Case Presentation of Group 1

CASE PRESENTATION OF COLON CANCER
Presented to the Faculty of the School of Nursing

Adventist Medical Center College
Brgy. San Miguel, Iligan City
In Partial Fulfillment
Of the Requirements for the Degree
BACHELOR OF SCIENCE IN NURSING
Amodia, Karr Shadrach

Badio, Jasmin
Balindong, Wafa
Bernales, Allyzah Faith
Cabahug, Kimberly
Credo, Sean EJ
Elias, Noralia
Flores, Kirk Clarence
Lucero, Synthyche
Macabago, Alnor Jr.
Mikunug, Jalilah
Paghasian, Lera Kym
SEPTEMBER 04, 2023

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TABLE OF CONTENTS
COVER PAGE……………………………………………………………………………1
TABLE OF CONTENTS………………………………………………………………….2
CASE PRESENTATION OBJECTIVES…………………………………………………3
INTRODUCTION………………………………………………………………………...4
DEFINITION OF TERMS………………………………………………………………..6
VITAL INFORMATION…………………………………………………………………7
ASSESSMENT
A. NURSING HISTORY………………………………………………………..8
B. GENOGRAM………………………………………………………………..10
C. GORDON’S………………………………………………………………….11
D. PEROS……………………………………………………………………….16
E. DIAGNOSTIC
TESTS……………………………………………………….23
NORMAL ANATOMY AND PHYSIOLOGY………………………………………….27
RISK FACTORS AND

PATHOPHYSIOLOGY………………………………………...32
NURSING MANAGEMENT
A. NURSING CARE PLAN…………………………………………………….33

B. HEALTH EDUCATION PLAN……………………………………………..38
C. DISCHARGE PLAN………………………………………………………...39
PROGNOSIS…………………………………………………………………………….42
BIBLIOGRAPHY………………………………………………………………………..43
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CASE PRESENTATION OBJECTIVES
General objective:
At the end of the one and half-hour case presentation, the student nurses and the
clinical instructors will be able to acquire a knowledge regarding the general health and
disease condition of the patient with diagnosis, its disease process, possible
complications, treatment plan, medical and nursing interventions.
Specific objectives:
During/ after the case presentation,
1. The presenters will be able to discuss relevant topics about patient’s condition.
2. The presenters will be able to systematically present the data pertinent to the case
being gathered.
3. The presenters will be able to answer relevant questions with positive attitude towards
criticisms and suggestions.
4. The student nurses will be able to generate new ideas regarding the disease condition
of the patient.
5. The student nurses will be able to impart the important information as health teachings
regarding the disease.
6. The student nurses will be able to enhance their knowledge and skills required in the
management of the patient's disease condition.
7. The clinical instructors will guide the presenters regarding the case presented.
8. The clinical instructors will assess the presenters reasoning skills.
9. The clinical instructors will assess the student nurses’ knowledge gained.
INTRODUCTION
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Colon and rectal tumors are relatively common; in particular, the colorectal
region, which includes both the colon and the rectum, accounts for the third most new
cancer cases in the US. According to the American Cancer Society [ACS], 2020, there
are roughly 104,600 new cases and 53,200 deaths due to colorectal cancer each year, with
3640 of the deceased being under the age of 50. According to the WHO, there were
approximately 861,000 fatalities and 1.8 million new cases globally in 2018 (Macrae &
Bendel, 2020). In the United States, colorectal cancer is the second most common cause
of cancer mortality among adults and the third most common cause of cancer death in
both men and women (ACS, 2020).
Currently, the median age of diagnosis is 66 years old, down from the median
age of 72 years back in 2000 (ACS, 2020). According to Macrae and Bendell (2020), the
prevalence of colorectal cancer in persons over 50 has been dropping by around 2% year.
This is consistent with an increase in colonoscopies of about 19% (Simonson, 2018).
However, recent trends in epidemiologic data from the National Cancer Institute's (NCI)
Surveillance, Epidemiology and End Results registry (SEER) found that approximately
one in seven new cases of colorectal cancer were diagnosed in people under the age of
50.
The third most prevalent kind of cancer in the world is colon and rectum
cancer. Colon cancer is more common compared to rectal cancer, industrialized nations'
colon to rectum cases ratio is 2:1 or higher (more so in females), although rates in
developing nations are often comparable. There are over 250,000 new colon cases in
Europe are identified each year, making up around 9% of all the malignancies. The
incidence of this cancer rises as cities and industries develop. It has become considerably
more prevalent, but is increasingly spreading to middle-and low-income nations in high
income countries.
The third most frequent kind of cancer in people is CRC. Globally, men and
females, respectively. It explains for over 9% of all cancer cases, with an estimated 1.4
million cases, millions of instances in 2012.
The countries of Eastern Europe and Asia are seeing the biggest rises in colon
cancer incidence. In Europe, the overall (age-adjusted) rates in Western Europe and
Oceania have remained rather stable. United States since the middle of the 1980s, the
incidence has decreased but there hasn't been a comparable reduction in the people of
color.
According to the American Cancer Society (ACS), 30% of people with

colorectal cancer have a family history of the illness. Although risk factors for colon and
rectal cancer have been discovered, the specific etiology is still unclear. Lynch syndrome,
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also known as hereditary non-polyposis colorectal cancer (HNPCC), is a particular kind

of inherited colorectal cancer.
The prognosis for colon cancer depends on the stage of presentation. The 5-year
survival rate is 89% if the illness is contained and treated before it spreads; with distant
metastases, the survival rate would fall to 15% (ACS, 2020). The total 5-year survival
rate for all phases is estimated by SEER to be 67% (ACS, 2020). Many persons go years
without experiencing any symptoms and then seek medical attention when they have
rectal bleeding or detect a change in their bowel habits (ACS, 2020). To detect and lower
death rates, early screening, preventive, and education are essential.
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DEFINITION OF TERMS
Colon - The major part of large intestine. is about 1.5–1.8 m long and consists of four
parts: the ascending colon, the transverse colon, the descending colon, and the sigmoid
colon.
Colon Cancer - Whose malignant cells have metastasized to the liver, for example,
replaces liver tissue but cannot perform any of the liver’s essential functions.
Colorectal Cancer - Is predominantly (95%) adenocarcinoma, with colon cancer
affecting more than twice as many people as rectal cancer. It may start as a benign polyp
but may become malignant, invade and destroy normal tissues, and extend into
surrounding structures.
Electrolyte Imbalance - Occurs when the body contains excess or insufficient amounts
of a particular mineral.
Hyponatremia – Signifies that the blood's sodium level is below normal. 135 to 145
milliequivalents per liter (mEq/L) of sodium is considered to be normal.
SGPT - A blood test used to assess Alanine Transaminase (ALT), an enzyme produced
in the liver. High levels of SGPT may indicate liver injury or damage.
Sigmoid Colon – Last part of colon. Forms an S-shaped tube that extends medially and
then inferiorly into the pelvic cavity and ends at the rectum.
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VITAL INFORMATION
Name: Mr. M
Room Number: ICU - Bed 2
Age: 73 years old
Gender: Male
Civil Status: Married
Date of Birth: June 1, 1950
Birthplace: Iligan City, Philippines
Cultural Group: Filipino
Primary Language: Bisaya
Religion: Roman Catholic
Highest Educational Attainment: College Graduate
Occupation: None
Usual Health Care Provider: Dr. BDDC, Internal Medicine
Reason for Health Contact: Fever and Chills
Date of Confinement: November 11, 2023 @ 1:35pm
Source of History: S/0=50%, Chart=25%, Doctor=15%, Patient= 10%
Attending Physician/s: Dr. BDDC, Internal Medicine
Impression/ Final Diagnosis: Typhoid Fever
Description of Patient: Patient is 165cm, has a weight of 64kgs, has a brown skin color
with white-straight hair; 1 inch in length; with areus senilis eyes; oval-shaped face; lying
on bed at semi-fowlers position, GSC 11 (M6, E4, V1), weak looking with sluured
speech, attached to mechanical ventilator at following settings: FIO2: 41%, PEEP
5cmH2O, Pressure control: 12 cmH2O, Insp. Time: 0.8s, O2: 100%, with ongoing IVF of
PNSS at 40cc/hr hooked at left metacarpal vein via IV pump, with FBC attached to
urobag draining urine output, with restraints on both arm, NGT in placed, no edematous
extremities noted, no signs of bleeding, with strong palpable peripheral pulses.
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NURSING HISTORY
Biographical Data
Name: Mr. M
Address: Purok 10A, Buru-un, Iligan City, Lanao Del Norte
Room Number: ICU - Bed 2
Age: 73
Gender: Male
Birth Date: June 1, 1950
Birthplace: Iligan City, Philippines
Educational Attainment: College Graduate
Occupation: None
Referral (primary care physicians/practitioner): Dr. BDDC, Internal Medicine
Final Diagnosis/Impression: Typhoid Fever
Marital Status: Married
Ethnicity/Nationality: Filipino
Source of History
Patient’s wife, Mrs. N., who seems reliable by 50%, chart with 25% reliability,
AP 15%, and the patient 10% with a total reliability of 100%
Reason for Seeking Care
The patient was brought to the hospital for chemotherapy.
Present Health or History of Present Illness
Few months PTA, onset of hypogastric pain, was anemic and fainted, he also had
blood transfusion. Sought consult, had UTZ-WA abdomen, diagnosed to have sigmoid
colon, referred to Dr. Debalucos and was advised for surgery. On May 2023 he
underwent sigmoid colon surgery. After 1 month of surgery, he had his first session of
chemotherapy on July 4, second session on July 18, and third session on August 2. 1 day
PTA, Px is scheduled for 4th session of chemotherapy, however, upon laboratory results
are out, SGPT is increased and therapy was postponed to next month. Due to decrease
BP of 80/60, pt. was advised for admission.
Past Health History
- Diagnosed with BPH – 2022
- Diagnosed with sigmoid colon CA – May 2023
- With history of hypertension
Childhood Illness
The patient has no experience of childhood illness.
Accidents or Injuries
The patient has no experience of accident or injuries.
Serious or Chronic Illness
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The patient has a history of hypertension based on his lifestyle he was a former
smoker; stopped last 2022; consumed 1 pack/day and occasional alcoholic beverage
drinker.
Hospitalization
The patient was admitted to Mercy Community Hospital INC. Camague, Iligan
City, last May 2023
Operation
He underwent sigmoid colon surgery last May 2023 at Mercy Community
Hospital INC. Camague, Iligan City
Immunizations
The patient had a complete Covid-19 vaccine as well as booster.
Last Examination Date
The patient and S/O cannot recall.
Allergies
The patient is not allergic to any food or medication.
Current Medication
He is taking Amlodipine 5mg OD for his hypertension.
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GENOGRAM
Paternal Maternal
? ? ? ?
? ?
68 66 64 62 60
Legend:
- Male - Hypertension
- Female
? - Unrecalled Age
- Patient - Colon Cancer
- Deceased - Benign Prostatic Hyperplasia
- Unknown Cause of Death - Alive and Well

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GORDON’S
Health Patterns Before Hospitalization During Hospitalization
1. Health According to the patient’s The S/O believes that her husband
Maintenance S/O he was admitted last will get through this, they feel at
Management May 18, 2023 at Mercy ease because they think they can't
Hospital, Iligan City due to do anything about it because it’s
loss of consciousness and already there. Also, the doctor
was scheduled for endoscopy assured them that the pt. will be
on May 19,2023. And had well if he just continues his
his sigmoid colectomy chemotherapy and takes his
surgery last May 23, 2023. medicines consistently.
There’s nothing they can do if they
After the patient retired from just moped around worry for the
work, according to the S/O, patient's health.
the patient does not have any
hobbies and lives a sedentary
lifestyle mostly watching
TV, but she still thought of
him as someone who is
healthy because he does
exercise (jogging) at times,
but when the pandemic
happened she told her
husband to stop as way to
protect themselves from the
virus.
The patient occasionally

drinks alcohol and would
consume a pack of cigarette
each day (ever since he was
a teenager) and only stopped
last year after he had
problems with his health,
specifically hypogastric pain
and sought healthcare advice
on a private clinic by Dr.
Lily Fuentes (General
Practitoner) in Bacolod,
Lanao del Norte.
The patient would get

regular check-ups in clinics
and assigned doctors to their
station because it is a
requirement for his job as a
PNP officer. And oftentimes
they would just let a simple
fever subside if ever the
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patient experiences one.
The patient religiously takes

Amlodipine 5mg OD when
he was diagnosed with
hypertension around the year
2005.
2. Nutritional/ Before the patient retired Patient was put on NPO except
Metabolic Pattern from his work 10 years ago, medications, and was placed under
the S/O couldn’t really keep TPN (Combiflex) at right hand at
track of her husband's diet 60 cc/hr
because he works here in
Iligan and she was left with
her children at home in
Bacolod. But she assumed
that her husband would just
eat what is prepared for him
and that is usually
“sinugbang karne, kinilaw,
etc”.
After his retirement, the

patient now has a healthier
diet, as per his wife, “Ilocano
biya, mahilig ug gulay,
pakbet, law-oy” and their
diet all-in-all consists of
meat and vegetables. The
patient would consume a
normal amount of rice. The
patient starts the day with a
black coffee every day or tea
(Lipton). He eats three times
a day and is not fond of
drinking carbonated drinks
and is not particularly fond
of snacks as well.
The patient would only drink

water when he eats, and is
also not fond of drinking
water, “kanang mu inom
rana siya pag mukaon, dayun
ingon ka nga mangita gyud
ug tubig para mu inom?
Dili” as verbalized by the
S/O.
According to the S/O, there

is not much of a change
when it comes to the
patient's weight.
3. Elimination Bowel Habits: Mr. Z Bowel Habits: During our shif,t

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Pattern
would defecate for at least August 30, 2023, the patient is
once a day, usually at 3:00 severely constipated, with no
am early in the morning, records of BM during our duty.
according to the S/O. His
wife assumes that his stool
was usually dark brown or
yellow and hard in Bladder Habits: During our shift,
consistency, nothing really August 30, 2023, his total output
changed with the client's was 105cc. During our 2nd shift,
bowel habits after his August 31, 2023, he was on a
surgery. According to S/O Foley Bag Catheter attached to
he doesn’t have difficulty Urobag. He was able to void
in elimination. “Wa sab ko once with a total of 280 cc. With
kadumdom gikalibanga na yellow orange in color
siya”
Bladder Habits: Mr. Z

usuallly eliminates 2x a day.
The patient would usually
urinate 2 to 3 times a day
according to the S/O.
4. Activity When the Px was still in During our shift, August 30, 2023,
Exercise Pattern service, he worked as a the patient is still able to walk
police officer for 30 years. around his room. August 31, 2023,
Mr. Z would jog and do the patient can only sit with
walking early in the morning assistance, and on our last day of
usually 3x a week but would duty September 1, 2023 the patient
just sit around after then is now fully bedridden.
watch TV and at times
would do chores like
sweeping and cooking.
5. Sleep/Rest The patient usually sleeps The patient had trouble sleeping all
Pattern around 7:00-8:00PM and throughout his hospitalization
wakes up at 3:00am to except on the morning of August
defecate. He then takes his 31, 2023 from 5:00 am to 10:00 pm
coffee and prepares breakfast the patient was able to sleep in
for his family and eat which the student nurses are task
together with them. After not to disturb the patient.
that he then take his nap for
about 3 hours and go through
his day watching TV and
spend the rest of the
afternoon sleeping again.
6. Cognitive- “Wala man siya’y problema The patient is not oriented to time
perceptual sa mata, naga gamit ra siyag and place. GCS 13. The patient
pattern antipara kana rang mag basa would usually grimace when he is
siya, dili man siya naga assisted to sit to take his
gamit ana permi.” according medication as a sign that he does
to the S/O. feel pain. Wong Baker Faces pain
rating scale: 8/10.
When asked what’s the
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patient's eye prescription the

S/O answered “wala mi
kabalo sa grado saiyang mata
kay pang basa raman niya
na.”
Patient did not experience

any problems with regards to
hearing, touch, taste, and
smell.
7. Self- The patient's wife describes The wife assumes that one of the
perception/Self the patient as a loving and reasons why her husband is restless
Esteem caring father, he makes the is probably because he’s not used
decision for the whole to the idea that he is just in bed and
family. And she thinks that gets to be taken care of by his
her husband is confident family.
with himself.
8. According to the S/O, the The patient was taken care of by

Role/Relationship patient is the main decision his nieces, nephew and wife, and
pattern maker of their household, he from time to time his son visits him
is a loving and loyal partner, and helps take care of the
and a loving and caring patient whenever he is free from
father to his 2 sons, he work.
usually does not get stressed
that much but when he does
his way of coping is through
watching TV, specifically
wrestling or boxing matches.
They depend on his pension

for their daily expenses, “dili
man gyud mi mangayo sa
akong anak gyud, sa iya lang
pension” according to the
S/O.
The patient and his family

are not fond of having
leisure activities outside as a
form of family bonding for
they think it’s a waste of
money. The patient is happy
with his lifestyle being at
home with his family.
9. Sexuality/ Married and satisfied with The patient is not sexually active
Reproductive sexual relationships. A father after his wife reaches the
pattern of 2 children and has no menopausal stage.
history of Sexually
Transmitted Disease or any
disease affecting her
genitals. But according to the
S/O they stopped having
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intercourse when she

reached her menopausal age.
He only uses condoms as a
form of contraceptives.
10. Coping/Stress The S/O does not recall that The patient is sometimes agitated
her husband is stressed, probably because of his underlying
however she assumes that his condition. But as verbalized by the
way of coping would S/O “think positive ra gyud mi ani,
probably be watching boxing bisag siya katong wala pa siya ma
and wrestling matches on ingon ana (referring to the current
TV. situation of the patient), wala ra
kaayo siya gapa stress kay naa
naman na.”
11. Value/Belief Mr. Z is a Roman Catholic “Ampo nalang gyud mi ani

Pattern and goes to church seldomly. pirminte, tabangan ra lagi mi ani sa
He does not have any Ginoo, siya na lang man gyud ang
superstitious beliefs and nakabalo” as verbalized the S/O.
believed that there is always
God’s redirection when he
generally doesn’t get what he
wants in life, as stated by the
S/O.
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PEROS
Areas Assessed Subjective Objective Findings Problem
Findings Identified
General Health - On August 30, General Appearance: - Altered
Survey 2023 (Wednesday) DAY 1 = Px is awake, Comfort
the Px was asked weak-looking, restless, - Acute
what was the date, ambulatory, with confusion
he replied distended abdomen (98 - Risk for Fall
“Sabado…ay cm), with nonpitting
nalimot na ko.” edema on both lower
extremities
As verbalized by
the S/O: DAY 2 = Px is asleep, still
“Ni niwang siya weak-looking, pale skin,
ma’am kompara ambulatory but with need
atong wala pa siya of assistance, with
gi admit ari sa enlarged abdomen noted
hospital.” (91 cm), still with
nonpitting edema on both
lower extremities
DAY 3 = Px is asleep,
appears weak and pale,
bed ridden, with enlarged
abdomen noted (93 cm),
still with nonpitting edema
on both lower extremities
Vital Statistics:
- Age = 66 years old
- Weight = 54.5 kg
- Height = 162 cm
- BMI = 20.8 (Normal)
Inspection:
- No smells or unpleasant
odor at patients bed
- Unable to respond
correctly due to discomfort
- Px needs assistance in
sitting, standing, and
walking
Integumentary “Wa” (Px does not Inspection: - Risk for
System have any skin - Px skin is brown and has Impaired Skin
rashes or lesions) senile skin turgor Integrity
“Di” (Px does not - Dry skin, with dark

sweat) chemo burns on both arms
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As verbalized by - Body hair are evenly

the S/O: distributed
“Wa mana siya’y
problema sa odor - Hair is dispersed evenly
ma’am, kana throughout Px body
raman gyud iyang
sakit sa tiyan iyang - Px has a black, straight
problema.” hair, 1-inch in length,
widow’s peak hairline
“Ayha raman na with minimal white
siya mainitan inig strands
mo gawas ky naa
ra man na siya - No dandruffs, mits, lice,
permis balay.” or other scalp conditions
“Di siya naga - Nails are wide and round

gamit ug
sunblock.” - Upper and lower
phalanges nails are not
“Kanang black trimmed well
ma’am sa iyahang
kamot kay tungod - Good capillary refill time
daw sa chemo, with < 2 seconds
nasunog” as
verbalized by the Palpation:
S/O. DAY 1 = Nonpitting
edema on both lower
When asked if the extremities
client’s back is
warm to touch the DAY 2 = Right side of
S/O replied “ Oo lower extremity is
ma’am, init maong somewhat turning into its
ana sila ipa takilid original form compared to
takilid gyud daw” the left side
DAY 3 = With minimal

nonpitting edema on both
lower extremities
HEENT As verbalized by HEAD AND FACE No problem
A. Head and the S/O: Inspection: identified
face “Wala man siyay - Head and face are
B. Eyes problema sa mata, symmetrical, normal in
C. Ears naga gamit ra siyag size, proportional, and has
D. Nose antipara kana rang even contours
E. Oral Cavity mag basa siya, dili
man siya naga - Facial movement is
gamit ana permi.” symmetrical
Palpation:
“Wala mi kabalo sa - No presence masses
grado saiyang mata
ky pang basa EYES
raman niya na.” Inspection:
- Eyebrows and lashes are
“Dugay na siya ga even in hair distribution
gamit ug antipara
mga 40 pa iyang - Has brown eyes
edad, murag
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pangka-upat na - Pale palpebral

niya ron.” conjunctivae
“Kadaghan na siya - Both pupils of the eyes

nakapa check-up are black and equal in size.
saiyang mata, didto The iris is flat and round.
sa salang likod PERRLA (pupils equally
police station.” round respond to light
accommodation),
“Wala siya’y illuminated and non-
problema sa illuminated pupils
pandungog, di pud constricts.
siya hilig
maminaw ug mga - Pupils constrict when
kusog nga music.” looking at a near object
and dilate at a far object.
“Wala siya sukad
ka pa check-up - Pupils are normal, no
saiyang redness and swelling,
dalunggan.” discharges are not present
“Naga gamit siyag EARS

inhaler sugod Inspection:
March kas’a sa isa - Patient has no ear pus
ka adlaw para and odor.
saiyang baga ky
naga-panigarilyo - Color of the auricles is
mana siya.” the same as facial skin and
symmetrical
“Wala man siya’y
daot sa ngipon, - Without impacted
wala pud siya’y cerumen.
tonsil.”
NOSE
“Nakapa check-up Inspection:
na siya sa dentist - No discharge present in
didto samo’a sa the nose, no masses in
Bacolod.” external nose, and no
displacement of bone and
cartilage
ORAL CAVITY
Inspection:
- Dry lips, intact gums, no
presence of carries and
decays
- Able to swallow and

distinguish taste
- Tongue is pink and

evenly covered in papillae
Neck As verbalized by Inspection: No problem
the S/O: - Neck muscles are in identified
“Wala man siya equal size
sukad na stiff
neck.” - No neck vein
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enlargement
- Trachea is placed midline

of the neck
- Able to move in all

directions just by turning
his head
Palpation:
- Tissues of tongue feel
soft and resilient with no
palpable induration or
masses
- No tracheal deviation
- No enlargement of nodes
and thyroid gland
Respiratory System As verbalized by Inspection: - Altered
the S/O: - From the posterior and Comfort
“Wala man gyud lateral views, the thorax’s - Impaired Gas
na siya gi hubak or shape and symmetry are Exchange
galisud ug ginhawa normal
sauna, kato raman
gasugod saiyang - When breathing, Px’s
pag panigarilyo chest rises normally
maong ga gamit
siya’g inhaler.” DAY 1 = Px reports of
DOB (9am RR = 17, 1pm
“Galisod na siya RR = 25)
karon ug ginhawa,
ma’am.” DAY 2 = Still experiences
DOB (9am RR = 15, 1pm
RR = 18)
DAY 3 = No complaints
of DOB with O2 support
inhalation at 2Lpm
(9am RR = 19, 1pm RR =
20)
Percussion:
- No signs of flat sounds
and all intercostal spaces
resonated upon being
percussed.
Cardiovascular As verbalized by Inspection: No problem
System the S/O: - No notable abnormalities identified
“Wala mana siya’y
sakit sa dughan Palpation:
ma’am.” - Presence of nonpitting
edema on the lower
extremities
- Capillary refill time is <

2 seconds
20
- Palpable peripheral
pulses in temporal, carotid,
brachial, and radial
- No vibrations upon
palpation on the anterior
chest wall
Auscultation:
- No signs of bruits heard
during auscultation
- No abnormal heaves or
pulsations noted
DAY 1 (9AM)
PR = 84
BP = 120/80
(1PM)
PR = 98
BP = 120/80
DAY 2 (9AM)
PR = 72
BP = 110/70
(1PM)
PR = 82
BP = 130/80
DAY 3 (9AM)
PR = 75
BP = 110/70
(1PM)
PR = 89
BP = 130/70
(AUGUST 30, 2023)

 RBC = 4.49
 Hemoglobin = 148
 White blood cells =
14.02
 Platelet Count =
169
Breast and Axilla - Px does not Inspection: No problem
perform breast - Normal breast size, identified
self-examination. symmetry, contour, shape,
- Px have not and color.
undergone - No presence of lesions
mammography and discharges.
procedures.
- Px have not had Palpation:
any breast surgery. - Normal axillary,
- Px does not subclavicular, and
experience breast supraclavicular lymph
tenderness. nodes, and not painful
during palpation.
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Gastrointestinal “Ang problema Inspection: - Acute pain

System and the ma’am kana ra - Px can swallow but has a -
Abdomen gyud iyang tiyan ni hard time. Dysfunctional
dako. Pero wala - NGT open to drain with gastrointestinal
man siya nagsuka” dark green discharges motility
as verbalized by noted.
the S/O. Day 1 = 15cc
Day 2 = 315cc
- No pulsations felt Day 3 = 1cc
- Reports - Normal umbilicus, no
abdominal pain discharges noted.
C – Numbing pain - Distented/enlarged
O – Started on abdomen
August 26, 2023 Abdominal Girth (Day 1)
(Saturday) while = 98 cm
admitted when his Abdominal Girth (Day 2)
abdomen started = 91 cm
getting big Abdominal Girth (Day 3)
L – Suprapubic/ = 93 cm
hypogastric region
D – Has been Auscultation:
going on since its - Ileus upon auscultation
onset
S – PS: 8/10 Percussion:
(Wong Baker - Presence of distention
Faces Pain Scale) due to enlarged spleen and
P – It becomes liver
worse when the - Dullness over percussion
patient sits or
stands, it becomes
less painful when
lying down
A – Unable to sit
or stand for long
and back pain
Genito-urinary/ As verbalized by (Day 1) - Fluid volume
Reproductive System the S/O: 24-hour intake = 2,830cc excess
“Oo, maka control 24-hour output = 595cc no
raman siya, wa BM and vomitus
man siyay (Day 2)
problema sa pag- 24-hour intake = 1,230cc
ihi ma’am.” 24-hour output = 1,825cc
no BM and vomitus
“Dili ra sya (Day 3)
makaihi sa 24-hour intake = 1,110cc
higdaanan.” 24-hour output = 1,101cc
with 1 BM (watery with
particles), no vomitus
Musculoskeletal “Sakit akong luyo” Inspection: - Acute pain
System as verbalized by - Stooped posture - Impaired
the Px. - Tall and thin body size physical
C – Numbing pain - Symmetrical neck muscle mobility
O – Started after and good ROM
the 2nd cycle of - Good arm ROM
chemotherapy - Nonpitting edema noted
(July 18, 2023) on lower extremities (both
L – Lower back feet)
22
D – Has been
going on since its Palpation:
onset - No joint deformities
S – Severe noted
P – Becomes worse - No abnormal
when sitting or growth/protrusion of bone
standing, relieved noted
when lying down - No masses on muscles
A – Unable to sit noted
or stand long - Muscle strength: (4/5)
Active movement against
gravity with some
resistance
Neurologic System As verbalized by Balance: - Risk for

the S/O: - Poor balance fall/injury
“Kuan ra ma’am, - Needs assistance when
irritable kaayo siya walking or sitting
kay di mahimutang - Able to perform hand to
tungod sa iyang nose, pronation and
tiyan” supination of both hands,
fingers to thumb.
“Wa man sya
katabi ug binhod.” Strength:
- Good arm strength with
slight and no resistance
- Can slightly squeeze
fingers
- Fair leg strength with
slight and no resistance
Sensory:
- Good sharp and dull
sensation
- Can identify number of
hands holding
- Can identify objects
Lymphatic/Hemato- As verbalized by Inspection: No problem
logic Sytem the S/O: - Nonpitting edema on identified
“Kapoyan siya ug both lower extremities
tindog” - No flushed appearance
on skin but the lips
“Wa raman siyay appears pale
bukol bukol - No signs of bleeding in
saiyang liog ug different areas of the body
ubang parts sa
lawas” Palpation:
- No enlargement of lymph
- No presence of nodes noted upon
pain noted palpation
23
DIAGNOSTIC TESTS
HEMATOLOGY (08/24/2023)
TEST RESULTS REFERENCE
Red Blood Cells 3.28 5.2 - 5.4 M/mm^3
Hematrocrit 0.31 0.42 - 0.52
Hemoglobin 107.0 135 - 180 g/L
White Blood Cells 10.76 4.0 - 10.5 x10^3 cells/mm^3
Differential Counts
Segmenters 0.78 0.35 - 0.66
Lymphocytes 0.12 0.24 - 0.44
Stabs (Bands) 0 0.05 - 0.11
Monocytes 0.08 0.03 - 0.06
Eosinophils 0.02 0.00 - 0.03
BASOPHILS 0 0.00 - 0.01
Platelet Count 222 150 - 400 x10^3/mm^3
BLOOD TYPING (08/24/2023)

TEST RESULTS
Blood Type B
RH Positve
CLINICAL CHEMISTRY (08/24/2023)

TEST RESULT REFERENCE UNIT
SGOT/AST 476.3 8 - 37 lu/L
Creatinine 130.99 62 - 120 Umol/L
SGPT/ALT 42.5 5 - 41 U/L

TEST RESULT REFERENCE
Potassium 4.46 3.5 - 5.3 mmol/L
Sodium 132.0 135 - 148 mmol/L
PROTIME (08/24/2023)
TEST RESULT UNITS
Patient 13.6 Seconds
Control 13.9 Seconds
Activity 100 %
INR 0.97
24
CROSSMATCHING (08/25/2023) TIME: 01:07PM

TEST RESULT TEST RESULT
Compatible with Blood 2023-1796 Blood Group and RH B Positive
Bag No. Type
Blood Preparation PRBC Expiry Date 09-21-2023
Volume of Blood 324CC Crossmatched By
Tranfusion Reaction (To be filled by NOD
Record for Charting)
Blood Bag Number 2023-1796 Administration Time August 26, 2023 at
and Date 3:45 am
Volume of Blood 324CC Administered By CRIZZA MARIZ D.
MAGLASANG, RN
LIC NO. 0838704
Reactions and Remarks Time of Completion 8:20 AM
CROSSMATCHING (08/25/2023) TIME: 01:47PM

TEST RESULT TEST RESULT
Compatible with Blood BLB-2023- Blood Group and RH B Positive
Bag No. 1446 Type
Blood Preparation PRBC Expiry Date 09-20-2023
Volume of Blood 314CC Crossmatched By YZEE KYLE T.
MORENTE, RMT
Transfusion Reaction (To be filled by
Record NOD for Charting)
Blood Bag Number BLB-2023- Administration Time 08/25/2023 at 4:05
1446 and Date
Volume of Blood 314CC Administered By ROELENE C.
GLORIA, RN
LIC NO. 0352633
Reactions and Remarks NONE/DONE Time of Completion

SGOT/AST 269.7 8 - 37 lu/L
Hematocrit 0.33 0.42 - 0.52
Differential Counts
Segmenters 0.77 0.35 - 0.66
Lymphocytes 0.10 0.24 - 0.44
Stabs (Bands) 0 0.05 - 0.11
Monocytes 0.09 0.03 - 0.06
Eosinophils 0.04 0.00 - 0.03
Basophils 0 0.00 - 0.01
Platelet Count 143 150 – 400 x10^3/mm^3
25
Hematocrit 0.40 0.42 - 0.52
Differential Counts
Segmenters 0.85 0.35 - 0.66
Lymphocytes 0.07 0.24 - 0.44
Stabs (Bands) 0 0.05 - 0.11
Monocytes 0.08 0.03 - 0.06
Eosinophils 0 0.00 - 0.03
Basophils 0 0.00 - 0.01

SGOT/AST 449.1 8 - 37 lu/L
Creatinine 157.71 62 - 120 Umol/L
SGPT/ALT 63.9 5 - 41 U/L
Albumin 28.07 38 - 54 g/L

Sodium 116.4 135 - 148 mmol/L
TOTAL PROTEIN ALBUMIN/ GLOBULIN (08/30/2023)

Total Protein 65.9 60 - 82 g/L

TEST RESULT REFERENCE UNITS
Creatinine 194.30 62 - 120 umol/L
Total Calcium 3.43 2.15 - 2.57 mmol/L
Albumin 32.12 38 – 54 g/L
26
Hematocrit 0.36 0.42 - 0.52
Differential Counts
Segmenters 0.85 0.35 - 0.66
Lymphocytes 0.05 0.24 - 0.44
Stabs (Bands) 0 0.05 - 0.11
Monocytes 0.09 0.03 - 0.06
Eosinophils 0.01 0.00 - 0.03
Basophils 0 0.00 - 0.01

Sodium 120.0 135 – 148 mmol/L
TOTAL PROTEIN ALBUMIN/ GLOBULIN (09/02/2023)

Total Protein 72.5 60 - 82 g/L
27
NORMAL ANATOMY AND PHYSIOLOGY
Colon
The colon (large intestine) is the distal part of the gastrointestinal tract, extending
from the cecum to the anal canal. It receives digested food from the small intestine, from
which it absorbs water and electrolytes to form feces. Anatomically, the colon can be
divided into four parts – ascending, transverse, descending and sigmoid. These sections
form an arch, which encircles the small intestine.
Caecum and appendix
Chyme that has not been absorbed by the time it leaves the small intestine passes
through the ileocecal valve and enters the large intestine at the caecum. On receipt of the
contents of the ileum, the caecum continues the absorption of water and salts. The
caecum is about 6cm long and extends downwards into the appendix, a winding tubular
sac containing lymphoid tissue. The appendix is thought to be the vestige of a redundant
organ; its narrow and twisted shape makes it an attractive site for the accumulation and
multiplication of intestinal bacteria.
Rectum, anal canal and anus

28
Distally, the large intestine opens into the rectum, which is continued by the anal
canal. The rectum forms the final 20cm of the GI tract. It is continuous with the sigmoid
colon and connects with the anal canal and anus. The rectum ends in an expanded section
called the rectal ampulla, where feces are stored before being released; the rectum is
usually empty since feeces are not normally stored there for long. The anal canal located
in the perineum (outside the abdominopelvic cavity), is 3.8-5cm long and opens to the
exterior of the body at the anus. It has two sphincters:
 Internal anal sphincter, which is controlled by involuntary muscles;

 External anal sphincter, which is made of skeletal muscle and is under
voluntary control.
Ascending colon
20-25 cm long, located behind the peritoneum
Transverse colon
The transverse colon is a section of the large intestine that runs across the
abdomen. It is where the body absorbs water and salts from material that it cannot digest.
Later, this becomes feces.
Hepatic flexure
The right colic flexure, also called the hepatic flexure, consists of a curve at the
junction with the transverse colon. A peritoneal fold extending from the hepatorenal
ligament most likely supports this portion of the large intestine.
Splenic flexure
The splenic flexure is the sharp bend that connects the transverse colon to the
descending colon. This bend is in the upper abdomen and forms a part of the GI system.
It sits near the spleen, an organ that mainly filters the blood. Many blood vessels come
together in this part of the body.
Descending colon
The descending colon is a part of the large intestine. It connects the transverse
colon to the sigmoid colon and primarily stores stool that will eventually empty into the
rectum. The colon as a whole works to absorb nutrients from the diet and to form and
release feces.
29
Sigmoid colon
Sigmoid colon, a terminal section of the large intestine that connects the
descending colon to the rectum; its function is to store fecal wastes until they are ready to
leave the body.
Rectosigmoid segment
The rectosigmoid is that portion of the large intestine in which the narrow
sigmoid colon undergoes a gradual enlargement before joining the rectum. Its exact
position is variable. By some it has been estimated to be about 2 inches (5 cm.)
Kidney
The kidneys are a pair of bean-shaped, brownish-red structures located

retroperitoneally (behind and outside the peritoneal cavity) on the posterior wall of the
abdomen—from the 12th thoracic vertebra to the 3rd lumbar vertebra in the adult. The
average adult kidney weighs approximately 113 to 170 g (about 4.5 oz) and is 10 to 12
cm long, 6 cm wide, and 2.5 cm thick. The right kidney is slightly lower than the left due
to the location of the liver.
Externally, the kidneys are well protected by the ribs and by the muscles of the
abdomen and back. Internally, fat deposits surround each kidney, providing protection
against jarring. The kidneys and surrounding fat are suspended from the abdominal wall
by renal fascia made of connective tissue which holds the kidney in place. The fibrous
connective tissue, blood vessels, and lymphatics surrounding each kidney are known as
the renal capsule.
The renal parenchyma is divided into two parts: the cortex and the medulla. The
medulla, which is approximately 5 cm wide, is the inner portion of the kidney. It
30
contains the loops of Henle, the vasa recta, and the collecting ducts of the juxtamedullary
nephrons. The collecting ducts from both the juxtamedullary and the cortical nephrons
connect to the renal pyramids. The pyramids drain into minor calyces, which drain into
major calyces that open directly into the renal pelvis. The renal pelvis is the beginning of
the collecting system and is composed of structures that are designed to collect and
transport urine. Once the urine leaves the renal pelvis the composition or amount of urine
does not change.
The cortex, which is approximately 1 cm wide, is located farthest from the center
of the kidney and around the outermost edges. It contains nephrons (the structural and
functional units of the kidney responsible for urine formation).
Liver
The liver is a large, highly vascular organ located behind the ribs in the upper
right portion of the abdominal cavity. It weighs between 1200 and 1500 g in the average
adult and is divided into four lobes. A thin layer of connnective tissue surrounds each
lobe, extending into the lobe itself and dividing the liver mass into small, functional units
called lobules.
The circulation of the blood into and out of the liver is of major importance to
liver function. The blood that perfuses the liver comes from two sources. Approximately
80% of the blood supply comes from the portal vein, which drains the GI tract and is rich
in nutrients but lacks oxygen. The remainder of the blood supply enters by way of the
hepatic artery and is rich in oxygen. Terminal branches of these two blood vessels join to
form common capillary beds, which constitute the sinusoids of the liver. Thus, a mixture
of venous and arterial blood bathes the hepatocytes (liver cells). The sinusoids empty into
31
venules that occupy the center of each liver lobule and are called the central veins. The
central veins joins to from the hepatic vein, which constitutes the venous drainage from
the liver and empties into the inferior vena cava, close to the diaphragm.
The liver can be considered a chemical factory that manufactures, stores, alters,
and excretes a large number of substances involved in metabolism. The location of the
liver is essential because it receives nutrient-rich blood directly from the gastrointestinal
(GI) tract and then either stores or transforms these nutrients into chemicals that are used
elsewhere in the body for metabolic needs. The liver is especially important in the
regulation of glucose and protein metabolism. The liver manufactures and secretes bile,
which has a major role in the digestion and absoprtion of fats in the GI tract. The liver
removes waste products from the bloodstream and secretes them into the bile. The bile
produced but the liver is stored temporarily in the gallbladder until it is needed for
digestion, at which time the gallbladder empties and bile enters the intestine.
32
RISK FACTORS AND PATHOPHYSIOLOGY

33
NURSING CARE PLANS

Client Name: Mr. Z
Age: 66 years old
Priority #1
34
Priority #2
35
Priority #3
36
Priority #4
37
Priority #5
38
HEALTH EDUCATION PLAN
Patient teaching is a critical component of care for patients with Colon Cancer. The
patient should also be encouraged to change lifestyle and manage the triggering factors.
1. Recommend the patient to have a regular screenings.

 It typically takes 10 to 15 years from the time the initial abnormal cells begin to
develop into polyps for them to turn into colorectal cancer.
 Most polyps can be discovered and removed with routine screening before cancer
develops.
 Patients aged 45-75 should be screened through stool tests and diagnostic exams.
2. Assist the patient in lifestyle modification.

 A diet high in fruits and vegetables are highy recommended diet.
 Avoiding processed meats, weight management.
 Teach patient about having regular exercises daily.
 Advice patient to avoid drinking alcohol, and quitting smoking.
3. Encourage patient to take supplements.

 Patient may take medicine such as Magnesium, calcium, and vitamin D may lower
the risk of colorectal cancer as prescribed by the doctor.
39
DISCHARGE PLAN
Name of Client: Mr.Z
Age: 66 y/o
Gender: Male
Religion: Roman Catholic
Admitting Diagnosis: Colon Cancer, S/P Chemo 3 cycles, S/P Exlap Colectomy
Surgery (if any): Sigmoid Colon Surgery
Hospital: Adventist Medical Center-Iligan
Room/Ward Bed No.: 297
Attending Physician/s: Dr. Audie L. Debalucos, Gastroenterologist
1. Exercise (Included step-by-step procedure)
It’s essential to consider a few things before starting a new workout routine.
 Check your health. It’s important to consult your healthcare provider and get a
physical medical examination before starting an exercise routine.
 Stay hydrated. Drinking fluids throughout the day is essential for maintaining healthy
hydration levels.
 Optimize your nutrition. Be sure to consume a balanced diet to support your fitness
program. Eat your breakfast before planning to exercise.
 Warm up. It’s important to warm up before your workout. Doing so can help prevent
injuries and improve your athletic performance.
 Cool down. Cooling down is also important because it helps your body return to its
normal state.
 Make sure you're wearing the right clothes and footwear for the workout you're
doing. Wearing the right sneakers on a long run will mean way more comfort, which
could translate to better endurance and a more enjoyable workout. Before you head
out the door, do a once over and make sure you're outfitted properly. Check out the
leggings, shorts, shoes and sports bras. Make sure you are wearing a sock to avoid
cold.
40
Recommended exercise for patient’s disease:
a) Moderate-to-high-intensity aerobic and resistance exercise.
b) Brisk walking
 To start brisk walking exercise, gaze ahead by keeping your head upright.
 Keep your shoulders, neck, and back stable and straight. Ensure that you are not
slouching. Remember, straighten your back but never keep them rigid or stiff.
 Engage your abdominal muscles.
 Start walking with a steady gait.
 Roll the foot ahead from the heel instead of using your toes.
 Keep your arms loose. You can swing or pump them while doing the brisk
walking exercise.
2. Therapy
 Water therapy
 Drug therapy
 Chemo therapy
3. Health Education
 Take your medicines exactly as prescribed. Call your doctor or nurse advice line
if you think you are having a problem with your medicine.
 Eat healthy food. If you do not feel like eating, try to eat food that has protein and
extra calories to keep up your strength and prevent weight loss. Drink liquid meal
replacements for extra calories and protein. Try to eat your main meal early.
 Take steps to manage your stress, such as learning relaxation techniques. To also
help reduce stress, get enough sleep, eat a healthy diet, and take time to do things
you enjoy.
Prevention:
 Eat a well-balanced diet.

 Reduce the fat you consume, particularly animal fat.
 Increase your consumption of fruits and vegetables.
 Exercise regularly.
 Don't smoke.
4. OPD
5. Diet: DAT (Diet as tolerated)
41
Breakfast: oatmeal, sweet potatoes, whole-wheat bread
Lunch: 1 cup brown rice and Fish
Dinner: brown rice, vegetables, egg
6. Spiritual Care
 Offered a prayer to the patient
PROGNOSIS
According to the U.S. National Cancer Institute (NCI) data shows that overall,
65% of people with colorectal cancer were alive five years after diagnosis. (A survival
rate is an estimate based on the experiences of people with specific kinds of cancer.)
42
Colorectal cancer survival rates vary based on the cancer stage at diagnosis. For
example, 73% of people with colorectal cancer that’s spread to nearby tissues, organs or
lymph nodes were alive five years after diagnosis. That five-year survival rate drops to
17% if the cancer spreads to a distant organ or lymph node.
On account of that, about 90 percent of colorectal cancers and deaths are thought
to be preventable and highly treatable. In addition to regular colorectal cancer screenings,
exercise and maintaining a healthy weight can reduce your risk of colorectal cancer.
The prognosis is good for colon cancer since most patients make a spontaneous
recovery. Patients with colon cancer always require treatment. In the case of our 66 year
old male patient the prognosis is good since he has a strong family support. He also
received interventions and had done successful surgery.
BIBLIOGRAPHY
Books
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CASE PRESENTATION OF COLON CANCER

Presented to the Faculty of the School of Nursing

Amodia, Karr Shadrach

SEPTEMBER 04, 2023

CASE PRESENTATION OBJECTIVES…………………………………………………3

NORMAL ANATOMY AND PHYSIOLOGY………………………………………….27

RISK FACTORS AND

A. NURSING CARE PLAN…………………………………………………….33

CASE PRESENTATION OBJECTIVES

During/ after the case presentation,

8. The clinical instructors will assess the presenters reasoning skills.

According to the American Cancer Society (ACS), 30% of people with

also known as hereditary non-polyposis colorectal cancer (HNPCC), is a particular kind

Colorectal Cancer - Is predominantly (95%) adenocarcinoma, with colon cancer

milliequivalents per liter (mEq/L) of sodium is considered to be normal.

Room Number: ICU - Bed 2

Age: 73 years old

Civil Status: Married

Date of Birth: June 1, 1950

Birthplace: Iligan City, Philippines

Cultural Group: Filipino

Primary Language: Bisaya

Religion: Roman Catholic

Highest Educational Attainment: College Graduate

Usual Health Care Provider: Dr. BDDC, Internal Medicine

Reason for Health Contact: Fever and Chills

Date of Confinement: November 11, 2023 @ 1:35pm

Source of History: S/0=50%, Chart=25%, Doctor=15%, Patient= 10%

Attending Physician/s: Dr. BDDC, Internal Medicine

Impression/ Final Diagnosis: Typhoid Fever

- Patient - Colon Cancer

- Deceased - Benign Prostatic Hyperplasia

- Unknown Cause of Death - Alive and Well

Health Patterns Before Hospitalization During Hospitalization

The patient occasionally

The patient would get

patient experiences one.

The patient religiously takes

After his retirement, the

The patient would only drink

According to the S/O, there

3. Elimination Bowel Habits: Mr. Z Bowel Habits: During our shif,t

Bladder Habits: Mr. Z

patient's eye prescription the

Patient did not experience

8. According to the S/O, the The patient was taken care of by

They depend on his pension

The patient and his family

intercourse when she

11. Value/Belief Mr. Z is a Roman Catholic “Ampo nalang gyud mi ani

“Di” (Px does not - Dry skin, with dark

As verbalized by - Body hair are evenly

“Di siya naga - Nails are wide and round

DAY 3 = With minimal

pangka-upat na - Pale palpebral

“Kadaghan na siya - Both pupils of the eyes

“Naga gamit siyag EARS

- Able to swallow and

- Tongue is pink and

- Trachea is placed midline

- Able to move in all

- Capillary refill time is <

(AUGUST 30, 2023)