anaphylactic reaction patients who have a history
(even with first dose). of seizures or who are
Skin: Rash. Special concurrently using drugs
Senses: Visual that lower the seizure
disturbances. Urogenital: threshold.
Urinary Monitor ambulation and
retention/frequency, take appropriate safety
menopausal symptoms. precautions.
Problem List:
Subjective cues: Acute pain related to inflammation of the 2 - This condition may have a life
- “Masakit ang akin tiyan” as liver at the right upper quadrant as threatening condition that warrants
verbalized by the patient. manifested by abdominal surgery or may have something
Objective cues: enlargement/distention simple as constipation or even just
- Coherent, conscious gas in the bowel (wind).
- With abdominal pain at the
RUQ.
- Pain score: 7
- With facial grimace
- With abdominal tenderness
- Abdominal girth measures
105cm
Subjective cues: Increased fluid volume in the lower 3 - a fluid overload with normal saline
- “Namamanas ang mga binti ko.” extremities related to excess sodium intake and/or 5% dextrose can cause
As verbalized by the patient. as manifested by weight gain in a short similar problems but for different
Objective cues: period of time and decrease urine output. reasons. When the body is
- Edema scale +3 functioning normally it is almost
- Numbness impossible to produce an excess of
- Fatigue total body water. However this can
- Pallor occur during IV treatment w/
- oliguria normal saline or 5% dextrose. The
effect can be overload of both salt
and water or just salt or dilutional
low sodium.
Subjective cues: Imbalanced nutrition less than body 4 - Adequate nutrition is necessary to
- “wala akong ganang kumain” as requirement related to increase metabolic meet the body’s demands. During
verbalized by the patient needs caused by disease processes as times of illness, adequate nutrition
Objective cues: manifested by weight loss. plays an important role in healing
- Weight loss and recovery.
- Generalized weakness
- Hyperactive bowel sounds
- Thinning/loss of hair
Subjective cues: Fatigue related to altered body chemistry 5 - The patient with chronic illness
- “Nanghihina ang pakiramdam – side effects of pain or other medication experiencing fatigue may not be
ko at parang lagi akong pagod” such as chemotherapy as manifested by able to participate in their own care
as verbalized by the patient. drowsiness and inability to restore energy and fulfill role responsibilities.
Objective cues: after sleep. Moreover, it can result to chronic
- Disinterest in the surrounding. fatigue syndrome characterized by
- Lethargy prolonged debilitating fatigue,
- Pallor neurologic pattern, general pain,
- Dizziness GI problems and flu-like
- BP: 120/80 symptoms.
- PR: 90
- RR: 22
- Temp: 37.3
Assessment Nursing Background of Goals and objective Nursing intervention Rationale Evolution
Diagnosis Knowledge
Subjective cues: Hyperthermia Etiology - Within the end Independent - At the end of the
- “Mainit po ang related to of the shift/ after shift, patient’s body
aking elevated body Immediate 8 hrs. of duty, - Monitor the - Temperature of 38.9
pakiramdam” temperature due cause: patients body patient’s vital – 41.1 C suggest temperature was
as verbalized to underlying temperature will signs. Give infectious disease reduced to 37.5
by the patient infection as Inflammatory reduced or particular attention process. Fever may from 38.5.
Objective cues: evidenced by response of the maintained to
to the temperature. aid in diagnosis. - Goal was met.
- T = 38.5 elevated WBC body against normal range.
- Flushed face count microorganisms.
- With body
malaise Intermediate
- With chills cause:
sensation - Asses for presence - Note for further care
- Warm to touch Elevated WBC
of posturing or given
(skin)
- With dry skin, Root cause: seizures. - Oliguria and/or renal
lips, mucous - Monitor/record all failure may occur
- Restlessness Weakened fluid loss such as during hypotension,
- Irritability to immune system urine. dehydration.
fall asleep - Note - Evaporation is
- PR = 120 Health presence/absence decreased by
- RR = 25 implication:
of sweating as environmental
- WBC = 331 X
100 g/l Fever of 40 C or body attempts to factors of high
higher demand increase heat loss humidity and low
immediate home by evaporation , ambient
treatment and conduction and temperature.
subsequent diffusion.
medical - Provide TSB;
attention, as they
avoid use of - May help reduce
can result in
delirium and alcohol fever
convulsion
particularly in
children. Dependent
- Administer
antipyretics as - Used to reduce lover
ordered by the by central action on
physician. the hypothalamus.
- Administer Fever may be
replacement of beneficial in limiting
fluid and growth of
electrolytes microorganism and
- Provide high enhance destruction
calorie diet. of infected cell
- Provide use of - To support
supplemental circulating volume
oxygen and tissue perfusion
- To meet increase
metabolic demand.
Collaborative
- Discuss the - To offset increased
importance of oxygen demand and
adequate fluid consumption.
intake
- Identify
community
resources to
address specific - To prevent
need dehydration
Assessment Nursing Background of Goals and objective Nursing intervention Rationale Evalution
Diagnosis Knowledge
Subjective cues: Increased fluid Etiology - Within the end Independent - At the end of the
- “Namamanas volume in the of the shift/ after shift, patient’s
ang mga binti lower Immediate 8 hrs. of duty, - Note presence of edema was
ko.” As extremities cause: patient will be medical/condition alleviated
verbalized by the related to excess able to that potentiate
patient. sodium intake as Excess enumerate -
fluid excess
Objective cues: manifested by interstitial fluid methods of
- Edema scale +3 weight gain in a relaxation - Note amount/rate
- Numbness short period of Intermediate technique such of fluid intake
- Fatigue time and cause: as destruction from all sources
- Pallor decrease urine technique, deep - Review intake of
- oliguria output.2l Decrease urine breathing sodium
output exercise, - Measure of
medication and - For changes that
abdominal girth
Root cause: prayer. may indicate
Dependent increasing
Excess sodium
retention/edema
intake - Administer
medication as
Health
implication: directed by the
physician
Excessive fluid - Restrict sodium
may be intake as indicated
manifested by - Weigh daily or on
venous regular schedule,
engorgement or - Provides
as indicated
edema comparative
formation. baseline data and
Collaborative evaluate the
- Assist with effectiveness of
procedures as diuretic therapy
indicated.
- Consult dietician
as needed.
Assessment Nursing Background of Goals and objective Nursing intervention Rationale Evalution
Diagnosis Knowledge
Subjective cues: Imbalanced Etiology - Within the end of Independent - At the end of the
- “wala akong nutrition less the shift/ after 8 shift, patient was
ganang kumain” than body Immediate hrs. of duty, - Provide pleasant - Useful in promoting able to understand
as verbalized by requirement cause: patient will be atmosphere at appetite and the causative factor
the patient related to able to verbalize mealtime; remove reducing nausea
Objective cues: increase Chemotherapy understanding of and necessary
noxious stimuli intervention
- Weight loss metabolic needs causative factor
- Generalized caused by Intermediate when known and - Assist in oral -
- Clean moth enhances
weakness disease cause: necessary hygiene during
appetite
- Hyperactive processes as interventions meals if already
bowel sounds manifested by Malabsorption indicated
- Thinning/loss of weight loss. by the intestine - May lessen nausea
- Offer effervescent
hair of nutrients meals if already
from food
indicated
Root cause: Dependent
Intestinal - Consult with
obstruction;
dietician as
blockage of the
indicated; - Useful in
intestine by the
tumor advanced diet as establishing
tolerated. Restrict nutritional needs and
Health gas producing most appropriate
implication: foods. route.
Underweight
teens and adult
can seriously
damage their
bone and put
themselves at
risk of
osteoporosis
Assessment Nursing Background of Goals and objective Nursing intervention Rationale Evaluation
Diagnosis Knowledge
Subjective cues: Fatigue related Etiology - Within the end of Independent - At the end of the
- “Nanghihina to altered body the shift/ after 8 shift, patient was
ang chemistry – side Immediate hrs. of duty, - Have the patient - Helps in developing able to improve a
pakiramdam ko effects of pain or cause: patient will be rate fatigue, using a plan to managed sense of energy.
at parang lagi other report improve numeric scale. fatigue.
akong pagod” as medication such Chemotherapy sense of energy.
- Encourage - Adequate intake is
verbalized by as
the patient. chemotherapy Intermediate nutritional intake necessary to meet
Objective cues: as manifested by cause: metabolic need.
Collaborative
- Disinterest in the drowsiness and
surrounding. inability to Growth of - Programmed daily
- Refer to physical
- Lethargy restore energy malignant exercise can help
- Pallor after sleep. tumor in the therapy.
the patient maintain
- Dizziness intestine.
and increase
- BP: 120/80
- PR: 90 Root cause: strength.
- RR: 22
Temp: 37.3 Intestinal
obstruction;
blockage of the
intestine by the
tumor
Health
implication:
can cause
prolonged
debilitating
fatigue,
neurologic
pattern, general
pain, GI tract
problems.