I.

Introduction
Our case study aims to present about colon malignancy. In here, we were able to focus
on its leading cause, factors in reducing risks of having one, early detection and the treatment
available. The study was also based on a client who had a diagnosis of colon malignancy. In
this study, there are further elaborations regarding the cause and certain diagnostic tests in
diagnosing the said colon malignancy of the client. Furthermore, the following sets of data
would be focusing not only on the disease alone but also the interventions that could be made
after the thorough analysis of the clients case. The purpose of this study doesnt only focus
on the pathophysiology of the disease alone but also involves the disease prevention and also
the rehabilitative phase through the different ways of treatment.
Colon cancer is also one of the most curable types of cancer if it is diagnosed early. hen
detected at its earliest stages, chances for a cure are as high as !" percent. There are several
e#cellent screening and diagnostic methods to detect colon cancer early, before it has spread
to vital organs. There are also a variety of simple steps you can take to help prevent it.
$earning about the risk factors, knowing the signs and symptoms, and having regular
screenings for colon cancer are your best defenses against this all%too%common cancer. &ou
can help reduce your risk by keeping in mind several factors that may put you at a moderate
to high risk of developing colon cancer.
The key to successful colon cancer treatment is finding the cancer at an early stage,
before it has spread to surrounding tissues and organs. 'ost colon cancers develop from
polyps, small growths found inside the intestine. (eep in mind, though, that most polyps are
not cancerous.
$ikewise, this study was designed to give ample knowledge on caring of patients with
intestinal disorders by using nursing process as a framework. The target audience of this
study is the patient itself, the family of the patient and also the nursing student.
II. Profile of the Client
)dmitting *istory
Ten days prior to consult, patient e#perience abdominal pain, generali+ed, tolerable, not
aggravated by food intake and relieved with passage of flatus, associated with loose bowel
movement, four to five times, watery, yellowish, non%foul smelling amounting to about seven
cups per bout. ,o other signs and symptoms noted a distention of the abdomen, flatulence,
regurgitation, vomiting, melena, dysuria and di++iness. -atient sought consult to a private
doctor. .nrecalled medications were given and abdominal #%ray was re/uested.
Three days prior to consult, patient went for follow%up check%up still with abdominal
pain, generali+ed, increasing severity 0123"4, relieved with passage of stool, associated with
constipation. -atient was advised to undergo colonoscopy and to continue unrecalled
medications previously given. -atient was referred to our institution.
-ersonal and 5ocial *istory
*igh school graduate, worked as an all%around laborer at a leathery factory.
'arried for four years, has eight children.
,o food preference.
-revious smoker 6" packs per year.
Occasional alcohol drinker.
$ived with family in a two%storey house with three bedrooms, one comfort room with
good flush, well ventilated, water supply from 'aynilad, drinking water purified,
garbage collected everyday.
-ast 'edical *istory
07""14 diagnose with nephrolithiasis bilateral and hospitali+ed at ,ational (idney and
Transplant Institute, maintenance meds are )calka, 8owatine# and another unrecalled
medications. .nderwent shock wave lithotripsy in the same year.
094 -T: suspect, no medications given, needed further work%up.
0%4 cancer
0%4 hypertension
0%4 ;'
0%4 -.;
,o known allergy to foods and drugs
Family *istory
094 *-, < 'other and 5iblings
0%4 heart disease
0%4 asthma
094 cancer < 'other side
0%4 kidney disease
0%4 -T:
0%4 ;'
III. Anatomy and Physiology
)natomy = -hysiology of the Colon
To better understand the health of the digestive system and colon, it is helpful to first
understand the different parts of the colon and their specific functions. This can help you
become a stronger advocate for your own health and may grant you further insight into how
your body works.
The colon is made up of > parts all working collectively for a single purpose. Their
purpose is ridding the body of to#ins that have entered the body from food sources,
environmental poisons, or to#ins produced within the body. The colon?s role is to transfer
nutrients into the bloodstream through the absorbent walls of the large intestine while
pushing waste out of the body. In this process, digestive en+ymes are released, water is
absorbed by the stool, and a host of muscle groups and beneficial microorganisms work to
maintain the digestive system.
Overview of the Colon?s )natomy
The colon is appro#imately 6.@ feet long, 7.@ inches wide, and is a muscular tube
composed of lymphatic tissue, blood vessels, connective tissue, and speciali+ed muscles for
carrying out the tasks of water absorption and waste removal. The tough outer covering of
the colon protects the inner layer of the colon with circular muscles for propelling waste out
of the body in an action called peristalsis. .nder the outer muscular layer is a sub%mucous
coat containing the lymphatic tissue, blood vessels, and connective tissue. The innermost
lining is highly moist and sensitive, and contains the villi% or tiny structures providing blood
to the colon.
The colon is actually Aust another name for the large intestine. The shorter of the two
intestinal groups, the large intestine, consists of parts with various responsibilities. The
names of these parts areB the transverse colon, ascending colon, appendi#, descending colon,
sigmoid colon, and the rectum and anus.
-arts of the ColonB
Transverse, Ascending, and Descending Colons
The transverse, ascending, and descending colons are named for their physical locations
within the digestive tract, and corresponding to the direction food takes as it encounters those
sections. ithin these parts of the colon, contractions from smooth muscle groups work food
material back and forth to move waste through the colon and eventually, out of the body. The
intestinal walls secrete alkaline mucus for lubricating the colon walls to ensure continued
movement of the waste.
The ascending colon travels up along the right side of the body. ;ue to waste being
forced upwards, the muscular contractions working against gravity are essential to keep the
system running smoothly. The ne#t section of the colon is termed the transverse colon due to
it running across the body hori+ontally. Then, the descending colon turns downward and
becomes the sigmoid colon, followed by the rectum and anus.
Ileocecal and Cecum Valves
The ileocecal valve is located where the small and large intestines meet. This valve is an
opening between the small intestine and large intestine allowing contents to be transferred to
the colon. The cecum follows this valve and is an opening to the large intestine.
The Rectum and the Anus
The rectum is essentially a storage place for waste and is the final stop before elimination
occurs. The CtoneC of the muscles of the anal sphincter and a person?s ability to control this
skeletal%muscular system are vital for regulating bowel movement urges. hen elastic
receptors within the rectum are stimulated, these nerves signal that defecation needs to occur.
In other words, these muscle and nerve groups convey when a bowel movement is necessary
but allow a person to control when waste will actually be removed, as the final step in the
digestive process. The anus is the last portion of the colon, and is a speciali+ed opening
bound with elastic membranes, sensitive tissues, and muscles and nerves allowing it to
stretch for removing bowel movements of varying si+es. If, for e#ample, you suffer from
constipation, these tissues can become damaged and lose their ability to function normally if
waste has to be forced out or remains in the body for prolonged periods. 5o it?s definitely
good practice to keep things moving along at a regular pace. Ideally, you should have two
bowel movements per day but at least once a day is pretty goodD anything less than that could
spell trouble for not only your digestive health but general health as well.
-hysiology of the Colon
To summari+e, appro#imately @"" ml 0milliliters4 of food pass through the colon daily.
The various sections of the digestive tract absorb and remove water, propel waste throughout
the long system of muscular tubes, work to keep the body alkali+ed, and accommodate the
coloni+ation of billions of beneficial microorganisms to aid us in breaking down waste
matter. 8egardless of the depth of your knowledge regarding the colon?s functions, please
reali+e the importance of its functions for promoting overall health. :e good to your body on
the inside as well as out by following a healthful diet, drinking ample of water, and keeping
all your biological systems well maintained with stimulating e#ercise and by getting plenty
of rest.
IV. Pathophysiology
V. Course in the Ward
From the admission, the patient is on observation, if the abdominal girth is increasing.
The doctor re/uested for abdominal cleansing for the preparation of colonoscopy and he also
re/uested for all serum and blood e#amination for clearance. hen the colonoscopy was
performed, the physician ordered to have a rectal mass biopsy and laparotomy, the mass that
have been removed was e#amined. )fter the patient undergo the laparotomy the surgeon that
the patient will have a permanent colostomy. The histopathologist ordered that the patient
will undergo chemotherapy.
VI. Diagnostic Examination Significance
5erum E#amination, Complete :lood Count, ECF, )bdominal G%ray and CT scan, F:5
.rinalysis,, .ltrasound was done for preparation of the client to have a surgery.
Colonoscopy was ordered for viewing the entire colon and to detect and prevent colon
cancer.
Cancer of the colon is
predominantly adenocarcinoma
0arising from the epithelial
lining of the intestine4
It may start as a benign polyp
but may become malignant.
It will invade and destroy
normal tissue.
)nd then it will e#tend into
surrounding structures.
Cancer cells may migrate away
for the primary tumor and
spread to other parts of the
body.
VII. Drug Study
Brand
ame
or
!eneric
ame
Dosage Action Classification Contraindication Side Effect ursing
"esponsi#ilities
,albuphine
Holteran
Adult
".3@%".7
mg2kg
body
weight.
Children
".3%".7
mg2kg
body
weight up
to a total
single
dose of 3"
mg 5C,
I' or IH.
'ay be
repeated
I%> hourly
as needed.
Adult 1@%
3@"
mg2day
Post$op
1@ mg
infused
over I"
minutes to
7 hours.
'aybe
repeated
after a few
hours.
Inhibits
ascending
pain
pathways in
limbic
system,
thalamus,
midbrain,
hypothalamus
by binding to
opiate
receptor sites,
thus altering
pain
perception
and response
Inhibits
prostaglandin
synthesis by
decreasing
en+yme
needed for
biosynthesisD
analgesicD
antipyretic
propertiesD
anti%
inflammatory
Opioid
analgesic
,on%steroidal
anti%
inflammatory,
non%opioid
analgesic
*ypersensitivity,
addiction.
-regnancy 0I
rd

Trimester4,
hypersensitivity to
aspirin, iodides,
other ,5)I;s,
asthma.
5edation,
infre/uently
sweating,
FI upsets,
vertigo,
di++iness,
dry mouth,
headache,
allergic
reactions.
,ausea,
vomiting,
dysuria,
pruritus,
alopecia,
dyspnea.
J )ssess pain
location
J 'onitor vital
signs
J 'onitor
mental status
J 'onitor
allergic reaction
J 'onitor blood
counts during
therapy
J )ssess for
asthma
J'onitor liver
function
J'onitor for
blood dyscrasias
.nasyn Oral
(alium
;urule
Adult
I1@%1@"
mg bid.
Children
@" mg2kg
per day in
7 divided
doses.
Adult 6"%
3"" mE/
per orem
in divided
doses ti/%
/id.
Children
7%6
mE/2kg
per day
per orem.
Inhibits the
growth of
bacteria
,eeded for
ade/uate
transmission
of nerve
impulses and
cardiac
contraction,
renal
function,
intracellular
ion
maintenance
)ntibiotic
Electrolyte,
mineral
replacement
*istory of allergic
reaction to any
penicillins.
8enal disease,
severe hemolytic
disease,
hyperkalemia,
acute dehydration,
e#tensive tissue
breakdown.
FI upsets,
phlebitis,
skin rashes,
itching,
blood
disorders,
and
anaphyla#is.
Confusion,
bradycardia,
nausea,
vomiting,
oliguria,
rash, cold
e#tremities.
J 'onitor vital
signs
J )ssess allergic
reaction
J )ssess ECF
J 'onitor
potassium level
J )ssess cardiac
status
VIII. %edical and ursing %anagement
'edical and 5urgical 'anagement
Assessment ursing
Diagnosis
Analysis Planning ursing
Inter&ention
"ationale E&aluation
)bdominal
pain,
generali+ed,
increasing
severity
0123"4
8elieved with
passage of
stool,
associated
with
constipation
;istended
abdomen,
hypoactive
bowel sounds,
Tympanic,
094 muscle
guarding,
094 tenderness
8.K and
8$K, liver
not palpable,
0%4 kidney
punch test
Impaired
skin
integrity
related to
surgical
incision
;amage to
mucous
membrane
)ttainment of
optimal level
of nutrition
8eduction of
an#iety
'aintenance
of optimi+e
healing
)voidance of
complications
$earning
about self%
care after
discharge
Teach client
the benefits of
healthy diet,
also helps to
identify foods
that can cause
e#cessive odor
and gas
5uggest
methods for
reducing
an#iety
*elp patient
splint the
abdominal
incision during
coughing to
lessen tension
on the edges of
incision
'onitor vital
sign and report
rectal bleeding
Instruct patient
specific
direction and
review
treatments
Teach client
on how to
irrigate the
colostomy and
how to change
the appliance
To maintain
optimal
nutrition
To provide
emotional
support
To provide
wound care
To prevent
complications
To promote
home and
community%
based care
)fter the
intervention was
applied the
clients were
able to
consume a
healthy diet,
feels less
an#ious,
ac/uires
information
about self%care
after discharge,
maintains clean
incision, stoma,
perineal wound,
and recovers
without
complications
,ursing 'anagement
Assessment ursing
Diagnosis
Analysis Planning ursing
Inter&ention
"ationale E&aluation
)bdominal
pain,
generali+ed,
increasing
severity
0123"4
8elieved
with passage
of stool,
associated
with
constipation
;istended
abdomen,
hypoactive
bowel
sounds,
Tympanic,
094 muscle
guarding,
094
tenderness
8.K and
8$K, liver
not palpable,
0%4 kidney
punch test
)cute or
chronic
pain may
be related
to the
disease
process
possibly
evidenced
by pain
scale.
.npleasant
sensory and
emotional
e#perience
arising from
actual or
potential
tissue
damageD
sudden or
slow onset
of any
intensity
from mild to
severe.
8eport pain is
relieved or
controlled.
Herbali+e
methods that
provide relief.
Follow
prescribed
medications.
;emonstrate
use of
rela#ation
skills and
diversional
activities as
indicated for
individual
situation.
-erform an
assessment of
pain and
determine
possible causes
of pain.
)ccept clients
response to
pain.
Encourage
diversional
activities and
provide comfort
measure.
)dminister
analgesic as
prescribed of
doctor.
Encourage
ade/uate rest
periods to
prevent fatigue.
;iscuss impact
of pain on
lifestyle.
8eview ways to
lessen pain.
To assess
etiology 2
precipitating
contributory
factors.

To assist client
to e#plore
methods for
control of pain.
To evaluate
clients
response to
pain.
To promote
wellness.
)fter the
intervention was
applied the
clients were
able to relieve
with pain.
I'. Discharge Planning
Teaching the client the benefits of healthy diet and also helps to identify foods
that can cause e#cessive odor and gas
5uggest methods for reducing an#iety
Teaching the client to irrigate the colostomy and change the appliance
Encourage the client to have a chemotherapy