I.

INTRODUCTION
A. Overview of the study

Colon cancer ranks 6th overall leading cause of cancer-related deaths, 5th
among males and 7th among females. An estimated 2,963 new cases, 1,548 in males
1,415 in females, together with 1,567 deaths will be seen in 1998. Colon cancer
increases markedly after age 50.

A malignancy in the colon can be referred to as colorectal cancer. Strictly

speaking, a malignancy in the colon is colon cancer and a malignancy in the rectum is
rectal cancer. Most colon cancers occur on the left side in the sigmoid region.

The colon is a muscular tube approximately 6 feet long connecting the small
intestine to the rectum. The right side of your body has the “ascending colon” which
receives waste from the small intestine. This ascends upward to the “transverse colon”
which crosses over the small intestines and descends on the left side of the body as the
“descending colon”. At the bottom the colon again crosses the belly toward the rectum
as the “sigmoid colon”. Finally, the sigmoid colon empties into the 8-inch rectum.

When the cells that line the colon or rectum start to proliferate in an
uncontrolled manner it is called a tumor. It is common to find a benign type of growth
called polyps. These are small and produce few, if any, symptoms. However, over
time these polyps can grow and develop into cancer.

B. Objectives and Purpose of the Study

1
 As a student nurse, it is indeed my vocation to adjoined hands with the health
care team for the promotion of wellness of our clients.
My main goals for this study are the following:
· To establish rapport
· To identify chief complaints of clients to give its specific interventions
· To determine the family and personal history of the client that many affect client’s
present condition
· To identify the cause and effect the main problem through the correct analysis of the
pathophysiology of the case
· To determine the medical management given through identifying doctor’s order and
its rationale
· To make nursing care plans for the different health problems encountered by the
client
· To evaluate the effectiveness of the actual nursing care plan that was established
C. Scope and Limitation of the Study
Specifically this study is more concerned with the care of one patient in PGH ,
Medical Ward. I performed physical assessment to the patient to properly identify the
nursing problems, which requires necessary and direct interventions and medical
regimen. I had 2 days duty or 16 hours care for the patient and some limited
informants.. Thus this care study focuses on the particular case of the patient. The
study of the medications and doctor’s order are limited to our chosen patient, a case of
Colon Cancer.

II. HEALTH HISTORY

2
A. Patients Profile

Name of Patient: RF
Sex: Male
Age: 73
Birthday: May 31, 1938
Birthplace: Misamis Oriental
Religion: PIC
Civil Status: Married
Educational Attainment: CollegeLevel
Occupation: OFW
Number of Siblings: 5
Nationality: Filipino
Date Admitted: July 5, 2011
Time Admitted: 5:15 pm
Informant: Daughter
Blood Pressure: 110/60 mmHg
Temperature: 36.7O C
Pulse Rate: 82 bpm
Respiration: 21 cpm
Allergy: No known allergy
Attending Physician: Dr. O
Admitting Diagnosis: T/C Colon Cancer

B. Past Health History and Family history

Mr. RF verbalized he has been confined due to gastritis but he already forgot
about the date he was admitted. He has no allergy to any foods or other stuffs. The
paternal side of the patient had a heredity of cardiovascular disease while at the
maternal side, the patient can’t trace any diseases.

C. Chief Complains and History of Present Illness

3
 Patient RF, 83 years old, from Lapasan, CDOC, few days prior to admission
he already experienced poor appetite and severe generalized body weakness and due
to this instance,he was brought to PGH by his daughter last July 5, 2011 with the
admitting diagnosis of T/C Colonic cancer. the initial vital signs of: temperature- 36.7
˚C, respiratory rate- 21 cpm, and a pulse rate of 82 bpm.

III. DEVELOPMENT DATA

A. Erik Erikson’s Stages of Psychosocial Development Theory

Erikson describes eight developmental stages through which a healthily

developing human should pass from infancy to late adulthood. In each stage the
person confronts, and hopefully masters, new challenges. Each stage builds on the
successful completion of earlier stages. The challenges of stages not successfully
completed may be expected to reappear as problems in the future. Each of Erikson's
stages of psychosocial development are marked by a conflict, for which successful
resolution will result in a favourable outcome and by an important event that this
conflict resolves itself around. In the Eriksons 8th stage of psychosocial Development
theory which is Senior: Integrity vs. Despair (65 years onwards). Integrity means
moral soundness, whole or completeness of a person, Despair means being hopeless.
When it comes to my patient he was loosing hope that his illness will be cure, it is
because he feels that he was really old and he don’t have the capabilities of living the
way it should be. But still, because of the support of the family little by little he was
trying to understand his situation tried to think on positive side and for himr to live
longer for his family that still need him as a father, as a grandfather and as a husband.

B. Sigmund Freud’s Psychosexual Development Theory

According to Freud, people enter the world as unbridled pleasure seekers.

Specifically, people seek pleasure through from a series of erogenous zones. These
erogenous zones are only part of the story, as the social relations learned when
focused on each of the zones are also important. Freud's theory of development has 2
primary ideas: One, everything you become is determined by your first few years -
indeed, the adult is exclusively determined by the child's experiences, because
whatever actions occur in adulthood are based on a blueprint laid down in the earliest

4
years of life (childhood solutions to problems are perpetuated) Two, the story of
development is the story of how to handle anti-social impulses in socially acceptable
ways. My patient belongs to the genital stage which begins at puberty involves the
development of the genitals, and libido begins to be used in its sexual role. However,
those feelings for the opposite sex are a source of anxiety, because they are reminders
of the feelings for the parents and the trauma that resulted from all that.

C.Robert J. Havighurst’s Developmental Task Theory

Havighurst categorized the tasks, in first category are the tasks, which has to
be completed in certain period, and the second are the tasks that continue for a long,
sometimes for a lifetime.So what happens if the task is not completed in that stage or
completed in a later date? Havighurst reply to that it is critical that the tasks should be
completed during the appropriate stage, otherwise result will be the failure to achieve
success in future tasks.

D. Jean Piaget’s Theory of Development

According to Piaget, development is driven by the process of equilibration.

Equilibration encompasses assimilation (i.e., people transform incoming information
so that it fits within their existing schemes or thought patterns) and accommodation
(i.e., people adapt their schemes to include incoming information). My patient
belongs to the formal operational stage. In this stage, individuals move beyond
concrete experiences and begin to think abstractly, reason logically and draw
conclusions from the information available, as well as apply all these processes to
hypothetical situations. The abstract quality of the adolescent's thought at the formal
operational level is evident in the adolescent's verbal problem solving ability. The
logical quality of the adolescent's thought is when children are more likely to solve
problems in a trial-and-error fashion. Adolescents begin to think more as a scientist
thinks, devising plans to solve problems and systematically testing solutions. They
use hypothetical-deductive reasoning, which means that they develop hypotheses or
best guesses, and systematically deduce, or conclude, which is the best path to follow
in solving the problem.

5
IV. MEDICAL MANAGEMENT

A. DOCTORS ORDER

Order

7/5/11
 Please admit under the service of Dr. O
 Secure Consent to care
 Monitor or V/S q 4
 Start venodysis w/ D5NSS IL @ 15 gtts/min
 LAB’S:
-CBC

-Urinalysis
-Chest x-ray PA
-Serum Na+, K+ creatinine

 MEDS
- Vamin 500 cc for 12 hours
 I & O q shift

Refer accordingly
7/6/11

NaCl 1 tab TID

Iterax

tramal
7/7/11

hold iterax

Morphine 10g 1 tab q 8o

D/C tramal once Morphine is started
7/8/11

continue meds
7/9/11

Paracetamol 500g 1 tab q 4 PRN for fever

D/C vamin when consumed

Flanax 275 g 1 tab BID

IVF to ff D5NSS1L @ 15 gtts/min
7/10/11

d/c flanax

refer to Dr. RY for colonoscopy & Biopsy
- if for colonoscopy pls. do
1. CXR
2. ECG 12 leads
7/11/11
 may change FBC in AM per request
7/12/11
 follow – up CXR result
 for possible colo this am depending on response of bowel prep
 give morphine 10 mg 1 tab now
 increase IVF rate to 25 gtts/min
7/13/11

6
 give flanax 1 tab
 sched for colo @ 9 am tomorrow
- do the routine bowel prep
- refer to Dr. G

7/14/11
 suggest surgical consult
 colostomy schedule noted
 resume previous diet
 resume vamin 500 cc to run for 12 hours
 refer to Cr. RY for evaluation if ok w/ family
 plan : Diverting loop colostomy ?& debarment of perineal abcess
7/15/11
 request CBC, serum Nat, Kt, Crea, SGPT
 secure unit of PRBC for possible transfusion
 pls. facilitate hot sitz bath for 15 min 3 x a day for 2 -3 days
 provide bedside commode
 pls. transfuse 2 units of PRBCof blod type @ 20 gtts/min
 please close main IVF line once BT is ongoing
7/16/11
 secure another units of FWB for possible BT
 repeat CC result
7/17/11
 absolute NPO
 once vamin glucose is consumed; start kabiverl 2,000 kcal to run for 24 hours
 decrease IVF rate to 10 gtts/ min when kabivern is started
 repeat CBC result
 request for ECG 12 leads
 for possible sigmoid coop colostomy @ 1 pm
7/18/11
 hold all meds
 transfuse: 1 unit of available FWB @ 20 gtts/min
 start O2 @ 2 L/min
 check 02 sat
 proceed scheduled sigmoid loop colostomy @ 1 pm
7/19/11
 monitor V/S q 15 min
 I & O q shift
 Incorporate 20 meq kCl to ongoing IVF of D5NSS 1L regulated @ 20 gtts/min
7/20/11
 d/c tramadol
 decrease O2 inhalation to 2 L/min
 soft diet
 sinecoid forte 1 tab TID
 terminate D5NSS line
7/21/11
 full diet
7/22/11
 off O2 inhalation
 fluimucil 2m/sachet
7/23/11
 repeat CBC

7
 7/24/11
 start tsenam 500mg IV drip q 8 h
 encourage deep breathing exercise
 d/c fluimucil
7/25/11
 follow – up biopsy result
7/26/11
 continue tsenam
7/31/11
 V/S monitoring q 4
 Transfer in ICU
 Increase Dopa to 3cc.hr
8/1/11
 decrease ivf rate to 15 ggts/min
8/2/11
 decrease O2 inhaltion to 2 l/min
8/3/11
 start dopamine via syringe pump
 meds FeSO4 1 tab OD

8/4/11
 full diet
 continue vital signs
8/5/11
 v/s q hourly
 I & O q shift
8/7/11
 decrease dopamine rate to 9cc/hr
 decrease IV rate into 15 ggts/min
8/8/11
 decrease dopamine rate to 5cc/hr
 encourage deep breathing exercises
8/9/11
> decrease dopa to 4 cc/hr
> consume stock tsenam

B. LABORATORY TEST

CHEST XRAY
IMPRESSION

1. Consider atelectasis versus pneumothorax, right lung

8
2. Pneumonia, bilateral
3. Consider cardimegally
4. Atherosclerotic aorta
5. Minimal pleural effusion and or/ thicking, bilateral

URINALYSIS Color: pale yellow yellow

To detect metabolic Glucose: negative Negative
disease. To diagnose Turbidity: clear clear
Negative
many specific WBC: negative or rare
disorders. RBC: negative or rare Negative
pH: 4.5 -8.0 6.5
Speciy gravity:1.o15-1.025 1.020

Creatinine: 53-120 umol/L

BLOOD 181.4 umol/L High level of creatinine
because it was produced
CHEMISTRY
by the body during the
Ordered prior to process of normal muscle
surgery or a breakdown (colorectal
procedure to examine cancer)
the general health of
the patient.
Hemoglobin mass
concentration: 140-170 Indicates cancer
HEMATOLOGY
95g/dl
Detect blood forming Lymphocytes: Indicates an active viral
0.25-0.35
organs and blood infection.
diseases 0.38

Laboratory
Result

9
Potassuim 3.50-5.10 4.41 mmol/L Normal

10
V. PATHOPHYSIOLOGY & ANATOMY AND PHYSIOLOGY

A. PATHOPHYSIOLOGY COLON CANCER

Colorectal cancers arise from dysplastic adenomatous polyps in the majority of

cases. There is a multistep process involving the inactivation of a variety of tumour-
suppressor and DNA repair genes, along with simultaneous activation of oncogenes.
This confers a selective growth advantage to the colonic epithelial cell and drives the
transformation from normal colonic epithelium to adenomatous polyp to invasive
colorectal cancer.

Germline mutations underlie the well-described inherited colon cancer syndromes,

whereas sporadic cancers arise from a step-wise accumulation of somatic genetic
mutations. A single germline mutation in the adenomatous polyposis coli (APC)
tumour suppressor gene is responsible for the dominantly inherited syndrome that
bears the same name. Clinical expression of the disease is seen when the inherited
mutation of one APC allele is followed by a second hit mutation or deletion of the
second allele.

Ulcerative colitis and Crohn's colitis are associated with an increased risk of
colorectal cancer with an interim step of dysplastic epithelium. Spread of colorectal
cancer is to local lymph nodes and via the vasculature to liver and lungs and, less
commonly, to bone and brain. However, as survival improves with systemic
chemotherapy, bone and brain metastases have been increasingly reported.

B. ANATOMY AND PHYSIOLOGY

11
COLON

The colon is also called the large intestine. The ileum (last part of the small
intestine) connects to the cecum (first part of the colon) in the lower right abdomen.
The rest of the colon is divided into four parts:
• The ascending colon travels up the right side of the abdomen.
• The transverse colon runs across the abdomen.
• The descending colon travels down the left abdomen.
• The sigmoid colon is a short curving of the colon, just before the rectum.
The colon removes water, salt, and some nutrients forming stool. Muscles line the
colon's walls, squeezing its contents along. Billions of bacteria coat the colon and its
contents, living in a healthy balance with the body.

VI. NURSING REVIEW CHART

IV. PHYSICAL ASSESSMENT

12
 NURSING SYSTEM REVIEW CHART

Name: RF
Date: August 8, 2011
Vital Signs:
Pulse: 82 bpm BP: 110/60 Temp: 36.7 Respi: 20 cpm

EENT
[X] impaired vision [] blind
[] pain reddened [] drainage
[] gums [] hard of hearing [] deaf Blurry vision
[] burning [] edema [] lesion teeth
[] asses eyes, ears, nose
[] throat for abnormality [] no problem
RESPIRATION
[] asymmetric [] tachypnea [] barrel chest
[] apnea [] rales [] cough With pitting edema
[] bradypnea [] shallow [] rhonchi
[] sputum [] diminished [] dyspnea
[] orthopnea [] labored [] wheezing
[] pain [] cyanotic Abdominal pain
[] assess resp rate, rhythm, depth, pattern noted with the scale
[] breath sounds, comfort [X]no problem of 5/10
GASTRO INTESTINAL TRACT
[] obese [] distention [] mass
[] dysphagia [] rigidly [X] pain
[] asses abdomen, bowel habits, swallowing
[] bowel sounds, comfort []no problem
GENITO-URINARY and GYNE
[] pain [] urine color [] vaginal bleeding
[] hematuria [] discharge [] nocturia
[] assess urine freq., control, color, odor, comfort
[] grip, gait, coordination, speech, []no problem
NEURO Generalized
[] paralysis [] stuporous [] unsteady [] seizure weakness
[] lethargic [] comatose [] vertigo [] tremors
[] confused [] vision [] grip
[X] assess motor function, sensation, LOC, strength
[] grip, gait, coordination, speech, [X]no problem
2
MUSCULOSKELETAL and SKIN
[] appliance [] stiffness [] itching [] petechiae
[] hot [] drainage [] prosthesis [] swelling
[] lesion [X] poor turgor [] cool [] deformity
[] atrophy [] pain [] ecchymosis [] diaphoretic
[] assess mobility, motion, gait, alignment, joint function
[X] skin color, texture, turgor, integrity [] no problem

13
VII. NURSING MANAGEMENT
A. IDEAL NURSING MANAGEMENT
PATIENT: RF
ASSESSMENT DIAGNOSIS OBJECTIVE INTERVENTIONS RATIONALE EVALUATION

Subjective: Pain related to disease After 4-6 hours of -Determine the -To evaluate need for The goal has been
- “Sakit akung tiyan” process(inflammation) comprehensive location effectiveness partially met
as verbalized by the secondary to colon cancer nursing intervention, -To promote
patient. as evidenced by patient the patient will be able -Provide basic comfort relaxation and health
Objective: facial appearance of pain to verbalized a measure like refocus attention
- facial grimace minimal reduction of repositioning -Enable patient to
-gurading sign noted pain from score of 7 -Encourage use of participate actively
- pain scale of 5/10 to 5 (at the pain scale stress management and enhance sense o
ASSESSMENT DIAGNOSIS of 10OBJECTIVES
where 1 is the like INTERVENTIO RATIONALE
relaxation control ACTUAL EVALUATION
NS
lowest and 10 is the techniques like music.
highest) -To relieve the pain
Subjective: Imbalance After 4-6 hrs. of -Monitor daily -Identifies nutritional The goal has been partially
-Give medication strength
as
-“wa koy gana mo kaon” as nutrition less than comprehensive food intake / deficiencies met
ordered -To detect
-Metabolic whether
tissue needs the
verbalized by the patient body nursing -Encourage
-Monitor temperature patient has fever
-coherent requirements interventions, the patient to eat high as increases as will as
Objective: related to pain patient will be calorie, nutrient- fluid supplement can
play on important rule
-sagging of skin secondary to encouraged to eat rich w/ adequate in maintaining adequate
-w/ on going IVF of D5 LR 1L colon cancer even just a little fluid intake calorie and protein
@ 30 infusing well at the right sensation as in order to have intake
arm evidenced by something or the -Can trigger
-FBC attached to UB patient sagging of stomach to digest -Control nausea/vomiting
colostomy noted the skin without triggering environmental response
-sunken eyeballs nausea and factor -May prevent onset or
-thin vomiting. -Encourage use of reduce severity of
nausea, decrease
relaxation
anorexia and enable
techniques patient to increase oral
intake
-Often a source of
emotional distress,
-Encourage open especially for SO who
communication want to feed
regarding rejected/frustrated
anorexia problem -Help identify to degree
of biochemical 14
imbalance/malnutrition
-Review and influence choice of
laboratory studies dietary interventions
as indicated
ASSESSMENT DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE ACTUAL
EVALUATION

15
SUBJECTIVE: Fatigue related to altered bodyAfter 4-6 hrs of-Have patient rate fatigue, using a -Help in developing a plan for managing fatigue. The goal has been
“nagluya ko, paminaw nako chemistry, side effects of pain andnursing. numeric scale, If possible, the time of day-Frequent rest periods or naps are needed to restore or partially met
kanunay ko kapoy” as other medications. interventions, when it is most severe. conserve energy. Planning will allow pt. to be active during
verbalized by the patient. the patient will-Plan care to allow rest periods. Schedule times when energy. Planning will allow patient to be active
OBJECTIVE: report improveactivities for periods when patient hasduring times when energy level is higher, which may restore
-Disinterest in the sense of energy. most energy feeling of well being and a sense of control.
surrounding -Assist patient with self-care needs. Keep -Weakness may make activities of daily living and ambulation
-lethargy bed in low position and assist with difficult, further assistance is needed.
-seen pt. lying on bed ambulation. -Enhances strength and enables patient to become more active
-poor ROM noted -Encourage patient to do whatever without undue fatigue
- possible and increase activity level as-Poorly managed cancer pain can contribute to fatigue
tolerated. -Adequate intake o nutrient is necessary to meet energy
-Perform pain assessment and providereserves for activity.
pain mgt. as prescribed. -Programmed daily exercises and activities help patient
-Encourage nutritional intake. maintain or increase strength and muscle tone which
Collaborative: enhances sense of well being.
-Refer for physical therapy.

16
 B. ACTUAL NURSING MANAGEMENT
PATIENT: RF

S -“wa koy gana mo kaon” as verbalized by the patient

O -sagging of skin
-sunken eyeballs
-thin

A Imbalance nutrition less than body requirements

related to pain

P After 4-6 hrs. of comprehensive nursing

interventions, the patient will be encouraged to eat
even just a little in order to have something or the
stomach to digest
I -Monitored daily food intake
-Encouraged patient to eat high calorie, nutrient-rich
w/ adequate fluid intake
-Controled environmental factor
-Encourage use of relaxation techniques
-Encouraged open communication regarding
anorexia problem
-Reviewed laboratory studies as indicated

E The patient have eaten a little without vomiting.

17
S “sakit akong tiyan”
As verbalized by the patient

O >C pain scale of

7/10
>grimace noted
>irritable
>weakness noted
A Pain related to disease process(inflammation)
secondary to colon cancer

P At the end of 30 mins the patient will be able to

demonstrate relief from pain

I Independent:

>monitored v/s

>Instructed tondeep breathing excersise

>Encouraged to have Diversional activities like
watching t.v.
>Placed patient in a comfortable position
>Encouraged to have adequate bed rest
>Provided therapeutic touch
Dependent:
>Administered Ranitidine as ordered

E > goal partially met, patient demonstrate relief

from pain

18
S “nagluya ko, paminaw nako kanunay ko kapoy” as
verbalized by the patient.

O -Disinterest in the surrounding

-lethargy
-seen pt. lying on bed
-poor ROM noted

A Fatigue related to altered body chemistry, side effects of

pain and other medications.

P After 4-6 hrs of nursing. interventions, the patient will

report improve sense of energy.

I -Have patient rate fatigue, using a numeric scale, If

possible, the time of day when it is most severe.
-Planned care to allow rest periods. Schedule activities for
periods when patient has most energy
-Assisedt patient with self-care needs. Keep bed in low
position and assist with ambulation.
-Encouraged patient to do whatever possible and increase
activity level as tolerated.
-Perform edpain assessment and provide pain mgt. as
prescribed.
-Encouraged nutritional intake.
Collaborative:
-Referred for physical therapy
E . The goal has been partially met

19
C. DRUG STUDY
DRUG/MEDICATION CLASSIFICATION ACTION INDICATION SIDE EFFECTS NSG.
IMPLICATION

Tramadol Dose: Analgesics- relieve painUnknown. A centrally actingModerate to severeCNS: -use consciously in pt. risk for seizures

150mg without loss ofsynthetic analgesic compoundpain Dizziness, vertigo, headache,or respiratory depression; increased
intracranial pressure or head injury,
Frequency: consciousness not chemically related to and anxiety.
acute abdominal, condition or renalor
q 8 Anti-depressants-prevent opiates. Drug through to mind CV:
heptic impairment; and in physical
route: or relieve the symptomsto opiola receptors and inhibit Vasodilation
dependence on opiodes.
P.O. of depressions reuptate of norepinephrine EENT: -monitor bowel and bladder fxn.
and serotonin. Visual disturbances Anticipate need for laxative.
GI TRACT: - for better analgesic effect give drug
Nausea, constipation,before onset of intense pain.
vomiting,dyspepsia, dry-monitor pt. at risk for seizure. Drug
may reduce threshold.
mouth, and diarrhea.
-monitor pt. for drug dependence. Drug
SKIN:
can produce dependence similar to that
Pruritus, and rash.
of codeine or dextropropoxyphene and
thus has potential for abuse.

20
DRUGS/MEDICATION CLASSIFICATION ACTION INDICATION SIDE EFFECTS NSG. IMPLICATION

Paracetamol Route: P.O Antipyretic Antipyretic: reduces>common colds , otherCNS: headache, >observed the rights of
(biogesic) Dose: 500mg fever by acting directlyviral and bacterialCV: chest pain, dyspnea giving needs
Frequency: P.R.N forAnalgesic on the hypothalamicinfection with pain andGI: hepatic toxicity and>do not exceed the
fever heat-regulating center tofever. failure, jaundice. recommended dosage.
cause vasodilation and >d/c drug if
sweating w/c helps hypersensitivity reaction
discipate heat. occurs.
>assess allergy
>advice patient that
paracetamol is only for
short-term use.

21
DRUG/MEDICATION CLASSICATION ACTION INDICATION SIDE EFFECTS NSG.IMPLICATION

Tramal Dose:30 mg Non-steroidal anti- Unknwon. Though to Short-term CNS: drowsiness, >use cautiously in
Route: IVTT inflammatory drugs inhibit prostaglandin management o sedation, dizziness, patients with hepatic or
Frequency: q 8 =prevent synthesis moderately severe, headache. renal impairment
inflammation, pain Route: IV acute pain single-dose CV: edema, >carefUlly observed
and fever support the Onset: immediate treatment. hypertension, patients with
blood clotting function Peak: 1 to 3min. palpitations. coagulopathies and
of platelets, and Duration: 6 to 8 hrs. GI: nausea, dyspepsia, those taking coagulant.
protect the lining of GI pain, diarrhea, >don’t give drug
the stomach from the peptic ulceration, epidurally or
damaging effects of vomiting, constipation, intrathecally because of
acid flatulence, stomatitis. alcohol content.
HEMATOLOGIC: >correct hypovolemia
prolonged bleeding before giving.
time
SKIN: rash,
diaphoresis.

22
VIII. REFERRAL AND FOLLOW – UP

HEALTH TEACHINGS => Encourage the patient’s family to wash hands with an
antibacterial soap and maintain good hygiene.
=> Instruct the family to inform the health care providers if
symptoms persist beyond 3 days discharged from the hospital.
ANTICIPATORY S/S => Upon instructing the patient to take his medicines
ordered by his doctor, the patient will be able to lessen the pain at his incision sites.
=> After recommending the patient with his diet/nutrition he
will be able to gain weight and recover from undesired weight loss/cachexia
SPIRITUALITY => Encourage the patient’s family members to pray for the
patient’s fast recovery and encourage also the patient to have a strengthen faith to
GOD.
MEDICATION => Instruct the patient’s daughter to continue medication as
what his doctor has ordered for the patient and not to discontinue even If the patient
feels better.
=> Instruct also the patient’s family member to take home
the medication and follow the frequency ordered by the doctor.
INCISION CARE => Instruct the family members to clean and dressed with
bandage the incision site of the patient.
=> Instruct the Family members to use sterile materials in
assessing/cleaning the incision sites of the patient.
NUTRITION => Recommend patient to increase fluid intake and eat foods
that’s more on fiber.
ENVIRONMENT => Encourage the patient and his family members to
maintain clean surroundings (especially patients room).

IX. EVALUATION AND IMPLICATION

At the end of our hospital duty, I was able to render care to our patient to help him
resolve his health condition. Through observing the patient’s status, I was able to identify
priority problems related to his health. The patient was willing to pursue the medical
therapy just to promote health and wellness for the betterment of his condition. I have
also made the patient’s daughter realize the importance of completing the course of
therapy by taking the medicines prescribed or ordered for him by his physician. In
addition, eating healthy or nutritious foods that were prescribed to him by the health
providers was further been explained to the benefits he will gain in eating those foods.
Moreover, this several intervention to him as given to the patient made his body
conditioning normal and I can say that our patient has somehow recovered from his
illness.

X. BIBLIOGRAPHY

23
BOOKS
 Suzzanne C. Smeltzer, EdD, RN,FAAN,et.al
Medical Surgical Nursing
11th Edition,
 Lippincott Williams and Wilkins
Manual of Nursing Practice
7th Edition
c 2001 by Lippincott Williams and Wilkins

WEBSITES
www.nursingcrib.com
www.scribd.com
www.wikipedia.com/coloncancer

24