A Case Study On Colon Mass
A Case Study On Colon Mass
A Case Study On Colon Mass
____________________
___________________
By
Mishael A. Dawame
June 2016
ACKNOWLEDGEMENT
The success and final outcome of this case study required a lot of guidance and
assistance from many people and I was extremely fortunate to have got this all along
the completion of my case study. Whatever I have done is only due to such guidance
and assistance and I would not forget to thank them.
First and foremost, I would like to thank our loving Creator who made us curious
being, who loves to explore his creation and for giving me the opportunity to have this
case study. Without Him, I cant do anything.
My deepest gratitude is to our Clinical Instructor Maam Cristin G. Ungab. I have
been amazingly fortunate to have an advisor who gave me the freedom to explore on
my own, and at the same time the guidance to recover when our steps faltered. Maam
taught me how to question thoughts and express ideas. Her patience and support
helped me overcome many crisis situations and finish this case study.
Most importantly, none of this would have been possible without the love and
patience of my family. My immediate family to whom this case study is dedicated to, has
been a constant source of love, concern, support and strength all these years.
INTRODUCTION
Colon cancer is cancer of the large intestine (colon), the lower part of your
digestive system. Rectal cancer is cancer of the last several inches of the colon.
Together, they're often referred to as colorectal cancers. Most cases of colon cancer
begin as small, noncancerous (benign) clumps of cells called adenomatous polyps.
Over time some of these polyps 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 become colon cancer.This annual report provides the estimated numbers
of new cancer cases and deaths in 2015, as well as current cancer incidence,
mortality, and survival statistics and information on cancer symptoms, risk factors,
early detection, and treatment. In 2015, there will be an estimated 1,658,370 new
cancer
cases
diagnosed
and
589,430
cancer
deaths
in
the
mortality
than
other
countries.
In
February 2010,
the World
Health
Organization predicted that the number of cancer deaths worldwide would increase from
7.6 million to 17 million deaths in 2030. In the Philippines, cancer ranked third in the list
of leading causes of death in the country in 2010, with the following as the ten top
causes
of
cancer
deaths
in
the
country
for
that
same
year.
OBJECTIVES
General Purpose
The primary concern of this study is to further enhance understanding of Colon
mass in congruence with learned concepts, as well as broaden the knowledge of the
patient who are suffering from this type of illness and those people who are high risk of
acquiring this kind of disease.
Specific Objectives
This study seeks answers to the following questions:
1. What are the etiologies of Colon mass?
2. What are the Signs and Symptoms of Colon mass?
3. What
is
the
pathophysiology
of
Colon
mass?
Gender: Male
Nationality: Filipino
prior to his admission he was able to experienced severe pain on his abdomen at right
lower quadrant. They immediately went to the hospital to seek medical advice.
D.PAST MEDICAL HISTORY
Mr. C was able to confirm he had been completely vaccinated. On December 28,
2015 he undergone major operation which is Cholecystectomy. He have no known
allergies to foods and drugs. Theres no previous accident encountered by him.
FAMILY, SOCIAL AND PERSONAL HISTORY
E.1 Personal History:
Mr. C is the eldest among 3 siblings, Mr. C finished his course at University OF
BICOL with the degree of BACHELOR OF SCIENCE IN NURSING. When he passed
the nursing licensure examination he worked at Canada as an ER nurse. He came back
to the Philippines and applied in the Philippine Army as a soldier, his current position as
of now is a lieutenant colonel. Her mother died due to ovarian cancer at the age of 71
years old, and his father has Diabetes. He verbalized his uncle diagnosed with Colon
Cancer.According to him, he started to drink alcohol at the age of 14 years old and
loves to eat fatty foods and vegetables until he was diagnosed with colon mass. He was
also fun of reading books and newspaper..
F. PATIENT NEED ASSESSMENT
1. PHYSIOLOGICAL NEED
I. Oxygenation
character
and
pattern:
normal
rate
and
rhythm
IV. Elimination
Defecated 10x a day, as claimed with watery stool and urinates 5x within the shift,
yellowish in color urine, no foul odor noted.
V. Rest-Sleep
Sleep (Pattern, amount of sleep): Bed Time: 2:00am, Waking up: 4:00am, 2 hours
Problems (as verbalized): Dilijudkokatulogugtarong, tubgodsasakitsaakongtiyan
VI. Stimulation-Activity
Work: Soldier
Recreation / Pastime: Bonding with family
Hobbies / vices: Reading newspaper and watching TV
2. SAFETY-SECURITY NEED
Neuro VS: both eyes are symmetrical, iris constricted to 3mm when stimulated by light,
both
Mental
hands
are
Status:
3. LOVE-BELONGING NEED
strong,
Conscious,
both
legs
Responsive,
are
strong.
Coherent
Have 5 children; has good relationship with them. Living with wife and has a good
relationship with her.
4. SELF-ESTEEM NEED
He is aware about his condition and is willing to recover, for his family and
especially to his wife.
5. SELF-ACTUALIZATION NEED
He realized that things right now are not the way it used to be, he accepted that due
to his old age he is now weak and will lessen the intensity of his daily work and will now
focus more on his health.
I. PHYSICAL ASSESSMENT
General Survey
Received lying on bed, awake, responsive and coherent. Has a life supporting
apparatus attached; IVF. With clean and tidy bed and bed linens, things on the side of
the bed are properly arranged, room is humid with adequate lighting, pleasant smell,
and minimal noise.
REVIEW OF SYSTEMS
Integumentary System
No jaundice noted, no cyanosis noted. Skin is brown in color, with poor skin turgor.
HEENT (HEAD, EYES, NOSE, NECK, THROAT)
HEAD
Head is normal in size, symmetric, round erect and in midline. No head and scalp
lesion noted. With smooth and fine white hair evenly distributed, no dandruff noted.
EYES
Patients eyes are symmetrical; sclera is white in color. No eye discharges noted.
Eyebrows and eyelashes are equally distributed. Conjunctivae is pale in color. Swelling
and lesions not noted. With dark circles on the orbital are noted. Both eyes are alert.
EARS
Mr.C can hear clearly. Clients ears are both symmetrical; No discharges observed, no
lesions, wounds or discoloration noted upon inspection.
NOSE
Nostril are symmetrical, normally red nasal mucosa with no drainage. The color is
the same as the rest of the face.
NECK
Short, no tracheal deviations felt upon placing a finger along one side of the
trachea. No swollen lymph nodes upon palpation.
THROAT
Lips is dry and without lesions or swelling. Tongue is pinkish and is free of
swelling and lesions. The buccal mucosa of Mr. C appears pink and dry, without lesions.
Tonsils are present and they are normally pink and symmetric. No exudates, swelling or
lesions was present.
Pulmonary System
No Adventitious breath sound noted; symmetrical chest expansion. Theres an
equal rise and fall of the chest with a rate of 20 cycles per minute. Breathing character
and pattern is on normal rate and rhythm. Not in respiratory distress.
Cardiovascular System
Upon auscultation there is no blowing and murmurs heard. Regular cardiac rate and
rhythm. He has a blood pressure of 110/80 and pulse rate of 80 beats per minute.
Capillary refill is less than 2 seconds.
Gastrointestinal System
Genito-urinary System
Defecated 10x a day with watery stool and urinates 5x within the shift, yellowishin
color, no foul odor noted.
Neurologcial Status
No neurologic deficits, no auditory and visual hallucination.
COURSE IN THE WARD
Date & Assessmen Medical
Shift
t
Managemen
t
6/20/1 D: Received Intravenous
6
lying
on therapy
as
bed, awake, ordered;D5L
conscious
R 1L SFSR
and
x2
coherent.
with
IVF
#4D5LR 1L
@ 140cc/
infusing well
at
Left
basilic vein
Rationale
Nursing
Intervention
Rationale
Hypertonic
solutions
are
those
that
have
an effective
osmolarity
greater than
the
body
fluids. This
pulls
the
fluid into the
vascular by
osmosis
resulting in
an increase
vascular
volume. It
raises
intravascula
r
osmotic
pressure
and
provides
fluid,
electrolytes
and calories
-IV
tube
checked.
-IV site checked.
-IV rate check.
-To
check
tube
patency
- To check
for
any
swelling and
discoloration
.
To
calculate the
amount that
will
be
infused.
for energy.
.
8:00
am
D:
Temp:36.4
PR:80bpm
RR:20cpm
BP:110/80
6/21/1
6
73 Shift
8:05
am
D: Received
lying
on
bed, awake,
conscious
and
coherent.
with D5LR
1L@
140cc/ on
KSS
with
ongoing
blood
transfusion
of 1 unit
fresh whole
blood
A+
with serial
no
8200002078-2
and expiry
date of july
7,
2016
infusing well
@
Left
Basilic vein
9:00A
M
-Vital
signs To monitor
monitored and vital
signs
regulated
and assess
for
any
unusualities
Transfusion
Therapy:
Secure
3
units
fresh
whole blood
as ordered
Blood
is
transfused
either
as
whole blood
(with all its
parts)
or,
more often,
as
individual
parts. The
type
of
blood
transfusion
you
need
depends on
your
situation.an
illness that
stops your
body from
properly
making
a
part of your
blood, you
may need
only
that
part to treat
the illness.
Check
the
VS
before,
during
and after
Monitor
for
the
reactions.
- sent to x-rat
room
per
wheelchair
-To
have
baseline
data
-
1:00
PM
Dcomplained
of
right
lower
quadrant
abdominal
pain
upon
moving and
exertion @
rate pain as
7/10 in a
scale of 110
Nubain 5mg
IV q 6 hours
PRN
as
ordered.
Relief
of -1. Referred to
moderate to NOD.
severe
2.
.Reassess
pain.
patients level of
pain at least 15
and 30 minutes
after parenteral
administration
BLOOD CHEMISTRY
ELECTROLYTES
Lab Exam
Normal
Result Implication
Value
136.00137
145.00 mmol/
L
S.SODIUM
S. POTASSIUM
3.505.00mmol/L
S.
CALCIUM 1.12(ionized)
5.00mmol/L
S.CHLORIDE
96.00106.00mmol/
L
S.MAGNESIUM
0.701.05mmol/L
S.PHOSPHORUS 0.801.50mmol/L
Date: June 19, 2016
4.1
1.15
Time: 3:02 PM
HEMATOLOGY REPORT
Date: June 19,2016
Lab Exam
Hemoglobin
Normal Value
Resul
t
Male: 134.00- 103
160g/L
Time: 3:00 PM
Implication
Interpretation:
Below
normal.
Implication: Nutrition need, rest and sleep
Female:120.0
0-150.00g/L
Hematocrit
Male:0.400.54
Female:0.360.45
0.31
Leucoocyte
No.
Concentratio
n
Segmenters
5.00-10.00
10^9/L
0.40-0.60
0.59
Lymphocytes
0.25-0.40
0.21
Monocytes
Eosinophils
Basophils
Stabs
Thrombocyte
s
0.01-0.12
0.01-0.05
0.005
0.01-0.05
150.00-440.00
X 10^9/L
0.17
0.02
0.01
Reference: http://healthyeating.sfgate.com/dietperson-suffering-low-hemoglobin-9801.html
Interpretation:
Below
normal
range
Implication: Nutrition need
Reference:http://www.livestrong.com/article/4206
35-diet-changes-that-can-help-low-hematocritlevels/
X 10.8
372.0
TIME
PROTHROMBIN
TIME
UNKNON
PLASMA
13.2
SECONDS
CONTROL
PLASMA
13.1
SECONDS
INR
1.13
% ACTIVITY
94.4
26.8
SECONDS
CONTROL
PLASMA
27.9
SECONDS
COLONOSCOPY RESULT
DATE/ JUNE 11, 2016
FINDINGS:
THE SCOPE WAS INSERTED UP TO THE ASCENDING AREA. A LARGE
FUNGATING FRIABLE MASS WAS SEEN AT THE ASCENDING MULTIOLE
BIOPSIES WERE TAKEN AND SENT FOR HISTOPATHOLOGIC STUDIES. THERE
WAS DIFFICULT PASSING THE SCOPE BEYOND THE MASS.THE REST OF THE
COLON HAD GOOD DISTENSIBILITY ON AIR INSUFFLATION. THE COLONIC
MUCOSA APPERED SMOOTH, SHINY AND PINKISH WITH NO, ULCER NOR
POLYPS SEEN.THE HEMORRHIODAL VESSELS WERENOT ENGORGED.
COMPLICATIONS: NONE
BIOPSY: SENT TO MDMRC
DIAGNOSIS:
COLONIC MALIGNANCY, ASCENDING
Gastrointestinal tract
Is an organ system responsible for transporting and digesting foodstuffs,
absorbing nutrients, and expelling waste. The tract consists of the stomach and
intestines, and is divided into the upper and lower gastrointestinal tracts. The GI tract
includes all structures between the mouth and the anus, forming a continuous
passageway that includes the main organs of digestion, namely, the stomach, small
intestine, and large intestine. In contrast, the human digestive system comprises the
gastrointestinal tract plus the accessory organs of digestion (the tongue, salivary
glands,
pancreas,
liver,
and
gallbladder)
The
GI
tract
releases hormones from enzymes to help regulate the digestive process. These
hormones, including gastrin, secretin, cholecystokinin, and ghrelin, are mediated
through either intracrine or autocrine mechanisms, indicating that the cells releasing
these hormones are conserved structures throughout evolution. The colon is about six
feet long and has four parts namely the ascending colon, transverse colon, the
descending colon, and the sigmoid colon. Beyond the sigmoid colon is the rectum and
the anus. The colon from cecum to the mid-transverse colon is also known as the right
colon.
The
remainder
is
known
as
the
left
colon.
The ascending colon, on the right side of the abdomen, is about 12.5 cm long. It is the
part of the colon from the cecum to the hepatic flexure (hepatic means liver). The
transverse colon extends from the hepatic flexure to the splenic flexure(near the
spleen). The descending colon extends from the splenic flexure to the beginning of the
sigmoid colon. The sigmoid colon starts after the descending colon and ends before the
rectum.
The
name
sigmoid
means
S-shaped.
The rectum is about eight inches and connects the sigmoid colon with the anal canal.
The anal canal is 2.5 - 4 centimeters long. It's situated between the rectum and
anus.The functions of the Colon are absorption of water and minerals and the formation
and elimination of feces. The small intestine absorbs the nutrients from the food and
pours the leftover sludge into the cecum. This sludgy waste then moves from the cecum
to the colon for further processing. The colon absorbs water from the sludge while
transporting it toward the rectum. The colon stores the waste material until it is time for it
to be evacuated. The colon moves the waste material through by involuntary wavelike
contractions, made possible by smooth muscles within the colon wall, a process which
is referred to as peristalsis.The urge to defecate is signaled by the propulsion of feces
from the sigmoid colon to rectum. Distention of the rectum causes relaxation of the
internal anal sphincter (involuntary sphincter). For defecation to proceed, the external
anal sphincter must voluntarily relax. Defecation is facilitated by squatting or sitting and
by
increasing
intra-abdominal
pressure.
SYMPTOMATOLOGY
SYMPTOMS
A change in
your bowel
habits.
ACTUAL
SYMPTO MS
IMPLICATION
Rectal
bleeding or
blood in your
stool
Persistent
abdominal
discomfort,
such
as
cramps, gas
or pain
Weakness or
fatigue
Unexplained
weight loss
ETIOLOGY
Older age.
ACTUAL
SYMPTOMS
IMPLICATION
African-American
race.
Family history
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.
http://www.mayoclinic.org/diseasesconditions/colon-cancer/symptomscauses/dxc-20188239
Lifestyle
If you're inactive, you're more likely to
develop colon cancer. Getting regular
physical activity may reduce your risk of
colon cancer.
http://www.mayoclinic.org/diseasesconditions/colon-cancer/symptomscauses/dxc-20188239
Low-fiber, high-fat
diet.
Diabetes
People with diabetes and insulin resistance
may have an increased risk of colon cancer.
http://www.mayoclinic.org/diseasesconditions/colon-cancer/symptomscauses/dxc-20188239
Smoking
People who smoke may have an increased
risk of colon cancer.
http://www.mayoclinic.org/diseasesconditions/colon-cancer/symptomscauses/dxc-20188239
PATHOPHYSIOLOGY
Predisposing Factors
Precipitating Factors
Lifestyle
Age
Gender
Hereditary
b.)Bloody stool
c.)Abdominal Pain
d.)weakness
e.)Diarrhea
Polyps occur
if untreated
Continue increase in
size
Proliferation of cancer
cells in that area
if treated
Surgical Mgt.
Nursing Mgt.
-Colonoscopy
-Chemotherapy
-Radiation
- Monitoring of VS
- Administration of drugs
ordered
-Instructed to increase oral fluid
intake
-Encourage Rest
-Instructed to have a good diet
Formation of new
tumor
Complications
occur
DEATH
Written Pathophysiology
intestine(colon)
or rectum (terminal
portion
of
the
large
intestine). Colon cancer (or bowel cancer) and rectal cancer are sometimes referred to
separately. Colorectal cancer develops slowly but can spread to surrounding and distant
tissues
of
the
body.
Chronic
inflammatory
bowel
diseases
such
as Crohn
disease or ulcerative colitis are associated with colorectal cancer, as is the presence of
a large number of noncancerous polyps along the wall of the colon or rectum. Other risk
factors include physical inactivity and a diet high in fats. Those who have previously
been treated for colorectal cancer are also at increased risk of recurrence. Certain gut