A

CASE STUDY
OF
COLON CANCER
• D A G ATA N • ADRIAS
• D A LM A N • QUIMIGING
• D E PO S O Y • RECAMARA
• RICO • RY G I ELS K I
 OUTLINE
 Case Study G. Anatomy and Physiology
◦ General Objectives
H. Pathophysiology
◦ Specific Objectives
I. Laboratory Tests and Results
A. Terminologies
J. Drug Study
B. Overview of the Case Study
K. IVF Study
C. Patient’s Profile
L. Nursing Care Plan
D. Physical Assessment
M. Related Readings with Summary
E. Gordon’s Functional Health Pattern
N. References
F. Introduction
 CASE STUDY
∞ OBJECTIVES
 General Objectives
After 2 hours of Case Presentation, the nursing students will be able to enhance the
knowledge of nursing students who had or will encounter patients with Colon Cancer,
build up skills to expand their knowledge as they will have their practice in the Surgical
Ward, and develop an optimistic outlook towards providing appropriate and holistic care of
patient with this condition through the understanding of the concepts of this study.
 ∞ Specific Objectives
After 2 hours of Case Presentation, the nursing students will be able to:

Patient-Centered Student-Centered

 Obtain knowledge about the patient’s present health
condition.
 Gather information about the patient’s health history,
reason for hospitalization, and medication history.
 Obtain detailed knowledge about disease condition
including signs and symptoms, nursing management,
pharmacological management, and complications.
• Learn how to establish rapport to the client with
Colon Cancer.
• Have a complete and clear understanding of the case.
• Implement a plan of care.
• Attain a wider knowledge about the case being
presented.
• Educate the patient with the prevention of Colon
Cancer.
 A. TERMINOLOGIES
∞ Adenocarcinoma - cancer that forms in the glandular tissue, which lines certain
internal organs and makes and releases substances in the body, such as mucus,
digestive juices, and other fluids.
∞ Adenomatous polyps - gland-like growths that develop on the mucous membrane
that lines the large intestine.
∞ Adjuvant therapy - additional cancer treatment given after the primary treatment
to lower the risk that the cancer will come back. Adjuvant therapy may include
chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological
therapy.
∞ Anastomosis - a surgical connection between two structures.
∞ Benign - refers to a tumor that is not cancerous. The tumor does not usually
invade nearby tissue or spread to other parts of the body.
∞ Biopsy - the removal of small samples of abnormal tissue for microscopic
examination to achieve a diagnosis.
∞ Bosniak 1 - a simple cyst which has a hairline-thin wall, without calcifications,
septations, or enhancement. 
∞ Carcinoma - cancer that starts in skin or tissues that line the inside or cover the
outside of internal organs.
∞ Chemotherapy - the use of drugs to kill cancer cells.
∞ CT Scan - take a series of detailed pictures of the inside of your body.
∞ Colonic J-pouch - allows you to eliminate waste normally after removal of your entire
large intestine (colon and rectum). 
∞ Colonoscopy - examination of the inside of the colon using a colonoscope, inserted into
the rectum. 
∞ Colorectal Cancer - Cancer of the colon and/or rectum usually at an advanced age. It is
an adenoma and the primary site of metastasis is the liver.
∞ Colostomy - an opening into the colon from the outside of the body.
∞ Excision - The removal of tissue from the body using a scalpel (a sharp knife), laser, or
other cutting tool.
∞ Familial Adenomatous Polyposis - autosomal dominant inheritance (mutation of the
adenomatous polyposis coli gene), characterized by hundreds to thousands of colorectal
adenomas usually by age 20.
∞ Mass - a lump in the body.
∞ Metastasis - the spread of cancer from the place where the cancer began to another
part of the body. 
∞ Miles resection - the optimal surgical operation for cancer involving the lowermost
third of the rectum.
∞ Polyps - protuberance into the lumen of normally flat colonic mucosa.
∞ Radiation therapy -  which sends targeted radiation beams to destroy cancer cells.
∞ Tenesmus - the feeling that you need to pass stools, even though your bowels are
already empty.
∞ Tumor - an abnormal mass of tissue that forms when cells grow and divide more
than they should or do not die when they should.
∞ 
∞ 
B. OVERVIEW OF THE CASE STUDY
A case of Patient X, 27 year old male, Roman Catholic, born last July 28, 1994,
currently residing at Sitio Lubing Ogis, Dipolog City, admitted in Corazon C. Aquino
Hospital last March 29, 2022 at 11:00am for Recurrent Colon Tumor; S/P
Chemotherapy; S/P Colostomy; S/P Cholecystectomy.
 C. PATIENT’S PROFILE
Hospital: Corazon Cojuanco Aquino Date of Admission: March 29, 2022
Hospital Time of Admission: 11:00 am
Patient’s Patient X Accommodation: Private Ward
Name:
Admitting Physician: Dr. King O. Santos
Age: 27 years old
Attending Physician: Dr. Oswaldo “Boyet” Lamdag
Sex: Male
Chief Complaints: For excision recurrent colon tumor
Birthdate: July 28, 1994 Final Diagnosis: Stage III Colon Cancer
Birthplace: Dipolog City Intravenous Fluids: PLR 3L @ 30gtts/min
Address: Sitio Lubing Ogis, Dipolog Medications:  Omeprazole 40mg IV once on NPO
City  Ondansetron 4mg IV on call to OR
Civil Status: Married  Ketorolac 1 amp IVTT PTOR ANST
 Tramadol 50mg IV now then q6h
Religion: Roman Catholic  Cefuroxime 750mg IV q8h
Nationality: Filipino
 D. PHYSICAL ASSESSMENT
General Assessment: The patient is alert, oriented, and has a GCS of 15. Vital signs are as
follows: Temp: 36.7°C; HR: 67 bpm; RR: 20 cpm; BP: 128/71 mmHg.

A. SKIN, SCALP, HAIR, NAILS

 (-) Pallor
 (-) Jaundice
 (-) Rubor
 Hair is black and evenly distributed on head.
 Scalp is clean and dry.
 Fingernails are clean and trimmed.
 Skin pinches easily, and immediately returns to its previous state which indicate good skin
turgor.
 D. PHYSICAL ASSESSMENT
B. HEAD, FACE, AND NECK
 Head is symmetric, round, erect and in midline appropriately related to body size.
 Head is hard and smooth, without lesions.
 Face is symmetric with a round appearance.
 No abnormal movements noted.

C. EYES
 Eyes are symmetrical upon inspection.
 Eyelashes and eyebrows are equally distributed.
 The sclera is white in color and the palpebral conjunctiva appears pink.
 (+) PERRLA
 D. PHYSICAL ASSESSMENT
D. EARS
 Ears are equal in size bilaterally.
 Skin is smooth, with no lesions, lumps, or nodules.
 Canal walls are pink and smooth, without nodules.
E. MOUTH
 Lips and mucous membranes are dry.
 Teeth are white with smooth surfaces and edges without decayed areas.
 (-) Ulcers
F. NECK
 Neck is supple, with several small anterior cervical lymph nodes.
 Carotid pulse is palpable.
 Trachea is in midline.
 No swollen lymph nodes palpated.
 D. PHYSICAL ASSESSMENT
G. CHEST AND LUNGS
 Breath sounds are clear.
 Chest movements are normal.
H. HEART
 Pulses are equally strong; a 2+ or normal with no variation in strength from beat to beat.
 Rate is 67 beats/min, with regular rhythm, without murmur.
I. ABDOMEN
 Abdomen is flat, non-tender with colostomy.
 (+) colostomy site at left lower quadrant; stoma is color pink.
 (+) palpable mass at left lower quadrant at superior border of colostomy site.
 D. PHYSICAL ASSESSMENT
J. LEGS, FEET, TOES
 Leg muscles are symmetrically aligned.
 Knees are symmetric, no swelling or deformities found.
 Hair is evenly distributed from legs to toes.
K. MUSCULOSKELETAL
 Patient needs assistance of his wife during moving and ambulating.
 Patient does not have any joint pain.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION
Health Perception - Health According to the patient, health is very Patient is oriented, conscious and
Management Pattern important. He said that whenever he coherent. He is concerned about his
felt pain or if he has a fever, cough, and condition and for the operation but
colds, he usually buys OTC drugs like patient states he is willing to accept and
Biogesic, Neozep, Solmux, Mefenamic listen to health teachings so he will
Acid at the nearest pharmacy. recover easily and fast.
According to him, he rarely visits a
doctor to have a check-up and medical
assistance. He also uses herbal
medicines like oregano, ginger, and
malunggay leaves.
 E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN
Nutrition & Metabolism Pattern
PRIOR TO HOSPITALIZATION
Patient states he eats more fruits and
vegetables. He eats his meals 3x a
day with snack in between. He can
drink up to 1.5L of water a day. He
drinks coffee after waking up in the
morning and drinks milk before
going to sleep in the evening. He
has no any food and drug allergies,
and no difficulties with eating and
swallowing.
DURING HOSPITALIZATION
Patient is on soft diet as instructed
by the physician. The patient has
been eating porridge, soft fruits like
bananas and melon, and scrambled
or boiled eggs. He drinks water up
to 7 glasses a day.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO
HOSPITALIZATION
Elimination Pattern Patient voids more than 4x a day
with yellow colored urine. He
stated that he doesn’t have any
discomfort during elimination nor
any unusualities of his urine and
stools. He usually moves her
bowel every morning with brown
and formed stools.
DURING HOSPITALIZATION
Patient voids 4x a day with yellow
colored urine. He has a colostomy
bag attached in the left lower
quadrant changed every 2 to 4 days
and emptied when it is about 1/3
full.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO DURING
HOSPITALIZATION HOSPITALIZATION

Activity - Exercise Pattern Patient’s form of exercise is Patient changes position on

by taking morning walks bed with the help of his wife.
around his house and by
helping his wife with
household chores.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO
HOSPITALIZATION
Sleep - Rest Pattern Patient can sleep straight 7-9 hours
per night. He usually sleeps around
10pm and wakes up early in the
morning at around 6:30am. He
sometimes take a nap at noon for
about 1 hour after having lunch. He
has no difficulties in going to sleep
and doesn’t use any medication to
promote sleep.
DURING HOSPITALIZATION
Patient sleeps at 8pm and wakes up
at 6am. He can also consume 10
hours of sleep but sometimes
sleeping time gets distracted and
interrupted due to pain,
administration of medications, and
visitors. With rest intervals, he can
usually naps for 4 hours.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO DURING HOSPITALIZATION
HOSPITALIZATION

Cognitive & Perception Pattern Patient is oriented to people, time, Patient is oriented to people, time,
and place. He responds to stimuli and place. He has no cognitive or
physically and verbally. He is sensory deficits.
able to read, write, and
comprehend words in Bisaya and
Tagalog.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO DURING HOSPITALIZATION
HOSPITALIZATION

Self-Perception & Self-Concept
Pattern
He perceived himself as a
hardworking and responsible
husband to his wife and father to
his children who does everything
just to provide the needs of his
family.
The patient is worried about his
children back home of how they
are, what they eat, and how they
doing because he is in the hospital
with his wife waiting for his
recovery.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN
Roles & Relationship Pattern
PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION
He is a father of 2 and happily Because of his admission, his
married with his wife. Both children children are the ones taking care of
are in elementary level. He teaches themselves at home since his wife is
them good manners and when with him in the hospital to assist
children get home from school, he and help him.
usually help them with their home
works and other tasks given to them
by their teachers. He also asks his
children about how was school
together with his wife.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION

Sexuality & Reproduction Patient states he is sexually active. Patient and his wife states that due
Pattern The patient and his wife verbalizes to the condition of the husband,
that they used family planning since both of them are not having sexual
the patient has no stable job yet to activities that makes them sexually
support their family. inactive.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO DURING HOSPITALIZATION
HOSPITALIZATION

Coping & Stress Tolerance Patient’s way of coping stress is Patient is consistent in coping
Pattern to listen to music to feel relaxed, stress. He listens to music, talk to
talk to his friends and loved ones, his family member, and prays to
and by praying to God. God continually.
E. GORDON’S FUNCTIONAL HEALTH PATTERN
HEALTH PATTERN PRIOR TO
HOSPITALIZATION
Values & Belief Pattern The patient is Roman Catholic,
have strong faith in God, and goes
to church every Sunday with his
family to attend mass.
DURING HOSPITALIZATION
Despite his admission, he never fails to
pray every day and talk with his children
through the phone that they should go to
church every Sunday even without him
or just even pray at home for his fast
recovery. There is no restrictions in the
procedure brought by religion. The
admission and surgery don’t interfere
with spiritual practices.
F. INTRODUCTION
Definition
Colorectal cancer (colon cancer) is a disease in which normal cells in the
lining of the colon or rectum begin to change, start to grow uncontrollably, and
no longer die.  Adenocarcinoma is the most common type of colon cancer and
may spread by direct extension through the walls of the intestine or through the
lymphatic or circulatory system. Metastasis is most often to the liver.
Duke’s Classification of Colorectal Cancer
Stage A: confined to bowel mucosa, 80-90 % 5 years survival rate

Stage B: invading muscle wall

Stage C: Lymph node involvement

Stage D: Metastases or locally unresectable tumor, less than 5%,

5 years survival rate.

 CAUSES / RISK FACTORS
Modifiable
• Diet (high-fat, high-protein, low-
fiber diet)
• Overweight or obesity
• Cigarette Smoking
• High alcohol consumption
Non-Modifiable
• Increasing age
• Gender (Male)
• Family history of colon cancer or polyps (familial adenomatous
polyposis)
• History of genital cancer (e.g., endometrial cancer, ovarian
cancer) or breast cancer (in women)
• History of inflammatory bowel disease and history of type 2
diabetes
• Previous colon cancer or adenomatous polyps
• Race or ethnic background (African American or Ashkenazi
Jewish)
 CLINICAL MANIFESTATIONS
Symptoms are determined by the location of the • Change in bowel habits (most common presenting
tumor, the stage of the disease, and the function of symptom)
the affected intestinal segment: • Passage of blood in or on the stools (second most
common symptom)
• Unexplained anemia
• Anorexia
• Weight loss
• Fatigue

Symptoms associated with RECTAL lesions: • Tenesmus, rectal pain, the feeling of incomplete
evacuation after a bowel movement, alternating
constipation and diarrhea, and bloody stool.
 CLINICAL MANIFESTATIONS
Symptoms associated with RIGHT-SIDED lesions: • Dull abdominal pain and melena (i.e., black, tarry
stools)

Symptoms associated with LEFT-SIDED lesions: • Those associated with obstruction (i.e.,
abdominal pain and cramping, narrowing stools,
constipation, distention), as well as bright red
blood in the stool.
 Warning Signs of Colon Cancer:
• Blood in the stool or rectal bleeding
• Persistent abdominal cramping, pain, or gas
• Poor bowel emptying, or passing “skinny” stools
• Myalgia and body weakness
• Bloating
• Severe or persistent constipation
• Fatigue
• Unexplained weight loss
 COMPLICATIONS
•Partial or Complete bowel obstruction or perforation
•Acute Hemorrhage (rare)
•Metastasis
 ASSESSMENT
Ascending (Right) Colon Cancer: • Occult blood in stool
• Anemia
• Anorexia and weight loss
• Abdominal pain above umbilicus
• Palpable mass

Distal Colon/ Rectal Cancer: • Rectal bleeding

• Change bowel habits
• Constipation or diarrhea
• Pencil or ribbon shaped stool
• Tenesmus
• Sensation of incomplete
 LABORATORY
AND
DIAGNOSTIC EVALUATIONS
Digital rectal exam (DRE) - a health care provider inserts a lubricated, gloved
finger into the rectum to feel for any problem areas. Have this test every 5 to 10
years at the time of other screening tests (flexible sigmoidoscopy, colonoscopy, or
DCBE).

Colonoscopy – an exam when a health care provider looks at the rectum and the
entire colon using a colonoscope, an instrument with a light on the end. If polyps
are found, they can be removed. Have this test every 5 to 10 years.
Flexible Sigmoidoscopy – similar to colonoscopy but only views the distal part
of the colon (sigmoid colon and rectum).

Double contrast barium enema (DCBE) – a series of x-rays of the colon and
rectum. You are first given an enema with barium in it, which outlines the colon
and rectum on the x-rays. Have this test every 5 to 10 years (only if not having a
colonoscopy every 10 years).
Fecal occult blood test (FOBT) – checks for hidden blood in the stool. Sometimes
cancers or polyps can bleed and this test is used to pick up small amounts of bleeding.
Have this test every year.
Blood tests - the doctor may order a blood test to check for the chemical released of by
colon tumor, called carcinoembryonic antigen (CEA), which is also referred to as
“tumor marker”. Complete Blood count (CBC), may or may not reveal anemia.
Chemistry panel to determine baseline status.
Liver Function Tests – to screen for possible liver metastasis.
 GERONTOLOGIC CONSIDERATIONS
◦ Carcinomas of the colon and rectum are common malignancies in advanced age. In men, only the
incidence of prostate cancer and lung cancer exceeds that of colorectal cancer. In women, only the
incidence of breast cancer and lung cancer exceeds that of colorectal cancer. Symptoms are often
insidious.
◦ Colon cancer in the older adult has been closely associated with dietary carcinogens. Lack of fiber is
a major causative factor because the passage of feces through the intestinal tract is prolonged, which
extends exposure to possible carcinogens. Excess dietary fat, high alcohol consumption, and smoking
all increase the incidence of colorectal tumors.
 PREVENTION
Several primary prevention strategies might thwart the onset of colorectal cancer:
• Smoking cessation

• Physical activity

• Diet

• Weight reduction strategies

 THERAPEUTIC / MEDICAL MANAGEMENT

Treatment of cancer depends on stage of disease and related complications.

Obstruction is treated with intravenous fluids and nasogastric suction and with blood
therapy if bleeding is significant. Supportive therapy and adjuvant therapy (e.g.,
chemotherapy, radiation therapy, and immunotherapy) are included.
 SURGICAL MANAGEMENT
Surgery is the primary treatment for most colon and rectal cancers; the type of surgery
depends on the location and size of tumor, and it may be curative or palliative.
Possible surgical procedures include the following:
◦ Segmental resection with anastomoses (i.e., removal of the tumor and portions of the bowel
on either side of the growth, as well as the blood vessels and lymphatic nodes).

◦ Abdominoperineal resection with permanent sigmoid colostomy (i.e., removal of the tumor
and portions of the sigmoid and all of the rectum and anal sphincter called Miles resection).
 SURGICAL MANAGEMENT
◦ Temporary colostomy followed by segmental resection and anastomosis and
subsequent reanastomosis of the colostomy, allowing initial bowel
decompression and bowel preparation before resection.

◦ Permanent colostomy or ileostomy for palliation of unresectable obstructing

lesions.

◦ Construction of a coloanal reservoir called a colonic J-pouch.

 NURSING INTERVENTION

•Prepare the patient physically before surgery.

•Provide information about postoperative care.

•Supporting the patient and family emotionally.

G. ANATOMY
AND
PHYSIOLOGY
 Parts of the large intestine
The large intestine is made up of the cecum, colon, rectum and anus. The colon and rectum are
held in the abdomen by folds of tissue called mesenteries.
Cecum
◦ The cecum is a pouch-like passage that connects the colon to the ileum (the last part of the small
intestine). If cancer develops in the cecum, it is treated like colon cancer
Colon
◦ The colon is the longest part of the large intestine. It receives almost completely digested food
from the cecum, absorbs water and nutrients, and passes waste (stool or feces) to the rectum. The
colon is divided into 4 parts:
 Parts of the large intestine
◦ The ascending colon is the start of the colon. It is on the right side of the abdomen.
It continues upward to a bend in the colon called the hepatic flexure.
◦ The transverse colon follows the ascending colon and hepatic flexure. It lies across
the upper part of the abdomen. It ends with a bend in the colon called the splenic
flexure.
◦ The descending colon follows the transverse colon and splenic flexure. It is on the
left side of the abdomen.
◦ The sigmoid colon is the last part of the colon and connects to the rectum.
 Parts of the large intestine
The proximal colon is the ascending colon and the transverse colon together.
The distal colon is the descending colon and the sigmoid colon together.

Rectum
• The rectum is the lower part of the large intestine that connects to the sigmoid colon. It is
about 15 cm (6 in) long. It receives waste from the colon and stores it until it passes out of
the body through the anus.
Anus
• The anus is the opening at the lower end of the rectum through which stool is passed from
the body. Cancer in the anal canal or anus is treated differently from colorectal cancer. 
 Parts of the large intestine
Mesentery
• Mesentery is made of fatty connective tissue that contains blood vessels, nerves, lymph nodes
and lymph vessels. The mesocolon is a mesentery that attaches the colon to the wall of the
abdomen. The rectum is surrounded by a mesentery called the mesorectum.

• When part of the colon or rectum is removed to treat cancer, nearby mesentery is also
removed. The lymph nodes within the mesentery are examined to see if they contain cancer
cells.
 FUNCTION
The colon and rectum:
• absorb water and some nutrients from what we eat and drink
• form and store stool
• move waste out of the body
Partly broken down or digested food moves from the small intestine into the
colon. Sections of the colon tighten and relax to move the food through the colon
and rectum. This movement is called peristalsis.
 FUNCTION
In the colon, bacteria break down food into smaller pieces. The inner layer of the mucosa
(called the epithelium) absorbs, or takes up, water and some nutrients. The liquid waste
remaining in the colon is formed into semi-solid stool.
The mucosa also makes mucus that helps stool move easily through the colon and rectum.
As stool moves through the colon, more water is absorbed from it and it becomes more solid.
Stool leaves the colon and moves into the rectum. The rectum is a holding area for the stool.
When the rectum is full, it pushes the stool out of the body through the anus.
H. PATHOPHYSIOLOGY
I. LABORATORY TESTS
& RESULTS
 Test Normal values Results Significance
RBC Male: 4.5 – 6.2 1012/L
5.0 Normal
Female: 4.2 – 5.4 10 /L
12

Hemoglobin (Hgb) Male: 14.0 – 16.5 g/dL

14.0 Normal
Female: 12.0 – 16.0 g/dL
Hematocrit (Hct) Male: 42 – 52%
40.7 Anemia
Female: 35 – 47%
WBC 4.5 – 11.0 × 109/L 8.9 × 109/L Normal
Platelet 150 – 400 × 109/L 310 × 109/L Normal
Lymphocytes 20 – 40% 32.6% Normal
Neutrophils 55 – 70% 56.5% Normal
Monocytes 2 – 8% 6.3% Normal
MCV 80 – 90 fL 82.1 fL Normal
MCH 25 – 35 pg 28.2 pg Normal
MCHC 31 – 37% 34.4% Normal

A. Hematology
 Test Normal values Results Significance

Eosinophil 1 – 4% 3.9% Normal

Basophils 0 – 2% 0.7% Normal

Bleeding time 3 to 6 minutes 3min 2 sec Normal

Clotting time 2 – 6 minutes 4 min 18 sec Normal

11 – 13 seconds 10.5 sec Blood clots more

PT quickly than normal.

INR < 1 sec 0.86 Normal

B. Coagulations
 Test Normal values Results Significance
2 hrs. postprandial < 140 mg/dL 111 mg/dL Normal
hbA1C 7% or lower 4.6% Normal
Creatinine 0.6 – 1.3 mg/dL 0.76 mg/dL Normal
ALT Male: 10 – 55 units/L 18 units/L Normal
Female: 7 – 30 units/L

AST Male: 10 – 40 units/L 22 units/L Normal

Female: 9 – 25 units/L

Sodium 135 – 145 mEq/L 153 mEq/L Hypernatremia

Potassium 3.5 – 5.0 mEq/L 4.2 mEq/L Normal
Chloride 95 – 105 mEq/L 109 mEq/L Hyperchloremia
Calcium 4.5 – 5.5 mEq/L (8.5 to 10.5 mg/dL) 2.15 Hypocalcemia

C. BLOOD CHEMISTRY
 Triglycerides < 150 mg/dL 74.18 Normal

< 200 mg/dL Normal

Cholesterol 182.66mg/dL

30 – 70 mg/dL Normal
HDL 43.81 mg/dL

< 130 mg/dL Normal

LDL 124.01mg/dL

< 30 mg/dL Normal

VLDL 14.84

5.0 Normal
CHOL/HDL ratio 4.17

C. Blood Chemistry
 RADIOLOGY REPORT
A. CHEST PA

  Both lungs are clear. The trachea is in the midline. The heart is not enlarged.
Both hemidiaphragm are sharp and distinct. The osseous thoracic cage showed no
significant abnormality.
IMPRESSION:
◦ Normal Chest X-ray
 RADIOLOGY REPORT
B. CT SCAN

CT images show colostomy site in the left hemiabdomen with note of exteriorization of the
proximal descending colon with note of increased soft tissue focus with significant enhancement
overlying the anterior abdominal wall defect. Lumen of exteriorized bowel now collapsed.
More proximal transverse and ascending colon not dilated. Distal descending, sigmoid and
rectal bowel loops are not dilated with no focal lesion.
Stomach suboptimally distended.
No gallbladder visualized (S/P cholecystectomy)
 RADIOLOGY REPORT
B. CT SCAN
IMPRESSION:
◦ Known case of colon carcinoma, S/P colostomy with enhancing soft tissue
density in site tumor recurrence suspected.
◦ Interval appearance of right pulmonary nodule and right pelvic
lymphadenopathy worrisome for metastasis.
◦ + Local pleural nodules, bilateral posterior lower hemithoraces.
◦ Minimal ascites.
◦ Renal cyst, right Bosniak 1
J. DRUG STUDY
K. IVF STUDY
L. NURSING CARE PLANS
M. RELATED READINGS
WITH SUMMARY
• Colorectal cancer (CRC) is the third most common diagnosis and second deadliest malignancy for both
sexes combined. CRC has both strong environmental associations and genetic risk factors. The incidence
of new cases and mortality has been steadily declining for the past years, except for younger adults
(younger than 50 years), possibly related to an increase in cancer screening and better therapy modalities.
Approximately 5% of all CRC are attributed to two inherited syndromes, Familial Adenomatous
Polyposis, and Lynch syndrome.  The change of the normal colonic epithelium to a precancerous lesion
and ultimately an invasive carcinoma requires an accumulation of genetic mutations either somatic
(acquired) and/or germline (inherited) in an approximately 10 to 15-year period. Chromosomal instability,
mismatch repair, and CpG hypermethylation are the major pathways to CRC.
• The most important prognostic colon cancer indicator is the pathological stage at presentation. All
new CRC cases should be universally screen for DNA mismatch repair/microsatellite status, and
RAS/BRAF mutational testing when considering for prognostic and predictive of chemotherapy
efficacy. In almost all patients, a diagnostic or screening colonoscopy is required for tissue biopsy
pathological confirmation of colon carcinoma. Baseline computed tomography (CT) of the chest,
abdomen, and pelvis with contrast and carcinoembryonic antigen (CEA) are the preferred cost-
effective, colon-cancer staging studies done before surgical resection. Surgical resection is the main
treatment modality for localized early-stage colon cancer. Adjuvant therapy could augment the
chance of cure on high-risk patients with colon cancer.
• Oligo-metastatic, liver and lung, and local-recurrence patients with colon cancer are potential
curable candidates with multimodality therapies. Palliative systemic therapy is reserved for non-
surgical colon cancer candidates aiming to improve quality of life and prolong life expectancy.
• Colorectal cancer (CRC) is a common health problem, causing a significant burden in terms of
morbidity and mortality. However, if detected early, the disease is highly curable. Primary care
physicians are therefore in a unique position to enhance prevention and prompt diagnosis. The
purpose of this paper was to review the main topics of CRC in the current literature to provide a
more comprehensive understanding of its pathogenesis, risk and protective factors, as well as
screening techniques.
N. REFERENCES
Books:
∞ Brunner and Suddarth’s Texbook of Medical-Surgical Nursing 14 th Edition, Volume 2
∞ Murr, Alice, (et. al) Nursing Care Plans, Guidelines for Individualizing Client Care Across the
Life Span, 9th Edition
PDF: file:///D:/2021%20Lippincott%20Nursing%20Drug20Handbook-1.pdf
Internet Source:
∞ https://rxistsource.blogspot.com/2013/03/intravenous-fluid-plr-solution-lr.html
∞
https://nursestudy.net/colorectal-cancer-nursing-review-care-plans/#:~:text=Nursing%20Diagnosis%3A%2
0Imbalanced%20Nutrition%3A%20Less%20than%20Body%20Requirements,nausea%20and%20vomiting
%2C%20and%20loss%20of%20appet%20ite
∞ https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/colorectal-cancer/
∞
https://www.medindia.net/patientinfo/colorectal-cancer.htm#anatomy-and-physiology-of-the-colon-and-rect
um
∞https://nurseslabs.com/normal-lab-values-nclex-nursing/
THANK YOU!