INTRODUCTION

My patient, whom I called Patient Y, is a 73 years old, a resident of Km. 13, Trinidad,
Surigao City, Surigao del Norte. Patient Y was admitted in Caraga Regional Hospital last
September 23, 2018 @2:20pm because of the feeling of generalized body weakness.Patient
Ywas diagnosed with Colon Cancer, end stage. I decided to present this case in order to be able
to learn more about this disease.

Colon cancer is cancer of the large intestine (colon), which is the final part of your
digestive tract. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells
called adenomatous polyps. Over time some of these polyps can 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 and removing
polyps before they turn into cancer.

Colorectal cancer most often begins as a polyp, a noncancerous growth that may develop
on the inner wall of the colon or rectum as people get older. If not treated or removed, a polyp
can become a potentially life-threatening cancer. Recognizing and removing precancerous
polyps can prevent colorectal cancer.

There are several forms of polyps. Adenomatous polyps, or adenomas, are growths that
may become cancerous. They can be found with a colonoscopy (Polyps are most easily found
during colonoscopy because they usually bulge into the colon, forming a mound on the wall of
the colon that can be found by the doctor.

About 10% of colon polyps are flat and hard to find with a colonoscopy unless a dye is
used to highlight them. These flat polyps have a high risk of becoming cancerous, regardless of
their size.

Hyperplastic polyps may also develop in the colon and rectum. They are not considered
precancerous.

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 REVIEW RELATED LITERATURE

COLORECTAL CANCER

According to statistics from World Health Organization (WHO), in 2012, 8553 new cases
of colorectal cancer were newly enlarged in the Philippines, the mortality rate ranked second
with 6576 dead cases. Minimally invasive targeted therapy can help prevent colorectal cancer
patients from colon and anus resection and suffering from

Symptoms

Signs and symptoms of colon cancer include:

 A change in your bowel habits, including diarrhea or constipation or a change in the

consistency of your stool, that lasts longer than four weeks

 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

Many people with colon cancer experience no symptoms in the early stages of the disease. When
symptoms appear, they'll likely vary, depending on the cancer's size and location in your large
intestine.

When to see a doctor

If you notice any symptoms of colon cancer, such as blood in your stool or an ongoing
change in bowel habits, do not hesitate to make an appointment with your doctor.

Talk to your doctor about when you should begin screening for colon cancer. Guidelines
generally recommend that colon cancer screenings begin at age 50. Your doctor may recommend

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more frequent or earlier screening if you have other risk factors, such as a family history of the
disease.

Causes

In most cases, it's not clear what causes colon cancer. Doctors know that colon cancer
occurs when healthy cells in the colon develop errors in their genetic blueprint, the DNA.

Healthy cells grow and divide in an orderly way to keep your body functioning normally.
But when a cell's DNA is damaged and becomes cancerous, cells continue to divide — even
when new cells aren't needed. As the cells accumulate, they form a tumor.

With time, the cancer cells can grow to invade and destroy normal tissue nearby. And
cancerous cells can travel to other parts of the body to form deposits there (metastasis).

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.

The most common forms of inherited colon cancer syndromes are:

 Hereditary nonpolyposis colorectal cancer (HNPCC). HNPCC, also called Lynch

syndrome, increases the risk of colon cancer and other cancers. People with HNPCC tend
to develop colon cancer before age 50.

 Familial adenomatous polyposis (FAP). FAP is a rare disorder that causes you to develop
thousands of polyps in the lining of your colon and rectum. People with untreated FAP
have a greatly increased risk of developing colon cancer before age 40.

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FAP, HNPCC and other, rarer inherited colon cancer syndromes can be detected through genetic
testing. If you're concerned about your family's history of colon cancer, talk to your doctor about
whether your family history suggests you have a risk of these conditions.

Association between diet and increased colon cancer risk

Studies of large groups of people have shown an association between a typical Western
diet and an increased risk of colon cancer. A typical Western diet is high in fat and low in fiber.

When people move from areas where the typical diet is low in fat and high in fiber to
areas where the typical Western diet is most common, the risk of colon cancer in these people
increases significantly. It's not clear why this occurs, but researchers are studying whether a
high-fat, low-fiber diet affects the microbes that live in the colon or causes underlying
inflammation that may contribute to cancer risk. This is an area of active investigation and
research is ongoing.

Risk factors

Factors that may increase your risk of colon cancer include:

 Older age. The great majority of people diagnosed with colon cancer are older than 50.
Colon cancer can occur in younger people, but it occurs much less frequently.

 African-American race. African-Americans have a greater risk of colon cancer than do

people of other races.

 A personal history of colorectal cancer or polyps. If you've already had colon cancer or
adenomatous polyps, you have a greater risk of colon cancer in the future.

 Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as

ulcerative colitis and Crohn'sdisease, can increase your risk of colon cancer.

 Inherited syndromes that increase colon cancer risk. Genetic syndromes passed through
generations of your family can increase your risk of colon cancer. These syndromes include

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 familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is
also known as Lynch syndrome.

 Family history of colon cancer. You're more likely to develop colon cancer if you have a
parent, sibling or child with the disease. If more than one family member has colon cancer
or rectal cancer, your risk is even greater.

 Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a diet low
in fiber and high in fat and calories. Research in this area has had mixed results. Some
studies have found an increased risk of colon cancer in people who eat diets high in red
meat and processed meat.

 A sedentary lifestyle. If you're inactive, you're more likely to develop colon cancer.
Getting regular physical activity may reduce your risk of colon cancer.

 Diabetes. People with diabetes and insulin resistance have an increased risk of colon
cancer.

 Obesity. People who are obese have an increased risk of colon cancer and an increased risk
of dying of colon cancer when compared with people considered normal weight.

 Smoking. People who smoke may have an increased risk of colon cancer.

 Alcohol. Heavy use of alcohol increases your risk of colon cancer.

 Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous
cancers increases the risk of colon and rectal cancer.

PREVENTION
Get screened for colon cancer
People with an average risk of colon cancer can consider screening beginning at age 50.
But people with an increased risk, such as those with a family history of colon cancer, should
consider screening sooner.

Several screening options exist — each with its own benefits and drawbacks. Talk about
your options with your doctor, and together you can decide which tests are appropriate for you.

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Make lifestyle changes to reduce your risk

You can take steps to reduce your risk of colon cancer by making changes in your everyday life.
Take steps to:

 Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains
contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer
prevention. Choose a variety of fruits and vegetables so that you get an array of vitamins
and nutrients.

 Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of
alcohol you drink to no more than one drink a day for women and two for men.

 Stop smoking. Talk to your doctor about ways to quit that may work for you.

 Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If
you've been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your
doctor before starting any exercise program.

 Maintain a healthy weight. If you are at a healthy weight, work to maintain your weight
by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor
about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the
amount of exercise you get and reducing the number of calories you eat.

Colon cancer prevention for people with a high risk

Some medications have been found to reduce the risk of precancerous polyps or colon
cancer. However, not enough evidence exists to recommend these medications to people who
have an average risk of colon cancer. These options are generally reserved for people with a high
risk of colon cancer.

For instance, some evidence links a reduced risk of polyps and colon cancer to regular
use of aspirin or aspirin-like drugs. But it's not clear what dose and what length of time would be
needed to reduce the risk of colon cancer. Taking aspirin daily has some risks, including

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gastrointestinal bleeding and ulcers, so doctors typically don't recommend this as a prevention
strategy unless you have an increased risk of colon cancer.

Diagnosis

Screening for colon cancer

Doctors recommend certain screening tests for healthy people with no signs or symptoms
in order to look for early colon cancer. Finding colon cancer at its earliest stage provides the
greatest chance for a cure. Screening has been shown to reduce your risk of dying of colon
cancer.

People with an average risk of colon cancer can consider screening beginning at age 50.
But people with an increased risk, such as those with a family history of colon cancer, should
consider screening sooner. African-Americans and American Indians may consider beginning
colon cancer screening at age 45.

Several screening options exist — each with its own benefits and drawbacks. Talk about
your options with your doctor, and together you can decide which tests are appropriate for you. If
a colonoscopy is used for screening, polyps can be removed during the procedure before they
turn into cancer.

Diagnosing colon cancer

If your signs and symptoms indicate that you could have colon cancer, your doctor may
recommend one or more tests and procedures, including:

 Using a scope to examine the inside of your colon. Colonoscopy uses a long, flexible and
slender tube attached to a video camera and monitor to view your entire colon and rectum.
If any suspicious areas are found, your doctor can pass surgical tools through the tube to
take tissue samples (biopsies) for analysis and remove polyps.

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  Blood tests. No blood test can tell you if you have colon cancer. But your doctor may test
your blood for clues about your overall health, such as kidney and liver function tests.

Your doctor may also test your blood for a chemical sometimes produced by colon cancers
(carcinoembryonic antigen or CEA). Tracked over time, the level of CEA in your blood
may help your doctor understand your prognosis and whether your cancer is responding to
treatment.

Colon cancer stages

Once you've been diagnosed with colon cancer, your doctor will order tests to determine
the extent (stage) of your cancer. Staging helps determine what treatments are most appropriate
for you.

Staging tests may include imaging procedures such as abdominal, pelvic and chest CT
scans. In many cases, the stage of your cancer may not be determined until after colon cancer
surgery.

The stages of colon cancer are:

 Stage I. The 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. The cancer has grown into or through the wall of the colon or rectum but hasn't
spread to nearby lymph nodes.

 Stage III. The cancer has invaded nearby lymph nodes but isn't affecting other parts of
your body yet.

 Stage IV. The cancer has spread to distant sites, such as other organs — for instance, to
your liver or lung.

Surgery for early-stage colon cancer

If your colon cancer is very small, your doctor may recommend a minimally invasive approach
to surgery, such as:

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  Removing polyps during a colonoscopy. If your cancer is small, localized and completely
contained within a polyp and in a very early stage, your doctor may be able to remove it
completely during a colonoscopy.

 Endoscopic mucosal resection. Removing larger polyps may require also taking a small
amount of the lining of the colon or rectum in a procedure called an endoscopic mucosal
resection.

 Minimally invasive surgery. Polyps that can't be removed during a colonoscopy may be
removed using laparoscopic surgery. In this procedure, your surgeon performs the
operation through several small incisions in your abdominal wall, inserting instruments
with attached cameras that display your colon on a video monitor. The surgeon may also
take samples from lymph nodes in the area where the cancer is located.

Surgery for invasive colon cancer

If the cancer has grown into or through your colon, your surgeon may recommend:

 Partial colectomy. During this procedure, the surgeon removes the part of your colon that
contains the cancer, along with a margin of normal tissue on either side of the cancer. Your
surgeon is often able to reconnect the healthy portions of your colon or rectum. This
procedure can commonly be done by a minimally invasive approach (laparoscopy).

 Surgery to create a way for waste to leave your body. When it's not possible to
reconnect the healthy portions of your colon or rectum, you may need an ostomy. This
involves creating an opening in the wall of your abdomen from a portion of the remaining
bowel for the elimination of stool into a bag that fits securely over the opening.

Sometimes the ostomy is only temporary, allowing your colon or rectum time to heal after
surgery. In some cases, however, the colostomy may be permanent.

 Lymph node removal. Nearby lymph nodes are usually also removed during colon cancer
surgery and tested for cancer.

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Surgery for advanced cancer

If your cancer is very advanced or your overall health very poor, your surgeon may
recommend an operation to relieve a blockage of your colon or other conditions in order to
improve your symptoms. This surgery isn't done to cure cancer, but instead to relieve signs and
symptoms, such as bleeding and pain.

In specific cases where the cancer has spread only to the liver but your overall health is
otherwise good, your doctor may recommend surgery to remove the cancerous lesion from your
liver. Chemotherapy may be used before or after this type of surgery. This approach provides a
chance to be free of cancer over the long term.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy for colon cancer is
usually given after surgery if the cancer has spread to lymph nodes. In this way, chemotherapy
may help reduce the risk of cancer recurrence and death from cancer. Sometimes chemotherapy
may be used before surgery as well, with the goal of shrinking the cancer before an operation.
Chemotherapy before surgery is more common in rectal cancer than in colon cancer.

Chemotherapy can also be given to relieve symptoms of colon cancer that has spread to
other areas of the body.

Radiation therapy

Radiation therapy uses powerful energy sources, such as X-rays, to kill cancer cells, to
shrink large tumors before an operation so that they can be removed more easily, or to relieve
symptoms of colon cancer and rectal cancer. Radiation therapy either alone or combined with
chemotherapy is one of the standard treatment options for the initial management of rectal cancer
followed by surgery.

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Targeted drug therapy

Drugs that target specific malfunctions that allow cancer cells to grow are available to
people with advanced colon cancer, including:

 Bevacizumab (Avastin)

 Cetuximab (Erbitux)

 Panitumumab (Vectibix)

 Ramucirumab (Cyramza)

 Regorafenib (Stivarga)

 Ziv-aflibercept (Zaltrap)

Targeted drugs can be given along with chemotherapy or alone. Targeted drugs are typically
reserved for people with advanced colon cancer.

Some people are helped by targeted drugs, while others are not. Researchers have
recently made progress in determining who is most likely to benefit from specific targeted drugs.
Until more is known, doctors carefully weigh the possible benefit of targeted drugs against the
risk of side effects and the cost when deciding whether to use these treatments.

Immunotherapy

Some patients with advanced colon cancer have a chance to benefit from immunotherapy
with antibodies such as pembrolizumab (Keytruda) and nivolumab (Opdivo). Whether a colon
cancer has the chance to respond to these immunotherapies can be determined by a specific test
of the tumor tissue.

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Proton beam therapy

One of the newest radiation therapies available at Mayo Clinic in the Minnesota and
Arizona locations, proton beam therapy can benefit children, young adults, and those with
cancers located close to critical organs and body structures. Mayo Clinic's Proton Beam Therapy
Program features intensity-modulated proton beam therapy with pencil beam scanning allowing
Mayo radiation oncologists to destroy cancer while sparing healthy tissue.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and
other symptoms of a serious illness. Palliative care specialists work with you, your family and
your other doctors to provide an extra layer of support that complements your ongoing care.

When palliative care is used along with all of the other appropriate treatments, people
with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained
professionals. Palliative care teams aim to improve the quality of life for people with cancer and
their families. This form of care is offered alongside curative or other treatments you may be
receiving.

Coping and support

A cancer diagnosis can be emotionally challenging. In time, people learn to cope in their
own unique ways. Until you find what works for you, you might try to:

 Know what to expect. Learn enough about your cancer to feel comfortable making
treatment decisions.

Ask your doctor to tell you the type and stage of your cancer, as well as your treatment
options and their side effects. The more you know, the more confident you'll be when it

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 comes to making decisions about your own care. Look for information in your local library
and on reliable websites.

 Keep friends and family close. Keeping your close relationships strong will help you deal
with cancer. Friends and family can provide the practical support you'll need, such as
helping take care of your house if you're in the hospital. And they can serve as emotional
support when you feel overwhelmed by cancer.

 Find someone to talk with. Find a good listener who is willing to listen to you talk about
your hopes and fears. This may be a friend or family member. The concern and
understanding of a counselor, medical social worker, clergy member or cancer support
group also may be helpful.

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 NURSING HEALTH HISTORY
Biographic Data
Case No. : 43091
Ward : Medical Ward
Room : Number 5
Name : Patient Y
Age : 73 years old
Sex : Female
Birth date : November 24, 1945
Birthplace : Cabatuan Leyte
Address : Km. 13, Trinidad, Surigao City, Surigaodel Norte
Civil Status : Married
Religion : Catholic
Nationality : Filipino
Height : 5’3
Weight : 45kg
Educational Attainment : Elementary graduate
Occupation : None
Health Care financing and : From children with the help of Philhealth and
source of medical care Senior Citizen
Source and reliability of : Primary Source (Patient)
data gathered: Secondary Source (Patient’s chart and S.O.)
Admission data
Date and time of admission : September 23, 2018 at 2:20 PM
Mode of admission : Ambulatory
Date and time of clinical encounter : September 26, 2018. 6:00am-2:00pm shift
Admitting Vital Signs:
 Temperature :36.7 degree celsius
 Pulse Rate :111 bpm
 Respiratory Rate :25 cpm
 Blood Pressure :90/70 mmHg

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Admitting Diagnosis/Impression :Obstructive Jaundice Secondary to Colorectal CA
IV, Renal CA, DM Type 2, HCVD, Hemorrhoidal
Disease
Final Diagnosis : Colon CA, end stage.
Admitting Physician : Alexander V. Morala, M.D.
Attending Physician : Jamallodin Demao, M.D.
Hospital : Caraga Regional Hospital
Chief Complaint : Generalized body weakness, fatigue, jaundice,
known case of Colon CA.

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 HISTORY OF PRESENT ILLNESS

The patient had her first pregnancy at the age of 16 and she delivered her youngest at the
age of 38, she had a total of 11 children with the interval of 2 years. Patient delivered her
children through normal delivery at home with the help of “manghihilot”. At the age of 40, she
felt that there was something bulging in her anus. She didn’t know what it was until one of her
neighbors told her that it was “almuranas” and told her that it can be developed because of eating
too much spicy foods, she didn’t do anything about it but she avoided eating spicy foods since
then.

Patient is not picky when it comes to food, she ate whatever is served in their table. The
patient can consume 3-4 cups of rice in every meal with no specific viand. She claimed that she
eats too much fatty foods specially her favorite “humba” when there is a celebration like fiesta or
birthday, “mas hamok oil, mas lami” as verbalized by the patient. She can only consume 3-4
glass of water per day I asked her why, she verbalized “amora man gud ako mo suka mam kung
mo inom ko tubig inday, kalood ba”. She claimed that she experienced having constipation back
then but without the presence of blood in the stool, she took OTC drugs to ease her constipation.

At the age of 55, she usually experienced chest pain and dyspnea but thought that it was
nothing and was just due to her position when sleeping. When she felt body malaise, she’ll just
rest and sleep because she thinks that she did overworked doing household chores (e.g. cooking,
washing clothes of her children, cleaning the house, etc.). Whenever she experienced muscle
pain, she always seek for “manghilotay” to ease the pain and it was effective as claimed by the
patient.

At the age of 68 she experienced blurr vision in her right eye, her children wants her to
get checked but unfortunately their income is just enough to sustain their daily needs, some of
her children has stable job but it was only enough to provide their own families.

A year prior to admission, the patient experienced a week of constipation with a drop of
blood in the stool, she ignored it because she thought that the presence of blood was due to her
constipation, she thought that there was a laceration inside the rectum due to a bulk of stool
passing through her anus. As usual, she just took OTC drugs to ease the pain and constipation.

16
 When she feels sick, she refused to get admitted because it will just add up their debt and
bills to pay, instead she’ll just take OTC drugs for her to feel better.

June 2018, 3 months prior to admission the patient experienced frequent but minimal
urination with pain that scaled 5 out of 10, and she only defecates 2-3 times per week with a
presence of blood in the stool, she also experienced fatigue and shortness of breath but again, she
ignored it.

Two months prior to admission it was July 2, 2018, patient was admitted for 2 days to
Surigao Medical Center with a chief complaint of weakness, fatigue and shortness of breathing
and was then transferred to Caraga Regional Hospital on July 4, 2018, several tests was done to
the patient during hospitalization but there was no clear diagnosis, someone they knew advised
the family of the patient to go to Cebu for proper check-up, they think about it and decided to ask
for help to their relatives and fortunately they got helped. It was July 18, 2018 when the patient
was diagnosed with Colon Cancer Stage IV at Chung Hua Hospital, Cebu City. The physicians
advised them to undergo chemotherapy but the patient itself refused because of financial
problem. The patient decided to go home against medical advice because they don’t have enough
money to sustain her needs in the hospital though the bills in the hospital is free, but her
medications were not.

A night prior to admission, the patient felt severe generalized body weakness, fatigue,
dyspnea, and with the presence jaundice in the skin. Her children was really worried and advised
their mother to get hospitalized but she refused once again.

Last September 23, 2018, patient woke up at 8am and she felt really weak, she has no
appetite. At 10am that day, the patient felt sudden shortness of breath and couldn’t move her
body, she cried for help and her husband decided to call an ambulance and rushed her wife to the
hospital . The patient was brought to Caraga Regional Hospital to seek for medical assistance
and arrived there at 02:20 pm. She was initially assessed by the physician on duty and advised to
have series of laboratory test for further assessment.

Patient Y, a 73 years old woman, is a resident of Km. 13, Trinidad, Surigao City, Surigao
Del Norte. She was admitted to Caraga Regional Hospital on September 23, 2018 with a chief

17
complaint of generalized body weakness and fatigue, jaundice, and known case of Colon cancer
end stage.

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 PAST HEALTH HISTORY

a) Childhood Illness

Patients Y experienced chickenpox at the age of 10. According to her she did not
experienced any other childhood illnesses such as mumps, measles and rubellabut patient
claimed that fever, cough and colds were very common during her childhood years.

b) Childhood Immunization
Patient Y claimed that she haven’t received any immunization because it wasn’t
introduced yet during their time.
c) History of hospitalization

Surgical history

The patient had undergone gallbladder drainage or Cholecystostomy during her

present hospitalization at Caraga Regional Hospital last September 24, 2018. The surgeon
was Jamallodin Demao M.D.

Medical history

The patient had history of hospitalization at Surigao Medical Center for 2 days
last July 2, 2018in the morning and was then transferred to Caraga Regional Hospital last
July 4, 2018 due to financial problem.

d) Accidents and injury

The patient never been into accident or injuries.

e) Obstetric History
Patient Y had her menarche at the age of 14 and menopaused at the age of 42. She
had regular menarche that lasted 3-5 days, however she can consume 2-3 pads per day.
She never experienced having dysmenorrhea while having her menstruation.
The patient had 11 children with G12T11P1A1L11, she had her first pregnancy
when she was 16 years old in the year of 1961. She had her first born child on September
21, 1962, the second child was born on June 29, 1964, she had her third child on August 3,
1966, her fourth child on November 11, 1968, her fifth child on December 8, 1970, her

19
 sixth child on June 5, 1972, her seventh child on November 26,1974, her eighth child on
January 6, 1976, her ninth child was born on September 18, 1978, her tenth child was born
on July 18, 1980, and her eleventh child was born on December 15, 1982. She had her last
pregnancy in the year of 1983 at the age of 38 and was aborted during her first trimester.
Each children had an interval of approximately 2 years.
f) Allergic reaction

No known allergy to foods, drugs, insects or other environmental agents according to the
patient.

g) Medications

The patient claimed that she took OTC drugs Neozep, Mefenamic Acid, Biogesic and
Carbocisteine to treat fever, cough, colds and headache.

During hospitalization, the patient was taking six(6) prescription drugs such as:

 Ursodeoxycholic Acid 250mg, 1 cap BID, P.O.

 Lactouse 30cc OD, P.O.
 Furosemide 40mg IVTT q8hours
 Metronidazole 500 mg IV drip q8hours
 Cefuroxime 750 mg, IVTT, q8hours, ANST
 Ketorolac 30 mg IVTT, q8hours PRN
 Paracetamol 300mg IVTT q8hours, PRN

h) Family Health History

The client is the oldest among 5 siblings, 2 female and 3 male. Her mother died due to
old age with ulcer in abdomen, her 4th sibling is an Army and died due to encounter with
NPA’s, and their youngest died due to heart disease at the age of 24.

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 PERSONAL AND SOCIAL HISTORY
1. Lifestyle:
1.1. Personal habits
She wakes up early in the morning to prepare breakfast for her family. She
loved watching television. She also loves drinking tea which she can consume
3 cups in a day. With regards to hygiene, the patient takes a bath 2 to 3 times a
week because she feels really cold to take a bath everyday as claimed by the
patient. Patient’s husband stated that her wife was never been into an
alcoholic drinks and never used tobacco.
1.2. Diet
Before hospitalization:
The patient’s typical diet on a normal day is 2-3 cups of rice; with a viand
of fish, red meat, vegetables, noodles, canned goods, anything that they can
only afford. She drinks 2-4 glasses of water per day; she usually eats 3 times a
day and have snacks in the afternoon; Patient claimed that she has no food
allergy.
During hospitalization:
The patient’s appetite decreased and could consume only half of rice
served, few servings of vegetables and fish and drank only 2-4 glasses of
water per day.
1.3. Sleep and rest pattern
Before hospitalization:
Patient Y usually sleeps around 8 to 9 o’clock in the evening and wakes up
between 4 to 5 o’clock in the morning. Approximately she had 8 hours with
interruptions of sleep each day.
During hospitalization:
The patient couldn’t get enough sleep due to the new environment and was
always interrupted by taking the vital signs and giving medications. The
patient verbalized that she can only sleep approximately 3-4 hours with
interruptions at night and took a nap for about 30 minutes in the morning and
in the afternoon as claimed.

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 1.4. Elimination pattern
Before hospitalization:
The patient usually urinates 2 to 3 times a day with pain and minimal
amount of urine upon urinating for 3 months started July 2018; she deficates 2
to 3 times a week with pain and presence of a drop of blood in the stool upon
defecating for 1 year that started between April and May 2017as claimed by
the patient.
During hospitalization:
The patient is in urinary catheter to monitor the output of the urine; In 4
days of being admitted, patient only defecated once as claimed by her
husband.
1.5. Activities of daily living
Before hospitalization:
The patient had no difficulties in performing ADL’s and other
instrumental activities of daily living. She could eat, dress, groom, eliminate,
stand, walk and do household chores with no assistance needed.
During hospitalization:
The patient was able to eat, groom, dress, with assistance because of pain,
weakness and fatigue
1.6. Recreation and hobbies
Before hospitalization:
She loved watching TV and talks with neighbors.
During hospitalization:

The patient just lies and sits on the bed.

2. Social Data

a) Family Relationships/Friendships
Patient claimed that she recieved a lot of love from her family and friends and she
can lean on with her family and friends when she is depressed and on stressful situations.

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b) Ethnic Affiliation
The patient and her husband assimilated the values, beliefs and culture of
Surigaonon. Surigaonon is known to be loving, hard-working, religious and hospitable.
She verbalized that if some health problem will arise, they prefer to go to quack doctors
because they can only spend less money there than in hospitals.
c) Educational History
Patient’s highest level of education attained is elementary graduate due of
financial problems.
d) Occupational History
The patient is a housewife.
e) Economic Status
Their family belongs to low class. The client sometimes received financial help
from her siblings and asked relatives for help.
f) Psychological data
The client’s major stressor is financial problem and her current condition but she
gains strength from her children and her husband, she stated that she always prays and
asks guidance from God, the client has the ability to verbalized appropriate emotions and
uses nonverbal communication such as an eye movement, gestures and interacts clearly
during an interview.
g) Patterns Of Health Care

Every time the client or any member of the family experienced illnesses, they
usually takes OTC drugs (e.g. Neozep, Mefenamic Acid, Biogesic, Carbocisteine) when
fever, cough, colds and headache persist. Sometimes she makes herbal preparations as an
immediate remedy such as steamed “karabo” (I Tbsp PO every after meal) and “agre” (7
pieces in a warm water OD). The patient consults a quack doctor whenever she is sick. But
when not cured, that’s the time that they’ll seek a medical help. Adequate care was rendered
to the patient and access in hospitals is quite a problem.

23
 PHYSICAL ASSESSMENT

(September 26, 2018. 7:00am)

General

Recieved patient lying in bed with unfixed hair, dirty clothe, slightly unpleasant odor,
awake, conscious, responsive, coherent, with an IVF of PNSS 1L @KVO well hooked at the
right arm with a blood transfused packed RBC inserted at the IV line, nasal cannula inserted to
the nostril of the patient at 2L/minute. Urinary catheter is inserted to the patient with darkcolor of
urine at the level of 150mland a Cholecystostomy tube inserted to the RUQ of the patient. With
the ff. vital signs of;

 Temperature: 36.6 degree celsius

 Pules Rate: 105bpm
 Respiratory Rate: 20cpm
 BP: 140/90 mmHg

weight 44kg
BMI = = 5′ 3ft.
height

1 ft. = 12 inches

1 inches = 2.54cm

1cm = 0.01 meter

5 x 12 = 60 inches + 3 inches = 63 inches

2.54 cm
63 inches x = 160.02 cm
1 inches

0.01 meters
160.02 cm x = 1.6002
1 cm

44 kg
= 1.6002 (m2)

44 kg
= 2.56064m2

BMI = 17.2 kg/m2

24
 Based on the BMI Category; Normal is 18.5-24.9. Below 18.5 is underweight. 25-29.9 is
overweight. 30 above is considered obese.

Patient’s present BMI is 17.2 that belongs to underweight category.

Integumentary

Skin
o Skin is brown in color noted
o Slightly jaundice noted
o Pale skin noted in all area
o Dry skin noted
o Skin is warm to touch upon palpation
o Poor skin turgor (springs back to its previous state in >3 seconds – pinched at the
chest)
Hair
o Short hair and evenly distributed on the scalp upon inspection
o Colorof mixed black and white hairnoted
o Unfixed hair noted
o Dandraff noted
o No lice infestation noted
o Oily hair upon palpation noted
o Thin hair strands noted
Nails
o Rounded, untrimmed, dirty nails noted upon inspection
o Thick nails; with a nail plate angle about 160 degree
o Poor capillary refill, goes back in 4 seconds
o Skin around nails is intact
o No lesion noted
Head, Eyes, Ears, Nose, Throat
Skull and face
o Symmetrical color of the face, intact skin around the face noted
o Oily face noted

25
 o Skull is normocephalic and symmetrically round
o No lesion or masses noted

Eyes and Vision

o Eyebrows and eyelashes are evenly distributed

o Eyebrows are symmetrically aligned and move equally upon inspection
o Eyelashes are equally distributed and slightly curved outward upon inspection
noted
o Eyelids appear symmetrically round
o Sclera appears slightly jaundice
o Pale palpebral conjunctiva
o No discharges noted in the lacrimal apparatus
o Pupils are equally round and reactive to light and accomodation with a size of
3mm
o Eyes slightly cloudy noted
o Can’t clearly see the letters written in the RLE manual noted

Ears and Hearing

o Symmetrical and in line with the outer canthus of the eyes

o Brown in color, smooth and can hear normally
o No inflammation or lesions noted
o Presense of minimal earwax noted
o No hearing difficulty

Nose and Sinuses

o Nose is symmetrical to the midline of the face noted

o No lesions or swelling and dischargesnoted
o Airways are patent and free from obtruction noted

Oropharynx (mouth and throat)

o Plaques and yellowish teeth are noted

o Pale dry lips

26
 o Pale tongue noted
o Tongue is symmetrical in the midline of the mouth
o No lesions noted

Thorax and Lungs

 Spine vertically aligned noted
 Chest is symmetric and intact noted
 Shortness of breathing noted
 No tenderness or masses noted upon palpation
 No adventitious breath sounds heard upon auscultation noted
Abdomen
 Intact skin, smooth and uniform in color noted
 Slightly bloated abdomen noted
 Cholecystostomy tube inserted to the RUQ of the patient due to Obstructive Jaundice
secondary to Colon CA stage 4.
 Hypoactive bowel sound upon auscultation noted (3 bowel sound per minute)
Cardiovascular System
 Palpable peripheral pulses
 rapid heart rate with 105 bpm
 palpitation noted upon auscultation
 chest pain as claimed by the patient noted
Musculoskeletal System
 No deformities, equally grip noted
 Body weakness noted
 Moved her shoulders rigidly upon inspection noted
 Able to flex arms and rest of the forearm slowly noted
 No lesions and masses noted
 Muscle pain felt at the bicep upon palpation noted
Neurologic System
 Oriented to date, time and place, as verbalized by the patient

27
  Displays normal verbaland nonverbal communication noted
 Patient can immmediately recall recent, remote and immediate memory (ex.
Immediate – she was able to recall the last food she ate. Remote – she was able to
recall the date of her birthday. Recent – she was able to recall the date of her
admission)
Reproductive System
 Patient refused to be assessed on her genital area but claimed that there is a presence
of external hemorrhoids in her anus, about 1 inch long noted.
 Patient had her menarche at the age of 14.
 Patient menopaused at the age of 42.
 Had her first pregnancy at the age of 16.
 Patient had 11 children with 2 years of interval noted.

28
 REVIEW OF SYSTEMS

General

The usual weight of the client is 45kg upon hospitalization, the patient’s weight
decreased to 44kg. Weakness and fatigue noted upon assessment.

Integumentary system

Patient had no history of skin diseases but she has skin lesion due to gallbladder drainage
during her present hospitalization, she had no allergic reactions to food and drugs taken. She
experienced excessive sweating at the face and underarms.

Head, Eyes, Ears, Nose and Throat (HEENT)

She had no history of head injury, she has a cloudy eyes, and no history of ear infection,
she had no history of nasal allergies, neck lumps, goiter or any thyroid problem. Had no history
of excessive tearing, double vision, and sensitivity to light but she experiences blurr vision. She
had no history of accident resulting in unconsciousness. Had no history of changes of voice or
hoarseness as claimed. She had no history of epistaxis or nose bleed, sore, lumps and difficulty
of swallowing as claimed.

Respiratory System

Patient had no history of pneumonia, asthma, and COPD but she experienced dyspnea as
claimed.

Cardiovascular System

The patient had a history of palpitations and chest pain and was diagnosed with
Hypertensive Cardiovascular Disease.

Gastrointestinal System

Patient claimed that she experienced episodes of constipation. She experienced difficulty
in defecating and she experiencedpain in the abdomen with a scale 8 out of 10 and a presence of
a drop of blood in the stool as claimed. She had a history of nausea, vomiting, loss of appetite,
diarrhea and hyperactive bowel sound. There is a presence of external hemorrhoid as claimed by
the S.O. The patient was diagnosed with Colorectal Cancer, end stage.
29
Genitourinary System

She urinates 3-4 x a day, she experienced pain upon urination. The patient was diagnosed
with Renal CA. Had no history of sexually transmitted disease such as gonorrhea and syphillis as
claimed.

Muscuskeletal System

Client experienced of body weakness and fatigue and had a history of muscle pain but no
history of bone fractures.

Endocrine System

Client had no history of goiter, or any thyroid problem. The patient had history of severe
thirst. The patient was diagnosed with Diabetes Mellitus Type II.

Neurologic System

Client had no history of difficulty of walking, unconsciousness, seizures, tremors,

paralysis, numbness, speech problem, and disorientation as claimed.

30
 ANATOMY AND PHYSIOLOGY

GASTROINTESTINALSYSTEM

The gastrointestinal tract (GIT) consists of a

hollow muscular tube starting from the oral cavity,
where food enters the mouth, continuing through the
pharynx, esophagus, stomach and intestines to the
rectum and anus, where food is expelled. There are
various accessory organs that assist the tract by
secreting enzymes to help break down food into its
component nutrients. Thus the salivary glands, liver,
pancreas and gall bladder have important functions in
the digestive system. Food is propelled along the length of the GIT by peristaltic movements of
the muscular walls.

The primary purpose of the gastrointestinal tract is to break food down into nutrients,
which can be absorbed into the body to provide energy. First food must be ingested into the
mouth to be mechanically processed and moistened. Secondly, digestion occurs mainly in the
stomach and small intestine where proteins, fats and carbohydrates are chemically broken down
into their basic building blocks. Smaller molecules are then absorbed across the epithelium of the
small intestine and subsequently enter the circulation. The large intestine plays a key role in
reabsorbing excess water. Finally, undigested material and secreted waste products are excreted
from the body via defecation (passing of faeces).

Basic structure

The gastrointestinal tract is a muscular tube lined by a special layer of cells, called
epithelium. The contents of the tube are considered external to the body and are in continuity
with the outside world at the mouth and the anus. Although each section of the tract has
specialized functions, the entire tract has a similar basic structure with regional variations.

The wall is divided into four layers as follows:

31
Mucosa

The innermost layer of the digestive tract has

specialized epithelial cells supported by an underlying
connective tissue layer called the lamina propria. The
lamina propria contains blood vessels, nerves,
lymphoid tissue and glands that support the mucosa.
Depending on its function, the epithelium may be
simple (a single layer) or stratified (multiple layers).

Submucosa

The submucosa surrounds the muscularis mucosa and consists of fat, fibrous connective
tissue and larger vessels and nerves. At its outer margin there is a specialized nerve plexus called
the submucosal plexus or Meissner plexus. This supplies the mucosa and submucosa.

Muscularisexterna

This smooth muscle layer has inner circular and outer longitudinal layers of muscle fibres
separated by the myenteric plexus or Auerbach plexus. Neural innervations control the
contraction of these muscles and hence the mechanical breakdown and peristalsis of the food
within the lumen.

Serosa/mesentery

The outer layer of the GIT is formed by fat and another layer of epithelial cells called
mesothelium.
INDIVIDUAL COMPONENTS OF THE GASTROINTESTINAL SYSTEM

Oral cavity

The oral cavity or mouth is responsible for the intake of food. It is lined by a stratified
squamous oral mucosa with keratin covering those areas subject to significant abrasion, such as
the tongue, hard palate and roof of the mouth. Mastication refers to the mechanical breakdown of
food by chewing and chopping actions of the teeth. The tongue, a strong muscular organ,
manipulates the food bolus to come in contact with the teeth. It is also the sensing organ of the
mouth for touch, temperature and taste using its specialized sensors known as papillae.

32
Salivary glands

Three pairs of salivary glands communicate with the oral cavity. Each is a complex gland
with numerous acini lined by secretory epithelium. The acini secrete their contents into
specialized ducts. Each gland is divided into smaller segments called lobes. Salivation occurs in
response to the taste, smell or even appearance of food. This occurs due to nerve signals that tell
the salivary glands to secrete saliva to prepare and moisten the mouth. Each pair of salivary
glands secretes saliva with slightly different compositions.

Parotids

The parotid glands are large, irregular

shaped glands located under the skin on the side of
the face. They secrete 25% of saliva. They are
situated below the zygomatic arch (cheekbone) and
cover part of the mandible (lower jaw bone). An
enlarged parotid gland can be easier felt when one
clenches their teeth. The parotids produce a watery
secretion which is also rich in proteins.
Immunoglobulins are secreted help to fight microorganisms and a-amylase proteins start
to break down complex carbohydrates.

Submandibular

The submandibular glands secrete 70% of the saliva in the mouth. They are found in the
floor of the mouth, in a groove along the inner surface of the mandible. These glands produce a
more viscid (thick) secretion, rich in mucin and with a smaller amount of protein. Mucin is a
glycoprotein that acts as a lubricant.

Sublingual

The sublinguals are the smallest salivary glands, covered by a thin layer of tissue at the
floor of the mouth. They produce approximately 5% of the saliva and their secretions are very
sticky due to the large concentration of mucin. The main functions are to provide buffers and
lubrication.

33
Esophagus

The esophagus is a muscular tube of approximately 25cm in length and 2cm in diameter.
It extends from the pharynx to the stomach after passing through an opening in the diaphragm.
The wall of the esophagus is made up of inner circular and outer longitudinal layers of muscle
that are supplied by the esophageal nerve plexus. This nerve plexus surrounds the lower portion
of the esophagus. The esophagus functions primarily as a transport medium between
compartments.

Stomach

The stomach is a J shaped expanded bag, located just left of the midline between the
esophagus and small intestine. It is divided into four main regions and has two borders called the
greater and lesser curvatures. The first section is the cardia which surrounds the cardial orifice
where the esophagus enters the stomach. The fundus is the superior, dilated portion of the
stomach that has contact with the left dome of the diaphragm. The body is the largest section
between the fundus and the curved portion of the J.

This is where most gastric glands are located and where most mixing of the food occurs.
Finally the pylorus is the curved base of the stomach. Gastric contents are expelled into the
proximal duodenum via the pyloric sphincter. The inner surface of the stomach is contracted into
numerous longitudinal folds called rugae. These allow the stomach to stretch and expand when
food enters. The stomach can hold up to 1.5 liters of material. The functions of the stomach
include:

1. The short-term storage of ingested food.

2. Mechanical breakdown of food by churning and mixing motions.

3. Chemical digestion of proteins by acids and enzymes.

4. Stomach acid kills bugs and germs.

5. Some absorption of substances such as alcohol.

34
Most of these functions are achieved by the secretion of stomach juices by gastric glands in the
body and fundus. Some cells are responsible for secreting acid and others secrete enzymes to
break down proteins.

Small intestine

The small intestine is composed of the

duodenum, jejunum, and ileum. It averages
approximately 6m in length, extending from the
pyloric sphincter of the stomach to the ileo-caecal
valve separating the ileum from the caecum. The small
intestine is compressed into numerous folds and
occupies a large proportion of the abdominal cavity.

The duodenum is the proximal C-shaped section that curves around the head of the
pancreas. The duodenum serves a mixing function as it combines digestive secretions from the
pancreas and liver with the contents expelled from the stomach. The start of the jejunum is
marked by a sharp bend, the duodenojejunal flexure. It is in the jejunum where the majority of
digestion and absorption occurs. The final portion, the ileum, is the longest segment and empties
into the caecum at the ileocaecal junction.

The small intestine performs the majority of digestion and absorption of nutrients. Partly
digested food from the stomach is further broken down by enzymes from the pancreas and bile
salts from the liver and gallbladder. These secretions enter the duodenum at the Ampulla of
Vater. After further digestion, food constituents such as proteins, fats, and carbohydrates are
broken down to small building blocks and absorbed into the body’s blood stream.

Large intestine

The large intestine is horse-shoe shaped

and extends around the small intestine like a
frame. It consists of the appendix, caecum,
ascending, transverse, descending and sigmoid
colon, and the rectum. It has a length of

35
approximately 1.5m and a width of 7.5cm.

The caecum is the expanded pouch that receives material from the ileum and starts to
compress food products into faecal material. Food then travels along the colon. The wall of the
colon is made up of several pouches (haustra) that are held under tension by three thick bands of
muscle (taenia coli).

The rectum is the final 15cm of the large intestine. It expands to hold faecal matter before
it passes through the anorectal canal to the anus. Thick bands of muscle, known as sphincters,
control the passage of faeces.

The mucosa of the large intestine lacks villi seen in the small intestine. The mucosal
surface is flat with several deep intestinal glands. Numerous goblet cells line the glands that
secrete mucous to lubricate faecal matter as it solidifies. The functions of the large intestine can
be summarised as:

1. The accumulation of unabsorbed material to form faeces.

2. Some digestion by bacteria. The bacteria are responsible for the formation of intestinal
gas.

3. Reabsorption of water, salts, sugar and vitamins.

Liver

The liver is a large, reddish-brown organ situated in the right upper quadrant of the
abdomen. It is surrounded by a strong capsule and divided into four lobes namely the right, left,
caudate and quadrate lobes. The liver has several important functions. It acts as a mechanical
filter by filtering blood that travels from the intestinal system. It detoxifies several metabolites
including the breakdown of bilirubin and oestrogen. In addition, the liver has synthetic functions,
producing albumin and blood clotting factors. However, its main roles in digestion are in the
production of bile and metabolism of nutrients.

Gall bladder

The gallbladder is a hollow, pear shaped organ that sits in a depression on the posterior
surface of the liver’s right lobe. It consists of a fundus, body and neck. It empties via the cystic

36
duct into the biliary duct system. The main functions of the gall bladder are storage and
concentration of bile. Bile is a thick fluid that contains enzymes to help dissolve fat in the
intestines. Bile is produced by the liver but stored in the gallbladder until it is needed. Bile is
released from the gall bladder by contraction of its muscular walls in response to hormone
signals from the duodenum in the presence of food.

Pancreas

Finally, the pancreas is a lobular, pinkish-grey organ that lies behind the stomach. Its
head communicates with the duodenum and its tail extends to the spleen. The organ is
approximately 15cm in length with a long, slender body connecting the head and tail segments.
The pancreas has both exocrine and endocrine functions. Endocrine refers to production of
hormones which occurs in the Islets of Langerhans. The Islets produce insulin, glucagon and
other substances and these are the areas damaged in diabetes mellitus. The exocrine (secretrory)
portion makes up 80-85% of the pancreas and is the area relevant to the gastrointestinal tract.

It is made up of numerous acini (small glands) that secrete contents into ducts which
eventually lead to the duodenum. The pancreas secretes fluid rich in carbohydrates and inactive
enzymes. Secretion is triggered by the hormones released by the duodenum in the presence of
food. Pancreatic enzymes include carbohydrases, lipases, nucleases and proteolytic enzymes that
can break down different components of food. These are secreted in an inactive form to prevent
digestion of the pancreas itself. The enzymes become active once they reach the duodenum.

37
 PATHOPHYSIOLOGY

PREDISPOSING FACTORS: PRECIPITATING FACTORS:

 Being elderly (40-50 of age)  Low-fiber diet, high fat diet
 Male  Bowel habits (2x a week)
 Family history of Colon  Stress
Disease  Diabetes Mellitus type 2

Excess fat converts normal flora of the intestines

over time into a polyps

Fecal matter retention due to infrequent

defecation

Irritating intestinal lining due to infrequent

defecation

-Diarrhea
-Fever and fatigue
Inflammation -Abdominal pain and cramping
-Blood in your stool
-Reduced appetite
- Infection -Unintended weight loss
- Tissue Damage Polymorphic leukocytes causes
- Inflammatory Diseases
abscessing
- Kidney Failure And
- Diabetic Ketoacidosis

Widens inflammation and necrosis

Ulcerating lesion

38
 Repeating process overtime causes dysplasia
then genetic mutation of cellular DNA

-Growth of tumor in the colon

-Weight loss
CANCER -Pain in abdomen
-Constipation
-Blood in the stool

LEGEND:

BLUE – Clinical Manifestation

YELLOW – Manifested by the patient
GREEN - Cause

39
 DRUG STUDY
Drug Study # 1
Generic Name: Furosemide
Brand Name: Lasix
Classification: Diuretics
Dosage: 40mg IVTT q 8 hours. Hold for BP less than 90/60 mmHg
Mechanism of Action:
Inhibit reabsorption of sodium and water in the ascending limb of the loop of Henle by
interfering with the chloride binding site of the 1Na+, 1K+, 2Cl- co-transport system. Loop
diuretics increase the rate of delivery of tubular fluid and electrolytes to the distal sites of
hydrogen and potassium ion secretion, while plasma volume contraction increases aldosterone
production.
Indications:
Edema due to cardiac, hepatic & renal disease, burns; mild to moderate HTN,
hypertensive crisis, acute
Contraindications:
Anuria; hepatic coma & precoma; severe hypokalemia &/or hyponatremia; hypovolemia
w/or w/o hypotension. Hypersensitivity to sulfonamides.
Adverse Reactions/Side Effects
CNS: blurred vision, dizziness, headache, vertigo EENT: hearing loss, tinnitus CV: hypotension
GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, ↑ liver enzymes, nausea, pancreatitis,
Nursing Considerations:
 Assess fluid status. Monitor daily weight, intake and output ratios, amount and location
of edema, lung sounds, skin turgor, and mucous membranes. Notify health care
professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs.
 Monitor BP and pulse before and during administration. Monitor frequency of
prescription refills to determine compliance in patients treated for hypertension.
 Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps,
paresthesia, and confusion. Patients taking digoxin are at increased risk of digoxin
toxicity because of the potassium-depleting effect of the diuretic. Potassium supplements
or potassium-sparing diuretics may be used concurrently to prevent hypokalemia.

40
Drugs Study # 2

Generic Name: Cefuroxime

Brand Name: ceftin

Classification: anti- infective

Dosage: 750mg IVTT q8

Action:

Bind to bacteria cell wall membrane causing cell death.

Indication:

Pharyngitis, tonsillitis, infections of the urinary and lower respiratory tracts, and skin and skin-
structure infections caused by Streptococcus pneumoniae and S. pyogenes,
Haemophillusinfluenzae, Staphylococcus aureus, Escherichia coli

Contraindicated:

Contraindicated in patients hypersensitive to drug.* Use cautiously in patients hypersensitive to

penicillin because of possibility of cross-sensitivity with other beta-lactam antibiotics.* Use with
caution in breast-feeding women and inpatients with history of colitis or renal sufficiency

Side effects:

GI: Diarrhea, nausea, antibiotic-associated colitis.

Skin: Rash, pruritus, urticaria.

Urogenital: increased serum cretonne and BUN, decreased creatinine clearance

Nursing implication:

 Determine history of hypersensitivity reactions to cephalosphorins, penicillins and history

of allergies particularly to drugs before therapy is initiated.
 Report onset of loose stools
 Absorption of cefuroxime is enhanced by food.
 Notify prescribe about rashes or super-infections

41
Drug Study # 3

Generic Name: Ketorolac

Brandname: Toradol

Classification: analgesic

Dosage: 30mg IVTT q8 PRN

Action: Inhibits prostaglandin synthesis, producing peripherally mediated analgesia- Also has
antipyretic and anti-inflammatory properties. - Therapeutic effect: Decreased pain

Indication: Short term management of pain (not to exceed 5days total for all routes combined)

Contraindicated: Hypersensitivity- Cross-sensitivity with other NSAIDs may exist¨ Pre- or

perioperative use- Known alcohol in tolerance Use cautiously in: 1) History of GI bleeding2)
Renal impairment (dosage reduction may be required) 3) Cardiovascular disease

Side effect:

CNS:drowsiness, abnormal thinking, dizziness, euphoria, headache—

RESP: asthma, dyspnea-

CV: edema, pallor, vasodilation-

GI: GI Bleeding, abnormal taste, diarrhea

Nursing implication:

 Monitor BP upon administration. < 90/80never administer. Refer to doctor.-

 Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk
for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria
 Assess pain (notetype, location, and intensity) prior to and1-2 hr following
administration.

42
Drug Study # 4
Generic Name: Ursodeoxycholic Acid
Brand Name: URSOFALK
Classification: gallstone-solubilizing drug
Dosage: 250 mg, 1 cap, P.O., BID

Mechanism of Action:

Drug reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones in patients
who want an alternative to surgery. Drug is very expensive however, and if the pt. stops taking it,
the gallstone tend to recur if the condition that gave rise to their formation does not change, for
these reasons, it has not supplanted surgical treatment by cholecystectomy.

Indications:

Ursofalk is indicated in the treatment of chronic cholestatic liver diseases

Contraindications:

Ursofalk must not be used in the presence of acute inflammation of the gallbladder and bile
ducts; and obstruction of biliary tract.

Adverse Reactions:

UDCA is generally well tolerated with few side effects. Diarrhea is the main reported side
effects. Increased cholestasis, nausea, vomiting and sleep disturbances.

Nursing Considerations:

History: allergy to bile salts, hepatic impairment, calcified stones, radiopaque stones, unremitting
acute cholecystitis, cholangitis, biliary obstruction, gallstone, pancreatitis, biliary-GI fistula,
pregnancy, lactation.

Physical: urea evaluation, abdominal examination, affect, orientation; skin color, lesions, LFTS,
hepatic and biliary radiological studies, biliary ultrasound.

43
Drug Study # 5

Generic name: Paracetamol

Brand name: Biogesic

Classification: anti-pyretics

Dosage: 300mg IVTT q’8 PRN for fever

Action: Produces analgesia by unknown mechanism, but it is centrally acting in the CNS by
increasing the pain threshold by inhibiting cyclooxygenase. Reduces fever by direct action on
hypothalamus heat-regulating center with consequent peripheral vasodilation, sweating, and
dissipation of heat. It provides temporary analgesia for mild to moderate pain.

Indication: Symptomatic relief of pain and fever.

Contraindication: Contraindicated in patients hypersensitive to drug. Use cautiously in patients

with long term alcohol use because therapeutic doses cause hepatotoxicity in these patients

Adverse reaction: Hematologic: Hemolytic anemia, leukopenia, neutropenia, pancytopenia, and

thrombocytopenia. Hepatic: liver damage, jaundice Metabolic: hypoglycemia Skin: rash,
urticuria

Nursing implication:

 Use liquid form for children and patients who have difficulty swallowing.
 In children, don’t exceed five dose sin 24 hours.
 Advise patient that drug is only for short term use and to consult the physician if giving
to children for longer than 5 days or adults for longer than 10 days.
 Advise patient or caregiver that many over the counter products contain acetaminophen;
be aware of this when calculating total daily dose.
 Warn patient that high doses or unsupervised long term use can cause liver damage

44
Drug Study # 6

Generic name: Lactose

Brand name: Cephulac

Classification: Osmotic laxative

Dosage: 30cc OD

Action: Lactulose is a semisynthetic disaccharide that is not absorbed from the gastrointestinal
tract

Indication: Chronic constipation and Systemic encephalopathy in patients with hepatic disease.

Contraindication: Contraindicated in Intestinal obstruction and Galactosaemia.

Adverse reaction: Abdominal cramps, Abdominal discomfort, abdominal distension, Flatulence,

Belching, Diarrhea, Nausea and vomiting.

Nursing implication:

 Mix with half a glass of water, milk or fruit juice to improve taste.
 May take up to 48 hours to act.
 Diarrhea may indicate the dose is too high.
 Evaluate therapeutic response: decreased constipation or blood ammonia level.
 Assess amount, color and consistency of stool.
 Advise to drink plenty of fluid while taking this medicine.

45
Drug Study # 7

Generic name: Metronidazole

Brand name: Flagyl

Classification: Antibiotic

Dosage: 500mg IV Drip q’8

Action: Inhibits growth of amoebae by binding to DNA, resulting in loss of helical structure,
strand breakage, inhibition of nucleic acid synthesis and cell death.

Indication: Acute infection with susceptible anaerobic bacteria Acuteintestinalamoebiasis.

Contraindication: contraindicated to Active organic disease of the CNS

Adverse reaction: Headache, Nausea, dry mouth, vomiting, diarrhea

Nursing implication:

 Observe the10 Rs before giving the drug.

 Instruct to take drug with food or milk to decrease GIupset
 Inform that drug may turn urine brown, don’t be alarmed

46
 NURSING CARE PLANS

Nursing Care Plan # 1

ASSESSMENT
Subjective:
“Dili ko ganahan mo kaon ma’am” as verbalized by the patient
Objective:
 Decreased of weight as evidence by from 45kg to 44kg noted
 BMI of 17.2 kg/m2 noted
 Poor skin turgor noted
 Body weakness noted
 Bowel movements of 2-3 times a week noted
DIAGNOSIS
Imbalanced Nutrition: Less Than Body Requirements related to loss of appetite.
PLANNING

Within 8 hours of nursing interventions the patient will demonstrate behaviors, lifestyle
changes to recover and/or keep appropriate weight.

Interventions Rationales

Ascertain healthy body weight for age Experts like a dietician can determine nitrogen balance
and height. Refer to a dietitian for as a measure of the nutritional status of the patient. A
complete nutrition assessment and negative nitrogen balance may mean protein
methods for nutritional support. malnutrition. The dietician can also determine the
patient’s daily requirements of specific nutrients to
promote sufficient nutritional intake.

Set appropriate short-term and long-term Patients may lose concern in addressing this dilemma
goals. without realistic short-term goals.

Provide a pleasant environment during A pleasing atmosphere helps in decreasing stress and is
mealtime. more favorable to eating.

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Promote proper positioning during Elevating the head of bed 30 degrees aids in swallowing
mealtime. and reduces risk for aspiration with eating.

Provide good oral hygiene and dentition. Oral hygiene has a positive effect on appetite and on
the taste of food. Dentures need to be clean,
fit comfortably, and be in the patient’s mouth to
encourage eating.

If patient lacks strength, schedule rest Nursing assistance with activities of daily living (ADLs)
periods before meals and open packages will conserve the patient’s energy for activities the
and cut up food for patient. patient values. Patients who take longer than one hour to
complete a meal may require assistance.

Provide companionship during mealtime. Attention to the social perspectives of eating is

important in both hospital and home settings.

Consider the use of seasoning for patients Seasoning may improve the flavor of the foods and
with changes in their sense of taste; if not attract eating.
contraindicated.

Consider six small nutrient-dense meals Eating small, frequent meals lessens the feeling of
instead of three larger meals daily to fullness and decreases the stimulus to vomit.
lessen the feeling of fullness.

Determine time of day when the patient’s Patients with liver disease often have their largest
appetite is at peak. Offer highest calorie appetite at breakfast time.
meal at that time.

Encourage family members to bring food Patients with specific ethnic or religious preferences or
from home to the hospital. restrictions may not consider foods from the hospital.

Offer high protein supplements based on Such supplements can be used to increase calories and
individual needs and capabilities. protein without conflict with voluntary food intake.

Offer liquid energy supplements like Energy supplementation has been shown to produce
Lipovitan. weight gain and reduce falls in frail elderly living in the
community.

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 Discourage caffeinated or carbonated These beverages will decrease hunger and lead to early
beverages. satiety.

Keep a high index of suspicion of Impaired immunity is a critical adjunct factor in

malnutrition as a causative factor in malnutrition-associated infections in all age groups.
infections.

Encourage exercise that is appropriate to Metabolism and utilization of nutrients are improved by
the age and condition of the patient. activity.

Consider the possible need for enteral or Nutritional support may be recommended for patients
parenteral nutritional support with the who are unable to maintain nutritional intake by the oral
patient, family, and caregiver, as route. If gastrointestinal tract is functioning well, enteral
appropriate. tube feedings are indicated. For those who cannot
tolerate enteral feedings, parenteral nutrition is
recommended.

Validate the patient’s feelings regarding Validation lets the patient know that the nurse has heard
the impact of current lifestyle, finances, and understands what was said, and it promotes the
and transportation on ability to obtain nurse-patient relationship.
nutritious food.

EVALUATION
The patient was able to demonstrate behavior, lifestyle changes to regain appropriate weight.
Therefore, goal was met.

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Nursing Care Plan # 2

ASSESSMENT
Subjective: “Maam dili ako katuyog nan tarong” as verbalized by the patient.
Objective:
 Restlessness noted
 4 hours of sleep with interruptions noted
 Frequent yawning noted
 Decreased in reaction time noted
 Drowsiness noted
DIAGNOSIS
Disturbed sleep pattern related to interruptions for therapeutics, monitoring, laboratory
test, other generated awakening.
PLANNING
After 8 hours of nursing intervention the patient will report improvement in sleep pattern.
NURSING INTERVENTION
Individual Intervention:
1. Position the client in comfortable position.
Rationale: To alleviate discomfort and promote sleep.
2. Provide comfort measures.
Rationale: to distract attention on pain
3. Assess sleep pattern.
Rationale: To provide comparative baseline.
4. Encourage client to express concerns when unable to sleep.
Rationale: Vasodilation of the veins a sleep, lazy effect, causing client to sleep.
5. Suggest abstaining from daytime naps.
Rationale: Because they impair ability to sleep at night.
6. Limiting fluid intake before sleeping
Rationale: To reduce need for night time elimination.
EVALUATION
Goal met. The patient reported improvement in sleep pattern.

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Nursing Care Plan # 3

ASSESSMENT

Subjective:
“Uno man ka delikado ako sakit maam?” as verbalized by the patient.
Objective:
 A diagnosis of Colon Cancer noted
 Asking questions noted
 Elementary graduate noted
DIAGNOSIS
Knowledge deficit regarding condition and treatment related to absence of information
PLANNING
After 4 hours of nursing intervention, patient explains disease state, recognizes need for
medications, and understands treatments.
INTERVENTION
1. Identify the learner: the patient, family, significant other.
Rationale: Some patient’s especially older adults or the terminally ill view themselves as
dependent on the caregiver, therefore will not allow themselves to be part of the educational
process.
2. Assess ability to learn or perform desired health-related care.
Rationale: Cognitive impairments must be recognized so an appropriate teaching plan can be
outlined.
3. Assess motivation and willingness of patient to learn.
Rationale: Learning requires energy. Patients must see a need or purpose for learning. They also
have the right to refuse educational services.
4. Determine priority of learning needs within the overall care plan.
Rationale: This is to know what needs to be discussed especially if the patient already has a
background about the situation. Knowing what to prioritize will help prevent wasting valuable
time.
5. Allow the patient to open up about previous experience and health teaching.
Rationale: Older patients often share life experiences to each learning session. They learn best
when teaching builds on previous knowledge and experience.
6. Observe and note existing misconceptions regarding material to be taught.

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Rationale: Assessment provides an important starting point in education. Knowledge serves to
correct faulty ideas.
7. Consider the patient’s learning style, especially if the patient has learned and retained
new information in the past.
Rationale: Every individual has his or her learning style, which must be a factor in planning an
educational program. Some may prefer written materials over visual materials, while others
prefer group sessions over an individual instruction. Matching the learner’s preferred style with
the educational method will facilitate success in mastery of knowledge.
8. Determine the patient’s self-efficacy to learn and apply new knowledge.
Rationale: Self-efficacy refers to a person’s confidence in his or her own ability to perform a
behavior. A first step in teaching may be to foster increased self-efficacy in the learner’s ability
to learn the desired information or skills. Some lifestyle changes.
9. Render physical comfort for the patient.
Rationale: Based on Maslow’s theory, basic physiological needs must be addressed before the
patient education. Ensuring physical comfort allows the patient to concentrate on what is being
discuss or demonstrated.
10. Grant a calm and peaceful environment without interruption.
Rationale: A calm environment allows the patient to concentrate and focus more completely.
11. Provide an atmosphere of respect, openness, trust, and collaboration.
Rationale: Conveying respect is especially important when providing education to patients with
different values and beliefs about health and illness.
12. Provide clear, thorough, and understandable explanations and demonstrations.
Rationale: Patients are better able to ask questions when they have basic information about what
to expect.
EVALUATION
Goal met. After 4 hours of nursing intervention, patient explained disease state,
recognized need for medications, and understands treatments.

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Nursing Care Plan #4

ASSESSMENT

Subjective:

“Usahay rako maligo mam kay lujahan man gud ko” as verbalized by the patient.

Objective:

 Slightly unpleasant odor noted

 Dirty clothe noted
 Unfixed and oily hair noted
 Oily face noted
 Dry skin noted
 Weakness due to Colon Cancer noted

DIAGNOSIS

Self-care deficit related to weakness and fatigue

PLANNING

Within 8 hours of nursing care, the patient will be able to perform personal hygiene
within level of own ability

INTERVENTIONS

1. Assess patient’s ability to bathe self through direct observation noting specific
deficits and their causes
Rationale: use of function provides complementary assessment data for goal and
intervention planning

2. Plan activities to prevent fatigue during bathing

Rationale: energy conservation increases activity intolerance and promotes self-care

3. Instruct patient to select bath time when he is rested and unhurried

Rationale: hurrying may results to accidents and the energy required for these activities
may be substantial

4. Encourage independence, but intervene when patient cannot perform

Rationale: an appropriate level of assistive care can prevent injury with activities without
causing frustration

5. Use consistent routines and allowed adequate time for patient to complete tasks
Rationale: this helps patient organize and carry out self-care skills.

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 6. Provide privacy during bathing/dressing as appropriate
Rationale: the need for privacy is fundamental for most patients.

7. Encourage use of clothing one size larger

Rationale: this ensures easier dressing and comfort

EVALUATION

Goal met. After 8 hours of rendering nursing care plan, the patient was able to perform
personal hygiene within level of own ability.

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Nursing Care Plan # 5

ASSESSMENT

Subjective: “kaisa pa gajud jaun sija naka-libang sugod na hospital” as verbalized by the S.O.

Objective:

 Bloated abdomen noted

 Hypoactive bowel sound noted (3 bowel sounds per minute)
 4th day of hospitalization noted
 Food intake of low-fiber and high-fat diet (half cup of rice and half of fish)
 Fluid intake of 2-4 glasses of water noted

DIAGNOSIS

Constipation related to insufficient fiber or fluid intake

PLANNING

Within 24 hours, patient will be able to verbalize relief from discomfort of constipation.

INTERVENTIONS

Interventions Rationales

Encourage the patient to take in fluid 2000 to 3000 Sufficient fluid is needed to keep the
mL/day, if not contraindicated medically. fecal mass soft. But take note of some
patients or older patients having
cardiovascular limitations requiring
less fluid intake.

Assist patient to take at least 20 g of dietary fiber (e.g., Fiber adds bulk to the stool and makes
raw fruits, fresh vegetable, whole grains) per day. defecation easier because it passes
through the intestine essentially
unchanged.

Urge patient for some physical activity and exercise. Movement promotes peristalsis.
Consider isometric abdominal and gluteal exercises. Abdominal exercises strengthen
abdominal muscles that facilitate
defecation.

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Encourage a regular period for elimination. Most people defecate following the
first daily meal or coffee, as a result of
the gastrocolic reflex.

Digitally eliminate the fecal impaction. Stool that remains in the rectum for
long periods becomes dry and hard;
debilitated patients, especially older
patients, may not be able to pass these
stools without manual assistance.

EVALUATION

The goal was met. After 24 hours, patient verbalized relief from discomfort of
constipation.

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Nursing Care Plan # 6

ASSESSMENT

Objective:

 Weakness and fatigue noted

 Need assistance in sitting down noted
 Weakness due to Colon Cancer noted
 Hemoglobin level of 4.3 g/dL noted

DIAGNOSIS

Activity intolerance related to generalized body weakness secondary to decreased

hemoglobin level as evidenced by 4.3 g/dLin the laboratory result.

PLANNING

Within 24 hours of nursing intervention the patient will be able to increase energy level.

INTERVENTIONS

Interventions Rationales

Establish guidelines and goals of Motivation and cooperation are enhanced if the patient
activity with the patient and/or participates in goal setting.
SO.

Evaluate the need for additional Coordinated efforts are more meaningful and effective in
help at home. assisting the patient in conserving energy.

Have the patient perform the Helps in increasing the tolerance for the activity.
activity more slowly, in a longer
time with more rest or pauses, or
with assistance if necessary.

Gradually increase activity with Gradual progression of the activity prevents overexertion.
active range-of-motion exercises
in bed, increasing to sitting and
then standing.

57
Dangle the legs from the bed Prevents orthostatic hypotension.
side for 10 to 15 minutes.

Refrain from performing Patient with limited activity tolerance need to prioritize
nonessential activities or important task first.
procedures.

Assist with ADLs while Assisting the patient with ADLs allows conservation of
avoiding patient dependency. energy. Carefully balance provision of
assistance; facilitating progressive endurance will
ultimately enhance the patient’s activity tolerance and
self-esteem.

Provide bedside commode as Use of commode requires less energy expenditure than
indicated. using a bedpan or ambulating to the bathroom.

Encourage physical activity Helps promote a sense of autonomy while being realistic
consistent with the patient’s about capabilities.
energy levels.

Instruct patient to plan activities Activities should be planned ahead to coincide with the
for times when they have the patient’s peak energy level. If the goal is too low,
most energy. negotiate.

Encourage verbalization of This helps the patient to cope. Acknowledgment that

feelings regarding limitations. living with activity intolerance is both physically and
emotionally difficult.

EVALUATION

Goal was met. After 24hours of rendering nursing care plan, patient verbalized that her
fatigue lessened.

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Nursing Care Plan #7

ASSESSMENT

Objective:

 Increased WBC with the level of 15.7 x 109/L noted

 decreased of weight from 45kg-44kg

DIAGNOSIS

Infection related to Colon Cancer as evidenced by increased WBC with the result of 15.7
x 109/L.

PLANNING

Within 8 hours of nursing intervention, the patient will be able to verbalize understanding
of individual causative risk factors.

INTERVENTIONS

Nursing Interventions Rationale

These laboratory values are closely linked to

Routinely monitor the patient’s white blood
the patient’s nutritional status and immune
cell count, serum protein, and serum albumin.
function.

Take note of the patient’s current medications, Some medications and treatment modalities
like corticosteroids and anti-neoplastic agents. causes immunosuppression.

People with insufficient immunization may not

Check the patient’s immunization history.
have adequate acquired immunity.

Neutropenic patients may not have adequate

Assess temperature of neutropenic clients
inflammatory response. In most cases, fever is
every 4 hours.
the only symptom they’ll show.

Monitor the patient for any signs of swelling,

purulent discharge or presence of pain from These are the classic signs of infection.
wounds, injuries, catheters or drains.

Wash hands and encourage the patient to do

Hand washing is an effective technique to
the same. Dry hands with a paper towel after
prevent the spread of infection. Dry surfaces
washing.
are better in preventing transfer of

59
 microorganisms.

It helps thin out secretions and replace fluid

Encourage patient to increase fluid intake if loss during fever. It also prevents stasis of urine
not contraindicated. by promoting diluted urine and frequent
emptying of bladder.

It can reduce stress and boost the immune

Encourage adequate rest.
system.

A balanced intake of omega 3 and omega 6

fatty acids, protein, vitamins A, C and E, zinc
Encourage patient to eat a balanced diet.
and iron is essential in reducing risk of
infection.

It prevents stasis of secretions and pathogens in

Help patient change positions frequently.
the lungs and bronchial tree.

Strictly observe sterile technique when

The Genito-Urinary tract is one of the most
inserting urinary catheter. Ensure that catheters
common site for nosocomial infections.
are cared for every shift.

Wear gloves during any contact with mucus, It prevents the transfer of microorganisms that
blood, and other body fluids. Use goggles are already on the hands and to protect the
when appropriate. hands from becoming contaminated.

This is to limit the risk of the patient being

Limit the number of visitors allowed.
exposed to pathogens.

EVALUATION

After 8 hours of nursing intervention the patient verbalized and understands the
individual causative risk factors.

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Nursing Care Plan #8

ASSESSMENT

Subjective:

“sakit ako tijan maam” as verbalized by the patient

Objective:

 Guarding behavior noted

 Positioning to ease pain noted
 Pain scale of 7/10 noted

DIAGNOSIS

Acute pain related to tissue compression and obstruction secondary to colon cancer

PLANNING

Within 30 minutes to 1 hour of rendering effective nursing interventions, the client will
be able to cope with incompletely relieved pain from pain scale of 7/10 to 0-3/10

INTERVENTION RATIONALE
 Assessed for referred pain Helps determine possibility of underlying
condition
 Observed and noted non verbal cues and Observations may be congruent with verbal
pain behavior reports or may be only indicator present when
client can’t express feelings.
 Assessed intensity and characteristics of To rule out degree and type of pain experienced
pain by client
 Provided comfort measures such as To promote non-pharmacological pain
positioning and back rubbing management
 Assisted and educated client on relaxation Techniques are used to bring about a state of
techniques such as breathing exercises physical and mental awareness and tranquility.
The goal of these techniques is to reduce tension,
subsequently reducing pain

EVALUATION

Goal met as the client cooperates with nursing interventions done and is able to cope
effectively to ease pain felt.

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 APPENDICES

GENOGRAM

Ulcer

Heart
Colon Disease
Cancer

LEGEND:

FATHER

U
MOTHER
l
c PATIENT
e
r SISTER

BROTHER

DEAD

62
LABORATORY RESULTS

HEMATOLOGY SEPTEMBER 23, 2018

EXAM NAME RESULT NORMAL SIGNIFICANCE

VALUES
WBC H 15.7 4.00-10.00 Increase in WBC indicates the
presence of infection in the
patient’s body
NEUTROPHIL H 82.9 50.0-70.0 Neutrophilia
LYMPHOCYTE L 10.7 20.0-40.0 Low lymphocyte count
(Lymphocytopenia) could
indicate that you are at greater
risk of developing infections
because your lymphocytes are
low
MONOCYTE 4.1 3.0-12.0 Normal
EOSINOPHIL 1.8 0.5-5.0 Normal
BASOPHIL H 0.5 0.0-0.1 Basophilia
RBC L 1.58 3.50-5.00 Anemia
HEMOGLOBIN L 4.3 12.0-16.0 Anemia
HEMATOCRIT L 15.0 37.0-47.0 Anemia
MCV 95 80.0-100.0 Normal
MCH 27.1 27.0-34.0 Normal
MCHC L 28.5 31.0-37.0 Anemia
PLATELET 459 150-400 Secondary Thrombocytosis
COUNT
(High platelet count is the first
sign of cancer.)
RDW 14.2 11.0-16.0 Normal

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Blood Chemistry SEPTEMBER 23, 2018

EXAM NAME RESULT NORMAL SIGIFICANCE

VALUES
CREATININE 0.76 mg/dL 0.6-1.2 Normal
SGOT/AST H 103.70 U/L 0.4 Indicates liver damage
SODIUM L 129.50 mmol/L 135-145 Hyponatremia
POTASSIUM 5.06 mmol/L 3.5-5.5 Normal
CHLORIDE 103.00 mmol/L 98-108 Normal

Blood Chemistry SEPTEMBER 24, 2018

EXAM NAME RESULT NORMAL SIGNIFICANCE

VALUES
SGPT/ALT 73.84 0-34 U/L Indicates liver damage

SEPTEMBER 23, 2018

Medical Imaging Result

Examination Performed: Chest AP

Clinical Expression: Obstructive Jaundice

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DISCHARGE PLAN

Upon discharge from the hospital, Patient Y and her significant others will be given home
care instructions containing in the following:

 Anti-nausea medicine may be given to calm your stomach

and prevent vomiting.
 Prescription pain medicine may be given. Do not wait until
the pain is severe before you take this medicine.
 Take your medicine as directed. Contact your healthcare
provider if you think your medicine is not helping or if you
MEDICATIONS have side effects. Tell him or her if you are allergic to any
medicine.
 Keep a list of the medicines, vitamins, and herbs you take.
 Include the amounts, and when and why you take them.
 Bring the list or the pill bottles to follow-up visits.
 Carry your medicine list with you in case of an emergency.

 Promote use of relaxation techniques to decrease stress and

TREATMENT anxiety due to the illness.
 Follow treatment regimen specially take home medications.
 Do not smoke: Nicotine can damage blood vessels and make
it more difficult to manage your colorectal cancer. Smoking
also increases your risk for new or returning cancer and
delays healing after treatment.
HEALTH TEACHING  Limit or do not drink alcohol as directed: Men should limit
alcohol to 2 drinks per day. Women should limit alcohol to 1
drink per day. A drink of alcohol is 12 ounces of beer, 5
ounces of wine, or 1½ ounces of liquor.
 Drink liquids as directed: Ask how much liquid to drink each

65
 day and which liquids are best for you. If you have nausea or
diarrhea from cancer treatment, extra liquids may help
decrease your risk for dehydration.
 Exercise as directed: Ask about the best exercise plan for
you. Exercise may improve your energy levels and appetite.

 Follow up with your oncologist as directed: You will need to

see your oncologist for ongoing treatment and follow-up.
OUT-PATIENT Your healthcare provider may want you to have a yearly
CHECK-UP colonoscopy to check for colorectal cancer. Write down your
questions so you remember to ask them during your visits.

 Eat healthy foods: Healthy foods include fruits, vegetables,

whole-grain breads, low-fat dairy products, beans, lean
meats, and fish. You may need to change what you eat
DIET during treatment. Do not eat foods or drink liquids that cause
gas, such as cabbage, beans, onions, or soda. A dietitian may
help to plan the best meals and snacks for you.

 Encourage patient to be more faithful and have trust in God

SPIRITUAL  Encourage patient and SO to pray for the patient’s fast
recovery.

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