Discussion Report

Nursing Care of Clients with Ca. Colon stage 3

By:
Savinah Najihah Izhari (I1J021001)
Rayinda Marthia Dilargutty (I1J021007)
Nur’Azizah (I1J021008)
Silvia Amanda Zahra ( I1J021010)
Celsi Desfayanti ( I1J021014)
Ruth Christine Simatupang (I1J021031)
Haeqal Wildanta Assofa (I1J019002)
Jonathan Puji (I1J020009)

Nursing Study Program, Faculty of Health Sciences

General Soedirman University

 CHAPTER 1

INTRODUCTION

Background

Loss is an event that any individual must have experienced and will
experience in his life, either losing property, losing a job, losing limbs or the
function of limbs, losing a place to live, or losing a loved one either completely
or only partial, whether gradual or sudden, whether temporary or permanent. The
cause of loss can be due to carelessness, accident, natural disaster, divorce, or
death. Loss is defined as an actual or potential situation that can be experienced
by individuals when parting with something that previously existed, either in part
or in whole, or a change occurs in life resulting in a feeling of loss (Hidayat, 2012).
Generally individuals do not want to be in a loss situation, because loss is
a difficult situation to accept, because apart from the individual having to get used
to the new conditions due to loss, loss is also very closely related to individual
emotional control. Losing the closest person, especially because death is a form
of loss that is very unpleasant and frightening, this is because death means that
someone will lose the closest person forever and because of the intimacy, intensity
and dependence of the bonds or relationships that have been formed for so long,
so it is not uncommon for individuals to will experience a disorder such as
depression, trauma and other disorders that can hinder the development or
activities of the individual as a result of the loss. In line with what was stated by
Suntrock (2002) loss can come in life in various forms such as divorce, job loss,
death of a pet, but there is no greater loss than the death of a loved one and
cherished as a parent, sibling, spouse, relative or friend.
Individuals who experience loss will be in a state of grieving (grief)
because loss and grieving are integral, according to Hidayat (2012), grieving is an
emotional reaction from loss and occurs simultaneously with loss either due to
separation, divorce or death. While the term bereavement is a state of grieving
that is shown during an individual going through a reaction or a period of
mourning (mourning). Grief (Grief) is an emotional response that is expressed
when someone experiences a loss which is then manifested in the form of feelings
of sadness, anxiety, anxiety, shortness of breath, insomnia, and so on (Suseno:
2004)
The effects of loss and grief include behaviors that will hinder individual
development in the future, such as reluctance to do their own tasks, sadness,
smiling, talking to themselves, daydreaming, not focusing, and withdrawing from
the environment. . This is what attracts researchers to conduct research on loss
and grief. Many factors can cause unresolved loss and grief, including the
individual's relationship with the person who left him, good, close and intimate
relationships will certainly affect the grieving response of loss, positive closeness
and deep intimacy will make the individual more resilient. it is difficult and long
to go through the stages and processes of loss and grief until the individual can
return to normal conditions. This will certainly be very detrimental to his life, in
addition to hampered activities, development as well as health will be disrupted,
if conditions like this where sadness and grief deepen and seem to never end and
continue of course not only himself will be disturbed but those around him will
also get the impact and bad results.
In order for the individual to return to normal conditions, external and
internal support is needed. External support is influenced by the social
environment (Ginanjar, 2009) and internal is influenced by 3 kinds of intelligence
factors that each individual has, namely intellectual intelligence, spiritual
intelligence, and emotional intelligence (Agustian, 2002)
Emotional intelligence is part of the personal aspect that is owned by each
individual which differs from one individual to another individual, emotional
intelligence is the focus of this research because emotional intelligence is very
important for the process of individual development (Goleman, 2002)
Individuals who have emotional intelligence High students can control and
regulate emotions well so that they will become individuals who can solve
problems, become individuals who are effective in achieving goals and will
increase productivity towards others (Patton, 2000). Loss and grieving greatly
affect the emotional state of the individual experiencing it, hence emo
intelligence.
Objective

From the explanation of the background above, it can be concluded that

the purpose is
a. Analyzing Factors Associated with Psychosocial Problems in Patients
b. Knowing the relationship between parental support and clients
 CHAPTER 2

LITERATURE REVIEW

Grieving
Grief is an emotional and psychological process that occurs when someone
experiences the loss of a family member. In the context of psychosocial care,
grieving is a normal reaction to loss that affects the individual as a whole. The
grieving process involves a variety of changes in emotions, thoughts, and behavior
that can vary in intensity and duration. In psychiatric care, grieving is also known
as Traumatic Grief when it occurs in the context of a sudden, unexpected, or
traumatic death. In Traumatic Grief, individuals may have difficulty dealing with
and processing strong emotions, have nightmares or disturbing memory replays,
and have difficulty functioning socially and emotionally.
Psychosocial care and psychiatric care have an important role in helping
grieving individuals. A treatment team trained in this area can provide emotional
support, assist the individual in processing complex emotions, and provide the
information and resources needed to deal with loss. In psychosocial care, a
commonly used approach is bereavement counseling. Grief counseling aims to
help individuals express and understand their feelings, explore ways to honor and
remember the deceased, and develop healthy coping strategies. In psychiatric
care, grieving therapy is an approach that is often used. This therapy involves in-
depth therapeutic conversations to help individuals overcome trauma and
difficulties in grieving. Therapists may also use trauma processing techniques that
can help individuals process the emotions associated with loss and promote
healing.
Overall, psychosocial care and psychiatric care play an important role in
supporting individuals grieving the loss of a family member. A sensitive and
trained approach to responding to an individual's emotional and psychological
needs can help them deal with and experience the grieving process in a healthy
and supportive way. In dealing with grief, there are several needs that need to be
met to assist individuals in dealing with and absorbing the grieving process in a
healthy manner. Some of these needs include: Emotional Support: Individuals
who are grieving need emotional support from family, friends, or medical
personnel. Listening empathetically, giving them space to talk about their feelings
and emerging emotions, and showing presence and concern can all help reduce
emotional baggage. Information and Understanding: Understanding what
happened and why the loss occurred can assist individuals in processing and
accepting reality. Providing clear information about loss situations and providing
opportunities for individuals to ask questions and gain adequate understanding
can help reduce confusion and anxiety.
Space to Grieve: Individuals need to have a safe and comfortable space to
express their grief. Allowing them to feel emotions as they arise, express sadness,
anger, or loss, and express feelings in a healthy way can aid in recovery. Social
 Support: Having caring and supportive people around the grieving individual is
very important. Providing social support in the form of physical presence,
conversation, or sharing activities can help reduce feelings of isolation and
increase feelings of connection with others. Meeting Practical Needs: During
times of grief, the individual may need assistance with daily tasks or with practical
matters. Providing assistance with household chores, managing schedules or other
tasks, and ensuring basic needs such as food, rest, and self-care are met, can help
individuals focus on their grieving process.
Anxiety
Anxiety is a feeling of fear that is unclear and unsupported by the situation.
When feeling anxious, individuals feel uncomfortable or afraid or may have a
premonition that disaster will befall them even though they do not understand why
these threatening emotions occur (Videbeck, 2008)
Anxiety is an unpleasant emotional state characterized by fear and
physical symptoms that are tense and unwanted (Teifion Davies & TKJ Craig,
2009).
Anxiety is a disorder of feelings (affective) which is characterized by
feelings of fear or worry that are deep and continuous, do not experience
interference in assessing reality (reality testing ability/RTA, still good),
personality is still intact (not experiencing splitting of personality). ), behavior can
be disturbed but still within normal limits (Dadang Hawari, 2011).
Anxiety is a feeling of worry, a fear that is not clear why. Anxiety is a
great force in driving normal behavior and deviant behavior, both of which are
statements, appearances, manifestations of defense against anxiety. Fear is caused
by threats, so people will avoid themselves and so on. Anxiety can be caused by
external and internal dangers, and in general the threats are vague (Gunarsa and
Yulia, 2012).
Body image disturbance
Body image is a component of self-concept which is influenced by
cognitive growth and physical development. Body image is a collection of an
individual's conscious and unconscious attitudes toward his body, including past
and present perceptions, and feelings about shape, size, function, appearance and
potential. Disturbed body image is a feeling of dissatisfaction with changes in the
shape, structure and function of the body because it does not match what is
desired. Some of the causes of body image disturbance are invasive measures
(infusion, catheter, mag tube, oxygen), surgery, changes in function (paralysis,
shortness of breath, blindness and deafness).
Predisposing factors for body image disturbance according to Suliswati,
(2005) are:

1. Loss/damage of body parts (anatomy and function)

2. Changes in body size, shape, and appearance (due to growth and
development or disease)
 3. The pathological process of the disease and its impact on the structure
and function of the body.
4. Treatment such as radiation, chemotherapy, transplant.

Helplessness
According to NANDA International (2011) helplessness is the client's
perception or response that the behavior or actions he has taken will not bring the
expected results or will not bring about the expected results, so that it is difficult
for the client to control the situation that occurs or controls the situation that will
occur.
According to Carpenito (2009), powerlessness is caused by a lack of
knowledge, feelings of worthlessness, inadequate previous coping (such as:
depression), and lack of opportunity to make decisions. Factors related to
powerlessness according to Doenges, Townsend, M, (2008), namely:
a. Environmental health: loss of privacy, private property and control over
therapy.
b. Interpersonal relationships: abuse of power, abusive relationships.
c. Regimen-related illness: chronic illness or debilitating condition.
d. A lifestyle of helplessness repeats failure and dependency.
 CHAPTER 3

DISCUSSION

Case

Mrs D, 48 years old, was diagnosed with Ca. Colon stage 3. The client
underwent colon resection surgery and made a stoma 2 days ago. When he
regained consciousness after surgery, the hysterical client found a colostomy bag
in his stomach. The client says "I do not want to be like this". The family
accompanying the client said that 2 months ago a relative had the same disease
and died not long after the stoma operation. The client always remembers his
brother's experience. During treatment the client is accompanied by his younger
sister, child and husband the client has died. Several times the client said that he
always bothered his sister. The client also said "My condition is like this, it's
increasingly troublesome for my sister." The client has an infusion, nasal cannula,
NGT, and catheter installed. Today's TTV measurement: BP 130/80 mmHg, RR
20x/min, N 78x/min, S 37.8 OC. Pale and sweaty skin, and dry lips. The family
says today the client sleeps a lot.
 Discussion

(1) Explain the concept of psychosocial problems experienced by clients, including:

definition, etiology, signs and symptoms, management.

Definition: Altered perception of an individual's physical appearance, structure

and function.

Symptom :

- Changes in body structure/shape (eg amputation, trauma, burns, obesity, acne)

- Changes in body function (eg disease processes, pregnancy, paralysis)

- Changes in cognitive function

- Incompatibility of cultures, beliefs or value systems

- Developmental transitions

- Psychosocial disorders

- Effects of action/medication (eg surgery, chemotherapy, radiation therapy)

Major Symptoms and Signs

Subjective data : Objective Data :
Reveals a mess/missing body part Missing body parts
Body function/structure changes/disappears

Minor Symptoms and Signs

Subjective data : Objective Data :
Do not want to disclose disability / loss of body
parts Hide/show body parts excessively
Expresses negative feelings about body changes Avoid looking at and/or touching body parts
Expresses concern at the rejection/reaction of
others Excessive focus on body changes
Nonverbal response to body changes and
Reveals lifestyle changes perceptions
focus on past appearances and strengths
Social relationships change
(2) Identify nursing problems by analyzing subjective data and objective data

Data Analysis Nursing Problem

Subjective Data : Anxiety
- the client is worried about the
current condition and always
remembers the experience of his
sibling who died 2 months ago due
to the same disease
Objective Data :
- TTV
TD : 130/80 mmHg
S : 37,8C
- Pale Skin
- Sweat a Lot
- Dry Lips
- Lots of Sleep (Disturbed Sleep
Pattern)
Subjective Data : Situational low Self-esteem
- The client said “I do not want to be
like this”
- The client said “my condition like
this is getting inconvenient for my
sister”
- The family said the client sleeps a
lot
Objective Data :
- The client sleeps a lot
Subjective Data : Disturbed Body Image
- Do not want to reveal the client's
disability says "I don't want to be
like this"
Objective Data :
- Colon resection operation and
stoma creation
- There is a colostomy bag in the
client's stomach
Subjective Data : Grief
- The client always remembers the
experience of his sibling who had
the same disease and died not long
after the stoma surgery
- The client says "I do not want to be
like this"
Objective Data :
- The client is hysterical because he
found a colostomy bag in his
stomach
 - The client sleeps a lot
Subjective Data : Powerlessness
- The client also said "my condition
like this is getting inconvenient for
my sister"
Objective Data :
- The client has an infusion, nasal
cannula, NGT, and catheter
installed
- During treatment the client is
accompanied by her younger sister

(3) Determining the priority of diagnosis based on data analysis:

a. Grieving related to the loss (D.0081)

b. Anxiety related to the threat of death (D.0080)

c. Powerlessness related to complex or long-term care/medication programs (D.0092)

d. Disturbed body image related to bodily functions (D.0083)

(4) Create a problem tree

(5) Develop an intervention plan for all nursing diagnoses

NO Nursing Diagnosis Objectives and Outcome Nursing Intervention

Criteria
1. Grieving related to After nursing interventions Grief Process Support
loss (D.0081) for 3 x 24 hours, the level of (I.09274)
grieving decreased, with the
following criteria: Actions taken in the
intervention to support the
- The verbalization of grieving process based on
accepting the loss SIKI, include:
increases
- Verbalization of 1. Observation
expectations increases
- Verbalization of feelings - Identify the loss
of sadness decreased encountered
- Crying decreased - Identify the grieving
- Improved concentration process experienced
- Identify the nature of the
attachment to the lost
object or the person who
died
- Identify initial reactions
to loss

2. Therapeutic

- Show acceptance and

empathy
- Motivation to want to
express feelings of loss
- Motivation to strengthen
the support of family or
closest people
- Facilitation of performing
habits according to
culture, religion, and
social norms
- Facilitate expressing
feelings in a comfortable
way (ex: reading a book,
writing, drawing, or
playing)
- Discuss coping strategies
that can be used

3. Education
 - Explain to the patient and
family that denial, anger,
bargaining, depression,
and acceptance are
normal in the face of loss
- Suggest identifying the
greatest fear of loss
- Suggest expressing
feelings about the loss
- Teach them to go through
the grieving process
gradually
2. Anxiety related to After nursing interventions Anxiety Reduction (I.09314)
the threat of death for 3 x 24 hours, the level of
(D.0080) anxiety decreases, with the Actions taken in anxiety
following criteria: reduction interventions based
on SIKI, include:
- Verbalization of
confusion decreased 1. Observation
- Decreased restless
behavior - Identify when anxiety level
- Stressful behavior changes (eg condition, time
decreases of day, stressor)
- Improved concentration - Identify decision-making
abilities
- Monitor signs of anxiety
(verbal and nonverbal)

2. Therapeutic

- Create a therapeutic
atmosphere to foster trust
- Accompany the patient to
reduce anxiety, if possible
- Understand situations that
create anxiety
- Listen very attentively
- Use a calm and reassuring
approach
- Place personal items that
provide comfort
- Motivation identifies
situations that trigger
anxiety
- Discuss realistic planning
of upcoming events

3. Education
 - Describe the procedure,
including any sensations
you may experience
- Inform factually regarding
diagnosis, treatment, and
prognosis
- Instruct the family to stay
with the patient, if
necessary
- Suggest non-competitive
activities, as needed
- Encourage expressing
feelings and perceptions
- Practice diversionary
activities to reduce
tension
- Practice proper use of
self-defense mechanisms
- Practice relaxation
techniques

4. Collaboration

- Collaborative
administration of
antianxiety drugs, if
necessary
3. Powerlessness After carrying out nursing Promotion of Hope (I.09307)
related to complex interventions for 3 x 24
or long-term hours, empowerment The actions taken in the
care/medication increases, with the following hope promotion
programs (D.0092) criteria: intervention based on
SIKI, include:
- Verbalization is able to
carry out increased 1. Observation
activity
- Decreased verbalization - Identify patient and family
of frustration expectations in life
- Dependence on others achievement
decreases
2. Therapeutic

- Realize that the conditions

experienced have important
value
- Pandu recalls pleasant
memories
 - Involve the patient actively
in care
- Develop a treatment plan
that involves simple to
complex levels of goal
attainment
- Provide opportunities for
patients and families to be
involved with group
support
- Create an environment that
makes it easy to practice
spiritual needs

3. Education

- Suggest expressing feelings

towards the condition
realistically
- Suggest maintaining the
relationship (eg:
mentioning a loved one's
name)
- Suggest maintaining
therapeutic relationships
with others
- Practice setting goals that
match expectations
- Practice how to develop
your spiritual self
- Practice reminiscing and
enjoying the past (ex:
accomplishments,
experiences)
4. Disturbed body After nursing interventions Body Image Promotion
image related to for 3 x 24 hours, body image (I.09305)
bodily functions has improved, with the
(D.0083) following criteria: Actions taken in body image
promotion interventions based
- Seeing body parts on SIKI, include:
improve
- Touching body parts 1. Observation
improves
- Verbalization of body - Identify body image
parts disability improved expectations based on
- Verbalization of missing developmental stages
body parts improves
- Identification of culture,
religion, gender, and age
related to body image
- Identify changes in body
image that result in social
isolation
- Monitor the frequency of
self-critical statements
- Monitor whether the patient
can see the body parts that
change

2. Therapeutic

- Discuss changes in the body

and its functions
- Discuss the differences in
physical appearance on
self-esteem
- Discuss changes due to
puberty, pregnancy, and
aging
- Discuss stressful conditions
that affect body image (eg:
injury, illness, surgery)
- Discuss how to develop
realistic body image
expectations
- Discuss patient and family
perceptions of changes in
body image

3. Education

- Explain to the family about

the treatment of changes in
body image
- Suggest expressing self-
image of body image
- Suggest using assistive
devices (eg: clothes, wigs,
cosmetics)
- Suggest joining a support
group (eg: peer group)
- Train your body functions
- Practice self-improvement
(eg: dressing up)
 - Practice self-disclosure of
abilities to other people and
groups

(6) Identify at least 3 psychosocial nursing interventions from national and international
journal articles (published in the last 5 years)

a. The Effect of Autogenic Relaxation Techniques on Reducing Anxiety in

Primigravida Trimester III Mothers in the Working Area of the Todoy Health
Center, Bolaang Mangondow Regency (2020)
The conclusion in this study is that there is an effect of giving autogenic relaxation
techniques on reducing anxiety in third trimester primigravida mothers
https://ejournal.unimman.ac.id/index.php/jka/article/view/84
b. Nursing Interventions in Reducing Body Image Disorders in Breast Cancer
Patients: Literature Review (2022)
The conclusion nursing intervention, beauty treatment, scalp cooling, resistance
training and aerobic exercise, online writing exercise structure and online health
education can improve body image of breast cancer patients.
http://journal2.stikeskendal.ac.id/index.php/keperawatan/article/view/316
c. Effect of nurse-led hospital-to-home transitional care interventions on mortality
and psychosocial outcomes in adults with heart failure: a meta-analysis (2022)
The Conclusion is Generally, nurse-led hospital-to-home TCIs may play a
beneficial role in decreasing mortality, and improving HRQoL and self-care
behaviours for adults with HF. Additional studies are warranted to characterize
the optimal nurse-led TCIs for HF management.
https://academic.oup.com/eurjcn/article/21/4/307/6430915
 BAB 4

CLOSING

Conclusion
Loss is a condition where a person experiences a lack or non-existence of
something that used to exist or was once owned. Loss is an individual state of being
separated from something that previously existed to become nonexistent, either partially
or completely. Grief is a normal response to any loss. From the concepts and explanations
that have been described above, the writer can conclude that loss and grieving are integral
parts of life. Loss is an individual state of being separated from something that previously
existed, then becomes non-existent, either partially or completely, and grieving is an
emotional response that is expressed to the loss that is manifested, including emotional,
physical, spiritual, social, and intellectual responses and behaviors, namely individuals,
families, and communities, incorporate actual, adaptive, or perceived loss into their daily
lives.
References

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Autogenik Terhadap penurunan anxiety Pada Ibu primigravida trimester III di
Wilayah Kerja Puskesmas tadoy kabupaten bolaang mongondow, Jurnal
Kesehatan Amanah. Available at:
https://ejournal.unimman.ac.id/index.php/jka/article/view/84 (Accessed: 13 May
2023).

Utomo, E.K. et al. (2022) Intervensi Keperawatan dalam menurunkan Gangguan Citra
Tubuh Pada Pasien Kanker Payudara: Literature review, Jurnal Keperawatan.
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http://journal2.stikeskendal.ac.id/index.php/keperawatan/article/view/316
(Accessed: 13 May 2023).

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Prayuda hendi, Muhammad. Asuhan Keperawatan Pasien dengan Ca Colon. Lustupdate

13 november 2011