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Our Lady of Fatima University Valenzuela City

College of Nursing


In partial fulfillment of NCM 106 RLE

Submitted to:

Ms. Norilyn Limchanco

Clinical Instructor
Submitted by:

Ma. Liezel M. Camba

BSN 4Y1-1

Location: Armed Forces of the Philippines Medical Center

Rotation of Duty: February 19-21 and February 26 - 28, 2015

Case Study: Rectal Cancer

Table of Contents:

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I. Introduction
II. Objectives
III. Patients Profile
IV. Anatomy and Physiology (Normal and Abnormal)
V. Pathophysiology about the disease
VI. Course in the ward when patient was admitted
VII. Diagnostic and Laboratory with normal results and abnormal results with

VIII. Related Medical Treatment (Operations)
IX. Gordons Assessment
X. Drug Study
XI. Nursing Care Plan and Discharge Planning
XII. Learning Derived


You never need to apologize for how you choose to survive. Anonymous
If I were to interpret this quote, it simply depicts that as an individual live
their life, for exampledoing what they want, smoking, drinking alcohol, engaging
to drug addiction, uncontrolled and unhealthy ways of eating and a lot more, people
should think before they act on their own because one day illness and other
complications will follow that you wouldnt even know what to do next but will try
your best to survive.
Rectal cancer is a disease in which cancer cells form in the tissues of the
rectum; colorectal cancer occurs in the colon or rectum. Adenocarcinomas comprise
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the vast majority (98%) of colon and rectal cancers; more rare rectal cancers
include lymphoma (1.3%), carcinoid (0.4%), and sarcoma (0.3%). The incidence and
epidemiology, etiology, pathogenesis, and screening recommendations are common
to both colon cancer and rectal cancer.
Bleeding is the most common symptom of rectal cancer, occurring in 60% of
patients. However, many rectal cancers produce no symptoms and are discovered
during digital or proctoscopic screening examinations.
Other signs and symptoms of rectal cancer may include the following:

Change in bowel habits (43%): Often in the form of diarrhea; the caliber of
the stool may change; there may be a feeling of incomplete evacuation and

Occult bleeding (26%): Detected via a fecal occult blood test (FOBT)

Abdominal pain (20%): May be colicky and accompanied by bloating

Back pain: Usually a late sign caused by a tumor invading or compressing

nerve trunks

Urinary symptoms: May occur if a tumor invades or compresses the bladder

or prostate

Malaise (9%)

Pelvic pain (5%): Late symptom, usually indicating nerve trunk involvement

Emergencies such as peritonitis from perforation (3%) or jaundice, which may

occur with liver metastases (< 1%)
Perform physical examination with specific attention to the size and location
of the rectal tumor in addition to possible metastatic lesions, including enlarged
lymph nodes or hepatomegaly. In addition, evaluate the remainder of the colon.
Routine laboratory studies in patients with suspected rectal cancer follows. If
metastatic rectal cancer is suspected, radiologic studies may be obtained.
Management: A multidisciplinary approach that includes colorectal surgery,
medical oncology, and radiation oncology is required for optimal treatment of
patients with rectal cancer. Surgical technique, use of radiotherapy, and method of
administering chemotherapy are important factors. Strong considerations should be

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given to the intent of surgery, possible functional outcome, and preservation of anal
continence and genitourinary functions. The first step involves achievement of cure,
because the risk of pelvic recurrence is high in patients with rectal cancer, and
locally recurrent rectal cancer has a poor prognosis.
Surgery: Radical resection of the rectum is the mainstay of therapy. The
timing of surgical resection is dependent on the size, location, extent, and grade of
the rectal carcinoma.
As for this case study, the diagnosis of the student nurses patient diagnosis
is Rectal Adenocarcinoma, Stage III-B (CT4a, N1, Mo) Gallbladder Polyp External
Hemorrhoids, Essential Hypertension, Controlled. Anterior Resection Hartmann's
procedure is performed and patient was monitored for intake and output both in
colostomy bag and Jackson Pratts drainage.


General Objectives:
To provide the student a guide line in caring for people with Rectal
Adenocarcinoma using the nursing process appropriately and effectively.
To give information on the readers about the nature and the extent of well
differentiated adenocarcinoma rectal disease.
Lastly, to provide the general public of the new developments in nursing care
in regards of treating the disease condition.
Specific Objectives:

At the end of this study, I, the student nurse of this institution, will able to:
Define and identify the probable causative factors of rectal adenocarcinoma
Trace the anatomy and physiology.
Assess the nursing history of the patient.
Identify the signs and symptoms of the underlying disease.
Formulate the nursing care plan, to achieve the maximum wellness of the
patients well as awareness on the part of the significant others.

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