CASE STUDY

(COLON CANCER)

Submitted By: Tolentino, Ericka Louise D.

Submitted To: Dr. Joy P. Delen, RN, MAN

CASE STUDY
Name: Patient X
Gender: Female
Age: 52 years old
Date of Birth: May 28, 1964
Address: GMA Cavite
Religion: Roman Catholic
Case: Stage III Colon Cancer
The client continued to work. Her menstrual periods have been irregular but occasionally heavy.
She experienced recent weight loss of 10 lbs over the past 6 months.
A. Chief Complaint:
- Weakness
- Fatigue
B. Medical History:
The patient reported chronic constipation and hemorrhoids, mild dyspnea, exertion, and chronic
arthritis in her knees. She has been monitored for hypertension with current control using
diuretics. Her last mammogram 8 months ago was normal. The patient has had no screening
colonoscopy. She took oral contraceptives for 10 years, but is currently not receiving hormonal
therapy.
C. Family History:
Her mother has type 2 diabetes and her father died at age 60 of acute myocardial infarction. One
brother is alive at age 61 with hypertension.
D. Social History:
She is divorced with 2 children and lives alone. She has never smoked and rarely drinks alcohol.
She is an avid tennis player.

E. Physical Examination:
She was 56 tall and weighed 128 lbs. Vital signs were as follows: BP- 130/80 mmHg, PR- 86,
RR- 22, Temp.- 37. Cardiac examination was normal and present in all quadrants There was no
rectal examination revealed no masses or hemorrhoids.
F. Workup:
She was evaluated for an underlying cause for her anemia. Her history of menstrual blood loss
was not impressive, and she denied melena. The patient was referred to the Gastroenterology
Department for colonoscopy, which found a mass approximately 6 cm in size located in the
ascending colon and 18 inched from the anal verge, which was biopsied. An additional
adenomatous mass was removed from the transverse colon. A CT scan revealed an apple core
lesion in the same area of her colon as on colonoscopy. No lesions were seen in her liver. The
surgeon was reluctant to perform surgery with her hematocrit at 28 %. Her lack of response to
iron therapy was thought to be a result of an inflammatory state causing suppression of
erythropoietin.
G. Treatment Course:
The patient continuing weakness and fatigue caused her daughter to take leave from her job to
stay with her mother during chemotherapy. She tolerated her therapy without serious adverse
events until 4th cycle. The rest of her treatment was completed without significant toxicities.
H. Laboratory Result
Hemoglobin
Hematocrit
Red Blood Cells
White Blood Cells

Results
9.6
29
3.2
11,900

Segmenters

83%

Lymphocytes

14%

I. Physical Examination
AREA
Signs of distress in posture
or facial expression
Skin Color

TECHNIQUE
Inspection
Inspection

Skin Moisture

Inspection

Amount of body hair

Evennes of the growth,

Inspection
Inspection

thickness or thinness of hair

NORMS
No distress noted.
Varies from light to
deep brown.
Moisture in skin
folds and axillae
Variable
Evenly distributed

FINDINGS
The patient looks weak.
Uniform Skin Color
Skin is dry.
No abnormal hairiness.
Evenly distributed and

and covers the whole covers the whole scalp.

Inspection
Inspection

scalp.
Convex, curvature
Highly vascular and

Convex
Pale in color

color
Blanch test of Capilliary

Inspection,

pink in light
Promptly return of

Less than 4 seconds.

Refill
Presence of edema and

Palpation
Inspection and

pink or usual color.

No edema and

No edema and hollowness

hollowness in the eye

Color, texture and presence

Palpation
Inspection

hollowness
Pinkish in color with

Pale in color

Fingernail plate shape

Fingernail and toenail bed

of lesions in the palpebral

presence of small

conjunctiva.
Light reaction and

Inspection

capilliaries;moist
Constrict briskly

Constrict Briskly

accommodation
Symmetry of size and

Inspection

Symmetric

Both auricle are

Symmetry of

symmetrical
Pale in Color

position of ears
Symmetry and contour of

Inspection

the lips

contour, uniform

Gag reflex

Inspection

pink color
Present

Present

Tenderness and masses in

Palpation

Uniform

Uniform temperature; no

temperature; no

tenderness and masses

thorax

tenderness and
masses

Spinal Alignment

Inspection and

Spine vertically

Spine vertically aligned

Enlargement of liver or

Palpation
Palpation

aligned
No evidence of

No evidence of enlargement

enlargement of liver

of liver or spleen

Inspection and

or spleen
No swelling; no

Presence of swelling and

palpation

redness, no pain

pain.

spleen
Joint swelling

FUNCTIONAL HEALTH PATTERNS ASSESSMENT

Health Perception-Health Management Pattern
- The patients mother has Type 2 Diabetes and her father died because of Acute Myocardial
Infarction. The patients brother has hypertension. She has never smoked and rarely drink
alcohol.
Nutritional-Metabolic Pattern
- The patient was advised to eat high fiber and low fat foods. But she admitted that sometimes
she doesnt follow it. The patient said that she cant everything she wants because of some
restrictions on foods.
Elimination Pattern
- The client eliminates for about 1-2 times a day, has dark brown stools and sometimes she is
having difficulty in eliminating. And urine 3-4 times a day.
Activity-Exercise Pattern
- The patient is an avid tennis player. But when she was diagnosed with Colon Cancer, she is
unable to perform any exercise at all.
Sleep-Rest Pattern
- She usually sleeps for about 6-8 hours a day. He cannot sleep well because sometimes she feels
headache and back pain.

Cognitive-Perception Pattern
- The patient has hearing and eyesight problem. Sign Language is the one she is using when
communicating to other people, but she can hear a little.
Self-Perception, Self-Concept Pattern
- The patient didnt lose her hope because of her cancer, instead she just does her best just to
fight it. The patients daughters give her a reason to fight this cancer and live longer.
Roles-Relationship Pattern
- The patient is divorced with 2 children and lives alone.
Sexuality-Reproductive System
- When she and her husband were still together, they dont do sexual activities even before the
detection of the clients disease.
Coping-Stress Tolerance Pattern
- The clients cancer has a great impact on his life. She doesnt go to work anymore since she
was diagnosed with cancer because she was experiencing fatigue and weakness that caused her
daughter to take a leave from her job just to stay with her during the chemotherapy.
Values Belief Pattern
- She is a Roman Catholic and goes to church every Sunday. God serves as a guide to her family.

Anatomy and Physiology

The colon begin at the cecum, where it joins the end of the small intestine (ileum). The colon
changes to rectal tissue in its last 6 inches. Because there is not a clear border between the colon
and rectum, colon and rectal cancers are grouped together as colorectal.
The colon is divided into 4 parts:

Ascending Colon- begins at the cecum, where it joins the end of the small intestine, and
travels upward along the right side of the body to the transverse colon.

Transverse Colon- connects the transverse colon and the sigmoid colon and lies along the
left side of the body.

Sigmoid Colon- connects the descending colon and the rectum.

Function:
The main functions of the colon and rectum are to absorb water and nutrients from what we eat
and to move food waste out of our body.

The colon receives partially digested food, in a liquid form, from the small intestine.

Bacterial (bowel flora) in the colon break down some materials into smaller parts.

The epithelium absorbs water and nutrients. It forms the remaining waste into semi-solid
material (feces or stool).

The epithelium also produces mucus at the end of the digestive tract, which makes it
easier for stool to pass through the colon and rectum.

Sections of the colon tighten and relax (peristalsis) to move the stool to the rectum.

Pathophysiology