JG COLLEGE OF

NURSING

SUB: MEDICAL-SURGICAL NURSING

TOPIC: CARE PLAN ON COLON

CANCER

SUBMITTED TO: SUBMITTED BY:

MS.AMEE MAM VIRENDRA LOHAR
ASST.PROFESSOR SYMSc NURSING
JGCN
 IDENTIFICATION DATA OF THE PATIENT
Name: Sanjay Pandya

Age: 54 Year

Sex: Male

Address: Bodakdev, Ahmedabad

Marital status: Married

Religion: Hindu

Educational status: Primary education

Occupation: Self-Employed

Diet: Vegetarian

Register no.:

Bed no.:04

Ward: Supportive ward

Date and time of admission: 24/09/2019 at 2.40 pm

Diagnosis: Cancer of Colon readmitted with Surgical site Infection

 HISTORY OF THE PATIENT

CHIEF COMPLAINTS:

The below listed were the chief complains of the patient:

 High fever since 01 day

 Pain at the surgical site since 1 day
 Inflammation at the surgical site since 2 days.
 Fatigue and anxiety.

PRESENT HISTORY:

A 54 Year old male patient was relatively asymptomatic before 02 days then he
claimed that she had a complain of high fever 102◦ F and pain at Incision area
(pain scale 8/10).Two days prior to admission he stated that there was no any
signs of pain or inflammation..A day prior to admission she experienced
weakness and dizziness but he ignored it.An hour prior to admission she
experienced severe pain and discharge again so he accompanied by his wife
visited to HCG cancer hospital for reatment and examination.

PAST HISTORY:

The patient iwas diagnosed with Cancer of colon 8 weeks ago and had been under
treatmenrt undergone the surgery for that 1 week ago.

Apart from this patient does not have any history of any major communicable
diseases.

No any history of major non communicable diseases.

FAMILY HISTORY:

There are 6 members in the family.All the members of the family are health and
living.There is family history of colon cancer.

Key:

Male

Female
F
e
Patient
n
m
a
PERSONAL HISTORY:

Patient does not have any bad habit of smoking and Tobacco chewing. He is
vegetarian and consumes local available vegetables . When patient was diagnosed
with Ca colon he had complain of constipation.

SOCIO-ECONOMIC HISTORY:

Socio-economic status: Moderate

Income: 45,000-50,000 rs per month
Expenditure: 25,000-35,000 rs per month
No. of person earning: 3
Housing: Adequate with all basic lighting, sanitation and water supply
Behaviour: Extrovert
 PHYSICAL ASSESSMENT
Assessment Findings

General appearance

• Nourishment Well nourished

• Body built Obese

• Health Unhealthy

• Activity Absent

• Personal hygiene Untidy

Height 160 cms

Weight 74 kg

Vital signs

• Temperature 101º F

• Pulse 68 beats/min

• Respiration 22 breaths/min

• Blood pressure 134/84 mm of Hg

Integumentary

Wheatish complexion
 Skin Dry and rough skin

Evenly distributed hair.

 Hair
black and rough hair.

Convex and with capillary refill time of 2

 Nails
seconds.
 Rounded, normocephalic and symmetrical,
Skull smooth and has uniform consistency.
Absence of nodules or masses.
Symmetrical facial movement
Face
Slight puffy

Eyes and Vision

Hair evenly distributed with skin intact.
• Eyebrows Eyebrows are symmetrically aligned and
have equal.

Equally distributed.
• Eyelashes
Skin intact with no discharges and no
• Eyelids
discoloration.

• Bulbar conjunctiva Transparent with capillaries slightly visible

• Palpebral Conjunctiva Shiny, smooth, pink

• Sclera Appears white.

• Lacrimal gland, Lacrimal sac, No edema or tenderness over the lacrimal

Nasolacrimal duct gland and no tearing.

Black, equal in size with consensual and

• Pupils direct reaction, pupils equally rounded and
reactive to light and accommodation

Ear and Hearing

• External Ear Canal Without impacted cerumen.

Normal intact
• Tympanic membrane
Normal Hearing Acuity test
• Hearing Acuity Test
Nose and sinuses

Symmetric and straight, no flaring, uniform

• External Nares and nostrils
in color.
 Mucosa is pink, no lesions and nasal
• Nasal Cavity septum intact and in middle with no
tenderness.

 Nasal sinuses Normal

Mouth and Oropharynx

• Lips Symmetrical, pale lips, brown gums

With dental caries and decayed lower

• Teeth
molars

Central position, pale but with whitish

• Tongue and floor of the mouth coating, with veins prominent in the floor of
the mouth.

Positioned at the midline without tenderness

Neck and flexes easily. No masses palpated,
Central venous catheter is present
Head movement Can perform on command

Muscle strength Moderately adequate

Lymph Nodes Non-palpable, non-tender

• Thyroid Gland Not visible on inspection

Thorax and lungs

• Posterior thorax Chest symmetrical

• Spinal alignment Spine vertically aligned

Breath Sounds Normal breath sounds

Abdomen Lesions found and distended.

Symmetrical movements cause by

Abdominal movements respirations.On inspection redness around
inflammation site.

• Auscultation of bowel sounds

 Without scars and lesions on both
Upper Extremities extremities.

Without scars and lesions on both

Lower Extremities
extremities.

Muscles Coordination movement was present

Bones and Joints No deformities

Genitalia No any abnormality

Rectum and Anus

Observation No any abnormality found

Palpation No any masses

Mental Status

Language Speaks only Gujarati

Orientation Oriented to a person, place, date or time.

Attention span Decreased

Level of Consciousness Conscious

 INVESTIGATIONS

SR. NAME OF NORMAL

FINDINGS UNIT REMARK
NO INVESTIGATION VALUE

COMPLETE BLOOD COUNT (24/09/2019)

1. Haemoglobin 10.6 gm/dl 13-16 Decreased
2. WBC 12.50 *10^3/cmm 4-10 Increased
3. RBC 3.80 *10^6/cmm 3.8-4.8 Normal
4. Haematocrit 18.3 % 36-46 Decreased
5. MCV 83.90 Fl 80-99 Normal
6. MCH 27.60 Pg 27-32 Normal
7. MCHC 33.60 g/dl 31.5-34.5 Normal
8. MPV 9.10
9. RDWcv 16.6 % 11.5-14.5
10. Platelets 214.00 *10^3/cmm 150-450 Normal
11. Polymorphs 77.00 % 60-80 Normal
12. Lymphocytes 9.00 % 20-40 Decreased
13. Eosinophils 2.00 % 1-6 Normal
14. Monocytes 3.00 % 2-10 Normal
15. Basophils 0.00 % 0.3-1.5 Decreased
 MEDICATIONS
SR. NAME OF THE
DOSE ROUTE FREQUENCY
NO. MEDICATION

1. Inj.Pantaprazole 40mg IV BDS

2. Inj.Paracetamol 2ml IV BDS

3 Inj.Meropenum 1gm IV OD

4. Inj.Tramadol 50mg/ml IV BDS

5. Ini.Metrogyl 100ml IV BDS

IN THE PATIENT:
NAME OF NURSING
DOSE ROUTE ACTION INDICATION
THE DRUG RESPONSIBILITY

INJ. 40mg IV It is a proton pump

Pantaprazole inhibitor that  Erosive gastritis
 Check for any signs of
decreases the amount  Gastro esophageal
heart burn.
of acid produced in reflux disease.
the stomach.  Pathological
 Monitor magnesium
Hypersecretion
levels of the patient.
Associated with
Zollinger-Ellison
 Check if the patient is
Syndrome.
allergic to the
 Stress Ulcers
medicine before
 Helicobacter
administering it.
Pylori infections.
 Monitor the patient
for any side-effects.
SIDE-EFFECT

 severe stomach
pain, diarrhea that
is watery or
bloody;
 sudden pain or
trouble moving
your hip, wrist, or
back;
 bruising or
swelling where
intravenous
pantoprazole was
injected;
 kidney
problems -
urinating less than
usual, blood in
your urine,
swelling, rapid
weight gain;
 low magnesium -
dizziness, fast or
irregular heart
rate, tremors .
NAME OF
THE DOSE ROUTE ACTION INDICATION NURSING RESPONSIBILITY
DRUG

INJ. 2ml IV It does appear to  Acute pain.  Monitor patient for any
selectively inhibit COX side-effects.
Paracetamol
 Fever.
activities in the brain,
 Follow the rights of
which may contribute  Muscle pain. patients before
to its ability to treat administering the drug.
fever and pain.
 Osteoarthritis
 Check if the patient is
 Backache allergic to the medicine
before administering it.

 Monitor for allergic

SIDE EFFECTS reactions.

 Upset stomach or
throwing up.

 Trouble sleeping.
 Headache.

 Constipation.

 Injection site
pain
NAME OF
NURSING
THE DOSE ROUTE ACTION INDICATION
RESPONSIBILITY
DRUG

100ml IV It is an antibiotic and  Bacterial infections

Metrogyl antiprotozoal of stomach  Monitor patient for any
medication. ,vagina, skin or complications.
bones.
 Check for any
SIDE-EFFECTS inflammation at injection
site.
 diarrhea
 painful or difficult
urination  Ask the patient if they are
having difficulty in
 trouble sleeping, sleeping.
depression,
irritability
 Follow the 10 rights of
 headache, dizziness,
patient before
weakness administering the drug.
NAME OF
THE DOSE ROUTE ACTION INDICATION NURSING RESPONSIBILITY
DRUG

INJ. 2ml IV It is a narcotic-like

pain reliever.
Tramadol 50mg/ml Management of moderate  Monitor patient for any
Centrally acting
complications.
opiate receptor to moderately severe
agonist that inhibits
the uptake of pain.  Check for any inflammation
norepinephrine and at injection site.
serotonin,
suggesting both
opioid and  Ask the patient if they are
nonopioid feeling dizzy.
mechanisms of pain
relief. May produce  Follow the 10 rights of
opioid-like effects, patient before administering
but causes less the drug
respiratory
depression than
morphine.
SIDE-EFFECTS

 Constipation

 nausea, vomiting.

 stomach pain

 dizziness

 drowsiness

 tiredness

 headache
NAME OF
THE DOSE ROUTE ACTION INDICATION NURSING RESPONSIBILITY
DRUG

INJ. 1g IV It is used to treat a  Mengitis.

Meropenum wide variety of  Make sure patient is not
 Intra-abdominal
bacterial infections. hypersensitive to drug before
infections.
This medication is administering it.

known as a  Sepsis.
carbapenem-type  Follow the 10 rights before
 Pneumonia.
antibiotic. It works administering the drug.
by stopping the
SIDE EFFECTS  Monitor for any
growth of bacteria. complications.
 Upset stomach.
 Nausea.
 Vomiting.
 Diarrhea.
 Swelling,redness or
pain at injection site.
 PRIORITY OF THE NEEDS/ PROBLEMS

 Acute pain related to surgical incision as

evidenced by pain scale and verbal report of
pain by patient.

 Hyperthermia related to inflammatory process

as evidenced by taking vitals T:102 F.

 Impaired skin integrity related to surgery as

evidenced by swelling around incision site.

 Deficient knowledge regarding the condition,

treatment and prognosis as evidenced by patient
frequently asking questions regarding condition.

 Sleep pattern disturbance related to surgery as

evidenced by observing the sleep pattern of
patient.

 Anxiety related to situational crisis as evidenced

by verbal report of patient.
 Risk for fluid volume deficit related to bleeding
from incision site.

 Risk for altered nutrition less than body

requirements related to fatigue.
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Acute pain Providing To ask client Asked client about For obtaining Patient has
Data: related to comfort about pain. pain.Client rated 7/10 baseline data. verbalised
surgical and on pain scale. reduction in the
Patient says
incision as reducing level of pain
“I feel pain at evidenced by pain. from 7/10 t0
surgery site.” pain scale 4/10.
and verbal To provide Provided calm Decreases fatigue
calm environment and and conserves
report of pain
environment. scheduled rest energy,enhancing
by patient.
periods. coping abilities.
Objective Data:

Facial grimace
and
Restlessness Provided comfort Relieves
To provide
noted. measures such as discomfort.
comfort
frequent change of
measures.
position,back rubs
and support with
pillows.
Administer Administered Relieves the
analgesic as Injection Tramadol as pain.
ordered. ordered.
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Data: Hyperthermia Maintain To assess Assessed patient’s For baseline Psatient showed
related to ing body patient vitals. vitals T:102 F. data. improved vital
Patient says
inflammatory temperat signs
“I feel feverish.” process as ure. Temperature
evidenced by was reduced to
taking vitals 99 F after in
To provide Provided quite and For adequate
T:102 F terventions.
quiet and relaxed atmosphere rest.
Objective Data: relaxed for rest.
atmosphere.
Patients facial
grimace noted
and looks tired.

Decreases
To encourage
Encouraged ample chances of
ample fluid
fluid intake in order to dehydration.
intake.
avoid dehydration.
To give cold Given tepid sponge to Reduce the body
sponge. the patient. temperature.

To administer Administered Reduce the body

antipyretics. Paracetamol temperature.
injectable as ordered.
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Data: Impaired skin Measure To assess the Assessed the impaired For baseline Patient shows
integrity s to site of site and noted for data. progress in the
Patient says:
related to protect impaired skin swelling and redness healing process
“There is surgery as and heal integrity. and pain. around incision
swelling around evidenced by tissue site.
surgery area.” swelling and
Quickens the
around incision To provide Provided tissue care
healing process.
incision site. site care. tissue care. by changing dressings
at regular basis.

Objective Data:

Patients Followed strict aseptic Prevent further

To maintain
expressions of techniques while chances of
strict hygiene
grievance noted. changing dressings spreading
practices.
and cleaning the infection.
inflamed area.

To administer Administered
Inj.Meropenum IV. Stopping the
antibiotics.
bacterial growth.
ASESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Data: Deficient Providing To assess the Assessed the patient’s For baseline Patients
knowledge adequate patient’s knowledge regarding data. verablises of
Patient says
regarding the knowledge knowledge condition. Reviewed having better
“I don’t know
condition,treat about the the effects of surgical information
much about the
ment and condition. procedure regarding
effectiveness of
prognosis as condition and
treatment
evidenced by prognosis.
regimen.”
patient To clear any Assesssed the For clarity of
frequently misinterpreta patient’s knowledge the situation.
asking tions. and based on it clear
questions any misinformations
Objective Data: regarding or misinterpretations.
condition.
Patient looks
anxious. To provide
Provided adequate To clear any
the exact
knowledge reagarding misonceptions
information.
the condition and .
future considerations
regarding surgery.
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Anxiety Appear To assess the Identification of the For the Patient has
Data: related to relaxed and patient’s patient’s fears and purpose of expressed
situational verbalised condition. misconceptions. baseline data. verbalised relief
Patient says:
crisis as relief of to some extent.
“I am worried evidenced by anxiety.
about my verbal report To Provide Provided comfortable Provides
condition.” of the patient. surrounding environment and opportunity to
in which developed nurse vent out
patient feels patient relationship to feelings.
Objective data: safe to discuss build trust for making
feelings. patient comfortable to
Anxious look vent.
and facial
grimace noted
Provided calm Facilitates rest
To Promote
environment. to reduce
calm, quiet
anxiety.
environment.
 To Permit Allowed for Can reduce
expressions of expression of the anxiety and
anger, fear, emotions. enable patient
despair to make
without decisions and
confrontation choices based
and provide on realities.
accurate
information
regarding
health
condition.
 PROGRESS CHART
1st day visit:

 History is taken of the patient.

 Physical examination performed.s
 Patient is having pain, high grade fever and inflammation at surgical site.
 Unable to perform ADL due to weakness and fatigue.
 Blood investigation shows decreased Hb levels and elevated WBC.

2nd day visit:

 Performed physical examination.

 Pain scale rating: 7
 No any remarkable reduced in pain.
 Pain and swelling still present. .

3rd day visit:

 Pain scale rating: 5

 Patient still complains of fatigue and inability to do ADL.
 Vitals show hyperpyrexia.

4th day visit:

 Pain scale rating : 4

 Pyschological support provided to the patient.
 Fever reduced on administering medication.
 Signs of inflammation considerably reduced.
 Weakness and dizziness is reduced.
 HEALTH EDUCATION
Adviced the patient the following:

 Have a peaceful relaxing and a well ventilated room.

 Stay Hydrated.

 Have a stress free environment.

 Follow the prescribed meal plan.

 Have a clean environment to prevent lodging of infectious

micro-organisms.

 Follow strict hygiene practices.

 Instruct patient to visit hospital immediately in case of any

abnormality experienced.

 Avoid lifiting and shifting of heavy objects.

 Reach to recovery volunteer to discuss his thoughts and feelings.

 Be cautious about injury and infection on the incision site.

 Maintain a positive body image.

 DISCHARGE PLANNING

Upon discharge from the hospital,the patient will be given the

following instructions:

 Medication needs to be taken on a daily basis without skipping.

 Instructed patient to understand and follow discharge instruction

accurately.

 Patient is counselled regarding the importance of eating meals

on time and a in a relaxed setting.

 Instructed the patient to avoid any strainous or heavy activites.

 Notify the physician incase of any complications.

 SUMMARY AND CONCLUSION

To summarise it can be said that patient was diagnosed

with Cancer of colon and had undergone surgery for the
same but ad developed post surgery inflammation and
infection at the surgery site and has been undergoing
treatment for the same which included medications
along with the nursing care.
Patient has been making quite a recovery and progress
in the condition which was showed in progress
chart.Advices related to care of incision site to prevent
further complications have been adviced to the patient.
BIBLIOGRAPHY