DISCHARGE PLAN

Medication (la nko kbalo unsa pay meds na pwd sa discharge) Drugs Fluorouracil Dosage 15 mg/kg (max: 1 g/day) Nursing Implications Regular monitoring of blood counts. History of heart disease, hepatic or renal insufficiency, weak or malnourished patients. Patients who with history of high-dose pelvic radiation or use of alkylating agents. Patients with widespread metastases to the bone marrow. Dose should be halved in patients with poor nutritional status, impaired bone marrow, and within 30 days of major surgery.

Exercise Aerobic exercise gets the heart rate up and includes exercises like walking, bicycling and running. By alternating cardiovascular exercise with strength exercises, a person can increase lean muscle mass, decrease fat and increase the body's metabolism Walking exercises are generally safe right after a person has undergone cancer treatment Strength training improves muscle tone and fights muscle loss that can occur with aging. Balance A good sense of balance is vital for a workout free of slips or tumbles. Simple exercises such as walking a narrow path (putting one foot in front of the other, as if walking a tightrope) or heel raises (standing in place and raising each heel up and down) can improve balance Stretching For some cancers that require surgery, people may feel particular weakness in certain parts of their bodies

Therapy/Treatment Chemotherapy Is used to reduce the likelihood of metastasis developing, shrink tumor size, or slow tumor growth. Chemotherapy is often applied after surgery (adjuvant), before surgery (neoadjuvant), or as the primary therapy (palliative). The patient was recommended for 6 cycles or chemotherapy. Immunotherapy- Bacillus Calmette-Gurin (BCG) is being investigated as an adjuvant mixed with autologous tumor cells in immunotherapy for colorectal cancer. Radiotherapy- is more common for radiation to be used in rectal cancer, since the rectum does not move as much as the colon and is thus easier to target.

Health teachings Encourage client/so to view the colostomy site and assist with care as appropriate. Assume pt. in a low fowlers position during meal time & remain in that position for 20-30 minutes. Encourage the pt. to eat small, frequent portions of non irritating foods Discourage pt. to intake fluid with meals, instead, fluids may be consumed up to 1 hr before or 1 hr after mealtime Encourage discussion of individual situation with opportunity for expression of feelings without judgment.

OPD Visit/Referrals: A medical history and physical examination are recommended every 3 to 6 months for 2 years, then every 6 months for 5 years.

A CT-scan of the chest, abdomen and pelvis can be considered annually for the first 3 years for patients who are at high risk of recurrence (for example, patients who had poorly differentiated tumors or venous or lymphatic invasion) and are candidates for curative surgery (with the aim to cure). A colonoscopy can be done after 1 year, except if it could not be done during the initial staging because of an obstructing mass, in which case it should be performed after 3 to 6 months. Surveillance is especially important in the first 2 to 4 years after treatment, the guidelines note, citing data showing that 80% of recurrences occur in the first 2 to 2.5 years from the date of surgery, and 95% of recurrences occur within 5 years. A pelvic CT is also recommended, for example, annually for 3 to 5 years, although clinical judgment should be used when deciding on frequency, the guidelines state. For patients who have not received pelvic radiation, a rectosigmoidoscopy should be performed every 6 months for 2 to 5 years.

Spiritual Care Encourage the patient to pray and ask guidance from the Lord knowing that He is the greatest physician. Have a regular prayer and meditation periods. Always bring family to the church and ask Gods help to overcome the current crisis that they were facing.