ILOILO DOCTOR’S COLLEGE

BACHELOR OF SCIENCE IN NURSING

West Avenue Timawa, Molo, Iloilo City

NCM 112 (RLE)

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND
ELECTROLYTES, INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC
RESPONSE, CELLULAR ABERRATIONS, ACUTE AND CHRONIC
Question and Answers:
COLORECTAL CANCER

A Case Study Presented to the Department of Nursing of Iloilo Doctor’s College

PRESENTED TO: MRS.

Arvi Tenderly V. Melliza, RN, M.A.N.
(NCM 112 RLE & SKILLS CLINICAL INSTRUCTOR)

PRESENTED BY:

Camarista, Coleen Mae C.

(BSN III-G GROUP 1)

OCTOBER 20, 2021

BACHELOR OF SCIENCE IN NURSING
ILOILO DOCTOR’S COLLEGE
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

Questions:
1. What are diagnostic tests, laboratory studies needed for the diagnosis of
colorectal cancer?
Colonoscopy - Because colonoscopy is the only screening test that can also simultaneously remove
precancerous polyps, thus preventing colorectal cancer, other experts recommend 10-year colonoscopies
beginning at the age of 50 years as the major screening test for colorectal cancer, including the American
College of Gastroenterology (ACG; Rex, Johnson, Anderson, et al., 2009) and the National Comprehensive
Cancer Network (NCCN; Burt, Cannon, David, et al., 2013)

Biopsy - A patient who has a tumor found on screening colonoscopy should have the tumor biopsied and
tattooed during the colonoscopy to facilitate further workup. For the patient whose tumor was found on a
diagnostic test other than a colonoscopy (e.g., flexible sigmoidoscopy, FIT), a colonoscopy is indicated to
biopsy and tattoo the tumor.

Carcinoembryonic antigen - A baseline carcinoembryonic antigen (CEA) level is also obtained (Chang
et al., 2012). CEA is a tumor marker that is recommended for assessing the presence of colorectal cancer,
as well as its progression or recurrence, although it does yield both false-positives and false-negatives
(NCI, 2016b). However, at present there is no other readily available tumor marker test. Therefore, CEA is
not used as the sole predictor of tumor status, including progression or recurrence.

Fecal Occult Blood Test - finds blood in the stool that you cannot see. Blood in the stool may be a sign
of colorectal cancer or another medical problem, such as an ulcer or polyps. Polyps are growths that
develop on the inner wall of the colon and rectum.

MRI Scan - scans of the abdomen, pelvis, and chest, to screen for extent of the tumor and any metastases.
CBC - (may or may not reveal anemia)
SGPT Result - A high level of SGPT released into the blood may be a sign of liver damage, cancer, or
other diseases.

SGOT Result - The normal range of an SGOT test is generally between 8 and 45 units per liter of serum.
In general, men may naturally have higher amounts of AST in the blood. A score above 50 for men and 45
for women is high and may indicate damage.

2. Discuss the classification/staging of cancer.

STAGE 1 - Patients with Stage I colorectal cancer should have follow-up colonoscopies 1-year
postoperatively, then again in another 3 years, and then every 5 years.
STAGE 2 - Patients with Stage II disease who may also benefit from capecitabine are those who had
inadequately sampled lymph nodes, with T4-sized tumors, or with poorly differentiated tumors (Benson et
al., 2013). Capecitabine is equivalent to the dual chemotherapeutic drugs 5- fluorouracil and leucovorin. It
may be given either orally or intravenously. The most common adverse effects of capecitabine include
anemia, neutropenia, fatigue, diarrhea, and palmar-plantar erythrodysesthesia (PPE; hand-foot syndrome),
which manifests by reddening, pain, and swelling of the palms of the hands and soles of the feet (NCI,
2016b).
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

STAGE 3 - Patients with Stage III tumors are typically prescribed the combination chemotherapeutic drug
of 5-fluorouracil, leucovorin, and oxaplatin, called FOLFOX. This combination chemotherapeutic drug must
be administered
IV in 2-week cycles over 6 months. The adverse effects mirrors that of capecitabine, plus patients frequently
experience paresthesias of their hands and feet, which typically cease after the chemotherapy is completed
(NCI, 2016b).

(Patients with Stage II or Stage III tumors should have routine follow-ups and CEA testing every 3 to 6
months for 5 years. CT scans of the abdomen and chest should be done each year for 3 years. Colonoscopy
should also be done 1-year postoperatively, and then every 5 years (Meyerhardt, Mangu, Flynn, et al.,
2013).

STAGE IV - Patients with Stage IV or recurrent colorectal tumors have metastases to distant organs. The
treatment is highly variable and individualized, based upon the extent of the tumor mass(es), and the health
status and wishes of the patient. Treatment might consist of targeted therapy aimed at possible cure, or
palliative care.
 ILOILO DOCTOR’S COLLEGE
BACHELOR OF SCIENCE IN NURSING
West Avenue Timawa, Molo, Iloilo City

3. How important is therapeutic communication technique with this client?

- The nurse’s approach to the patient largely determines the amount and quality of the information
received. To achieve a relationship of mutual trust and respect, the nurse must communicate a
sincere interest in the patient. Examples of therapeutic communications are listening, silence,
restating, reflection, clarification, focusing, broad-openings, humor, informing, sharing
perceptions, theme-identifications, and suggesting.

4. What nursing theory is applicable for this client? Explain

Jean Watson’s “Philosophy and Theory of Transpersonal Caring” mainly concerns
how nurses care for their patients and how that caring progresses into better plans to promote
health and wellness, prevent illness and restore health. As for the case scenario Watson’s model
accompanied by seven assumptions can be relate to the situation of a patient experiencing
Colorectal Cancer as (1) Caring can be effectively demonstrated and practiced only
interpersonally the use of empathy as the ability to experience and thereby understand the
person’s perceptions and feelings and to communicate those understandings just like in the case
scenario where both John and his wife are stressing about their situation and as a nurse, effective
communication can be a cognitive and affective response to the couple. (2) Caring consists of
carative factors that result in the satisfaction of certain human needs. (3) Effective caring
promotes health and individual or family growth. (4) Caring responses accept the patient as he or
she is now, as well as what he or she may become. (5) A caring environment offers the
development of potential while allowing the patient to choose the best action for themselves at a
given point in time. (6) The science of caring is complementary to the science of curing. (7) The
practice of caring is central to nursing.

5. Explain the relevance of the nursing diagnosis, “Caregiver role strain” with this
client.
- Caregiver role strain is an important diagnosis that has been well-described and studied from
many aspects. The core of this care plan is on the supportive care provided by the family
members, significant others, or caregivers accountable for meeting the physical/emotional needs
of the patient. With short access to health care for many people, most diseases are diagnosed
and managed in the outpatient setting; and more caregiving is being provided by people who
aren’t health care professionals. It presents a carative factors such as the assistance with
gratification of human needs, development of a helping-trusting, human caring relation, and
assisting with basic needs, with an intentional caring consciousness which potentiates alignment
of wholeness and unity of being in all aspects of care.