COLEGIO DE SAN JUAN DE LETRAN – CALAMBA

School of Nursing
Brgy. Bucal, Calamba City

Case Study
On

COLON CANCER
Submitted by:
PANGANIBAN, DANICA D.

Submitted to:
Ms. Carol Alcantara RN, MAN

I. INTRODUCTION

BACKGROUND OF THE STUDY:

 Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last
several inches of the colon. Together, they're often referred to as colorectal cancers. Most cases of colon cancer begin as small,
noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers. Polyps may
be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer
by identifying polyps before they become colon cancer.

SIGNS AND SYMPTOMS:

 A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
 Rectal bleeding or blood in your stool
 Persistent abdominal discomfort, such as cramps, gas or pain
 A feeling that your bowel doesn't empty completely
 Weakness or fatigue
 Unexplained weight loss

CAUSES:
 Precancerous growths in the colon
Colon cancer most often begins as clumps of precancerous cells (polyps) on the inside lining of the colon. Polyps can
appear mushroom-shaped, or they can be flat or recessed into the wall of the colon. Removing polyps before they become
cancerous can prevent colon cancer.

 Inherited gene mutations that increase the risk of colon cancer

Inherited gene mutations that increase the risk of colon cancer can be passed through families, but these inherited genes are
linked to only a small percentage of colon cancers. Inherited gene mutations don't make cancer inevitable, but they can
increase an individual's risk of cancer significantly.
RISK FACTORS:

 Older age
  A personal history of colorectal cancer or polyps
 Inflammatory intestinal conditions
 Family history of colon cancer and colon polyps
 Low-fiber, high-fat diet
 A sedentary lifestyle
 Diabetes
 Obesity
 Smoking
 Alcohol
 Radiation therapy for cancer

DIAGNOSTIC TEST:

 Colonoscopy
 CT Scan

STAGES OF COLON CANCER:

 Stage I. Your cancer has grown through the superficial lining (mucosa) of the colon or rectum but hasn't spread beyond
the colon wall or rectum.
 Stage II. Your cancer has grown into or through the wall of the colon or rectum but hasn't spread to nearby lymph
nodes.
 Stage III. Your cancer has invaded nearby lymph nodes but isn't affecting other parts of your body yet.
 Stage IV. Your cancer has spread to distant sites, such as other organs — for instance to your liver or lung.

TREATMENT:

 Chemotherapy
  Radiation Therapy
 Drug Therapy

RATIONALE FOR CHOOSING THE CASE:

• I chose this study to promote awareness to the people who had this kind of disease by giving them information about the
actions to be done and those contributing factors that made the treatment more seriously. I also want to determine management
that can be done to help them to relieve some of the signs and symptoms of the disease as well as to teach them to prevent
further complications.

SIGNIFICANCE OF THE STUDY:

• The importance of this study is to have information about the proper management and care for those clients who have this kind
of illness. We can also educate people on how they can prevent and reduce the complication of the disease even if they already
have the disease or not. It can also promote awareness and consciousness.

SCOPE AND LIMITATION OF THE STUDY:

• I will be focused on the nursing aspect of care, to give a basic knowledge about Colon Cancer.

II. CLINICAL SUMMARY:

A. PERSONAL DATA
 Name: Patient C
Age: 72
Sex: Male
Address: 110 Pulo, Cabuyao, Laguna
Birth Date: May 28, 1941
Religion: Roman Catholic
Date of Admission: December 4, 2013, 11:30 am
Diagnosis: Caloric Mass T/C Colon Cancer

B. CHIEF COMPLAINT
 Loss of Appetite

C. HISTORY OF PRESENT ILLNESS:

 1 week prior to confinement patient have mass on the abdomen

D. PAST MEDICAL HISTORY:

 (+) Acute Gastritis
 (+) Hepa A

III. PHYSICAL EXAMINATION

AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
body built, height and Inspection Proportionate, varies with lifestyle Small body built, height and ABNORMAL
weight in relation to client’s weight was not taken Due to his present
age condition
Posture while sitting Inspection Relaxed, erect, posture, coordinated The patient can’t sit ABNORMAL
movement Due to his present
condition
.body and breath odor Inspection (talking No body odor or minor odor relative No body odor and breath odor NORMAL
with the patient) to work, or exercise; no breath odor
signs of distress in posture Inspection No distress noted The patient looks weak ABNORMAL
or facial expression Due to his present
condition
signs of health and illness Inspection Healthy appearance The client appears weak ABNORMAL
Due to his present
condition
client’s attitude Inspection Cooperative, able to follow The patient was cooperative NORMAL
instructions
client’s affect/ mood; Inspection Appropriate to the situation The patient answers questions NORMAL
appropriateness of client’s coherently without assistance
responses
quantity of speech, quality Inspection Understandable, moderate pace, clear Understandable, moderate and NORMAL
and organization tone, exhibits thought association clear

relevance and organization Inspection Logical sequence, makes sense, has Makes sense and has sense of NORMAL
of thoughts sense of reality reality

I. SKIN
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
skin color Inspection Varies from light to deep brown; Uniform skin color NORMAL
from yellow overtones to olive
. uniformity of skin Inspection Generally uniform except in Uniform in skin color NORMAL
color areas exposed to the sun; areas
lighter pigmentation (palms, lips,
 nailbeds) in dark skinned
assess edema Inspection No edema No edema NORMAL
skin lesions Inspection Freckles, some birthmarks, no No lesions NORMAL
abrasions or other lesions
skin moisture Inspection Moisture in skin folds and Skin is dry ABNORMAL
axillae Due to dehydration.

II. HAIR
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
evenness of the growth, Inspection Evenly distributed and covers Evenly distributed and covers NORMAL
thickness or thinness of the whole scalp the whole scalp
hair
texture and oiliness over Inspection Silky, resilient hair Silky resilient hair NORMAL
the scalp
presence of infection Inspection No infection and infestation No Infection and Infestation NORMAL
and infestation
amount of body hair Inspection Variable Variable. No abnormal NORMAL
hairiness

III. NAILS
AREA TECHNIQUE NORMS FINDINGS ANALYIS AND
INTERPRETATION
fingernail plate shape Inspection Convex, curvature; angle of nail Convex NORMAL
plate
fingernail and toenail Inspection Smooth texture Smooth texture NORMAL
texture
fingernail and toenail Inspection Highly vascular and pink in light Pale in color ABNORMAL
bed color skinned clients; dark skinned Due to anemia
clients may have brown or black
pigmentation in longitudinal
streaks
tissues surrounding nails Inspection Intact epidermis Intact epidermis NORMAL
blanch test of capillary Inspection, Promptly return of pink or usual Less than 4 seconds ABNORMAL
refill palpation color (generally less than 4 Due to low
seconds) hemoglobin or anemia

IV. HEAD
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
size, shape and Inspection Round (normocephalic with The client’s head is round, NORMAL
symmetry of the skull symmetrical frontal, parietal, and normocephalic with
occipital prominences) smooth symmetrical frontal, parietal,
skull contour and occipital prominences
presence of nodules, Inspection and Smooth uniform consistence; Smooth, absence of nodules or NORMAL
masses and depressions palpation absence of nodules, or masses masses
presence of edema and Inspection and No edema and hollowness No edema or hollowness NORMAL
hollowness in the eye palpation

V. EYES
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
color, texture and Inspection Pinkish in color with presence of Pale in color ABNORMAL
presence of lesions in small capillaries; moist, no Due to low
the palpebral foreign bodies hemoglobin
conjunctiva
sclera: color and clarity Inspection White in color; clear, no Yellowish in color ABNORMAL
yellowish discoloration, some Due to past medical
capillaries may be visible history of HEPA A
iris: shape and color Inspection Anterior chamber is transparent; Anterior chamber is NORMAL
no noted visible materials, color transparent; no noted visible
depends on the person’s race materials, black in color
cornea: clarity and Inspection No irregularities on the surface, No irregularities on the NORMAL
texture looks smooth, clear or surface; clear
 transparent
pupils: color, shape and Inspection Color depends on person’s race; Black, equal in size; equally NORMAL
symmetry of size size ranges from 3- 7 mm; and round; 4mm in size
are equal in size; equally round
light reaction and Inspection Constrict briskly/ sluggish Constricts briskly NORMAL
accommodation
visual acuity: near vision Inspection Can detect light and dark Can detect light and dark NORMAL
lacrimal gland: Palpation No edema or tenderness over No edema or tenderness NORMAL
palpability and lacrimal gland
tenderness of lacrimal
gland
extraocular muscles eye Inspection Both eyes coordinated, moved in Both eyes are coordinated in NORMAL
alignment unison with parallel alignment movement; parallel alignment
visual fields: peripheral Inspection When looking straight ahead the Patient sees objects in NORMAL
visual fields client can see objects in the periphery
periphery

VI. EARS
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
auricles: color, Inspection Color same as facial skin; Aligned with outer canthus of NORMAL
symmetry of size and symmetric; auricle aligned with the eye, same color as facial
position outer canthus of the eye; about skin, both auricle are
10 degrees from vertical symmetrical
texture, elasticity and Inspection and Mobile, firm and not tender, Mobile firm and not tender; NORMAL
areas of tenderness palpation pinna recoils after it is folded pinna recoils after folded
hearing acuity test: client Inspection/ rinne Normal voice tones audible The client can hear whispered NORMAL
response to normal voice test voices
tones

VII. NOSE
AREAS TECHNIQUES NORMS FINDINGS ANALYSIS AND
INTERPRETATION
any deviation in shape, Inspection Symmetric and straight; no Symmetric and straight; no NORMAL
size or color and flaring discharge; uniform in color discharge; uniform in color;
or discharge from nares not flaring and has no
discharge
nasal septum (between Inspection Nasal septum intact and in Nasal septum is in midline and NORMAL
the nasal chambers) midline intact
patency of both nasal Inspection Air moves freely as the client Air moves freely in both nares NORMAL
cavities breathes through the nares
tenderness, masses and Palpation Not tender; no lesions No lesions, not tender NORMAL
displacement of the
bones and cartilage
sinuses: identification of Palpation not tender Not tender NORMAL
the sinuses for
tenderness

VIII. MOUTH
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
lips: symmetry and Inspection Uniform pink color, soft, moist, Pale in Color ABNORMAL
contour, control and smooth texture, symmetry of Due to low
texture contour, ability to purse lips hemoglobin or anemia
buccal mucosa Inspection Pink color, moist, smooth, soft Pale in color ABNORMAL
glistening and classic texture Due to low
hemoglobin or anemia
gums: color and Inspection Pink gums; no retraction Pale in color ABNORMAL
condition Due to low
hemoglobin or anemia
tongue/ floor of the Inspection Pink color; moist, slightly rough; Pink color; moist, slightly NORMAL
mouth: color and texture thin; whitish coating; moves rough; thin; whitish coating;
of the mouth and freely; no tenderness moves freely; no tenderness
frenulum
position, color, and Inspection Central position, pink in color, Pink in color; smooth tongue; NORMAL
texture, movement and smooth tongue, base with base with prominent veins
base of the tongue prominent veins
any nodules, lymph Inspection Smooth with no palpable Smooth with no palpable NORMAL
nodes or exocrated areas nodules lumps or excoriated nodules
areas
plates and uvula: color Inspection and Light pink, smooth, soft palate, Soft palate, lighter pink hard NORMAL
shape texture and palpation lighter, pink hard palate, move palate
presence of bony irregular texture
prominences
position of the uvula and Inspection Positioned in midline of soft Positioned in midline NORMAL
mobility (while examing palates
the palates)
oropharynx and tonsil: Inspection Pink, smooth posterior wall Smooth posterior wall NORMAL
color and texture
size, color and discharge Inspection Pink and smooth posterior wall Smooth posterior wall NORMAL
of tonsils
gag reflex Inspection Present Present NORMAL

IX. THORAX
AREA TECHNIQUES NORMS FINDINGS ANALYSIS AND
INTERPRETATION
anterior thorax: Inspection Quiet, rhythmic, and effortless Effortless respiration NORMAL
breathing patterns respiration
temperature, tenderness Palpation Skin intact, uniform temperature, Uniform temperature; no NORMAL
and masses chest wall intact; no tenderness; tenderness or masses
no masses
anterior thorax Auscultation Bronchovesicular and vesicular Bronchovesicular NORMAL
auscultation breath sounds
posterior thorax: shape, Inspection Anteroposterior to transverse Anteroposterior to transverse NORMAL
symmetry and diameter in ration 1;2 chest diameter; symmetric
comparison of symmetric
anteroposterior thorax to
transverse diameter
spinal alignment Inspection and Spine vertically aligned Spine aligned vertically NORMAL
palpation
temperature, tenderness Palpation Skin intact, uniform temperature; No tenderness or masses; NORMAL
and masses chest wall intact, no tenderness intact
no masses
posterior thorax Auscultation Bronchovesicular and vesicular Bronchovesicular NORMAL
auscultation breath sounds

X. ABDOMEN
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
skin integrity Inspection Unblemished skin, uniform color Uniform color, unblemished NORMAL
skin
abdominal contour Inspection Flat, rounded (convex), scaphoid Presence of abdominal mass ABNORMAL
(concave) Due to his present
condition (colon
cancer)
enlargement of liver or palpation No evidence of enlargement of No evidence of enlargement of NORMAL
spleen liver or spleen spleen or liver
symmetry of contour Inspection Symmetric contour Symmetric contour NORMAL
abdominal movements Auscultation Symmetric movements caused Symmetric movement NORMAL
associated with by respiration; visible peristalsis
respiration, peristalsis or in very lean people; aortic
aortic pulsations pulsations in thin persons at
epigastric area
vascular pattern Inspection No visible vascular patter No visible vascular pattern NORMAL
 XI. MUSCULOSKELETAL SYSTEM
AREAS TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
muscle size and Inspection Proportionte to body; even in Proportionate to body, equal NORMAL
comparison on the other both sides strength on both sides
side
fasciculation and Inspection No fasciculation and tremors No fasciculation and tremors NORMAL
tremors in muscle
muscle tonicity Inspection Even and firm in muscle tone Even and firm in muscle tone NORMAL
muscle strength Inspection Has equal strength on both sides Has equal strengths NORMAL

XII. JOINTS
AREA TECHNIQUE NORMS FINDINGS ANALYSIS AND
INTERPRETATION
joint swelling Inspection and No swelling; no warmth, no No swelling, redness, pain or NORMAL
palpation redness, no pain, no crepitus crepitus
Extremities Inspection and No swelling, no warmth, no No swelling, warmth or NORMAL
palpation redness, no pain redness

IV. GORDON’s 11 FUNCTIONAL HEALTH PATTERN OF ASSESSMENT

GORDON’S FUNCTIONAL PRIOR TO HOSPITALIZATION DURING HOSPITALIZATION
HEALTH PATTERNS

Health Perception and Health The client thinks that health is a state of being well. The client thinks that it is important to consult to
Management the doctor when he doesn’t feel well.

Nutritional- Metabolic He eats 3 times a day and drinks 8 glasses of water a day. He can’t eat everything he wants because of
some restrictions on foods.

Elimination The client said he defecates 1-2 times daily and urinates 3-4 times a The client can defecate and urinate.
day

Activity and Exercise The client said he is not doing any exercise. He is unable to perform any exercise at all.

Cognitive- Perceptual The client said he is a positive thinker. The client is still positive thinker.

Sleep and Rest The client said the he always have 8 hours of sleep every day The client said that he can’t sleep well

Role Relationship The client is a responsible father. He is being dependent to everyone because of
his condition.

Coping Stress The client said he is coping to stress by means of rest. During hospitalization the client copes to stress
by means of sleeping.

Value Belief The client said she is a Roman Catholic. God serves as a guide to his The client thinks the same.
family.

V. ACTIVITIES OF DAILY LIVING

 ASPECT PRIOR TO DURING HOSPITALIZATION ANALYSIS AND
HOSPITALIZATION INTERPRETATION

1. NUTRITION LOW APPETITE LOW APPETITE Due to hospitalization the patient

has low appetite because she
doesn’t feel well.

2. ELIMINATION Urinates 3-4 times a day and Urinates 2-3 times a day and Due to hospitalization the patient
defecates 1-2 times a day. defecates once a day can eliminate properly.

3. EXERCISE The patient cannot exercise The patient cannot exercise Due to hospitalization the patient
cannot do his daily routine
because of his condition.

4. HYGIENE Proper hygiene The patient cannot go to CR to Due to hospitalization the patient
take a bath. cannot go to CR to take a bath and
need relative to assist him in doing
his personal hygiene

5. SLEEP AND REST 8 hours of sleep and take a naps He can’t sleep well because he feels Due to hospitalization the patient
during the afternoon uncomfortable. have altered sleeping pattern
because he doesn’t feel
comfortable.

VI. ANATOMY AND PHYSIOLOGY

 The large intestine is a hollow tube that makes up the last 6 feet of the digestive tract. It is often referred to as the large bowel
or colon (which is technically just one part of the large intestine). The large intestine consists of the cecum (a pouch-like structure at
beginning of the large intestine), colon, rectum and anus. The colon and rectum are next to other organs, including the spleen, liver,
pancreas, and reproductive and urinary organs. Each of these organs can be affected if colorectal cancer spreads beyond the large
intestine.

STRUCTURE:
The colon begins at the cecum, where it joins the end of the small intestine (ileum). The colon changes to rectal tissue in its last 6
inches. Because there is not a clear border between the colon and rectum, colon and rectal cancers are grouped together as colorectal
cancer.

The colon is divided into 4 parts:

 ascending colon – begins at the cecum, where it joins the end of the small intestine,
and travels upward along the right side of the body to the transverse colon
 transverse colon – connects the ascending colon to the descending colon and lies
across the upper abdomen

 descending colon – connects the transverse colon and the sigmoid colon and lies
along the left side of the body

 sigmoid colon – connects the descending colon and the rectum

FUNCTION:

The main functions of the colon and rectum are to absorb water and nutrients from what we eat and to move food waste out of our
body.

 The colon receives partially digested food, in a liquid form, from the small intestine.
 Bacteria (bowel flora) in the colon break down some materials into smaller parts.

 The epithelium absorbs water and nutrients. It forms the remaining waste into semi-solid material (feces or stool).

 The epithelium also produces mucus at the end of the digestive tract, which makes it easier for stool to pass through the colon
and rectum.

 Sections of the colon tighten and relax (peristalsis) to move the stool to the rectum.
  The rectum is a holding area for the stool. When it is full, it signals the brain to move the bowels and push the stool from the
Precipitating Factors:
body through the anus.
*Environment
VII. PATHOPHYSIOLOGY *Viruses
*Diet
*Tobacco Use
Predisposing Factors: Cellular DNA *Lifestyle
*Genetics mutation *UV exposure
*Other carcinogens

Malignant Cellular
Proliferation

Immune system failure to

destroy cancer cells

Malignant Cellular
Survival

Malignant Cellular Deprivation of Normal Cells of

Nutrition and other substances for sustenance

Malignant Cellular Compression of Normal Cells

NormalorCell
C-hanges in bladder Death
bowel habits
A-sore that doesn’t heal
U-nusual bleeding or discharges
T-hickening or lumps
I-ndigestion ordiffuclty swallowing
O-bvious changes in warts, moles, or the skin
N-agging cough or hoarseness of voice
U-nexplained anemia
S-udden loss of weight
VIII. LABORATORY RESULT

HEMATOLOGY

RESULTS NORMAL VALUE ANALYSIS

HGB 9.6 13-17 ABNORMAL

Decreased in hemoglobin can cause
anemia

HCT 29 40-54 ABNORMAL

Decreased in hemoglobin can cause
anemia

RBC 3.2 4-6 ABNORMAL

Decreased in hemoglobin can cause

anemia

WBC 11,900 5000-10000 ABNORMAL

There is an increase in WBC this
means that the patient has infection.
Increase in wbc may lead to
leukocytosis, this can result from
bacterial infection..
SEGMENTERS 83% 30-70 ABNORMAL
Increased in segmenters means that
there is infection.
 LYMPHOCYTES 14% 20-40 ABNORMAL
Increased in lymphocytes means that
there is infection.

IX. DRUG STUDY

NAME OF CLASSIFICATION MECHANISM OF SIDE EFFECTS CONTRAINDICATION NURSING

DRUG ACTION RESPONSIBILITY

Appetite Plus 1 Appetite Enhancers Stimulates appetite &  Headache  Hypersensitivity  Should be taken
cap BID enhances weight gain  Nausea with food.
 Constipation  Monitor vital
 Upset stomach signs
 Monitor Intake
and Output

Heraclene Forte 1 Appetite Enhancers Used for taking care of  Nausea and  Hypersensitivity  Monitor vital
tab OD weight loss, It also vomiting  Pregnancy signs
may be used for  Diarrhea  Lactation  Monitor I & O
 Acidity
treating tuberculosis
 Headache
and additional  GI disorders
persistent diseases,
recuperating from
severe surgery or
infection and defective
nutrition in elderly
patients.
X. FDAR

FOCUS DATA ACTION

Received patient awake, lying on bed with  IV fluids maintained and regulated
ongoing D5NM 1L @ 800 cc Level.  Encouraged to consume high-
caloric diet with adequate fluid
IMBALANCED NUTRITION  Body Malaise
 Weight Loss intake
 Poor muscle tone  Provided health teaching regarding
healthy nutritious food
 VS taken as follows:
 BP- 100/60  Monitored intake and output
 T- 36.3  Administered prescribe medication
 P-76
 R- 26 RESPONSE:

 Still for Continuity of care

XII. DISCHARGE PLANNING

Medications  Write the exact time and instruction when to take the medication and how to take the medication.
 Emphasize proper dosage of medication to be taken for the proper continuity of care.

Exercise  Instruct client to have light exercises.

Treatment  Continue medication as ordered by the physician

Health Teachings  Instruct the client’s relative to provide adequate rest

Out -patient  Follow up check up

Diet  Advise client’s relative to provide increased intake of fluid

 Advise client’s relative to provide high- calorie and food that rich in protein

Spiritual/sexual activity  Encourage patient to Pray always