Download doc - ZAMORA - COLON CANCER 2

FAR EASTERN UNIVERSITY

INSTITUTE OF NURSING

RIZAL MEDICAL CENTERPASIG CITY

CASE STUDY: COLON CANCER

DRUG STUDY

Generic Name / Trade Name

Dosage / Frequency

Classification Indications Contraindications Side Effects Nursing Responsibilities

Spironolactone Aldactone, Novospiroton†, Spiractin

Edema

Adults: Initially, 100 mg P.O. daily given as a single dose or in divided doses. Usual range is 25 to 200 mg P.O. daily.

Children: Give 3.3 mg/kg P.O. daily or in divided doses.

Hypertension

Adults: 50 to 100 mg P.O. daily or in divided doses. Some practitioners use a lower dose range of 25 to 50 mg daily and add another antihypertensive to the regimen, rather than

Pregnancy risk category D

Pharmacologic Class: potassium-sparing diuretic

Therapeutic Class: diuretic, antihypertensive, antihyperkalemic

For Edema, Hypertension , Diuretic-induced, hypokalemia, To detect primary, hyperaldosteronism, To manage primary hyperaldosteronism, Hirsutism in women, Premenstrual syndrome, Acne vulgaris and Familial male precocious puberty

Contraindicated in patients hypersensitive to drug and in those with anuria, acute or progressive renal insufficiency, or hyperkalemia.

Use cautiously in patients with fluid or electrolyte imbalances, impaired renal function, or hepatic disease, or in pregnant women.

CNS: headache, drowsiness, lethargy, confusion, ataxia.

GI: diarrhea, gastric bleeding, ulceration, cramping, gastritis, vomiting.

GU: inability to maintain erection, menstrual disturbances.

Hematologic: agranulocytosis.

Metabolic: hyponatremia, hyperkalemia, dehydration, mild acidosis.

Skin: urticaria, hirsutism, maculopapular eruptions.

Nursing considerations:

To enhance absorption, give drug with meals.

Protect drug from light.

Monitor electrolyte levels, fluid intake and output, weight, and blood pressure.

Monitor elderly patients closely, who are more susceptible to excessive diuresis.

Inform laboratory that patient is taking spironolactone because drug may interfere with tests that measure digoxin level.

Drug is less potent than thiazide and loop diuretics and is useful as an adjunct to other diuretic therapy. Diuretic effect is delayed 2 to 3





continually increasing this drug.

Children: Give 1 to 3.3 mg/kg P.O. (up to 100 mg daily) as a single dose or divided b.i.d.

Diuretic-induced hypokalemia

Adults: 25 to 100 mg P.O. daily.

To detect primary hyperaldosteronism

Adults: 400 mg P.O. daily for 4 days (short test) or 3 to 4 weeks (long test). If hypokalemia and hypertension are corrected, a presumptive diagnosis of

Other: gynecomastia, breast soreness, drug fever, anaphylaxis.

days when used alone.

Maximum antihypertensive response may be delayed for up to 2 weeks.

Watch for hyperchloremic metabolic acidosis, especially in patients with hepatic cirrhosis.

Breast cancer may occur, but a causal relationship hasn't been established.

Look alike-sound alike: Don't confuse Aldactone with Aldactazide.

Patient teaching:

Instruct patient to take drug in morning to prevent need to urinate at night. If second dose is needed, tell him to take it with food in early afternoon.

Alert: To prevent serious hyperkalemia, warn patient to avoid excessive ingestion of potassium-rich foods (such as citrus





primary hyperaldosteronism is made.

To manage primary hyperaldosteronism

Adults: 100 to 400 mg P.O. daily. Use lowest effective dose.

Heart failure, as adjunct to ACE inhibitor or loop diuretic, with or without cardiac glycoside

Adults: 12.5 to 25 mg P.O. daily. May increase to 50 mg daily after 8 weeks.

Hirsutism in women

Adults: 50 to 200 mg P.O. daily.

fruits, tomatoes, bananas, dates, and apricots), salt substitutes containing potassium, and potassium supplements.

Caution patient not to perform hazardous activities if adverse CNS reactions occur.

Advise men about possible breast tenderness or enlargement.





Or, 50 mg P.O. b.i.d. days 4 to 21 of menstrual cycle.

Premenstrual syndrome

Adults: 25 mg P.O. q.i.d. starting on day 14 of the menstrual cycle.

Acne vulgaris

Adults: 100 mg P.O. daily.

Familial male precocious puberty

Boys: 2 mg/kg P.O. daily with 20 to 40 mg/kg testolactone P.O. daily for at least 6 months.


Dosage / Frequency






Paracetamol Adult: PO/Rectal 0.5-1 g 4-6 hrly when needed. Max: 4 g/day. IV >50 kg: 1 g 4-6 hrly (Max: 4 g/day); <50 kg: 15 mg/kg 4-6 hrly (Max: 60 mg/kg/day).

Analgesics (Non-Opioid) & Antipyretics

Mild to moderate pain and fever.

Renal or hepatic impairment; alcohol-dependent patients; G6PD deficiency.

Nausea, allergic reactions, skin rashes, acute renal tubular necrosis.Potentially Fatal: Very rare, blood dyscrasias (e.g. thrombocytopenia, leucopenia, neutropenia, agranulocytosis); liver damage.

*Monitor for S&S of: hepatotoxicity, even with moderate acetaminophen doses, especially in individuals with poor nutrition or who have ingested alcohol over prolonged periods; poisoning, usually from accidental ingestion or suicide attempts; potential abuse from psychological dependence (withdrawal has been associated with restless and excited responses).

CLIENT TEACHING:*Do not take other medications (e.g., cold preparations) containing acetaminophen without medical advice; overdosing and chronic use can cause liver damage and other toxic effects.

*Do not self-medicate adults for pain more than 10 d (5 d

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in children) without consulting a physician.

*Do not use this medication without medical direction for: fever persisting longer than 3 d, fever over 39.5° C (103° F), or recurrent fever.

*Do not give children more than 5 doses in 24 h unless prescribed by physician.

*Do not breast feed while taking this drug without consulting physician.


Dosage / Frequency


Tramadol Adult & children >16 yr 1-2 tab 4-6 hrly. Max: 8 tab/day.

Analgesics (Non-Opioid) & Antipyretics, Analgesics (Opioid), Supportive Care Therapy

Management of moderate to severe pain.

Acute intoxication w/ alcohol, hypnotics, narcotics, centrally-acting analgesics, opioids/psychotropic.

Nausea, vomiting, constipation, drowsiness, hematological reactions including thrombocytopenia, leucopenia, resp depression, hypotension, HTN.

*Reassess patient’s level of pain at least 30 minutes after administration.

*Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations decrease or rate


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is below 12 breaths/min.

*Monitor bowel and bladder function. Anticipate need for laxative.

*For better analgesic effect, give drug before onset of intense pain.

*Monitor patients at risk of seizures. Drug may reduce seizure threshold.

*In the case of an overdose, naloxone may also increase risk of seizures.

*Monitor patient for drug dependence. Drug can produce dependence similar





to that of codeine or dextropropoxyphene and thus has potential for abuse.

*Withdrawal symptoms may occur if drug is stopped abruptly. Reduce dosage gradually.

*Look alike-sound alike: Don’t confuse tramadol with trazodone or trandolapril.


Dosage / Frequency


Ranitidine (Zantac) Tablets (150 mg, 300 mg), Capsules (150 mg, 300 mg); Syrup (15 mg/ml). May be taken with or without food.

H2-blockers Ranitidine blocks the action of histamine on stomach cells, and reduces stomach acid production. Ranitidine is useful in promoting healing of stomach and duodenal ulcers, and in

Impaired Liver and Kidney Function; Hypersensitivity

Minor side effects include constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting. Major

The nurse should observe the following:

-Renal and Hepatic patients are not a good candidate for this med.

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Since ranitidine is excreted by the kidney and metabolized by the liver, dosages of ranitidine need to be lowered in patients with significantly abnormal liver or kidney function.

reducing ulcer pain. Ranitidine has been effective in preventing ulcer recurrence when given in low doses for prolonged periods of time. In doses higher than that used in ulcer treatment, ranitidine has been helpful in treating heartburn and in healing ulcer and inflammation of the esophagus resulting from acid reflux .

side effects are rare; they include: agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregular heartbeat, rash, visual changes, and yellowing of the skin or eyes.

-No anti-inflamatories should be given. This includes aspirin and the like.

-Antacids should be taken one hour before or one hour after ranitidine, as they inhibit the effectiveness

-Avoid stomach and GI irritants -- this includes smoking and ETOH

-Watch for signs of GI bleeds.

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the









chest; swelling of the mouth, face, lips, or tongue); irritability; muscle spasms or twitching; pain, redness, or swelling at the injection site.


Dosage / Frequency


Bisacodyl OralConstipationAdult: 5-10 mg at night.Child: >4 yr: 5 mg at night time. Elderly: Oral

Laxatives, purgatives

A06AB02 - bisacodyl; Belongs to the class of contact laxatives. Used in the

For bowel evacuation and constipation

Acute surgical abdomen or intestinal obstruction, severe dehydration, faecal impaction, chronic use

Abdominal discomfort (colic, cramps). Suppositories may cause irritation and proctitis

The nurse should observe the following:

-Renal and Hepatic patients are not a good candidate for this med.

- remind the






Bowel evacuationAdult: Initially, 10-20 mg the night before the procedure followed by 10 mg suppository admin rectally the next morning.Child: >10 yr: Same as adult dose. 4-10 yr: 5 mg the night before the procedure and 5 mg suppository admin rectally the following morning. .RectalConstipationAdult: 10 mg suppository/enema admin in the morning.Child: <10 yr: 5 mg in the

treatment of constipation.A06AG02 - bisacodyl; Belongs to the class of enemas. Used in the treatment of constipation

patient :Do not give antacids or milk within 1 hr of taking the drug (enteric coated)





morning

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); irritability; muscle spasms or twitching; pain, redness, or swelling at the injection site.






Dosage / Frequency


Potassium Chloride (Elin Potassium Chloride)

Adult Plasma K level >2.5 mEq/L 10 mEq/hr-200 mEq/day, <2 mEq/L 40 mEq/hr-400 mEq/day. Childn 3 mEq/kg:vol of soln proportional to body size. Acute hypokalemia Up to 100 mEq by slow IV infusion w/ ECG control at rate not >20 mEq/hr of a soln not >40 mEq/L.

Electrolytes

Source of K & Cl ions. Untreated Addison's disease, heat cramps, acute dehydration, adynamia episodica hereditaria & hyperkalemia.

Pain in the legs

Weakness of the muscles

Uneven heartbeat

Anxiety, confusion or a feeling of dizziness

Constant diarrhea or pain in the stomach

Excessive vomiting

Dark or blackish stools

-Instruct client to take this drug with foods or just after meals





Tingling on your hands or feet

Dizziness and nausea


Dosage / Frequency

Classification Indications Side Effects Nursing Responsibilities

Moriamin Forte Adult 1-2 cap/day. Childn 1 cap/day

A11AB - Multivitamins, other combinations ; Used as dietary supplements.

Malnutrition, protein & vit deficiencies, anemia, convalescence, restoration & maintenance of body resistance, pregnancy & lactation, adjuvant in the therapy ofpeptic ulcer & TB.

Hypervitaminosis (large dose)

Tell patient that urine might turn yellow.

Generic Name / Trade Name Dosage / Frequency Action Side Effects Nursing ResponsibilitiesFerrous Sulfate 1 tab per day This

preparation contains the mineral, iron, which is

Liquid oral iron preparations can possibly blacken teeth.Acute

Tell patient of the side effects of the drug before administration. If allergic reactions appears halt the





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http://www.buzzle.com/articles/dizziness-and-nausea.html





necessary for the formation and function of red blood cells. It is these cells that carry oxygen through the blood stream. In tiny amounts, the mineral is also necessary for the chemical functioning of many of the bodies' cells

overdosage or iron accumulation symptoms may include arthritis, signs of gonadal failure (amenorrhea, early menopause, loss of libido, impotence), and shortness of breath/dyspnea. High doses may cause vomiting and diarrhea, followed by cardiovascular or metabolic toxicity, and death. It is unclear whether high levels are associated with cancer,

administration of drug.





coronary heart disease or myocardial infarction (MI).Gastrointestinal upset including nausea, vomiting, constipation, diarrhea, and dark stools have been reported. Gastrointestinal side effects are relatively common and corrective bowel regimens such as increasing dietary fiber or over the counter medication might be recommended to balance these side





effects. Supervision by a qualified healthcare provider is recommended.

PROBLEM PRIORITIZATION FOR PATIENT WITH COLON CANCER

NURSING DIAGNOSIS CUES RANK JUSTIFICATION

Constipation related to obstruction as manifested by decrease bowel frequency

S:

- “Bago ako maospital tatlong beses ako

1 Constipation is the prioritized problem since it is an actual problem. According to Abraham Maslow’s Hierarchy of Needs, This need is considered under a





dumudumi sa isang araw. Pero ngayon dumudumi dalawang beses pero konti lang. Masakit nga minsan sa tiyan pag nagsasabay ang dumi at ihi.”

O:

- Decrease bowel sounds during assessment.

- Minimal pain felt when palpation was done in the abdomen.

- Abdominal girth – 30.2 inches.

person’s physiologic needs because it’s under elimination needs of humans. Constipation is a serious problem that should be addressed first because if a stool will stay long in the colon it will hardened and could lead to further damage in the lining of the colon once it is being forced out by the client during excretion. Having breaks on the lining of the colon could worsen the condition and could also be a portal of entry for microbes that can cause infection. skin integrity thus this could be a portal of entry for microbes that can cause infection.

Impaired Skin Integrity related to treatment as manifested by dry, rough and scaly skin.

S:

- “ di naman ganto itsura ko dati, nung pagkatapos ng una kong opera tapos ng naospital ako at ng gagamot na ganito na balat ko. Nagbabalat minsan at nanunuyo” as verbalized by the patient.

O:

2 Impaired skin integrity is the 2nd

prioritized problem since it is an actual problem. According to Abraham Maslow’s Hierarchy of Needs, This need is considered under a person’s physiologic needs because providing interventions to this problem could alleviate patient’s problem with body image. Impaired skin integrity is also serious problem that should be addressed because it could lead to breaks in skin integrity thus this could also be a portal of entry for microbes.





- Rough and scaly skin were noted during the assessment

- Decrease skin turgor.- Dry skin / decrease

moisture was noted during the assessment.

Patient with Poor skin integrity are prone to develop bed sores

Activity Intolerance related to weakness as evidenced by inability to walk alone without assistance.

S:

- “Noon sobrang layo ng nalalakad ko pag trip ko maglakad at para makatipid; ngayon di ako makapunta ng magisa sa banyo pag di ako tinutulungan. Humina kasi mga binti ko ngayon” as verbalized by the patient.

- “pumyat ako ngayon sobrang lusog ko nun dati siguro nakaapekto yun kaya mahina ako”

O:

- Both lower extremities could do flexion, extension but with same decrease strength.

3 Activity Intolerance is the 3rd prioritized problem since it is also evident in the patient. Activity intolerance is the last one to be addressed because it is not the priority of the patient.





NURSING CARE PLAN FOR CONSTIPATION

Cues Analysis Nursing Diagnosis

Goal and Objectives Interventions Rationale Evaluation

S:

- “Bago ako maospital

The colon (large intestine) controls the

Constipation related to obstruction as

After 24 hours of nursing intervention the client will be able to have an

FACILITATIVE:Encourage daily fluid intake of 2000 to 3000 ml/day, if

Patients, especially elderly patients, may have cardiovascular

After 24 hours of nursing intervention the client was able to have an improved bowel





tatlong beses ako dumudumi sa isang araw. Pero ngayon dumudumi dalawang beses pero konti lang. Masakit nga minsan sa tiyan pag nagsasabay ang dumi at ihi.”

O:

- Decrease bowel sounds during assessment.

- Minimal pain felt when palpation was done in the abdomen.

formation and passage of stool from the body. The colon absorbs water out of the solid waste and moves the waste to the rectum and anus. Anything that changes the colon's ability to regulate the amount of water in stool or that affects the muscles and nerves of the colon that are responsible for moving waste toward the rectum and anus can lead to constipation. (world health organization site)

manifested by decrease bowel frequency

improved bowel status.

Objectives:

After 8 hours of shift, the patient will be able to achieve the following, accurately:

Be assessed on the characteristics of his bowel frequency and bowel status

Be assisted on the exploration of methods for having an improved bowel movement.

Be able to have continuity of care because of the knowledge that are also imparted to the guardian / family.

not contraindicated medically.

Encourage increased fiber in diet (e.g., raw fruits, fresh vegetables)

Encourage physical activity and regular exercise

Encourage a regular time for elimination

limitations, which require that less fluid is taken.

a minimum of 20 g of dietary fiber per day is recommended. Fiber passes through the intestine essentially unchanged. When it reaches the colon, it absorbs water and forms a gel, which adds bulk to the stool and makes defecation easier.

Ambulation and/or abdominal exercises strengthen abdominal muscles that facilitate defecation.

Many persons defecate following first daily meal or coffee, as a result of the gastro colic reflex; depending on the person’s usual

status.

Objectives:

After 8 hours of shift, the patient was able to achieve the following, accurately:

Be assessed on the characteristics of his bowel frequency and bowel status

Be assisted on the exploration of methods for having an improved bowel movement.

Be able to have continuity of care because of the knowledge that are also imparted to the guardian / family.





- Abdominal girth – 30.2 inches.

Encourage isometric abdominal and gluteal exercises.

o Warm sitz batho Hemorrhoidal preparations These shrink swollen hemorrhoidal tissue.Orient patient to location of bathroom and encourage use, unless contraindicated

Allow patient time to relax.

COLLABORATIVE:Digitally remove fecal impaction.

schedule, any time, as long as it is regular, is fine.

Exercises, unless contraindicated, strengthen muscles needed for evacuation.

minimize rectal discomfort

A sitting position with knees flexed straightens the rectum, enhances use of abdominal muscles, and facilitates

Stool that remains in the rectum for long periods becomes dry and hard; debilitated patients, especially elderly patients, may not be able to pass these stools without





SUPPLEMENTAL:Teach patients and caregivers to read product labels.

Explain or reinforce to patient and caregiver the importance of the following:o A balanced diet that contains adequate fiber, fresh fruits, vegetables, and grains Twenty grams per day is recommended.o Adequate fluid intake Drink 8 glasses/day or 2000 to 3000 ml/day.o Regular meals Successful bowel training relies on routine.o Regular time for evacuation and adequate time for defecationo Regular exercise/activityo Privacy for defecation

Teach use of pharmacological agents as

manual assistance.

It is important for patients and caregivers to determine the fiber content per serving.





ordered