GROUP II

CASE STUDY
COLORECTAL
CANCER
GENERAL OBJECTIVES:
The primary concern of this study is to further enhance the understanding of
Colorectal Cancer in congruence with the learned concepts of nursing students.
SPECIFIC OBJECTIVES:
This case presentation seeks to provide different information about the disease to be
presented and about the client being considered with the following specific objectives:
Give a brief introduction about Colorectal Cancer together with its signs and
symptoms.
Present the client’s demographic data and health history with its Gordon’s pattern of
functioning.
Present the abnormal results of the Physical Assessment made on the client.
Present the different laboratory results or test done to the client with its interpretation.
Discuss the normal Anatomy and Physiology of the GI tract.
Explain the Pathophysiology of Colorectal cancer.
Discuss the drugs prescribed to the client by a Drug Study.
Present an appropriate Nursing Care Plan for the most prioritized problem.
Give a Discharge Plan that the client may use upon discharge to the hospital.
Introduction
Cancer of the rectum is a malignant tumor in the
rectum. There may be a genetic basis or some types of
rectal cancer. In particular, an inherited disorder called
familial adenomatous polyposis (in which large
number s of polyps develop in the large intestine)
increases the risk. In most cases, however, the precise
cause is unknown. Dietary factor, such as eating a lot
of meat and fatty foods and not enough in fiber, may
also increase the risk. Cancer of the rectum is prone
from age 50-80.
Signs and Symptoms
Hematochezia(blood in stool)
Undefined weight loss
Pain upon defeacation
Constipation
Diarrhea
Vomiting
Change in bowel habits
Abdominal discomfort( frequent gas pains, fullness,
and/or cramps)
Ideal examinations for colorectal cancer:
Fecal occult blood test
Sigmoidscopy
Colonoscopy
Double contrast barium enema
Digital rectal exam
Radiology
Ultrasound
CT scan
Actual examinations for colorectal cancer:
Colonoscopy
Biopsy
ECG
Urinalysis
Blood chemistry
Hematology
Ideal treatment for colorectal cancer:
Surgery
Polypectomy : These procedures, described in the colon
surgery section, can be used to remove superficial cancers
or polyps.
Proctectomy with colo-anal anastomosis: is the removal of
the entire rectum (proctectomy) and the colon attached to
the anus.
Colectomy: the deceased area of colon is removed.
 Colostomy – is a procedure in which a part of the colon is

brought into the stomach serves as an artificial or

permanent opening for the feces.
Chemotherapy
Radiation therapy
Actual treatment for colorectal cancer:
Surgery
Proctotectomy
Colectomy
Colostomy
HEALTH HISTORY:
Chief complaint: Patient S.R. , a 75 yrs. Old, male, married
w/ 9 siblings, residing at Sogod, So. Leyte was admitted at
SOYMPH last Nov. 23,2009 due to pain upon defecating.
History of present illness:
Four days prior to admission Patient S.R. is complaining of
unusual bowel movement, he verbalized pain in defecating
and sometimes he even experienced hematochezia and
obstipation. Three days p.t.a. he decided to consult a
physician with his family. After the colonoscopic biopsy Dr.
Trumata spotted that the Pt. has a malignant tumor at his
rectum so he was confined for under observation.
Heirerdo Familial Disease: The paternal
side of the patient had a heredity of cardiovascular
disease while at the maternal side,the patient can’t
trace any diseases.
Past Health History
Pt. said that he can’t recall any past diseases he
encountered.
 Dead Smoker Alcoholic Hypertension Alive Cancer heart client
Disease

Geronimo Visitacion

Asuncion
Rogelio Liberato Amanda Ponciano Melchor Edad Margarita

Roger Mila Rodel Angelito Nolito Imee

 Gordon’s
HEALTH PERCEPTION
Patient usual health status is poor because he suffered in defecating now fair because there
no pain upon defecating. The patient is not satisfied with his health status because of his operation,
his smoke tobacco in half leaf, he drunk tuba ½ gallon. Patient can’t recall any past illnesses and his
immunization history can’t recall also , he is currently working in the farm and his living conditions
at home is good. When the patient forcing his self to get up he experience abdominal pain in his
insertion cut in the abdomen , his regular basis in exercise through working in the farm.

NUTRITIONAL- METABOLIC PATTERN

Patient did not gain weight in the past 6 months but he loss weight in about 5 kg in past 6
months . His appetite because he felt pain, his food intolerance as fatty foods, fiber foods the
patient like to gain weight because he is already conscious in his weight but made in impossible due
to his conditions . He has no problems nausea, vomiting, swallowing, chewing but since he is in the
state of pain that cause him to be anorexic , his usual lifestyle is sedate

ELIMINATION PATTERN

Patient usual frequency of bowel movement is 0-1 per day, the no# of bowel movements
change in the past week and decrease. The character of the stool is hard, color black and had
bleeding bowel movement, his visual voiding pattern 2 times per day and decrease

activities or jod that he likes is farming. But his dislike is gadget.

SELF PERCEPTION AND SELF-CONCEPT PATTERN

Patient major concern is how to recover from current situation.

Admission can cause lifestyle changes because in eating dietary habit . The
admission will result body changes because of defeacating through colostomy.
Patient usual view of his self is neutral and he believes in dealing problems with his
current situation in containing medication due to lack of financial.

SEXUALITY REPRODUCTIVE PATTERN

Male
History of prostate problem is no aid. History of penile
discharges, Bleeding and lesion is none and sexually transmitted disease is also
none.

VALUE- BELIEF PATTERN

patient is satisfied the way his life is. Developing and admission in
interfere his plan for future because some saving are being used. He is roman
catholic and religious restrictions to care is none. Patient doesn’t have like
contracted to visit him and religious belief help him to deal with his problems
through prayers.
ACTIVITY-EXERCISE PATTERN

0 - completely independent
1 – requires use of equipment
2 – requires help form another person for assistance supervision or teaching
3 – requires help from another person and equipment device
4 – dependent does not participate

BEFORE AFTER
feeding 0 2
Bathing – hygiene 0 2
Dressing – grooming 0 2
Toileting 0 3

Ambulation 0 3
Shopping o 2
Meal preparation o 4
Laundry o 4
transportation 0 3

PT. occupation is a farmer. His leisure time activities every Sunday is cock
fighting and no difficulties in maintaining activities o daily living, no problems with
concentration.
RULE-RELATIONSHIP PATTERN
The patient is not alone he live with his childrens and his
wife . He is married and have children ages 51, 48, 45, 42, 37, and 34.
He rate his parenting skills in average because he treated his children
well and look over them fairly without difficulties. He believes this
admission will result in any type of loss physically because his
sigmoid colon is removed. His usual social activities is limited he is
comfortable in social stiuation. The activities or jod that he likes is
farming. But his dislike is gadget.

COPING STRESS TOLERANCE PATTERN

Patient did not experience any stressful or traumatic

event in the past year, his usual handling of stress is average and
primary to deal stress is sleeping. His family did not use any support or
counseling in the past years because he believe the primary reason
behind the admission is to relieve pain and ho back to painless
elimination. After noting the symptoms he seek health care assistance
when he feel that he can’t bare it anymore ,He is not satisfied with the
care in home because facilities is incomplete.
PHYSICAL ASSESSMENT
General Appearance
 Patient is seen lying on bed at a supine position.
 Conscious
 Coherent
E.E.N.T.
Eyes
 Symmetric to the ears
 Sunken eyeballs
Ears
 No discharges
 Symmetric to the eyes
Ears
 No discharges
 No lesions and swelling
Throat
 No swelling or tenderness
RESPIRATORY SYSTEM:
 18 cycles/min.
Oxygenation:
 Relax upon breathing
Smoking: Yes For about 64 yrs. ½ tobacco/day
CARDIOVASCULAR SYSTEM:
120/70 mmHg
Pulses: 76 beats/min. at the right radial(strong)
INTEGUMENTARY SYSTEM:
Skin: Tan
Dry and warm
Wounds:
 3 cm at the left iliac region(colostomy)
 6-7 inches from epigastric region to hypogastric
region(abdominperineal surgery)
Hair:
 Gray hair
 Not fairly distributed
 No lice present
Nails:
 Clean finger nails
Nail bed:
 Pale
DIGESTIVE SYSTEM:
Diet:
 Soft Foods
No. of meals/day:
 4 – 6, about 4-5 spoons/meal
No. of fluid intake:
 3-5 glasses/day
Food restrictions R/T health problems:
 Hard to digest foods
Elimination
Tubes/drainage:
 Colostomy
 Catheter
Elimination problem before surgery:
 Constipation
 Obstipation
 Hematochezia
 Pain upon defeacation
Appetite:
 Anorexia
URINARY:
Oliguria
Urine Color:
 Yellowish
MUSCULOSKELETAL SYSTEM:
Mobility:
 Non-ambulatory
Muscle Strength:
 Weak
 Limited ROM
Body Type:
 Thin
-No deformities
w/ an IVF at the right arm( d5 LR 1L at 30drps.)
NEUROLOGIC
LOC:
 Alert
Sensory Function:
 Positive, the patient is able to identify sense of touch, sense of smell,
sense of hearing and sense of taste
Motor Function:
 Positive, able to react with light, and pain.
LABORATORY
EXAMINATION
DRUG EXAM. NORMAL PATIENT INDICATION
COLONOSCOPIC No lesions and Gross examination: Moderately
BIOPSY masses received a soft, tan- differentiated
To provide a visual brown tissue fragment adenocarsinoma
with an aggregate
diagnosis (ulceration diameter of 7mm
and polyps) and microscopic
grants the opportunity examination:
for biopsy or removal microscopic exam of
of suspected lesions. totally-processed
specimen shows
fragments of
malignant neoplasm
composed closely
packed glandular
events. These are
lined by multi layers of
anaplastic columnar
cells w/ large
hyperchromatic nuclei
and scant cytoplasm.
Mitotic figures are
present. The
surrounding
desmoplastic stroma
is mildly infiltrated
with round cells.
ELECTROCARDIOGRA Pwave: Upright Upright
PHY
It is used routinely in PR interval:
0.12 -0.20 seconds 0.16 seconds
physical examinations
and for monitoring a QRS interval:
patients condition 0.06 – 0.12 seconds 0.06 seconds
during and after
surgery, as well as in QT interval:
the intensive care 0.04 – 0.44 seconds 0.36 seconds
setting. Atrial rate and
ventricular rate:
60 – 100 bpm 83 bpm
Twave: upright Upright

ST segment:
Isoelectric(flat) Isoelectric(flat) Regular sinus
Interpretition: rhythm and
Sinus rhythm indicates a regular
within normal discharge from the
sinus node.
URINALYSIS Color: pale yellow yellow
To detect metabolic Glucose: negative Negative
disease. To diagnose Turbidity: clear clear
Negative
many specific WBC: negative or rare
disorders. RBC: negative or rare Negative
pH: 4.5 -8.0 6.5
Speciy gravity:1.o15- 1.020
1.025

BLOOD CHEMISTRY Creatinine: 53-120 181.4 umol/L High level of

creatinine because it
Ordered prior to umol/L was produced by the
surgery or a body during the
procedure to examine process of normal
the general health of muscle breakdown
the patient. (colorectal cancer)

HEMATOLOGY Hemoglobin mass 95g/dl Indicates cancer

Detect blood forming concentration: 140-
organs and blood 170 Indicates an active
Lymphocytes: 0.38 viral infection.
diseases 0.25-0.35
ANAPHYSIOLOGY
Mouth – mastication (process of chewing the food).

Pharynx – is the passage way w/c connects the mouth and the
esophagus.

Esophagus – peristalsis (power waves of contractions).

Stomach – breaking down of food. It also acts as storage of food.

Small Intestine – area w/c nutrients are extracted from food and
absorbed into the body.

Large Intestine – reabsorbs water, vitamins, and minerals salts into

bloodstream and expelled the waste material as feces.

Rectum – collects feces. It pressures on the rectal walls causes nerve

impulses to pass the brain; the urge to defecate occurs when
collected feces distend (stretch) the rectum.
DRUG STUDY
DRUG/MEDICINE DATE ORDERED CLASSIFICATION ACTION INDICATION SIDE EFFECT NSG.
IMPLICATION
Cefuroxime 11-24-09 Anti- infectives A second >Serious CV:phlebitis,
(Zinacef) Time: 9:25 =antibacterials, generation infections of the thromboplephitis. >observe the
Dose: 750 mg antivirals/antifun cephalosporin lower respiratory GI:pseudomembr right in giving
Route: IVTT gals depending that inhibits cell and urinary tract; anous colitis, meds.
Frequency: q 8 on the type of wall synthesis, skin and skin Nausea, anorexia, >beore giving
(-)anst microorganism promoting structure vomiting, drug ask patient I
they combat osmotic infection; bone diarrhea. he is allergic to
instability usually and joint Other: penicillin or
bactericidal. infection;septice hypersensitivity cephalosporins
Route: IV mia;meningitis; reaction, serum >administer
Onset: Immediate and gonorrhea sickness, medication with
Peak: Immediate and for anaphylaxis. food
Duration: perioperative >advice patient to
Unknown prophylaxis. report any signs
>acute bacterial of allergic/
maxillary sinusitis adverse reaction.
>bacterial
exacerbations o
chronic bronchitis
or secondary
bacterial
infection of acute
bronchitis.
>uncomplicated
skin and skin
structure
infection.
DRUG/MEDICAT DATE ORDERED CLASSIFICATION ACTION INDICATION SIDE EFFECTS NSG.IMPLICATIO
ION N

Omeprazole 11-23-09 Anti-ulcer Drug Inhibits activity >maintenance o CNS:headache,

( Prilosec ) Time: 9:25 =(PPI)proton of healing erosive dizziness >instruct client
Dose: 20 mg Hs pump inhibitors acid(proton)pu esophagitis GI:diarrhea, to take drugs 30
Route: PO that block the mp and binds to >symptomatic abdominal pain, minutes before
production of hydrogen gastro nausea, meals.
acid by the potassium esophageal vomiting, >tell patient to
stomach. adenosine, disease w/out constipation, swallow tablets
>antacid tryphosphatase, esophageal flatulence or capsules
=neutralizes located at lesions. MUSCULOSKELE whole and not
acid secretory <frequent TAL: back pain to open, crush
surface o the heartburn(2 or RESPIRATORY: or chew them.
gastric parietal more days a cough, upper >dosage
cells, to block week) respiratory tract adjustment
formation of <short-term infection. aren’t needed
gastric acid. treatment of SKIN: rash or patients with
Route: P.O active benign renal or hepatic
Onset: 1hr gastric ulcer impairment.
Peak: 2hrs >caution patient
Duration: <3 to avoid
days hazardous
activities I he
gets dizzy.
DRUG/MEDICAT DATE ORDERED CLASSICATION ACTION INDICATION SIDE EFFECTS NSG.IMPLICATIO
ION N

Ketorolac 11/24/09 Non-steroidal Unknwon. Short-term CNS: >use cautiously

(toradol) Time: 1:00 anti- Though to management o drowsiness, in patients with
Dose:30 mg inflammatory inhibit moderately sedation, hepatic or renal
Route: IVTT drugs prostaglandin severe, acute dizziness, impairment
Frequency: q 8 =prevent synthesis pain single-dose headache. >carefUlly
inflammation, Route: IV treatment. CV: edema, observed
pain and fever Onset: hypertension, patients with
support the immediate palpitations. coagulopathies
blood clotting Peak: 1 to 3min. GI: nausea, and those taking
function of Duration: 6 to 8 dyspepsia, GI coagulant.
platelets, and hrs. pain, diarrhea, >don’t give drug
protect the peptic epidurally or
lining of the ulceration, intrathecally
stomach from vomiting, because of
the damaging constipation, alcohol content.
effects of acid flatulence, >correct
stomatitis. hypovolemia
HEMATOLOGIC: before giving.
prolonged
bleeding time
SKIN: rash,
diaphoresis.
DRUG/MEDICA DATE ORDERED CLASSIFICATION ACTION INDICATION SIDE EFFECTS NSG.
TION IMPLICATION
Tramadol 11/24/09 Analgesics- Unknown. A Moderate to CNS: -use consciously in pt.
(ultram) Dose: relieve pain centrally acting severe pain Dizziness, vertigo, risk for seizures or
150mg without loss of synthetic analgesic headache, and respiratory depression;
Frequency: consciousness compound not anxiety. increased intracranial
q 8 Anti-depressants- chemically related to CV: pressure or head injury,
route: prevent or relieve opiates. Drug Vasodilation acute abdominal,
P.O. the symptoms of through to mind to EENT: condition or renalor
depressions opiola receptors and Visual disturbances heptic impairment; and
inhibit reuptate of GI TRACT: in physical dependence
norepinephrine and Nausea, on opiodes.
serotonin. constipation, -monitor bowel and
vomiting,dyspepsia, bladder fxn. Anticipate
dry mouth, and need for laxative.
diarrhea. - for better analgesic
SKIN: effect give drug before
Pruritus, and rash. onset of intense pain.
-monitor pt. at risk for
seizure. Drug may
reduce threshold.
-monitor pt. for drug
dependence. Drug can
produce dependence
similar to that of codeine
or dextropropoxyphene
and thus has potential
for abuse.
DRUGS/MEDI DATE CLASSIFICATI ACTION INDICATION SIDE EFFECTS NSG.
CATION ORDERED ON IMPLICATION

Paracetamol 11-27-09 Antipyretic Antipyretic: >common CNS: >observed the

(biogesic) Route: P.O reduces fever colds , other headache, rights of
Dose: 500mg Analgesic by acting viral and CV: chest giving needs
Frequency: directly on bacterial pain, dyspnea >do not
P.R.N for fever the infection with GI: hepatic exceed the
hypothalamic pain and toxicity and recommende
heat- fever. failure, d dosage.
regulating jaundice. >d/c drug if
center to hypersensitivi
cause ty reaction
vasodilation occurs.
and sweating >assess
w/c helps allergy
discipate >advice
heat. patient that
paracetamol
is only for
short-term
use.
NURSING CARE PLANS
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE OUTCOME ACTUAL
CRITERIA EVALUATION
Subjective: Pain related to After 4-6 hours -Determine the -To evaluate The patient The goal has
- “Sakit ahung disease of location need for verbalizes been partially
lobot inig process(inflammati comprehensive effectiveness minimal met
libang” as on) secondary to nursing -Provide basic -To promote retraction of pain
verbalized by rectal cancer as intervention, comfort relaxation and
the patient. evidenced by the patient will measure like health refocus
Objective: patient facial be able to repositioning attention
-seen patient appearance of pain verbalized a -Encourage use -Enable patient
lying in bed Scientific Basis: minimal of stress to participate
-Facial Inflammation is reduction of management actively and
grimacing the physical pain from score like relaxation enhance sense
noted. reaction of living of 7 to 5 (at the techniques like o control
-w/ on going tissues due to pain scale of 10 music.
IVF of D5 LR 1L infection. One of where 1 is the -To relieve the
@ 30 infusing the classical signs lowest and 10 is -Give pain
well at the right of inflammation is the highest) medication as
arm pain. ordered -To detect
-FBC attached Source: -Monitor whether the
to UB temperature patient has
- colostomy http://medical- fever
noted dictionary.thefreed
-garded ictionary.com/Infla
movement mation
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE OUTCOME CRITERIA ACTUAL EVALUATION
Subjective: Imbalance After 4-6 hrs. of -Monitor daily -Identifies nutritional The patient have The goal has been
-“wa koy gana mo nutrition less comprehensive food intake strength / deficiencies eaten a little without partially met
kaon” as than body nursing -Encourage -Metabolic tissue vomiting.
verbalized by the requirements interventions, the patient to eat needs as increases as
patient related to pain patient will be high calorie, will as fluid
-coherent secondary to encouraged to nutrient-rich w/ supplement can play
Objective: colorectal cancer eat even just a adequate fluid on important rule in
-sagging of skin sensation as little in order to intake maintaining adequate
-w/ on going IVF evidenced by have something calorie and protein
of D5 LR 1L @ 30 patient sagging of or the stomach to intake
infusing well at the skin digest without -Control -Can trigger
the right arm triggering nausea environmental nausea/vomiting
-FBC attached to Scientific Basis: and vomiting. factor response
UB Anorexia is lack -Encourage use of -May prevent onset or
-colostomy or poor appetite relaxation reduce severity of
noted which may affect techniques nausea, decrease
--sunken the eating pattern anorexia and enable
eyeballs and can cause patient to increase
--thin imbalanced oral intake
nutrition to the -Encourage open -Often a source of
patient communication emotional distress,
regarding especially for SO who
Source: anorexia problem want to feed
Blackwell’s rejected/frustrated
nursing -Review -Help identify to
dictionary, 2nd laboratory studies degree of biochemical
edition as indicated imbalance/malnutriti
on and influence
choice of dietary
interventions
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE OUTCOME ACTUAL
CRITERIA EVALUATION
Subjective: Grieving related After 4-6 hrs. of -Encourage -Patient may feel The patient The goal has
-“ Naguol ko to anticipated comprehensive verbalization of supported pain verbalizes been partially
tungod sa akong loss of nursing thought and expression of continuing met
sakit” as physiologic well- interventions, accept feeling by the normal lie
verbalized by the being like the patient will expression of understanding activities and
patient. change in body understand sadness that deep and looking forward
Objective: function as feelings of being often conflicting to life
-Facial grieving evidence by the supported in emotion a
noted patient grief work normal
-w/ on going communication experience by
IVF of D5 LR 1L pattern of other in the
@ 30 infusing grieving. difficult situation
well at the right Scientific Basis: -Visit frequently -Help reduce
arm Grieving is an and provide feeling of
-FBC attached emotional contact as grieving
to UB reaction caused desired
-colostomy by loss of a
noted treasure object . -Review past life -Opportunity to
experiences, rule identify skills
Source: changes, and that may help
Blackwell’s coping skills talk individual
nursing about that
dictionary, 2nd interest the
edition patient
ASSESSMENT DIAGNOSIS PLANNIN INTERVENTIONS RATIONALE OUTCO ACTUAL
G ME EVALUAT
CRITERIA ION
SUBJECTIVE: Fatigue related to After 4-6 -Have patient rate -Help in developing a plan for The The goal
“nagloja ko, altered body hrs of fatigue, using a numeric managing fatigue. patient has been
paminaw naho chemistry, side nursing. scale, If possible, the -Frequent rest periods or naps are report partially
kanunay ko effects of pain and interven time of day when it is needed to restore or conserve improve met
kapoy” as other medications. tions, most severe. energy. Planning will allow pt. to be d sense
verbalized by the Scientific Basis: the -Plan care to allow rest active during times when energy. of
patient. Colorectal cancer is a patient periods. Schedule Planning will allow patient to be energy.
OBJECTIVE: disease in which will activities for periods active during times when energy
-Disinterest in the normal cells in the report when patient has most level is higher, which may restore
surrounding lining of the colon or improve energy feeling of well being and a sense of
-lethargy rectum begin to sense of -Assist patient with self- control.
-seen pt. lying on change, start to grow energy. care needs. Keep bed in -Weakness may make activities of
bed un controllably, and low position and assist daily living and ambulation difficult,
-poor ROM noted no longer die. These with ambulation. further assistance is needed.
- changes usually take -Encourage patient to -Enhances strength and enables
years to develop; do whatever possible patient to become more active
however, in some and increase activity without undue fatigue
cases of hereditary level as tolerated. -Poorly managed cancer pain can
disease, changes can -Perform pain contribute to fatigue
occur within months assessment and provide -Adequate intake o nutrient is
to years. Normal cell pain mgt. as prescribed. necessary to meet energy reserves
functions are altered -Encourage nutritional for activity.
causing fatigue to the intake. -Programmed daily exercises and
patient. Collaborative: activities help patient maintain or
Source: -Refer for physical increase strength and muscle tone
Medical-surgical therapy. which enhances sense of well being.
nursing
  DISCHARGE PLAN
 
 HEALTH TEACHINGS => Encourage the patient’s family to wash hands with an antibacterial soap
 and maintain good hygiene.
 => Instruct the family to inform the health care providers if symptoms persist
 beyond 3 days discharged from the hospital.
 ANTICIPATORY S/S => Upon instructing the patient to take his medicines ordered by his doctor,
 the patient will be able to lessen the pain at his incision sites.
 => After recommending the patient with his diet/nutrition he will be able to
 gain weight and recover from undesired weight loss/cachexia.
 SPIRITUALITY => Encourage the patient’s family members to pray for the patient’s fast
 recovery and encourage also the patient to have a strengthen faith to
 GOD.
 MEDICATION => Instruct the patient’s wife to continue medication as what his doctor
 ordered for the patient and not to discontinue even If the patient feels

 better.
 => Instruct also the patient’s wife or the family member to take home the
 medication and follow the frequency ordered by the doctor.
 INCISION CARE => Instruct the family members or wife to clean and dressed with bandage the
 incision site of the patient.
 => Instruct the Family members to use sterile materials in assessing/cleaning
 the incision sites of the patient.
 NUTRITION => Recommend patient to increase fluid intake and eat foods that’s more on
 fiber.
 ENVIRONMENT => Encourage the patient and his family members to maintain clean
 surroundings (especially patients room).
 THE END
DIRECTOR: JILL MARIE TERRE

CASTS: JAMES RYAN VILLEGAS

JEROME GREG CABALES
JADE RESMA
JHOANA MARIE DAGUM
RITCHIELE GELSANO

STUNT WOMAN:
CARMINA BORNEO