Colon Cancer Case Study
Colon Cancer Case Study
Colon Cancer Case Study
Submitted by:
Group 3C
De Guzman, Muriel
Dela Cruz, Angelo
Dela Cruz, Gilson
Florindo, Louisiana
Galila, Cyvren
Gatuz, Sarah Mae
Group 3D
Gomez, Shennah Kyra
Gonzales, Cesar Nestor
Hipolito, Joana Mae
Joson, Sophia Chrischelle
Juat, Patricia Ellise
Mamacos, Francoise Caseyliam
Submitted to:
Mrs. Almira Gabriel, RN, MAN
January 2023
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
INTRODUCTION
Evidently, colorectal cancer, which describes co-occurring colon cancer and rectal
cancer, is common causes of mortality and morbidity throughout the world regardless of
numerous reliable screening tools and therapies available. Many patients with colon
cancer are diagnosed in early stages (stages I to III), but in this case study, the patient is
already in the late stage when diagnosed which makes it have a less opportunity for
cure. Stage 4 colon cancer is when the cancer cells present in the colon extend to other
parts of tissues and organs.
The symptoms of colon cancer vary on which type of cancer it is, how big is the
size, and whether it has spread to any other parts making it as important to get checked
if you have experienced the following: (1) changes in bowel habits, (2) rectal bleeding, (3)
presence of blood in the stool, (4) abdominal pain, (5) weakness & fatigue, and (6) weight
loss. For some instances, it does not show symptoms until the cancer cells are spread
out and grown; therefore, it is best to be tested earlier if there are suspicious symptoms.
Many screening tests and examinations may be done to confirm a colon cancer, but this
is depending on your symptoms. Doctors might order tests such as protein tests, gene
tests, colonoscopy, biopsy, CT scan, and ultrasound.
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
Epidemiology
As discussed lately, colon cancer is already the common cause of death in the
world. Its incidence is increasingly rising in developing nations. Main factor is genetic, but
it could also be a cause of dietary failure. According to GLOBOCAN (2018), colon cancer
is the topmost incident cancer in the world. Colon is the fourth most common incident
while rectal cancer is the eighth most incident. Making colorectal cancer as the third most
common diagnosed form of cancer globally.
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
The colon is also referred to as the large intestine or large bowel. It is an organ
that is a part of the human body's digestive system, which is also known as the digestive
tract. To eliminate feces and keep the body's fluid and electrolyte balance, it works with
organs like the stomach and small intestine. When it comes to how our bodies utilize the
food we eat, the colon plays a crucial role. The large intestine begins its connection to the
small intestine, the cecum. Then the rest of the colon's body portion is followed by five
sections, which are:
• Ascending colon - the hepatic flexure of the cecum marks the beginning of the
ascending colon, which measures about 10 cm in length. It connects with the
transverse colon along the right side of the abdomen.
• Transverse colon - which is 50 cm long, located adjacent to the gallbladder, liver,
and stomach. The distal, or left-sided, a portion of the large intestine joins to this
via the descending colon.
• Descending Colon - roughly 10 cm long, the downward left portion of the colon
connects the transverse colon to the sigmoid colon.
• Sigmoid colon - the colon's S-shaped portion that links to the rectum.
• Rectum - the section of the large intestine that starts at the sigmoid colon, follows
it, and finishes at the anus.
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
PATHOPHYSIOLOGY
New evidence has exposed that hamartomatous and serrated polyps could lead
to colorectal cancer. There are three major molecular pathways linked to colorectal
cancer: (1) chromosomal instability; (2) mismatch repair, and; (3) hypermethylation. The
chromosomal instability pathway is a gain of mutations unbalancing oncogene and tumor
suppressors equilibrium as seen with mutations in the adenomatous polyposis coli. Cells
with deficiency of DNA mismatch repair, commonly MLH1 or MSH2, accumulate errors
within the genome that further will be repeated causing high levels of microsatellite
instability, a hallmark of Lynch syndrome. CpG hypermethylation of DNA could activate
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
or silence the expression of certain genes, Sporadic oncogenes somatic mutations have
been implicated in colorectal cancer, with RAS the most clinical relevance. RAS mutation
variants are found in 50% of colorectal cancer sporadic cases, currently being exploited
on colorectal cancer screening by stool-DNA testing, the absence of epidermal growth
factor receptors, targeted therapy response and potential direct targeted agents. In the
other hand, tumor suppressors genes require bi-allelic loss (“two-hit model”) and are
described in loss of APC 5q21 gene (80% sporadic), TP53 17p gene (50-70% sporadic),
and DCC/SMAD2-4 18q gene (73% sporadic). Specific MMR gene mutations could occur
in hMSH2, hMLH1, hPMS1 and hPMS2, hMSH6, and hMLH3; each one of them that
interact with MLH1 and approximately found in 15% of all sporadic CRC causing a Lynch-
like syndrome with MSI-H calling for universal testing. MUTYH defects have a recessive
inheritance pattern at a time requiring bi-allelic second hits or in conjunction with APC
gene mutation. Cyclooxygenase and peroxisome proliferator–activating receptor genes
have been implicated in colorectal cancer tumorigenesis currently under investigation for
chemo-protection.
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
PHYSICAL ASSESSMENT
Subjective:
• (-) chest pain
• (-) abdominal pain
• (-) melena/ hematochezia
• (-) dysuria
Objective:
• Bp 90/60
• HR 89
• RR 16
• T 36.5
• O2 sat 98% at room air
Nurses’ Observation:
• Awake, conscious coherent, not in respiratory distress
• (+) icteric sclera, pink palpebral conjunctiva (-) neck vein distention
• (-) cervical lymphadenopathy
• Symmetrical chest expansion (-) retractions (-) lagging, clear breath sounds
• Adynamic precordium, normal rate, rhythm, (-) murmur
• Flabby, normal abdominal bowel sounds, tympanitic on all quadrant, non-tender,
liver span 20cm from the midline
• (-) edema, full equal pulses
• (+) dry extremities
• Gcs 15 (e4v5m6)
Impression: Urosepsis
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
Hematology
Differentiate
Count
Clinical Chemistry
---
Indirect umol/L 18.59 --- ---
Bilirubin
TPAG
Clinical Microscopy
Procedure Result
DRUG STUDY
MECHANI NURSING
DRUG CLASSIFICAT INDICATIO CONTRAINDICA SIDE
SM OF RESPONSIBILI
NAME ION N TION EFFECTS
ACTION TIES
Generic Belongs to the Meropene Wide Meropenem is More 1. Assess
name: class of m exerts spectrum contraindicated in common patient for
Meropen carbapenems. its antibiotic patients with previous
em bactericida used to known • Constipa sensitivity
Used in the l action by treat both meropenem tion reaction to
Brand systemic binding to Gram- hypersensitivity, a • redness carbapenems
name: treatment of penicillin- positive history of and
Merrem infections. binding and Gram- carbapenem swelling 2. Assess
proteins negative hypersensitivity, at the patient for signs
(PBPs) in infections or a previous injection and symptoms
the including anaphylactic site of infection,
bacterial pseudomo reaction to beta- Less including
cell wall nas spp. lactams. common characteristics of
and resistant to wounds,
inhibiting other •
Body sputum,urine,
peptidogly antibiotics. aches or stool.
can cross- Use to pain
linking treat • cold 3. Complete C/S
associated infections hands tests before
with cell like and feet beginning drug
wall meningitis, • cold therapy
synthesis, pneumonia sweats
which and intra- • congesti 4. Assess for
ultimately abdominal on allergic
leads to infections, • cool pale reactions,
cell death. complicate skin anaphylaxis
d skin/skin • dryness
structure or 5. Identify urine
infections. soreness output
of the
throat 6. Monitor blood
• increase studies
d hunger
• indigesti 7. Monitor
on electrolytes
• nightmar
es 8. Assess bowel
pattern daily
9. Monitor for
bleeding
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
NURSING
DRUG CLASSIFICAT MECHANISM INDICATI CONTRAINDICA SIDE
RESPONSIBILI
NAME ION OF ACTION ON TION EFFECTS
TIES
1. Assess for
level of pain
relief and
administer PRN
dose but not to
exceed the
recommended
total daily dose.
2. Monitor VS
and assess for
orthostatic
hypotension or
signs of CNS
depression.
• Constipa
Hypersensitivity to tion 3. Discontinue
tramadol or • Nausea drug and notify
Generi Binds to
opioids. Known or • Dizzines physician if S
c muopioid
suspected s &S of
Name: receptor.
Relief of gastrointestinal hypersensitivity
Trama • Analgesic Inhibits • Vertigo
moderate obstruction, occur.
dol (Centrally reuptake • Headach
to including paralytic
acting) of e
moderatel ileus. Concurrent 4. Assess bowel
Trade • Opioid serotonin
y severe use of • Drowsin and bladder
Name: analgesic and ess
pain monoamine function; report
Ultram norepinep • Vomiting
oxidase inhibitors urinary
hrine in the • Agitation
(MAOIs) or use frequency or
CNS. • Anxiety
within last 14 retention
days. • Mood
swings 5. Use seizure
precautions for
patients who
have a history of
seizures or who
are concurrently
using drugs that
lower the
seizures
threshold.
6. Monitor
ambulation and
take appropriate
safety
precautions.
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
MECHANI NURSING
DRUG CLASSIFICAT INDICATIO CONTRAINDICA SIDE
SM OF RESPONSIBILI
NAME ION N TION EFFECTS
ACTION TIES
• Tremor
It is used to s/
treat the shaking
symptoms in your
of slow arms/le
stomac gs
emptying • Confusi
It on 1. Monitor BP
(gastropare
promotes • Depres carefully during
sis) in
gut motility sion IV
patients
by the • Thought administration
with
following 3 s of
diabetes.
mechanis Patient with suicide 2. Monitor for
Metoclopramid ms: (1) pheochromocyto extrapyramidal
• Slow/jer
e is in a class Inhibition ma because the reactions and
It works by ky
Generic of medications of drug may cause a consult
increasing mucle
Name: called presynapti hypertensive physician if they
the movem
Metoclopra prokinetic c and crisis, probably occur.
movements ents in
mide agents. It postsynapt due to release of
or your
works by ic cathecholomines 3. Monitor
contraction face
Brand speeding the excitatory from the tumor. diabetic
s of the • Convuls
Name: movement of 5-HT4 Such patients,
stomach ion
Reglan food through receptors hypertensive arrange for
and (seizure
the stomach and crises may be alteration in
intestines. )
and intestines. antagonis controlled by insulin dose or
m of phetolamine. • Anxiety timing if diabetic
It relieves • Agitatio
presynapti control is
sypmtoms n
c inhibition compromised by
such as • Jittery
of alterations in
nausea, feeling
muscarinic timing of food
vomiting, • Trouble
receptors. absorption.
heatburn, a staying
feeling of still
fullness • Sleep
after meal problem
and loss of s
appetite. (insomi
a)
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
MECHANI NURSING
DRUG CLASSIFICA CONTRAINDIC SIDE
SM OF INDICATION RESPONSIBIL
NAME TION ATION EFFECTS
ACTION ITIES
Hydrochlo • Eradicatio
ric acid n of H.
(HCl) Pylori to
secretion reduce
into the the risk of
gastric duodenal CNS:
lumen is a ulcer • Dizzine
process recurrenc ss
regulated e in adult. • Drowsin
mainly by • Tx of ess 1. Monitor GI
the active • Fatigue symtoms to
H(+)/K(+) benign • Headac help determine
– ATPase gastric he if drug therapy
of the ulcer in • Weakne is successful.
proton adults ss
pump • Tx of 2. Assess
Generic expressed symptom CV: dizziness that
Name: in high atic Patients with • Chest might affect
Omeprazole It is in a class quantities GERD in history of pain gait, balance
of by the patients 1 hypersensitivity and other
Trade medications parietal year of to drug such as GI: functional
Name: called proton- cells of age and anaphylactic activities.
• Abdomi
✓ Losec pump the older shock,
nal pain
✓ Omecla inhibitors. It stomach. • Tx of angioedema, 3. Caution the
• Acid
mox works by erosive interstitial patient and
regurgit
✓ Omese decreasing ATPase is esophagit nephritis, family to guard
ation
c the amount of an is (EE) d/t anaphylaxis, against falls
✓ Prevido acid made in enzyme urticaria and • Constip and trauma.
acid-
lrx the stomach. on the bronchospasm ation
mediated
✓ Analge parietal GERD in may occur. • Diarrhe 4. Monitor other
sic Pak cell patients 1 a CNS side
membran month of • Flatulen effects and
e that age and ce report severe
facilitates older • Nausea or prolonged
hydrogen • Maintena • Vomitin effects.
and nce of g
potassium healing of 5. Monitor any
exchange EE d/t SKIN: chest pain.
through acid • Itching
the cell, mediated • Rash
which GERD.
normally • Pathologi
results in c
the hypersecr
extrusion etory
of conditions
potassium in adults.
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
and
formation
of HCl
(gastric
acid).
MECHANI NURSING
DRUG CLASSIFICA CONTRAINDICA SIDE
SM OF INDICATION RESPONSIBILI
NAME TION TION EFFECTS
ACTION TIES
A selective
inhibitor of
fungal
cytochrom
e P450 • Chest
dependent tightnes
enzyme s
lanosterol • Clay-
14-a- • Vaginal 1. Use hygiene
colored
demethyla yest measures to
stools
se. This infections prevent
caused by • Dyspha
enzyme gia reinfection
normally Candida
• Systemic • Tachyca
works to 2. Arrange for
rdia
It is used to convert Candida frequent follow-
infections • Hives,
prevent and lanosterol Hypersensitivity up while you are
Generic itching
treat a variety to • Both to drug. There is taking this drug.
Name: or skin
of fungal and ergosteril, esophage no information
Fluconaz rash
yeast which is al and regarding cross- 3. Health
ole • Swelling
infections. necessary oropharyn hypersensitivity teaching about
for fungal geal between on the the side effects
Trade face,
It belongs to a cell wall candidiasi fluconazole and of the drug.
Name: eyelids,
class of drugs synthesis. s other azole
Diflucan lips,
called azole • Cryptococ antifungal agents. 4. Immediate
antifungals The free tongue, report for rash,
cal
nitrogen meningitis throat, change in stool
atom hands, or urine color,
• UTI by
located on legs, difficulty
Candida
the azole feet or breathing and
• Peritonitis genitals
ring of by increased tears/
fluconazol • Light salivation.
Candida
e bings colored
with a stools
single iron • Stomac
atom h pain
located in
the heme
group of
lanosterol
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
14-a-
demthylas
e. This
prevents
oxygen
activation
and, as a
result,
inhibits the
demethyla
tiof
lanosterol,
halting the
process of
ergosterol
biosynthes
is.
Methylate
d sterols
are then
found to
accumulat
e in the
fungal
cellular
mebrane,
leading to
an arrest
of fungal
growth.
These
accumulat
ed sterols
negatively
affect the
structure
and
function of
the fungal
cell
plasma
membrane
.
OUR LADY OF FATIMA UNIVERSITY
120 MacArthur Hwy, Valenzuela, 1440 Metro Manila
References
Medical News Today. (2023). Stage 4 colon cancer life expectancy: Diagnosis and
decisions. Retrieved from https://www.medicalnewstoday.com/articles/325230
Rawla, P., Sunkara, T., & Barsouk, A. (2019). Epidemiology of colorectal cancer:
incidence, mortality, survival, and risk factors. Przeglad gastroenterologiczny, 14(2), 89–
103. https://doi.org/10.5114/pg.2018.81072
Wilkinson, Julie. “Can You Keep Your Colon Happy and Healthy?” Verywell Health,
Sept. 2022, www.verywellhealth.com/what-is-the-colon-796819.