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Colorectal Cancer Concept Map

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History of Present Illness (HPI), Pathophysiology of Admitting Dx
(Cite References) Medical, Surgical, Social History (1).
The elder told the physician that the symptom started some months ago.
There were times when he had diarrhea which suddenly was replaced by
constipation. Since that time his abdomen was always distended. The last
time he weighed himself he found out that he lost 13 pounds. In the last 3
days he also felt sick, he started vomiting and when he went to the toilet
he saw blood in the stool. That's what alarmed him and convinced him to
visit the doctor.
Pathophysiology of the DX: This type of cancer is the fourth in terms of
frequency. The main point of metastasis is represented by the liver
because of the venous circulation. There are several risk factors for this
diseases such as excessive red meat consumption or hypercaloric diet
with less than normal fibers. Smoking also creates the risk for this
neoplasm for 2 to 3 times and also obesity and sedentarism. Nevertheless,
genetic factors seem to be implicated too because 20% of the colorectal
cancers affect the patient who already has a 1 relative with this type of
cancer. (Rabeneck,Horton,Zaubet,2015)
Medical History
-Hypertension: is defined as a systolic blood pressure which exceeds 140
mmHg and a diastolic pressure of 90 mm Hg. These values need to be
high during two or more measurements. In 90 to 95% cases there is no
identifiable etiology for this pathology. The prognosis depends on several
features such as the level of the blood pressure, to co-existence of other
cv diseases, the age at presentation and the state of the target organs.
Nevertheless, studies pointed out that treatment of hypertension will
drastically reduce the risk for coronary artery diseases and also for stroke.
(Ashley,Niebauer,2004)
Surgical History
The patient has no surgical history. He was never admitted to the hospital
as he always prepared to take his medication at home. The biopsy of the
cancer was his first surgical procedure. After that the went a colectomy
surgery to remove the tumor follow to be the placement of a colostomy.
Social History
The patient admits he is a smoker. He denies alcohol consumption and
drug consumption. In terms of diet, he confirms that he has irregular
meals and likes fast food.
If it were to examine his background, this patient has many relatives with
different types of cancers. His mother died of breast cancer 19 years ago
and his brother was diagnosed at 44 years old with colorectal
adenocarcinoma.
Chief Complaint
The patient presents episodes of watery stools
alternating with hard stools. He previously
vomited and the last time he went to the toilet
the stool was bloody.
Admitting Diagnosis
Colorectal Adenocarcinoma
Patient Information
(1)
Name: F.L
Age:66
Gender: Male
Code Status: Full Status
DPOA: N/A
Living Will: N/A
Patient Education (In Pt.) & Discharge Planning (home needs)
-Avoid lifting anything which is heavier than 5 pounds.
-Avoid driving. If you ride a car for a trips stop frequently in order to
stretch your legs.
-The patient should be able to return to work in 6 to 8 weeks.
-Since the patient was left with a colostomy he needs to follow the
instruction of the health care in regard to how to care take of it.
-The incision site should be washed with water and soap and after that
used a dry towel to clean it. It also should be checked for any signs of
swelling or drainages.
-Avoid any herbal or supplements for a period of time and only take the
medication instructed.
-Contact the physician in case of fever over 100.4 F, signs of infection
at the site of the incision, change of color in case of the stoma, blood in
the stool or no gas, excessive leading and increased pain.
Concept Map
Student Name:
Instructor:
Diagnostic Test/ Lab Results with dates
and Normal Ranges (3)
Test
Norms
Date
Current
Value
White Blood
Count
4-11
8/30/20
18
12
CRP mg/dl
9-19
8/30/20
18
20
ESR
< 15
mm/h
8/30/20
18
88
CEA
< 3
ng/ml
8/30/20
18
11
ng/ml
CA 19-9
0-37
U/ml
8/30/20
18
66
U/ML
The patient went a colonoscopy
procedure during which a biopsy was
taken. Later the biopsy confirmed the
presence of a colorectal adenocarcinoma.
Medical Management/ Orders/ Medications & Allergies (2)
Name
Dose
RT
Freq.
MOA
RN
Considerations
Onset/Peak
/Duration
(Insulin)
Propanolol
(Preston,O
'Neal,Tala
ga,2017)
40
mg
PO
b.i.d
Non selective
beta blocker .
-Measure blood
pressure and
respiration
-Discuss about
salt intake
-Obtain medical
history to rule
out asthma and
allergy.
Aspirin
(Preston,O
'Neal,Tala
ga,2017)
100
mg
PO
o.d
Inhibitor for
plaetele
aggregation
-Check the IRN
of the patient
Erickson’s Developmental Stage Related to pt. & Cite
References (1)
At the age of 66, our patient is in the last stage of Erikson's
development list and is represented by the crisis between ego
integrity and despair. In this case, the basic virtue is wisdom.
At this time people slow down and start to explore life. It is
also that period in which we reflect on our accomplishments
and determine if we were successful in life. If we managed to
meet our goals and we are satisfied with our way of leaving we
state that we are successful at this stage and will lead to the
virtue of wisdom. Our patient is a retired bank accountant,
married with 1 son and 2 grandchildren. He is happy about the
way he lived and how he raised his son. Overall he is proud
that he is still able to help them when they need
him(Malone,Liu,Rentz,Waldinger,2016).

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Priority nursing diagnosis #1
Risk of Constipation or Diarrhea
- Since the patient underwent
chemotherapy and radiation
therapy also his mucous can be
irritated. Also, the tumor can
secrete hormones which can
influence the defecation process.
(Herdman,Kamitsuru,2017)
Vital Signs (4)
Temperature : 100.4 F (
low grade fever)
Heart Rate : 101
(tachycardia )
Breath : 27 (tachypnea)
Blood pressure : 90/60 (
hypotension)
Neurological (5)
The patient examined is:
*awake
*Oriented in terms of
space and time ( knows
where he is and what
time it is)
*Has normal tonus
Respiratory (7)
Sa202 = 88%
Tachypnea 27
No rhonchi could be
heard and neither
crackles.
Priority nursing diagnosis #2
A risk for the Impaired integrity
of the skin: The patient also
underwent radiotherapy and
also chemotherapy. Both of
them causes an immunologic
deficit and can lead to an altered
dermis and epidermis.
(Herdman,Kamitsuru,2017)
Outcome/Goal #2
Manage to find technique
through which the patient is able
to heal as fast as possible
without any complications that
would put him under even more
psychological stress.
Outcome/Goal #1
The goal is for the patient to be able to
maintain a bowel consistency and a
bowel pattern. The patient should
understand what are the solutions for
this kind of problem so he can take
measures when the nurse is not next to
him.
Interventions #1
Encourage the patient to drink 2000
ml /24 h and also to increases the fiber
intake. This will reduce constipation
and will stimulate the peristalsis.
Avoid foods that can cause diarrhea or
gas such as cabbage, fast food, nuts or
fluids high in caffeine. Caffeine can
stimulate the gastrointestinal tract and
can lead to frequent stools.
Make sure that the diet of the patient
matches his needs. Do not allow the
patient to undergo a low-calorie diet as
getting the required nutrients is
essential for the healing process.
Interventions # 2
Instruct the patient to take baths with
mild soap and lukewarm water. This is
specially designed so they won't irritate
the skin and at the same time, they will
maintain the body clean.
Turn the patient frequently because this
will promote circulation. Otherwise, the
pressure will be applied to specific parts
of the body and can damage the skin and
tissue.
Apply to the area of radiation water-
soluble moisturizing gel which will
reduce the skin irritation.
Instruct the patient to wear loose
clothing that is not directly attached to
the skin. This will protect the damaged
tissue from the ultraviolet ray from the
sun but will also ensure that the patient
is comfortable enough so he can walk.
Assessment/ Evaluation #1
Check the bowel sounds and record the bowel movements in
case of the patients.Chemotherapy ( vinca alkaloid) can
influence these parameters.
Monitor the patient's weight and also level of hydration in order
to be able to determine if he is eating and drinking enough.
Monitor his blood parameters especially electrolytes and
administer intravenous fluids in case of dehydration. In case of
severe diarrhea, antidiarrheal agents can be offered while in
case of constipation laxatives. (Herdman,Kamitsuru,2017)
Assessment/ Evaluation #2
Check the skin of the patient for side effect from the therapy.
Also is the nurse duty to note any delay healing. Radiation field
can lead to a reddening of the skin or a dryness. In severe cases,
blisters and loss of dermis can appear.
Also, review the skin care protocol for this patient. It is not
allowed to avoid rubbing or using all types of soaps. This will
minimize the pressure that is done on the tissue and will let it
heal effectively. (Herdman,Kamitsuru,2017)
PC Interventions
-Focus on the importance of personal hygiene
-Advice the patient to try to take short walks. This will prevent
stasis and its complications (thrombus/pneumonia)
-Explain to the patient what could be the possible side effects of
this treatment. Inform about the possible erectile dysfunction so
the patient can adapt better in case of that.
-Instruct the patient to take all his medications as required.
-In case of dehydration ensure that the patient is drinking enough
fluids or hydrate him intravenously. (Herdman,Kamitsuru,2017)
PC Evaluation Plan
-Monitor the temperature of the patient
-Assess all systems for signs and also symptoms of
infections.The earlier they are recognized the better the treatment
will be.
-Administer antibiotics if needed.
-Refer to a sex therapist if it is needed
-Determine the pain history of the patient and its intensity.
Determine if it is becoming worse. Determine what precipitates
these pains in order to be able to find out the cause.
(Herdman,Kamitsuru,2017)
PC Outcomes/Goal
Patient will heal fast.
He understand the risk of the surgery
but also its benefits
All complications are avoided
Patient is able to continue a normal
life.
Potential Complications/ at
risk for
Anastamotic Leak (5-
15%)
Hemmorhage
Ureteral injury
Erectile dysfunctions
Nutrition/Hydration
(8)
Patient lost weight in
the past month. He
admits that he lost 13
pounds in two months
without keeping any
diet.
Patient is dehydrated
Rest/ Exercise (11)
The patient is a little
bit lethargic. He is able
to walk on his own
without help but tends
to walk with very small
steps .
GI (9)
Patient shows
discomfort On
palpation
Hepatomegaly
Distended abdomen
Rectal exam : black