Case Study

On
CANCER OF
COLON
(Area of posting- Oncology Ward)

Submitted to:- Submitted by:

Resp. Mam Mrs. Shaminder Pooja
Demostrator [Link](N)1st year
UCON, Faridkot UCON, Faridkot
BIO DATA OF THE PATIENT
Name of the patient : Roop singh

Age/Sex : 74 year/ Male

Father name : Bishan Singh

RT no. : 21865

Ward : Oncology ward

Bed no. : 22

D.O.A : 01/06/2020

Religion : Hindu

Address : Kabal wala, Faridkot

Source of information : Patient and patient file

Doctor in charge : Dr. Romi kant Grover

Diagnosis : Sigmoid Colon cancer (T2N1M1)

Chief complaints

At the time of admission:

Pain in abdomen X 4 days

Pus in rectum X 3 days

Loss of appetite X 5 days

Generalized weakness X 4 days

At the time of Assessment :

Pus in rectum X 5 days

Loss of appetite X 7 days

Mild pain in abdomen (on analgesic).

HISTORY OF PRESENT ILLNESS: Patient came to G.G.S. Medical Hospital, Faridkot

through O.P.D. with the chief complaints of pain in abdomen, pus in rectum and loss of
appetite and general weakness. Patient admitted for chemotherapy (C1d15 folfox).
Present surgical history: No present surgical history is there.

 Past medical history:

Patient had a past history of treated chronic liver disease in 2017 and treated with
Tablet Chlorambucil 5mg at Bikaner.

On 4-02-2020, Contrast CT scan was done at DMC, Ludhiana which showed the long
segment asymmetrical circumferential wall thickening in decending & sigmoid colon
with pericolonic lympnodes.

On 7-02-2020, Colonoscopy was done at Dayanand medical hospital, Ludhiana which

showed the impression of sigmoid colon growth.

On 8-02-2020, Cytology done at DMC, Ludhiana which report showed positive for
malignant cells- Adenocarcinoma.

Patient took supportive treatment on 13-04-2020.

On cycle 1(C1D1), chemotherapy with FOLFOX 6 regimen given to the patient on 18-
03-2020

Now patient is admitted for chemotherapy(C1D15).

There is no any other past medical history of hypertension, diabetes, asthma, epilepsy
and cardiac heart disease.

 Past surgical history: Post- diversion Colostomy on 29-02-2020 in GGSMCH,

faridkot.

 Personal history: Patient is non-vegetarian, non-smoker, non-alcoholic etc.

Socioeconomic history
 Patient belongs to the middle –class family which is hindu by religion.
 They have good interpersonal relationship with their family members.
 They live in pacca house.
 All the other members are healthy in patient’s family.
FAMILY HISTORY:
There are four members in the family along with patient. All other family members are
healthy and there is no history of any medical condition in family members
Name of the Age Sex Education Relation Health
family status
member
Roop Singh 74years Male Illiterate Patient Unhealthy

Satya Devi 68 years Female Illiterate Wife Healthy

Baldev Singh 45years Male 8th passed Son Healthy

Rajni 42years Female Matric pass Daughter Healthy

FAMILY TREE : KEYS:

Patient Wife Male

Female

Son Daughter

Patient

PHYSICAL EXAMINATION:
General body appearance:

 Nourishment: Patient is not well –nourished.

 Activity: Patient is moderately active.
 Body built: Patient is thin

Mental status:

 Consciousness: Patient is fully conscious.

 Look: Patients look worried and anxious.

Posture:

 Body curves: No kyphosis, lordosis and scoliosis is present in the patient

 Movement: Flexion, extension of body organs is normal

Skin condition:

 Colour: Skin colour is wheatish.

 Texture: Skin of the patient is dry.
 Lesions: No macules and vesicles are present.
  *IV cannula- Cannula is at the site of right arm.

Head and face:

 Scalp: Scalp is clean and free from dandruff and pediculi.

 Face: Face looks worried but no any lesion or scar is present.

Eyes:

 Eyebrows: There is no dandruff having normal shape and size.

 Eyelashes: No infection or sty was present.
 Eyelids: There is absence of lesions and edema on eyelids.
 Eyeball: Eyeballs are not sunken and protruded.
 Sclera: White in colour
 Pupils: These are reactive to light.
 Lens: It is opaque or transparent.
 Vision: Visual [Link] myopia or hypermetropia is present.

Ears:

 External ear: No any discharge from the ear is present.

 Internal ear: No tinnitus is there.
 Tympanic membrane: No perforation is there.
 Hearing: Hearing acuity is normal.

Nose:

 External nostrils: No any lesions, crusts or discharge is present.

 Internal nostrils: No inflammation of the mucuos membrane is present.

Lips:

 Colour: Lips are pale and dry.

 Odour of mouth: No odour.
 Teeth: Teeth are white and clean.

Neck:

 Lymph nodes: No enlargement of lymph nodes found.

 Thyroid glands: No enlargement is there.
 Range of motion: Flexion and rotation of neck is present.

Abdomen:

 Observation: Rashes, scar are not present

 Palpation: Abdomen is soft by touch and colostomy bag is there.
 Percussion: No any presence of fluid is there in the abdomen.
 Auscultation: Normal bowel sound present.
Extremities:

 Upper extremities: Normal joint movement

 Lower extremities: Normal joint movement

1. SYSTEMATIC EXAMINATION

 Central nervous system: Patient is conscious, anxious look and oriented to time,
place and person at the time of assessment, patient is co-operative and answering to
commands
 Respiratory system: Respiration rate: 18/minute. Patient does not feel difficulty in
breathing. Patient is on room air. No abnormal wheezing sound.
 Cardiovascular system: Patient is having no history of cardiovascular disorders.
Normal S1S2heart sound present. Heart rate of the patient is 80bpm.
 Integumentary system: Skin colour is wheatish. Patient skin is dry. There is no
history of any skin disorder.
 Gastrointestinal system: Symmetric, abdominal pain present. Loss of appetite is
present. Pus in rectum is present during the time of admission. Colostomy bag is
attached.
 Urinary system: There is no loss of sensation and normal urination.
 Musculoskeletal system: there is no scoliosis, kyphosis and lordosis is present in the
patient. There is no cyanosis, clubbing of finger nails and toe is present. Flexion,
extension, adduction, abduction and rotation of upper extremities are normal.

VITAL SIGNS:
Date and time Blood pressure Pulse Temperature Respiration
02-06-2020; 9 am 120/80mmHg 70/min 98.60 F 18/min
03-06-2020 ;9 am 110/70mmHg 72/min 98.40F 20/min
04-06-2020 ;9 am 120/60mmHg 74/min 98.20F 18/min

LAB INVESTIGATIONS:
[Link] Lab investigation Patient value Normal value Remarks
1. Electrolytes:
[Link] 138 meq/l 135-155meq/l Normal
[Link] 4.0 meq/l 3.5-5.5meq/l Normal
[Link] 106 meq/l 98-107meq/l Normal

2. Liver function test

1. Total
bilirubin 0.6 MG% 0.3-11MG% Normal
level
2. Direct
 bilirubin 0.2 MG% 0.1-0.4MG% Normal
level
3. SGOT 12 IU/L 5-40 IU/L Normal
4. SGPT 18 IU/L 5-35 IU/L Normal
5. ALP 116 IU/L 60-150 IU/L Normal

3. VIRAL
MARKER
1. HIV Non- reactive - Non-reactive
2. HCV Non-reactive - Non-reactive
3. HBSAG Non- reactive - Non-reactive

DRUG PROFILE:
Symptomatic treatment
[Link]. Drug name Salt name Dose Frequency Rout Action
e
1 [Link] Pantaprazole 40mg BD IV Proton pump
inhibitor
2 [Link] Ciprofloxacin 100ml BD IV Antibiotic
3. [Link] Diclofenac 75mg SOS IV Analgesic
RR sodium

Chemotherapy
Regimen : FOLFOX 6
No. Of Cycles planned: 6
Chemotherapy drugs
 [Link] 100ml IV + DEXONA16mg + PANTAPRAZOLE +EMSET 16mg over 30
minutes OD
 LEUCOVORIN 700 mg in NS 500 ml IV over : 90 minutes
 OXALIPLATIN 140mg in 5% DNS 500 ml IV over : 90 minutes
 5- FLUOROURACIL 700mg in Direct IV over 5minutes
 5-FLUROURACIL 700mg in NS 500 ml IV over : 480 minutes
 5-FLUROURACIL 700mg in NS 500 ml IV over : 480 minutes
 5-FLUROURACIL 700mg in NS 500 ml IV over : 480 minutes
 5-FLUROURACIL 700mg in NS 500 ml IV over : 480 minutes
 5-FLUROURACIL 700mg in NS 500 ml IV over : 480 minutes
 5-FLUROURACIL 700mg in NS 500 ml IV over : 480 minutes
 Inj. DNS 500ml +MVI over 60 minutes OD
ANATOMY AND PHYSIOLOGY OF LARGE INTESTINE
 It is the end part of the alimentary canal. The primary function of this organ is to
finish the absorption of the nutrients, water, synthesise certain vitamins, form faeces and
eliminate the faeces from the body.

Structure: The large intestine runs from the appendix to the anus. It is called as large
intestine because of its diameter which is twice the diameter of the small intestine i.e. 3
inches.
The large intestine is sub divided into four main regions: the caecum, the colon, the rectum
and the anus. The ileocecal valve, located at the opening between the ileum and the large
intestine, controls the flow of the chime from the small intestine to the large intestine.
o Cecum:
The first part of the large intestine, a sac like structure that is suspended inferior to the
ileocecal valve. It is about 6cm long, receives the contents of the ileum and continues the
absorption of water and salts. The appendix is a winding tube that is attached to the cecum.
o Colon:
The cecum blends seamlessly with the colon. In colon, the food first enters the ascending
colon on the right side of the [Link] the inferior surface of the liver, the colon bends to
form the right colic flexure and becomes the transverse colon. The food then from transverse
colon travels to the left side of the abdomen, where the colon angles sharply immediate
inferior to the spleen at the left colic flexure. The food again passes to the descending colon,
becomes S-shaped sigmoid colon, and rectum.
o Rectum:
Rectum is located near the third sacral vertebrae. It is 20.3cm approx. in length. It has three
lateral bends that create a trio of internal transverse folds called the rectal valves. These
valves help separate the faeces from gas to prevent the simulation passage of faeces and gas.
o Anal Canal:
The food residues finally reaches the last part of the large intestine, the anal canal, which is
located in the perineum, completely outside of the abdomino-pelvic cavity. It is 3.8-5cm in
length which opens to the exterior of the body at the anus. It has two sphincters; the internal
and the external sphincter. The internal sphincter is made up of smooth muscles and
contractions are involuntary. On the other hand external sphincter is made up of skeletal
muscles and is voluntarily controlled.

Functions of the large intestine:

The residue of the chyme that enters the large intestine contains few nutrients except water,
which is reabsorbed as the residue lingers in the large intestine, typically for 12-24 [Link]
four main functions of large intestine is:
 Reabsorption of water and mineral ions such as sodium and chloride.
 Formation and temporary storage of faeces.
 Maintaining a resident population of over 500 species of bacteria.
 Bacterial fermentation of indigestible materials.
Mechanical digestion: In large intestine mechanical digestion begins when chyme moves
from the ileum into cecum, an activity regulated by the ileocecal sphincter. Right after eating,
peristalsis in the ileum forces chyme into cecum. Once the chyme enters the cecum, colon
movements begin.
Mechanical digestion in the large intestine includes a combination of three types of
movements. Sluggish segmentation in transverse and descending colon. These contractions
occur after every 30 minutes. The second movement is the peristalsis and the third is the
mass movements.
Chemical digestion: The glands in large intestine secrete mucus, they do not secrete
enzymes. The chemical digestion occurs because of bacteria in the lumen of the colon.
Through the process of saccharolytic fermentation, bacteria break down some remaining
carbohydrates. It results in the discharge of the hydrogen, carbondioxide, and methane gases
that create flatus in the colon. Each day 1500ml flatus is produced in the colon.
Absorption, Faeces formation and defecation: The small intestine absorbs about 90% of
water. The large intestine absorbs most of the remaining water, a process that converts the
liquid chyme into semi solid faeces. Faeces is composed of undigested food residues,
unabsorbed digested substances and water to let it pass smoothly out of body.
Faeces are eliminated through the contractions of the rectal muscles. The process of
defecation begins when mass movement force faeces from the colon into the rectum,
stretching the rectal wall and promoting defecation reflex.

DISEASE CONDITION ON CANCER OF COLON

Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the
final part of the digestive tract.

Colon cancer typically affects older adults, though it can happen at any age. It usually
begin as small, noncancerous (benign) clumps of cells called polyps that form on the inside of
the colon. Over time some of these polyps can become colon cancers. Colon cancer is
sometimes called colorectal cancer, which is a term that combines colon cancer and rectal
cancer, which begins in the rectum.

STAGES OF COLON CANCER:

Stage 1: The cancer has penetrated the lining, or mucosa, of the colon or rectum but hasn’t
spread to the organ walls.

Stage 2: The cancer has spread to the walls of the colon or rectum but hasn’t affected the
lymph nodes or nearby tissues yet.

Stage 3: The cancer has moved to the lymph nodes but not to other parts of the body yet.
Usually, one to three lymph nodes are involved at this stage.

Stage 4: The cancer has spread to other distant organs, such as the liver or lungs.
TNM Classification of Colon Cancer:

The most common staging system is the TNM (for tumors/nodes/metastases) system, from
the American Joint Committee on Cancer (AJCC). The TNM system assigns a number based
on three categories.

 "T" denotes the degree of invasion of the intestinal wall.

 "N" the degree of lymphatic node involvement.
 "M" the degree of metastasis.

Tumor (T)

The T stages of bowel cancer.

Numbers 0 to 4, with subgroups, are used to describe deepest tumor depth.

o TX: The primary tumor cannot be evaluated.

o T0: No evidence of cancer in the colon or rectum.
o Tis: (Carcinoma in situ) Cancer cells are found only in the epithelium or lamina
propria
o T1: Growth into the submucosa
o T2: Growth into the muscularis propria
 o T3: Growth through the muscularis propria and into the subserosa, or into tissues
surrounding the colon or rectum (but not the visceral peritoneum or surrounding
organs).
o T4a: Growth into the surface of the visceral peritoneum.
o T4b: The tumor has grown into or has attached to other organs or structures.

Node (N)

Numbers 0 to 2, and subgroups, are used to describe lymph node involvement:

 NX: The regional lymph nodes cannot be evaluated.

 N0: No evidence of spread to regional lymph nodes.
 N1a: Tumor cells found in 1 regional lymph node.
 N1b: Tumor cells found in 2 or 3 regional lymph nodes.
 N1c: There are cancerous nodules near the colon that do not appear to be lymph
nodes.
 N2a: Tumor cells found in 4 to 6 regional lymph nodes.
 N2b: Tumor cells found in 7 or more regional lymph nodes.

Metastasis (M)

Numbers 0 and 1, with subgroups, describe the metastasis status:

 M0: No evidence of distant metastasis

 M1a: Spread to 1 other part of the body beyond the colon, rectum or regional lymph
nodes.
 M1b: Spread to more than 1 part of the body other than the colon, rectum or regional
lymph nodes.
 M1c: Spread to the peritoneal surface.

Symptoms: Signs and symptoms of colon cancer include:

  A persistent change in your bowel habits, including diarrhea or constipation or a
change in the consistency of your stool
 Rectal bleeding or blood in your stool
 Persistent abdominal discomfort, such as cramps, gas or pain
 A feeling that your bowel doesn't empty completely
 Weakness or fatigue
 Unexplained weight loss
 Changes in stool color
 Changes in stool shape, such as narrowed stool
 Excessive gas
 Abdominal cramps

RISK FACTORS: Factors that may increase your risk of colon cancer include:

 Older age. Colon cancer can be diagnosed at any age, but a majority of people with
colon cancer are older than 50. The rates of colon cancer in people younger than 50
have been increasing, but doctors aren't sure why.
 African-American race. African-Americans have a greater risk of colon cancer than
do people of other races.
 A personal history of colorectal cancer or polyps. If you've already had colon
cancer or noncancerous colon polyps, you have a greater risk of colon cancer in the
future.
 Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon,
such as ulcerative colitis and Crohn's disease can increase your risk of colon cancer.
 Inherited syndromes that increase colon cancer risk. Some gene mutations passed
through generations of your family can increase your risk of colon cancer
significantly. Only a small percentage of colon cancers are linked to inherited genes.
The most common inherited syndromes that increase colon cancer risk are familial
adenomatous polyposis (FAP) and Lynch syndrome, which is also known as
hereditary nonpolyposis colorectal cancer (HNPCC).
 Family history of colon cancer. You're more likely to develop colon cancer if you
have a blood relative who has had the disease. If more than one family member has
colon cancer or rectal cancer, your risk is even greater.
 Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a
typical Western diet, which is 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.
 A sedentary lifestyle. People who are inactive are more likely to develop colon
cancer. Getting regular physical activity may reduce your risk of colon cancer.
 Diabetes. People with diabetes or insulin resistance have an increased risk of colon
cancer.
 Obesity. People who are obese have an increased risk of colon cancer and an
increased risk of dying of colon cancer when compared with people considered
normal weight.
 Smoking. People who smoke may have an increased risk of colon cancer.
 Alcohol. Heavy use of alcohol increases your risk of colon cancer.
 Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat
previous cancers increases the risk of colon cancer.

Prevention:
 a) Screening colon cancer: The people with an average risk of colon cancer consider
colon cancer screening around age 50. But people with an increased risk, such as
those with a family history of colon cancer, should consider screening sooner.
b) Lifestyle changes: To reduce your risk of colon cancer

 Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole
grains contain vitamins, minerals, fiber and antioxidants, which may play a role in
cancer prevention. Choose a variety of fruits and vegetables so that you get an array
of vitamins and nutrients.
 Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the
amount of alcohol you drink to no more than one drink a day for women and two for
men.
 Stop smoking. Talk to your doctor about ways to quit that may work for you.
 Exercise most days of the week. Try to get at least 30 minutes of exercise on most
days. If you've been inactive, start slowly and build up gradually to 30 minutes. Also,
talk to your doctor before starting any exercise program.
 Maintain a healthy weight. If you are at a healthy weight, work to maintain your
weight by combining a healthy diet with daily exercise. If you need to lose weight,
ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly
by increasing the amount of exercise you get and reducing the number of calories you
eat.

Diagnostic Evaluation:

 Medical and Family History.

 Physical Examination: They may press on your abdomen or perform a rectal exam
to determine the presence of lumps or polyps.
 Blood testing: High levels of CEA (carcino-embryonic antigen) level in the blood
indicate the metastasis of adenocarcinoma.
 Digital rectal examination: The doctor inserts a lubricated finger into the rectum to
feel for abnormal areas. It only detect tumor of large enough to be felt in the distal
part of the rectum but it useful as an initial screening test.
 Fecal occult blood test: It is used to detect microscopic blood in the stool, which may
indicate early colorectal cancer. When results of this test are positive, the diagnosis is
confirmed using barium enema, sigmoidoscopy and colonoscopy.
 Flexible sigmoidoscopy: It helps to detect the early signs of colorectal cancer (e.g.,
bleeding, polyps ) in the lining of the sigmoid colon and rectum. In this test, a flexible
tube containing a light and a camera is inserted through the rectum and sigmoid colon.
The sigmoidoscope is used to transmit images to the monitor.
 Colonoscopy: A colonoscopy involves the use of a long tube with a small, attached
camera. This procedure allows your doctor to see inside your colon and rectum to
check for anything unusual. During a colonoscopy, doctor can also remove tissue
from abnormal areas. These tissue samples can then be sent to a laboratory for
analysis.
 X-Ray: Your doctor may order an X-ray using a radioactive contrast solution that
contains the metallic element barium. Your doctor will insert this liquid into your
bowels through the use of an enema. Once in place, the barium solution coats the
lining of the colon. This helps improve the quality of the X-ray images.
  CT scan: CT scans provide your doctor with a detailed image of your colon. When
used in diagnosing colorectal cancer, another name for a CT scan is a virtual
colonoscopy.

MANAGEMENT: These are the types of treatment used in colon cancer:

 Surgery
 Chemotherapy
 Radiation therapy

Surgery: Surgery is often the main treatment for earlier-stage colon cancers. The type of
surgery used depends on the stage (extent) of the cancer, where it is, and the goal of the
surgery.

a) Polypectomy: This is a procedure that uses a long flexible tube with a small video
camera on the end that's put into the person’s rectum and threaded into the colon.
These surgeries can be done during a colonoscopy. The cancer is removed as part of
the polyp, which is cut at its stalk. This is usually done by passing a wire loop through
the colonoscope to cut the polyp off the wall of the colon with an electric current.

b) Colectomy: A colectomy is surgery to remove all or part of the colon. Nearby lymph
nodes are also removed. If only part of the colon is removed, it's called a
hemicolectomy, partial colectomy, or segmental resection. The surgeon takes out
the part of the colon with the cancer and a small segment of normal colon on either
side. Usually, about one-fourth to one-third of the colon is removed, depending on the
size and location of the cancer. The remaining sections of colon are then reattached. If
all of the colon is removed, it's called a total colectomy. Total colectomy isn't often
needed to treat colon cancer.A colectomy can be done in 2 ways:
 Open colectomy: The surgery is done through a single long incision (cut) in
the abdomen (belly).
 Laparoscopic-assisted colectomy: The surgery is done through many smaller
incisions and special tools. A laparoscope is a long, thin lighted tube with a
small camera and light on the end that lets the surgeon see inside the abdomen.
It's put into one of the small cuts, and long, thin instruments are put in through
the others to remove part of the colon and lymph nodes.

c) Colostomy or ileostomy: Some people need a temporary or permanent colostomy (or

ileostomy) after surgery. This can take some time to get used to and might require
some lifestyle adjustments.
Chemotherapy: Chemotherapy involves the use of drugs to kill cancer cells. It also may be
used prior to surgery to shrink the tumor, may be administered following surgery and may be
combined with biological and radiation therapy. Newer combination of drugs such as
FOLFOX (5-FU, Leucovorin and oxaliplatin) and FOFIRI (5-FU, Leucovorin and irinotecan)
may be used to prevent recurrence following surgery or to shrink tumor prior to surgery. A
combination of chemotherapy drugs administered intravenously and bevacizumab and
blocking agents (cetuximab) may also be used to treat metastatic colorectal cancer.

Radiation: Radiation uses a powerful beam of energy, similar to that used in X-rays, to target
and destroy cancerous cells before and after surgery. Radiation therapy commonly occurs
alongside chemotherapy.

COMPARATIVE STUDY:

CAUSES:

[Link]. According to book According to patient

1 Family history Not present
2. Obesity Not present in patient
3. Genetic disorder Not present in patient
(HNPCC)syndrome
4. History of Colostomy done and old treated chronic liver
inflammatory bowel disease
disease
5. Smoking Not present
6. Alcohol consumer Not present

CLINICAL MANIFESTATION:

[Link]. According to book According to patient

1 Rectal bleeding or blood in stool Pus in rectum is present

2. Persistent abdominal discomfort, Present

such as cramps, gas or pain
 3. Unexplained weight loss Present

4. Weakness or fatigue Present

5. Present
Loss of appetite

DIAGNOSTIC EVALUATION:

[Link]. According to book According to patient

1. Colonoscopy Done
2. CT scan Done
3. MDCT scan whole abdomen Done
4. Sigmoid colon growth biopsy Done
5. Faecal occult blood test Not done

MANAGEMENT:

[Link] According to book According to patient

1. Radiation therapy Not done
2. Immunotherapy Not done
3. Surgery Colostomy done
4. Chemotherapy Yes, FOLFOX (C1D1 complete)

NURSING MANAGEMENT
NURSING PROCESS

NURSING DIAGNOSIS

1. Acute pain related to the disease condition as evidenced by the patient verbalization.
2. Impaired skin integrity related to the surgical incisions, formation of stoma and
frequent faecal contamination of peristomal skin.
3. Imbalanced nutrition status less than body requirement related to anorexia as
evidenced by the loss of appetite and by checking weight of the patient.
4. Anxiety related to treatment as evidenced by asking questions.
5. Deficient knowledge related to disease condition as evidenced by the asking
questions.
SHORT TERM GOALS

 To relieve the pain.

 To maintain the nutritional status of the patient.
 To reduce the anxiety.
 To provide the knowledge regarding the treatment of
chemotherapy.

LONG TERM GOALS

 To prevent further complication.

 To rehabilitate the patient.
HEALTH EDUCATION

 ORAL HYGIENE
o Instruct the patient how to do gentle brushing.
o Instruct the patient to rinse mouth before meals.
 HYGIENE
o Educate the patient to take daily bath.
o Educate the patient to maintain personal hygiene.
 DIET
o Educate the patient to take balanced diet.
o Educate the patient to take plenty of fluids.
o Educate the patient to take high protein and high carbohydrate diet.
 MEDICATION
o Educate the patient to take medications according to prescription.
o Educate the patient to not skip the dose.
o Educate the patient to follow chemo regimen and not to skip any of the cycle/
day.
 COPING AND SUPPORT
o Educate the patient to stay connected to friends and family.
o Educate the patient to joining a support group for people with cancer.
o Encourage the patient to explore the feelings.
Prognosis:

DAYS PROGNOSIS VITAL SIGN

Ist day  Comfortable position( semi- BP-120/80mmhg

fowler) is given to the patient PULSE-70bpm
to reduce the pain. RESPIRATION-18bpm
 Diversional therapy is
provided to relieve pain like
geeta and kirtan .
 Analgesics are given to patient
as advised by doctor.
(diclogesic RR 75 mg)
 After this the pain level is
reduced from 4 to 2 and the
patient feels comfortable.
2nd day  Pain is relieved. Urine output BP-110/70mm/hg
is normal. PULSE-72bpm
 Encourage the patient to take RESPIRATION-20bpm
small and frequent diet.
 Educate the patient regarding
the diet.
 Encourage the patient to
ventilate his feeling.

3RD DAY  Knowledge is provided to the BP-120/60mhg

patient and family member
regarding chemotherapy PULSE-74bpm
treatment. RESPIRATION-18bpm
 Dietary therapy is provided .
 The patient feel comfortable
and pain is relieved.

Discharge planning:
Discharge planning is started at the time of admission. It depends upon the condition of the
patient and severity of disease.
 BIBLIOGRAPHY
 Wilson and Ross. Anatomy and Physiology in Health Illness. 11th ed. Published by
Elsevier. pp237-240
 Siddhartha’s and Brunner,” Textbook of Medical- Surgical Nursing, Edition 12 th,
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