Treatment in Patients with Rectal Cancer

CNA344: Becoming a RN: Practice consolidation
Practice Portfolio of Evidence PART B: Clinical Encounter Analysis
Consider the
patient
situation/contex
t
(@150 words)
Provide an
overview of the
encounter. What
happened, how it
occurred, what
was it that alerted
you to that fact
that you needed
to take action in
the encounter.
A Caucasian woman aged 56, presented to her physician for primary care to a 3-month history of intermittent bright
red rectal blood with defecation. She is an avid smoker with a history of smoking at least 10 cigarettes a day. She has
been a financial analyst for the past 25 years, however, left last year citing health problems. She has consulted a
physician for her distress and uncontrollable pain during defecation. After a reported colonoscopy and a pelvic
examination, she has been observed to have polyps which can result in colon cancer if not treated properly with a blood-
stained stool. She had been given bevacizumab and morphine after dinner with regular monitoring of the cancer
progression. Because of this medical condition, she has not been able to walk properly which has restricted her in
conducting daily activities.
During the morning handover, it was reported that the previous night, she has been agitated because of
experiencing constant pain in the anal area due to the polyps. Upon further questioning her family, it was known that she
is an avid sufferer of depression and anxiety.
Review (@150
words)
What key
information was
already available
to you and how
did this influence
Review:
During the morning handover at 0630, following information was gathered:
 Chronic Irritation was noted
 Pain while defecation
1

your thinking?
(eg: handover,
history, charts,
result of test,
assessments,
medical orders
etc.).
Gather(@150
words)
What was the
new information
you gathered
from additional
assessment?Dot points are
fine for this
section.
Recall(@200
words)
Recall and apply
your existing
knowledge to the
above situation to
ensure you have
a broad
understanding of
what is/may be
occurring before
proceeding with
the rest of the
cycle.
What was telling
you that the
encounter was
 Bright red rectal blood with defecation
 High smoking
 Not able to mobilise distinguishably
 BP: 109/78 mm/Hg
 Pulse: 87 bpm
 RR: 80 bpm
 Temp: 40 degrees
 Urine output: 40ml/hr
 Immunohistochemistry test: positive
 Colonoscopy examination was consistent and reviewed which highlighted invasion in squamous cell carcinoma
 An irregular region at a distance of 10 cm from anal edge was identified.
 DNA test for the virus (Human Papilloma Virus) turned out to be negative
 Medication chart: see below
Relevant medications (where relevant): (not included in word count)
 Bevacizumab 5 mg intravenously with bolus twice daily
 Cetuximab 2 mg/ml via injections twice in a day with 12-hour gap
 Panitumumab 100mg/5mL via injections once in a day
 Morphine 1 gram for pain every 6 hours
2

presenting you
with a problem
that required
resolution?
Use scholarly,
evidence-based
literature/clinical
guidelines and/or
policy/NSQHS
materials to
substantiate your
discussion
Gather:
For the appropriate assessment of the condition of the patient, it is critical for the physician to refer more tests such that
the root of the problem is identified.
 Commenced behaviour chart to assess the level of depression and anxiety
 CT scan of stomach, pelvis and chest.
 MRI scan for the pelvis area to assess the magnetic imaging of the polyps.
 PET scan
 NPRS pain score
 A commenced fluid balance chart – previously only urine output was measured.
 A commenced food chart
 The current bowel chart
 A carcinoembryonic antigen blood test to test the presence of cancer and monitor the further progression of cancer
cell.
 Upon gathering more information from her family, it was found that the patient suffers from chronic abdominal and
pelvic pain and hence cannot perform her daily habits properly. The significant factors also lead to her depression,
anxiety and stress.
 In addition, there has to be a collective review of the medications that have been previously administered to the
patient.
3

Recall:
In the case of the Caucasian woman, her situation is more critical as she has a history of smoking at least 10 cigarettes a
day. It has been observed after varied research that smoking and colon cancer are inter-related which can be the
scenario in the case of the Caucasian woman. After thorough research, it has also been identified that people who have a
history of smoking highly in their young age have a higher risk of developing colon polyps in the edge of the rectum just
like the Caucasian woman (Steele et al. 2015; Cheng et al. 2015). In the case of the smoking, the recurrence of polyps is
increased with increase in their size (Drew et al. 2016). The peptidic acids which are responsible for the appropriate
digestive mechanism for the foods ingested by the person, are degraded because of the smoking habit of the individual
(Praud et al. 2018). An assessment on the intensity of the pain that is endured by the patient is estimated by the usage of
NPRS on a scale of 1-10.
Symptoms that involves in such cases shows blood with stool, which is either too bright in colour or dark in colour as it
was noted in this case (Renzi et al. 2016). Moreover, other symptoms that prevails in such cases are pain in abdomen,
frequently changed and disturbed diet habit, diarrhoea and constipation (www.cancer.gov, 2020). In addition to these
symptoms, the patient may also feel distressed and anxious about the medical situation and may likely experience
depression (Lee et al. 2015; Jia et al. 2017). Hence, it is the priority of the nursing professional to assess the mental
condition of the woman and further investigate the aggressiveness and agitation of the patient.
Process Interpret, Relate and Infer:
4