ZAMORA - COLON CANCER 2

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FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER DRUG STUDYGeneric Name / Trade Name Spironolactone Aldactone, Novospiroton, Spiractin Dosage Frequency Edema / Classification Pregnancy risk category D Pharmacologic Class: potassiumsparing diuretic Therapeutic Class: diuretic, antihypertensiv e, antihyperkalemi c Indications For Edema, Hypertension , Diureticinduced, hypokalemia, To detect primary, hyperaldosteronism, To manage primary hyperaldosteronism, Hirsutism in women, Premenstrual syndrome, Acne vulgaris and Familial male precocious puberty Contraindications 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. Side Effects 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 Responsibilities 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 3Adults: 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 thanFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCERcontinually increasing drug. 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.thisChildren: Give 1 to 3.3 mg/kg P.O. (up to 100 mg daily) as a single dose or divided b.i.d. Diureticinduced hypokalemia Adults: 25 to 100 mg P.O. daily. To detect primary hyperaldostero nism 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 ofPatient 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-FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCERprimary hyperaldosteroni sm is made. To manage primary hyperaldostero nism 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 women in rich foods (such as citrus 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 possible tenderness enlargement. about breast orAdults: 50 to 200 mg P.O. daily.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCEROr, 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.Generic Name / Trade NameDosage Frequency/ClassificationIndicationsContraindicationsSide EffectsNursing ResponsibilitiesFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER 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); 16 yr 1-2 tab 46 hrly. Max: 8 tab/day. (Non-Opioid) & Antipyretics, Analgesics (Opioid), Supportive Care Therapy moderate to severe intoxication w/ pain. alcohol, hypnotics, narcotics, centrally-acting analgesics, opioids/psychotr opic. vomiting, constipation, drowsiness, hematological reactions including thrombocytope nia, leucopenia, resp depression, hypotension, HTN. level of pain at least 30 minutes after administration.*Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations decrease or rate 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 seizureFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER 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: Dont confuse tramadolFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER with trazodone trandolapril. orGeneric Name / Trade NameDosage Frequency/ClassificationIndicationsContraindicationsSide EffectsNursing ResponsibilitiesRanitidine (Zantac)Tablets (150 mg, 300 mg), Capsules (150 mg, 300 mg); Syrup (15 mg/ml). May be taken with or without food. Since ranitidine is excreted by the kidney and metabolized by the liver, dosages of ranitidine need to be lowered in patients withH2-blockersRanitidine 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 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,Impaired Liver and Kidney Function; HypersensitivityMinor side effects include constipation, diarrhea, fatigue, headache, insomnia, muscle pain, nausea, and vomiting. Major side effects are rare; they include: agitation, anemia, confusion, depression, easy bruising or bleeding, hallucinations, hair loss, irregularThe nurse should observe the following: -Renal and Hepatic patients are not a good candidate for this med. -No antiinflamatories 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 effectivenessFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER significantly abnormal liver or kidney function. ranitidine has been helpful in treating heartburn and in healing ulcer and inflammation of the esophagus resulting from acid reflux . heartbeat, rash, visual changes, and yellowing of the skin or eyes.-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 injectionFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER site.Generic Name / Trade NameDosage Frequency/ClassificationIndicationsContraindicationsSide EffectsNursing ResponsibilitiesBisacodylOral Constipatio n Adult: 5-10 mg at night. Child: >4 yr: 5 mg at night time. Elderly: Oral Bowel evacuation Adult: Initiall y, 10-20 mg the night before the procedure followed by 10 mg suppositoryLaxatives, purgatives A06AB02 bisacodyl; Belongs to the class of contact laxatives. Used in the treatment of constipation. A06AG02 bisacodyl; Belongs to the class of enemas. Used in the treatment ofFor bowel evacuation and constipationAcute surgical abdomen or intestinal obstruction, severe dehydration, faecal impaction, chronic useAbdominal The nurse should discomfort observe the following: (colic, cramps). Suppositories -Renal and Hepatic may cause patients are not a irritation and good candidate for proctitis this med. - remind the patient :Do not give antacids or milk within 1 hr of taking the drug (enteric coated)FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER admin constipation 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. . Rectal Constipatio n Adult: 10 mg suppository/e nema admin in the morning. Child: 2.5 mEq/L 10 mEq/hr-200 mEq/day, 20 mEq/hr of a soln not >40 mEq/L. ElectrolytesIndicationsContraindicati onsSide EffectsNursing Responsibilities -Instruct client to take this drug with foods or just after mealsSource of K & Cl ions.Untreated Addison's disease, heat cramps, acute dehydration, adynamia episodica hereditaria & hyperkalemia.Pain in the legs Weaknes s of the muscles Uneven heartbea t Anxiety, confusio n or a feeling of dizziness Constant diarrhea or pain in the stomach Excessiv e vomiting Dark or blackish stools TinglingFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER on your hands or feetDizziness and nausea Nursing Responsibilities Tell patient that urine might turn yellow.Generic Dosage / Classificati Name / Trade Frequency on Name Moriamin Forte Adult 1-2 A11AB cap/day. C Multivitam hildn 1 ins, other cap/day combinati ons ; Used as dietary suppleme nts.Indications Malnutrition, protein & vit deficiencies, anemi a, convalescence, restoration & maintenance of body resistance, pregnancy & lactation, adjuvant in the therapy ofpeptic ulcer & TB.Side EffectsHypervitamin osis (large dose)Generic Name / Trade NameDosage / FrequencyActionSide EffectsNursing ResponsibilitiesFerrous Sulfate1 tab per dayThis preparationLiquid oral iron Tell patient of the side preparations effects of the drugFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER contains the mineral, iron, which is 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 can possibly blacken teeth.Acute 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 before administration. If allergic reactions appears halt the administration of drug.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER levels are associated with cancer, coronary heart disease or myocardial infarction (MI).Gastrointe stinal 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 beFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER recommended to balance these side effects. Supervision by a qualified healthcare provider is recommended.PROBLEM PRIORITIZATION FOR PATIENT WITH COLON CANCERNURSING DIAGNOSIS Constipation related to CUES S: RANK 1 JUSTIFICATION Constipation is the prioritized problemFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCERobstruction as manifested by decrease bowel frequency-Bago ako maospital 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. Abdominal girth 30.2 inches. S: 2since it is an actual problem. According to Abraham Maslows Hierarchy of Needs, This need is considered under a persons physiologic needs because its 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.- 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.Impaired skin integrity is the 2nd prioritized problem since it is an actual problem. According to Abraham Maslows Hierarchy of Needs, This need is considered under a persons physiologic needs because providing interventions to this problem could alleviate patients problem with body image. Impaired skin integrity is also serious problem that should beFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCERaddressed because it could lead to breaks in skin integrity thus this could also be a portal of entry for microbes. Patient with Poor skin integrity are prone to develop bed soresO: Rough and scaly skin were noted during the assessment Decrease skin turgor. Dry skin / decrease moisture was noted during the assessment. S: 3-Activity Intolerance related to weakness as evidenced by inability to walk alone without assistance.--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: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.-Both lower extremities could do flexion,FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCERextension but with same decrease strength.NURSING CARE PLAN FOR CONSTIPATION Cues Analysis Nursing Diagnosis Goal and Objectives Interventions Rationale EvaluationFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCERS: Constipation related to obstruction as manifested by decrease bowel frequency After 24 hours of nursing intervention the client will be able to have an improved bowel status.---The colon (large intestine) controls the 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 O: nerves of the Decrease colon that are bowel responsible for sounds moving waste during toward the assessmen rectum and anus t. can lead to constipation. Minimal pain felt (world healthBago ako maospital tatlong beses ako dumudumi sa isang araw. Pero ngayon dumudumi dalawang beses pero konti lang. Masakit nga minsan sa tiyan pag nagsasaba y ang dumi at ihi.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.FACILITATIVE: Patients, Encourage daily fluid especially elderly intake of 2000 to 3000 patients, may ml/day, if not have contraindicated cardiovascular medically. limitations, which require that less fluid is taken. Encourage increased fiber in diet (e.g., raw a minimum of 20 g fruits, fresh vegetables) 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 Encourage physical gel, which adds activity and regular bulk to the stool exercise and makes defecation easier.After 24 hours of nursing intervention the client was able to have an improved bowel 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 theAmbulation and/or abdominal exercises Encourage a regular strengthen time for elimination abdominalFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCERwhen palpation was done in the abdomen.organization site)muscles facilitate defecation.thatguardian / family.-Abdominal girth 30.2 inches.Many persons defecate following first daily meal or coffee, as a result of the gastro colic Encourage isometric reflex; depending abdominal and gluteal on the persons exercises. usual schedule, any time, as long as it is regular, is o Warm sitz bath fine. o Hemorrhoidal preparations These Exercises, unless shrink swollen contraindicated, strengthen hemorrhoidal tissue. needed Orient patient to muscles for evacuation. location of bathroom and encourage use, unless contraindicated minimize rectal Allow patient time to discomfort relax. A sitting position with knees flexed straightens the COLLABORATIVE: Digitally remove fecal rectum, enhancesFAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER impaction. 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 manual assistance.SUPPLEMENTAL: Teach patients caregivers to product labels.and readExplain 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.It is important for patients and caregivers to determine the fiber content per serving.FAR EASTERN UNIVERSITY INSTITUTE OF NURSING RIZAL MEDICAL CENTERPASIG CITYCASE STUDY: COLON CANCER o Regular time for evacuation and adequate time for defecation o Regular exercise/activity o Privacy for defecation Teach use of pharmacological agents as ordered

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