A CASE STUDY ON COLON MASS

____________________

A Related Learning Experience Research Work

Presented to Mrs. Cristin G. Ungab

___________________

In Partial Fulfilment of the Requirements in BSN 4

Related Learning Experience (RLE) NCM 106

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

US. http://www.who.int/mediacentre/factsheets/fs297/en/ date Retrieved: June 25,

2016
Colorectal cancer is among the top five most common cancers in the Philippines
today. However, recent statistics show that the Philippines has a higher colorectal
cancer

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.

http://www.philstar.com/cebu-lifestyle/2015/05/04/1451051/top-10-common-cancersphilippines/ Date Retrieved: June 25, 2016

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?

4. What is the effective management for Colon Mass?

5. To identify the clients primary problem and formulate effective nursing care plan
II. ASSESSMENT
A. BIOGRAPHICAL DATA
NAME: Mr. C

Attending Physician: Dr. Magallen

AGE: 46years old

Admission Date/Time: June 19, 2016/ 12:12 PM

Gender: Male

Nationality: Filipino

ADDRESS: MAGSAYSAY EXTENSION, SOBRECAREY STREET, TAGUM CITY

DAVAO DEL NORTE
RELIGION: Roman Catholic
OCCUPATION: SOLDIER
STATUS: Married
AGENCY: Bishop Joseph Regan Memorial Hospital - St. Jude
Admitting Diagnosis: Colon Mass; To Consider Malignancy
B.CHIEF COMPLAINT
SAKIT AKONG TIYAN, SA TUO DAPIT AS VERBALIZED
DILI JUD KOKATULOG UG TARONG, TUNGOD SA SAKIT SA AKONG TIYAN AS
VERBALIZED
C.HISTORY OF PRESENT ILLNESS
Patient C was admitted on June 19, 2016 at 12:12 Pm at BISHOP JOSEPH REGAN
MEMORIAL HOSPITAL he came to the hospital together with his wife. According to him

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

BP: 110/600 mmHg PR: 80 bpm RR: 20cpm

Lungs (per auscultation)
Symmetry of chest expansion: normal
Lung sound: No adventitious sounds heard upon auscultation
Breathing

character

and

pattern:

normal

rate

and

rhythm

Cardiac Status:a dynamic precordium; no heaves and thrills; no murmurs; regular

cardiac rate and rhythm
Capillary Refill: with capillary refill of <2 seconds
Skin Character and color: brown in color and dry
Life supporting Apparatus: IVF: D5LR 1L at 140cc/hr infusing well at Left metacarpal
vein. And Blood transfusion line.
Other Observations: Cyanosis not noted. Nailbeds and conjunctivae are pale in color.
Not in respiratory distress
II. Temperature Maintenance
Temperature: 36.4 C
His skin is warm and dry to touch.
III. Nutritional Status
Height/Weight: 5'9 feet/ 74 KgsAmount of food consumed: Whole meal served
Prescribed diet: Diet as Tolerated
Skin character: Poor skin turgor

Eating pattern: Eats 3x a day

Intake: IVF: 300cc Water: 1000ml

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

Smooth, flat, umbilicus centrally located, no splenomegaly, no hepatomegaly, with

scar present on his abdomen.
Musculoskeletal System
Symmetrical structure; No lesions noted. Arms are able to move through active ROM.
Feet are symmetrical in shape.

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

D: for Chest Chest x-ray

X-ray
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

III.LABORATORY AND DIAGNOSTIC EXAMINATIONS

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

Sodium levels may get too low if your

body is losing too much water and
electrolytes. It may also be a symptom of
certain medical conditions.
http://www.healthline.com/health/hyponatr
emia#Overview1

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

Interpretation: Below Normal range

Implication: Nutrition need; to boost immune
system, infection mgt.
Reference:
//www.wikihow.com/IncreaseLymphocytes

372.0

PROTHROMBIN TIME/ ACTIVATED PARTIAL THROMBOPLASIN

TIME

JUNE, 20, 2016/ 11:19PM

PROTHROMBIN
TIME
UNKNON
PLASMA

13.2

SECONDS

CONTROL
PLASMA

13.1

SECONDS

INR

1.13

% ACTIVITY

94.4

ACTIVATED PARTIAL THROMBOPLASTIN TIME

UNKNOWN
PLASMA

26.8

SECONDS

CONTROL
PLASMA

27.9

SECONDS

DIGESTIVE ENDOSCOPY UNIT

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

REVIEW OF ANATOMY AND PHYSIOLOGY

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

Long-term constipation, diarrhea, or a change in

the size of the stool may be a sign of colon cancer.
Pain when passing urine, blood in the urine, or a
change in bladder function (such as needing to
pass urine more or less often than usual) could be
related to bladder or prostate cancer. Report any
changes in bladder or bowel function to a doctor.
http://www.cancer.org/cancer/cancerbasics/signsand-symptoms-of-cancer

Rectal
bleeding or
blood in your
stool

Unusual bleeding can happen in early or advanced

cancer. Coughing up blood may be a sign of lung
cancer. Blood in the stool (which can look like very
dark or black stool) could be a sign of colon or
rectal cancer.
http://www.cancer.org/cancer/cancerbasics/signsand-symptoms-of-cancer

Persistent
abdominal
discomfort,

Pain may be an early symptom with some cancers

like bone cancers or testicular cancer. A headache
that does not go away or get better with treatment

such
as
cramps, gas
or pain

may be a symptom of a brain tumor. Back pain can

be a symptom of cancer of the colon, rectum,
or ovary. Most often, pain due to cancer means it
has already spread (metastasized) from where it
started.
http://www.cancer.org/cancer/cancerbasics/signsand-symptoms-of-cancer

Weakness or
fatigue

Unexplained
weight loss

Fatigue is extreme tiredness that doesnt get better

with rest. It may be an important symptom as
cancer grows. But it may happen early in some
cancers,
like leukemia.
Some colon or stomach cancers can cause blood
loss thats not obvious. This is another way cancer
can cause fatigue.
http://www.cancer.org/cancer/cancerbasics/signsand-symptoms-of-cancer
Most people with cancer will lose weight at some
point. When you lose weight for no known reason,
its called an unexplained weight loss. An
unexplained weight loss of 10 pounds or more may
be the first sign of cancer. This happens most often
with
cancers
of
the pancreas, stomach, esophagus (swallowing
tube), or lung.
http://www.cancer.org/cancer/cancerbasics/signsand-symptoms-of-cancer

ETIOLOGY OF THE DISEASE

ETIOLOGY

Older age.

ACTUAL
SYMPTOMS

IMPLICATION

The great majority of people diagnosed with

colon cancer are older than 50. Colon
cancer can occur in younger people, but it
occurs much less frequently.
http://www.mayoclinic.org/diseasesconditions/colon-cancer/symptomscauses/dxc-20188239

African-American
race.

African-Americans have a greater risk of

colon cancer than do people of other races.
http://www.mayoclinic.org/diseasesconditions/colon-cancer/symptomscauses/dxc-20188239

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.

Colon cancer and rectal cancer may be

associated with a diet low in fiber and high in
fat and calories. Research in this area has
had mixed results. Some studies have found
an increased risk of colon cancer in people
who eat diets high in red meat and
processed meat.
http://www.mayoclinic.org/diseasesconditions/colon-cancer/symptomscauses/dxc-20188239

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

Abnormal proliferate of cell in the

colon area

Signs and Symptoms:

a.) Rectal Bleeding

Arising from epithelial lining of the

intestine

b.)Bloody stool
c.)Abdominal Pain
d.)weakness
e.)Diarrhea

Polyps occur

if untreated

Continue increase in
size

Metastases of cancer cells in

other organs.

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

Colorectal cancer, disease characterized by uncontrolled growth of cells within

the large

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

bacteria, including species of Fusobacterium, have been implicated in colorectal

cancer; Fusobacteriumare present at increased levels in colorectal cancer patients and
can trigger inflammatory responses associated with tumour growth and progression.
Because colorectal cancer is a disease of the digestive tract, many of the symptoms are
associated with abnormal digestion and elimination. Symptoms include episodes
of diarrhea or constipation that extend for days, blood in the stool, rectal bleeding,
jaundice, abdominal pain, loss of appetite, andfatigue. Because these symptoms
accompany a variety of different illnesses, a physician should be consulted to determine
their cause.