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Capitol University

College of Nursing

RECTAL PROLAPSE SECONDARY TO


RECTAL NEW GROWTH PROBABLY
MALIGNANT
(NEOPLASM OR POLYPS)

In partial fulfillment of the requirements


Of RLE 7 1st semester, SY 2010-2011

PRESENTED BY:
Katrene Lequigan

PRESENTED TO:
Ma. Liwayway Salcedo, RN
CLINCAL INSTRUCTOR

AUGUST 2010
Table of Contents

Introduction……………………………………………………………………………..

Client’s Profile………………………………………………………………………….

Socio-demographic data……………………………………………………..

Vital Signs……………………………………………………………………..

Physical Assessment………………………………………………………...

Anatomy and Physiology…………………………………………………………….

Pathophysiology………………………………………………………………………

Laboratory Tests and Results……………………………………………………...

Nursing Care Plans………………………………………………………………….

Drug Studies…………………………………………………………………………

Discharge Planning…………………………………………………………………

Learning Experiences………………………………………………………………

References.......................................................................................................
Introduction

In choosing an individual case study was very easy to find and choose but
in making it was very hard. But in making ICS is not about only to pass
something or to do it for a requirement but the essential thing there is what you
learn and being contented and successful of what you have studied. For me in
choosing Rectal Prolapsed secondary to rectal new growth was very challenging.
I was very curious about the disease condition that’s why I choose it.

Rectal cancer usually develops over several years, first growing as a


precancerous growth called a polyp. Some polyps have the ability to turn into
cancer and begin to grow and penetrate the wall of the rectum. A polyp is an
abnormal growth. Polyps can vary in size, shape and location; they may be
single or multiple. Some polyps are flat and some look like a grape with a narrow
stalk, or they may take the form of many fine projections, resembling the pile of a
carpet. Tumors of the colon and rectum are growths arising from the inner wall of
the large intestine. Malignant tumors of the large intestine are called cancers.
Cancer cells can also break away and spread to other parts of the body (such as
liver and lung) where new tumors form.
(http://www.emedicinehealth.com/rectal_cancer/page3_em.htm)

The incidence rate of rectal cancer is highest in the westernized countries


of North America, northern Europe, Australia, and New Zealand. Intermediate
rates are found in southern Europe, and there are low rates in Africa, Asia, and
South America. Rectal cancer shows less international variation than colon
cancer. Usually develops over several years, first growing as a precancerous
growth. The rate of risk rises for populations that migrate from low-risk to high-
risk areas, as demonstrated clearly in Japanese immigrants in Hawaii and the
continental United States, where rates among immigrants have risen to
approximately those of the native population. The 18-fold difference in rectal
cancer rates between the country with the highest rate and the country with the
lowest rate is significantly less than the 60-fold difference in colon cancer rates.
This may reflect dietary differences in fat and fiber intake in different countries.
These differences diminish when a western-type diet is adopted. Of patients with
rectal carcinoma, 90% are older than 50 years. Only 5% of patients are younger
than 40 years. Polyps are one of the most common conditions affecting the colon
and rectum, occurring in 15 to 20 percent of the adult population.
(http://emedicine.medscape.com/article/373324-overview)
Your risk of it depends on genetic and lifestyle and factor you can’t control
is the age-older than fifty years old. Malignant tumors of the large bowel usually
occur after 50 years of age, are slightly more frequent in women than in men,
and are common in the Western world. They are rare in children; clustering in
families is common. Drinking excess alcohol and smoking may also increase the
chances of you developing polyps. Women between ages 45 and 60 develop
common polypoid adenomas. The incidence of rectal polyps rises in both sexes
after age 70. (http://medical-dictionary.thefreedictionary.com/Rectal+neoplasm)

Patient may manifest rectal bleeding, changed in bowel habits,


constipation or diarrhea. A polyp in the rectum usually has no symptoms and is
usually found by chance. Larger polyps tend to bleed quite easily; the blood can
be mixed with the stools or can be visible on their surface. You may also notice a
clear mucus, which is passed with the stool. On rare occasions the bowel may
become partially or completely blocked and you may then experience symptoms,
such as constipation, diarrhea, abdominal pain, bloating and in severe cases
vomiting. Bleeding from the anus, the anus is the opening at the end of the
digestive tract where stool leaves the body. You might notice blood on your
underwear or on toilet paper after you’ve had a bowel movements; Constipation
or diarrhea that lasts more than a week can cause rectal prolapsed; Blood in the
stool. Blood can make stool look black, or it can show up as red streaks in the
stool. (http://nursingcrib.com/nursing-care-plan/nursing-care-plan-colon-cancer-
colorectal-cancer/)

………………………………………………………..

This case study has come to realization with the primordial aim of

understanding the disease condition in order to formulate plans of effective

nursing interventions that would help bring back the patient to the normal health

status in a gradual stage. Nursing care has been rendered to patient for one-duty

shift. Hence, evaluation of the effectivity and efficiency of such nursing

interventions was not well established.


Client’s Profile

Socio-demographic Data

Patient X is a 56-year-old, female, a Filipino citizen, from Bangun, Lingati,


Bukidnon. She is religiously affiliated to Baptist religious group. She is married
with 9 children and had home delivery assisted by hilot. Her primary language is
Cebuano and she is a high school graduate. She is a chronic spicy-food lover
and drinks coffee 1 cup everyday. She also has inherited diabetes mellitus and
hypertension.

One year ago, patient X experienced and manifests chronic constipation


and abdominal pain. After several months she noticed gradual protruding mass in
anal area, blood in her stool after she defecated and with some whitish
secretions. However, due to financial constraint the patient does self medication
and sought consultation to there nearest health institution and referred to transfer
at NMMC surgical ward, admitted on August 3, 2010. She was diagnosed of
rectal prolapsed secondary to rectal new growth probably malignant. Then on
August 10, 2010 she underwent to proctosigmoidoscopy, barium enema and x-
ray was conducted to examine the colon, and underwent ultrasound of liver.

Patient X’s age is 56 years old; her mobility status is limited due to her age
and condition. She requires special nutritional needs appropriate for her age –
low fat especially low saturated fats, and sugar. She also needs to eat
vegetables and fruits.

Vital Signs

Temperature: 37.1 degrees Celcius Respiratory Rate: 22 cpm

Pulse Rate: 78 bpm Blood Pressure: 100/70 mmHg

Physical Assessment

This portion of the case study will present the deviation from the abnormal
findings of the physical assessment presented in a cephalo-caudal approach.
These data are then considered in the making of the nursing care plan.

Head

Aspect of Consideration Findings

Hair Dry Hair

Eyes
Aspect of Consideration Findings

Conjunctiva Pale

Visual Acuity Nearsighted

Wears eyeglasses

Mouth

Aspect of Consideration Findings

Lips Pallor and dry

Teeth Missing teeth with dentures

Skin

Aspect of Consideration Findings

General color Pallor

Texture Rough

Moisture Dry

Abdomen

Aspect of Consideration Findings

Percussion Fluid wave

Bowel sounds Hyperactive

Elimination Pattern

Aspect of Consideration Findings

Usual bowel Pattern 3 -4 times per day, brown or green


colored stool, watery stool with
blood, pain at anal area during and
after defecation

Bowel sounds Hyperactive

Others: LBM August 19, 2010

Problems before Experienced constipation


Protruding mass at anal area
probably rectal prolapse

Nutrition and Metabolic Pattern:

Weight: weight loss, from 57 kg to 43 kg

Activities of Daily Living /Mobility Status

0- Total independence 3- Assist with device and person

1- Assist with device 4- Total dependence

2- Assist with person

Feeding: 0 Meal Preparation: 4 Bed Mobility: 2

Bathing: 2 Cleaning: 4 Chair /toilet transfer: 2

Dressing; 2 Laundry: 4 Ambulation: 2

Grooming: 2 Toileting: 2 ROM: 0

Cognitive – Perceptual Pattern

Aspect of Consideration Findings

Appropriate behavior/ communication Need adequate rest due to


weakness

Emotional state Worried, irritable

Pain

 at the anal area during and after defecation and occasional abdominal
pain during bedtime

 pain scale of 3/10

Sexuality-Reproductive Pattern

Menstrual pattern: Menopause


LPM: 46 years old

Pregnancy History: home delivery, assisted by hilot

Anatomy and Physiology


The Large Intestine
The large intestine is about 1.5 m (5 ft) long and is characterized by the
following components:
• The cecum is a dead-end pouch at the beginning of the large intestine,
just below the ileocecal valve.
• The appendix (vermiform appendix) is an 8 cm (3 in) long fingerlike
attachment to the cecum that contains lymphoid tissue and serves
immunity functions.
• The colon, representing the greater part of the large intestine, consists of
four sections: the ascending, transverse, descending, and sigmoid colons.
At regular distances along the colon, the smooth muscle of the muscularis
layer causes the intestinal wall to gather, producing a series of pouches
called haustra. The epithelium facing the lumen of the colon is covered with
openings of tubular intestinal glands that penetrate deep into the thick
mucosa. The glands consist of absorptive cells that absorb water and
goblet cells that secrete mucus. The mucus lubricates the walls of the large
intestine to smooth the passage of feces. The colon is approximately five
feet (1.5 meters) in length, begins at the ileocecal valve, and ends at the
rectosigmoid junction. Arterial blood supply to the colon from cecum to
splenic flexure is through the superior mesenteric artery which gives rise to
the ileocolic, right colic, and middle colic arteries. The left and sigmoid
colon is supplied by the inferior mesenteric artery which gives rise to the left
colic and sigmoidal arteries. There can be several anatomic variations in
the colic arteries including absent middle colic artery, absent right colic
artery, common trunk for right and ileocolic artery, and the presence of an
Arc of Riolan between the middle and left colic artery. The colonic wall
histologically from lumen outward consists of: (1) a simple columnar
epithelium which forms crypts, (2) lamina propria, (3) muscularis mucosa,
(4) submucosa, (5) muscularis propria formed by an inner circular and outer
longitudinal layer of smooth muscle, and (6) serosa. The typical colonic
malignancy is an adenocarcinoma. Once the neoplastic epithelial cells
penetrate the muscularis mucosa and into the submucosa, a malignant (the
ability to metastasize) adenocarcinoma is formed. The mainstay for
treatment is operative resection of the involved colonic segment along with
the draining lymph nodes located in the mesentery. Neoplastic cells
confined by the muscularis mucosa are termed carcinoma-in-situ or severe
dysplasia and are not as yet malignant thereby typically eliminating the
need for segmental colonic resection.
The outer longitudinal smooth muscle of the colon thickens in three
locations called tenia coli. The rectosigmoid junction is the point at which the
three tenia fan out and form a complete outer longitudinal layer. This anatomic
point has clinical significance. Carcinomas proximal to this point are colonic;
whereas distal tumors are rectal and as such may benefit from adjuvant
radiation therapy. Likewise, operative resection for classic sigmoid diverticular
disease should include the rectosigmoid junction with the anastomosis located
at the upper rectum. The function of the colon is (1) absorption of water and
electrolytes, and (2) propulsion and storage of unabsorbed fecal waste for
evacuation. Approximately one liter of fluid chyme enters the cecum each day
with an average of only 100cc excreted in the feces. Parasympathetc
innervation by preganglionic vagal fibers and pelvic fibers result in colonic
motility. Sympathetic innervation by the superior mesenteric plexus, inferior
mesenteric plexus, and the hypogastric plexus inhibits colonic motility. It
appears that the major control of motility depends on the colonic wall intrinsic
plexus (myenteric or Auerbach’s/submucous or Meissner’s). An absence of
intrinsic plexuses occurs in Hirschsprung’s Disease resulting in tonic wall
contraction and functional obstruction.
The rectum is the last 20 cm (8 in) of the large intestine. The mucosa in the
rectum forms longitudinal folds called anal columns. The rectum is the terminal
portion of the large intestine beginning at the confluence of the three tenia coli
of the sigmoid colon and ending at the anal canal. Generally the rectum is 15
cm in length, is intraperitoneal at its proximal and anterior end, and is
extraperitoneal at its distal and posterior end. The epithelial lining or mucosa of
the rectum is of a simple columnar mucous secreting variety.
The anal canal, the last 3 cm (1 in) of the rectum, opens to the exterior at the
anus. An involuntary (smooth) muscle, the interior anal sphincter, and a
voluntary (skeletal) muscle, the external anal sphincter, control the release of
the feces through the anus. The anal canal begins a few centimeters proximal
to the classic and well visualized dentate line and it ends at the anal verge.
The anal canal is about 5 cm in length. Histologically the proximal end of the
anal canal is the point at which the columnar epithelium of the rectum becomes
a transitional epithelium. This epithelium transitions to a stratified squamous
variety at the dentate line. The distal most end of the anal canal is the anal
verge which is the point where the stratified squamous epithelium becomes
true skin marked by the presence of hair follicles and sweat glands. The anal
verge is readily identified by noting the point at which hair shafts are seen. The
anoderm is a term used to describe the zone between the dentate line and the
anal verge. Perianal skin then describes the anatomic area beyond the anal
verge. Malignancies of the perianal skin are typical skin cancers usually
squamous cell carcinomas. Anal canal carcinomas are described as
epidermoid carcinoma, squamous cell carcinoma, cloacogenic carcinoma, or
baseloid carcinoma depending on their particular histologic features. The
importance of locating and anatomically defining the particular malignancy of
the anorectal region is in their treatment.

The functions of the large intestine include


• Mechanical digestion. Rhythmic contractions of the large intestine produce
a form of segmentation called haustral contractions in which food residues
are mixed and forced to move from one haustrum to the next. Peristaltic
contractions produce mass movements of larger amounts of material.
• Chemical digestion. Digestion occurs as a result of bacteria that colonize
the large intestine. They break down indigestible material by fermentation,
releasing various gases. Vitamin K and certain B vitamins are also
produced by bacterial activity.
• Absorption.Vitamins B and K, some electrolytes (Na+ and Cl−), and most
of the remaining water is absorbed by the large intestine.
• Defecation. Mass movement of feces into the rectum stimulates a
defecation reflex that opens the internal anal sphincter. Unless the external
and sphincter is voluntarily closed, feces are evacuated through the anus.

Pathophysiology
Predisposing
Precipitating Factors:
Factors: refer to
refer to figure B
figure A
Pathologic Report:
Rectal new growth
positive for
(neoplasm or Polyps)
malignancy

Developed chronically Intramucosal Uncontrollable


in the rectum epithelial lesion cell formation

Invading of
Formation of muscularis mucosa, Invading of Fatty
bowel mass of regional lymph distant site liver
tissue arises nodes at the especially liver grade II
from bowel wall rectum, vascular
structure
Attack
immune
Anemia of
Protrudes into the system
intestinal track
lumen and grow lesion
slowly (large)
Partial
Constrict the obstruction
intestinal lumen

Prolapsed through Blood in


Prolonged
the anus stool
constipation
and straining
Watery Abdomi
stool nal pain
White
and
mucu
cramps Nause
s
Diarr a/vom
secret
hea iting
ions

Electrol
yte
imbalan
ce Weig
ht
loss

Rectal
prolapsed

Predisposing Factors (figure A.)


Etiologic Factors Actual Rationale

Age: common in person Patient X is an Elderly person tend to be more


at all ages with mean age elderly, most likely at risk on developing rectal
of 50 years old and she is more prone prolapsed secondary to rectal
above on having rectal neoplasm
prolapsed
secondary to
rectal neoplasm,
age 56 years old

Gender: Recent studies Patient X’s gender Women are more prone to
found out that the female is female with 9 develop cancer than men.
is most commonly children
affected to it, with
multiple pregnancies

Lifestyle: impaired Patient X has Foreign studies found out that


physical activity; high fat limited physical impaired physical activity, high
diet, spicy-food lover activity and eats fat diet, spicy food lover greatly
fatty and spicy and prolong straining increase
foods the risk of developing the
Problem: constipation Patient disease
X
and straining experienced
prolonged
straining before
due to
constipation

Precipitating Factors (figure B.)

Etiologic Factors Actual Rationale


Developing abnormal Patient X 1 year prior to admission sudden
buildup of polyps or experienced onset of rectal bleeding
neoplasm in the rectum constipation, associated with severe pain and
abdominal pain, gradually protruding mass
and blood in the
stool, watery
stool, vomiting
and fever,
protruded mass in
the rectum

Laboratory Result
Hematology Report
8/3/10 8/8/10 8/9/10 8/12/10 8/13/10 8/17/10

WBC 13.6 12.4 14.3 19.5

5.0-10.0
10^3/uL

RBC 2.87 3.61 3.86 3.21

4.2-5.4
10^6/uL

Hgb 12.0- 10.9 7.2 8.2 9.4 10.0 8.3


16.0 g/dL

Hct 37.0-47.0 33.5 23.1 25.1 29.0 30.9 26.1


%

MCV 82.0- 76.5 80.5 80.3 80.1 81.3


98.0 fL

MCH 27.0- 24.9 25.1 26.0 25.9 25.9


31.0 pg

RDW-CV 21.4 21.6


12.0-17.0 %

PDW 9.0- 7.4 7.2 7.1 6.9 6.9


16.0 fL

MPV 8.0- 7.6 7.5 7.5 7.4 7.4


12.0 fL

Platelet 150- 640 532 450 468 510


400 10^3/uL

Lymphocyt 15.4 11.3


e

17.4-48.2 %

Eosinophils 0.5 0.2


1.0-3.0 %

Neutrophil 78.2
43.4-76.2 %

Monocyte 11.6
4.5-10.5 %

WBC Increase in various infections.


RBC Decreased RBC is usually seen in anemia of any cause with the possible
exception of thalassemia minor, where a mild or borderline anemia is seen with a
high or borderline-high RBC.

HGB A low hemoglobin is referred to as anemia; nutritional deficiency (iron,


vitamin B12, folate)

HCT A low hematocrit is referred to as being anemic; nutritional deficiency (iron,


vitamin B12, folate)

MCV Microcytic/hypochromic anemia (decreased MCV) Iron deficiency


(common); Anemia of chronic disease (uncommonly microcytic)

MCH Microcytic/hypochromic anemia (decreased MCH) Iron deficiency


(common); Anemia of chronic disease (uncommonly microcytic)

RDW-CV The RDW may also be useful in monitoring the results of hematinic
therapy for iron-deficiency or megaloblastic anemias.

MPV Mean platelet volume (MPV) is a machine-calculated measurement of the


average size of your platelets. New platelets are larger, and an increased MPV
occurs when increased numbers of platelets are being produced. MPV gives your
doctor information about platelet production in your bone marrow.

PLATELET Thrombocytosis is seen in many inflammatory disorders and


myeloproliferative states, as well as in acute or chronic blood loss, hemolytic
anemias, carcinomatosis, status post-splenectomy, post- exercise, etc.

LYMPHOCYTE Lymphopenia is characteristic of AIDS. It is also seen in acute


infections, Hodgkin's disease, systemic lupus, renal failure, carcinomatosis, and
with administration of corticosteroids, lithium, mechlorethamine, methysergide,
niacin, and ionizing irradiation. Of all hematopoietic cells lymphocytes are the
most sensitive to whole-body irradiation, and their count is the first to fall in
radiation sickness.

EOSINOPHILS Eosinopenia is seen in the early phase of acute insults, such as


shock, major pyogenic infections, trauma, surgery, etc. Drugs producing
eosinopenia include corticosteroids, epinephrine, methysergide, niacin,
niacinamide, and procainamide.

NEUTROPHIL Neutrophilia is seen in any acute insult to the body, whether


infectious or not. Marked neutrophilia (>25,000/µL) brings up the problem of
hematologic malignancy (leukemia, myelofibrosis) versus reactive leukocytosis,
including "leukemoid reactions." Laboratory work-up of this problem may include
expert review of the peripheral smear, leukocyte alkaline phosphatase, and
cytogenetic analysis of peripheral blood or marrow granulocytes. Without
cytogenetic analysis, bone marrrow aspiration and biopsy is of limited value and
will not by itself establish the diagnosis of chronic myelocytic leukemia versus
leukemoid reaction.

MONOCYTE Monocytosis is seen in the recovery phase of many acute


infections. It is also seen in diseases characterized by chronic granulomatous
inflammation (TB, syphilis, brucellosis, Crohn's disease, and sarcoidosis),
ulcerative colitis, systemic lupus, rheumatoid arthritis, polyarteritis nodosa, and
many hematologic neoplasms. Poisoning by carbon disulfide, phosphorus, and
tetrachloroethane, as well as administration of griseofulvin, haloperidol, and
methsuximide, may cause monocytosis.

Blood Chemistry Result

8/3/10 8/9/10 8/12/10 8/17/10

Glucose 59.9- 117.7 129.0


110.1 mg/dL

BUN 4.5-23.5 33.8


mg/dL

Albumin 3.70- 2.77 2.65


5.20 g/dL

Blood Sugar 117.7


60-110 mgs. %

Potassium 3.5- 2.99


5.3 mmol/L

GLUCOSE Hyperglycemia can be diagnosed only in relation to time elapsed


after meals and after ruling out spurious influences (especially drugs, including
caffeine, corticosteroids, estrogens, indomethacin, oral contraceptives, lithium,
phenytoin, furosemide, thiazides, thyroxine, and many more). Previously, the
diagnosis of diabetes mellitus was made by demonstrating a fasting blood
glucose >140 mg/dL (7.8mmol/L) and/or 2-hour postprandial glucose >200 mg/dL
(11.1 mmol/L) on more than one occasion.

BUN Decreased serum urea nitrogen (BUN) is seen in high carbohydrate/low


protein diets, states characterized by increased anabolic demand (late
pregnancy, infancy, acromegaly), malabsorption states, and severe liver
damage.

ALBUMIN Decreased serum albumin is seen in states of decreased synthesis


(malnutrition, malabsorption, liver disease, and other chronic diseases),
increased loss (nephrotic syndrome, many GI conditions, thermal burns, etc.),
and increased catabolism (thyrotoxicosis, cancer chemotherapy, Cushing's
disease, familial hypoproteinemia).

POTASSIUM Decreased levels of potassium indicate hypokalemia. Decreased


levels may occur in a number of conditions, particularly: dehydration, vomiting,
diarrhea, deficient potassium intake (rare).

Examination Results
8/3/10 8/12/10 8/17/10

Prothrombin 100 % 76 % 88.6 %


Activity (Therapeutic
range: 0-20 %)

APTT (activated 41.1 secs.


partial thrombin
time) Normal rate:
23.4-38.5 sec

Protime (Normal 16.4 sec.


rate: 10.2-15.2 sec.)

PROTHROMBIN ACTIVTY A prolonged, or increased, PT means that your blood


is taking too long to form a clot. This may be caused by conditions such as liver
disease, vitamin K deficiency or a coagulation factor deficiency.

APTT A prolonged PTT means that clotting is taking longer to occur than
expected and may be caused by a variety of factors (see the list below). Often,
this suggests that there may be a coagulation factor deficiency or a specific or
nonspecific inhibitor affecting the body’s clotting ability. Coagulation factor
deficiencies may be acquired or inherited. Several factors are Vitamin K
dependent. If a person has liver disease, for instance, or more rarely a Vitamin K
deficiency, he may have one or more factor deficiencies. Inherited factor
deficiencies may affect the quantity and/or function of the factor produced.

PROTIME The prothrombin time (PT) test measures how long it takes for a clot
to form in a sample of blood. In the body, the clotting process involves a series of
sequential chemical reactions called the coagulation cascade, in which
coagulation or “clotting” factors are activated one after another and result in the
formation of a clot. Prothrombin is one of the coagulation factors produced by the
liver. One of the final steps of the cascade is the conversion of prothrombin
(factor II) to thrombin. The PT test evaluates the integrated function of the
coagulation factors that comprise the extrinsic and common pathways of the
coagulation cascade, including factors I (fibrinogen), II (Prothrombin), V, VII and
X. It evaluates the body’s ability to produce a clot in a reasonable amount of time
and, if any of these factors are deficient, the PT will be prolonged.

Radiographic Report: August 10, 2010

Part Examined: Colon


Findings: Barium Enema

Clinical Data: Circumferential mass 5cm from the anal verge per
proctosigmoidoscopy findings: Scout film shows minimal gas filled bowel loops
within the abdomen without air fluid levels. The flank stripes and psoas shadows
are distinct. No definite mass, organomegaly and intra-abdominal calcification is
seen. Minimal spurs are seen along the lumbar spine margins. The rest of the
visualised osseuos structures are intact.

Subsequent fillins following introduction of barium mixture into the ano via
F24 catheter show ascert of barium from the rectum up to the cecum with
minimal passage into the terminal ileum (as visualised in the decubitus study).
There is a large mucosal irregularity with shouldering pattern with approximate
widest diameter of 8cm noted in the rectum. No other mucosal irregularity, mass
lesion effect is seen.

Post evacuation film show moderate retention of barium.

Impression:

1. Large area of mucosal irregularity with shouldering pattern in the area of


the rectum—suggestive of a neoplastic process, likely malignant.

2. Moderate barium retention

3. Lumbar spondylosis

Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium


enema, is an x-ray examination of the large intestine, also known as the colon.
This examination evaluates the right or ascending colon, the transverse colon,
the left or descending colon, the sigmoid colon and the rectum. The appendix
and a portion of the distal small intestine may also be included.
An x-ray (radiograph) is a noninvasive medical test that helps physicians
diagnose and treat medical conditions. Imaging with x-rays involves exposing a
part of the body to a small dose of ionizing radiation to produce pictures of the
inside of the body. X-rays are the oldest and most frequently used form of
medical imaging.
The lower GI uses a special form of x-ray called fluoroscopy and a contrast
material called barium or a water soluble iodinated contrast.
Fluoroscopy makes it possible to see internal organs in motion. When the lower
gastrointestinal tract is filled with barium, the radiologist is able to view and
assess the anatomy and function of the rectum, colon and sometimes part of the
lower small intestine.
A physician may order a lower GI examination to detect:

• benign tumors (such as polyps).


• cancer.
• causes of other intestinal illnesses.

The procedure is frequently performed to help diagnose symptoms such as:

• chronic diarrhea.
• blood in stools.
• constipation.
• irritable bowel syndrome.
• unexplained weight loss.
• a change in bowel habits.
• suspected blood loss.
• abdominal pain.

Images of the small bowel and colon are also used to diagnose inflammatory
bowel disease, a group of disorders that includes Crohn's disease and ulcerative
colitis.

Ultrasound Report: August 10, 2010

Findings:

The liver appears normal in size but with echogenic parenchyma. No


mass or calcification seen. Intrahepatic bile ducts and common bile duct are non-
dilated.

Gallbladder is normal in size. Its wall is not thickened. No intraluminal


mass or lithiasis seen.

Pancrease is unremarkable.

Diagnosis:

1. Fatty liver grade II

2. Non-remarkable UTZ findings in the gallbladder and pancrease.

Ultrasound imaging, also called ultrasound scanning or sonography, involves


exposing part of the body to high-frequency sound waves to produce pictures of
the inside of the body. Ultrasound exams do not use ionizing radiation (as used
in x-rays). Because ultrasound images are captured in real-time, they can show
the structure and movement of the body's internal organs, as well as blood
flowing through blood vessels.
Ultrasound imaging is a noninvasive medical test that helps physicians diagnose
and treat medical conditions.
An abdominal ultrasound produces a picture of the organs and other structures in
the upper abdomen.
A Doppler ultrasound study may be part of an abdominal ultrasound examination.
Doppler ultrasound is a special ultrasound technique that evaluates blood flow
through a blood vessel, including the body's major arteries and veins in the
abdomen, arms, legs and neck.
Abdominal ultrasound imaging is performed to evaluate the:

• kidneys
• liver
• gallbladder
• pancreas
• spleen
• abdominal aorta and other blood vessels of the abdomen

Ultrasound is used to help diagnose a variety of conditions, such as:

• abdominal pain or distention.


• abnormal liver function.
• enlarged abdominal organ.
• stones in the gallbladder or kidney.
• an aneurysm in the aorta.

Additionally, ultrasound may be used to provide guidance for biopsies.

Doppler ultrasound images can help the physician to see and evaluate:

• blockages to blood flow (such as clots).


• narrowing of vessels (which may be caused by plaque).
• tumors and congenital malformation.

Discharge Planning
Medication

> Strict compliance to the drug regimen should be emphasized

> Emphasis to take home medication consistently following the right drugs,
dosage, timing & frequency, and route.

Exercise

> It is best to start the exercise program slowly until you get stronger, also find a
suitable exercise program to suit your condition.

> Exercise is important this makes your heart stronger, lowers blood pressure,
and help keep your body healthy.

> Maintaining a regular exercise will help facilitate adequate blood flow for
nourishing different parts of the body and can help to increase peristaltic
movement.

> Exercise can reduce joint pain and fatigue. It can also increase ROM and
strength.

Treatment

> Have a regular check-up with your physician regarding with your condition for
any continuing treatment and medications.

Health Teachings

> Emphasis on personal hygiene to promote comfort and prevent infection.

> Do regular exercises, eat right food, and take medications to enhance recovery
and healing as indicated by the physician.

> Adequate rest is important.

> Information about her disease condition

> Have diversional activities to alleviate pain at postoperative area

> Adequate fluid intake to prevent dehydration

> Encourage to have a low fat diet and sugar level

Out Patient
> Regular check-up for monitoring of development and if there are presence of
complication.

Diet

> Consult a nutritionist for a proper diet program.

Tips:

> Eat nutritious and healthy food, to avoid constipation. Eat foods such as
oatmeal, whole-grain breads and cereals, fruits (banana for decrease potassium
level) and vegetables.

> Drink at least 8-10 glasses of water a day; limit the amount of soda, tea and
coffee.

> Diets high in vegetables and high-fiber foods such as whole-grain breads and
cereals may rid the bowel of these carcinogens and help reduce the risk of
cancer.

> Low fat diet and low sugar level


> High protein diet

Spirituality

>Tell the patient/client to pray for God, for him nothing is impossible. Ask for
inner strength to carry his trials

Learning Experience
In doing this case study, the essence of patience and hard working were
always there. Everything I have done entails patience, knowledge and skills in
doing research studies about the case. I have learned a lot about proper nursing
interventions, rendering care to my patients, regarding the disease conditions,
manifestations and a lot more. One should also need to analyze all the significant
data to know the relationship of other data.
While in the other hand, my experience in NMMC-Surgical Ward was
honestly a big and challenging experienced in my life. It was fortunate to have a
good relationship to my group mates, hospital staffs and to my beloved clinical
instructor as well. What happened in this rotation was a lot of new ideas, new
learning and new applications for my field. In the ward, I also learned a lot of new
procedures and I was totally amazed and proud to myself because I am confident
in doing some procedures in the ward. I admit that I have committed a couple of
mistakes, but what is more important is what I’ve learned from my mistakes.
I would like to thank, our ever grateful, God Almighty, thank you so much
for giving me strength to handle each situation confidently. To my dear CI,
Ma. Liwayway Salcedo, RN, thank you for being effective in the field. As a clinical
instructor, she emphasized the values of professionalism, respect and patience.
To my PCI that was patience and understanding, thank you Sir. To my beloved
parents who have shown support and understanding in all activities. And to the
Hospital Staffs who helped and guided me for this rotation.

References
http://www.google.com

http://www.yahoo.com

http://www.scrib.com

http://www.nursingcrib.com

http://www.wikipedia.com

http://www.webmd.com

http://www.emedicinehealth.com

http://www.medicinenet.com
http://web2.airmail.net/uthman/lab_test.html
http://www.radiologyinfo.org/en/info.cfm?pg=abdominus
http://medical-dictionary.thefreedictionary.com/Rectal+neoplasm
http://www.homehealth-uk.com/medical/polyps.htm
http://www.merck.com/mmpe/sec02/ch021/ch021g.html

http://www.procto-med.com/polyps-of-the-colon-and-rectum/

http://www.bestsyndication.com/?q=20080305_colorectal_polyps.htm

http://www.fascrs.org/patients/conditions/polyps_of_the_colon_and_rectum/

http://digestive.niddk.nih.gov/ddiseases/pubs/colonpolyps_ez/

http://www.healthline.com/galecontent/rectal-polyps/2

http://www.wrongdiagnosis.com/symptoms/rectal_prolapse/book-causes-20a.htm
http://emedicine.medscape.com/article/931455-overview
http://www.acg.gi.org/patients/women/rectal.asp
http://www.patient.co.uk/doctor/Rectal-Prolapse.htm
http://hcd2.bupa.co.uk/fact_sheets/html/rectal_prolapse.html
http://www.hemorrhoid.net/prolapse.php
http://www.embarrassingproblems.com/docspots/DocSpot-rectal-prolapse
http://www.umm.edu/ency/article/001132prv.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001132.htm

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