Nursing Case Study: Clinical Reasoning in Sigmoid Adenocarcinoma Care

This case study presents the nursing care of a 46-year-old female, Mrs. Zata, diagnosed with Stage IV sigmoid adenocarcinoma. The case study utilizes the Clinical Reasoning Cycle to examine the patient's situation, including her medical history of hyperlipidemia, hypertension, and family history of cancer. It details the patient's symptoms, vital signs, blood results, and current medications. The assignment identifies three key nursing problems: the presence of poorly differentiated adenocarcinoma, the reoccurrence of colorectal cancer, and the patient's unresponsiveness to medication. The study sets nursing goals to protect the patient, outlines interventions such as new prognosis and chemotherapy, and evaluates the effectiveness of these interventions. The paper also reflects on the lessons learned regarding thorough prognoses, the benefits of combining chemotherapy with surgery and radiotherapy, and the importance of assessing risk factors to prevent cancer recurrence. Finally, the case study concludes with a summary of the clinical issues and recommended treatment approaches for sigmoid adenocarcinoma.

Running head: CASE STUDY-NURSING 1
Case Study-Nursing
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CASE STUDY-NURSING
Case Study-Nursing
Sigmoid adenocarcinoma is a type of colon cancer arising from the epithelium
layers of the large intestine. The cancerous cells develop from the inner lining as they
spread outwards throughout the sigmoid area. The colon consists of lymph nodes and blood
vessels networked to enhance an efficient absorption of water from the stool. Zata’s case
highlights the clinical issues associated with a late diagnosis of sigmoid adenocarcinoma.
First, Zata has already undergone a sigmoid colectomy but still exhibits undifferentiated
adenocarcinoma from the obtained biopsy results. Secondly, she encounters difficulty in
bowel movements even after undergoing surgery. Lastly, the current medication Zata
receives is unresponsive. Therefore, this research paper will seek to discuss the clinical
issues presented in Zata’s case and devise the best clinical approach.
Patient Data
To begin with, Zata is forty-six years old, and her medical history aligns with the
leading causes of colon cancer. First, she has a medical history of hyperlipidemia and
hypertension. Secondly, her father was diagnosed with cancer, and she also had
appendectomy at the age of twenty-five years. Thirdly, her current marital status highlights
the psychosocial challenges she might be facing. Besides her medical history, Zata
underwent a laparoscopic sigmoid colectomy but still exhibits difficulty in passing stool.
Also, the biopsy results suggest the presence of a poorly differentiated adenocarcinoma.
Despite the medication she has been subjected to, Zata still harbors advanced signs and
symptoms of colon cancer.
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Discussion of The Patient’s relevant Data
Colorectal cancer is hereditary, especially for first degree relatives. Usually,
chromosomes contain vital information that can be conveyed down the generation line
(Munteanu & Mastalier, 2014). Parents pass damaged chromosomes to their children, which
consequently makes them develop colon polyps. It is through the acquired polyps that an
individual’s chances of contracting colorectal cancer are enhanced. As indicated in the case
study, Zata’s father was diagnosed with cancer, which implies that she may have obtained it
genetically.
Age is a significant risk factor in the acquisition of cancer. Usually, aging is
associated with the weakening of the immune system (Dulskas, Bagurskas, Sinkevicius &
Samalavicius, 2015). At forty-six, Zata’s genes designed to suppress illnesses may have
failed hence promoting the spread of cancer. Therefore, the poorly undifferentiated
adenocarcinoma tendencies witnessed by the patient could be as a result of her immune
system failing to contain the spread of cancer cells.
Moreover, Zata’s condition could be worsened by her dire mental status. As a
separated mother, the associated psychosocial factors could be altering her immune system
hence promoting cancer growth. According to Li, Gan, Liang, Li, and Cai (2015),
separation is associated with intense stress among couples. In the process, high amounts of
cortisol are secreted which consequently undermines the ability of white blood cells to
contain inflammatory processes (Li, Gan, Liang, Li & Cai, 2015). Therefore, Zata’s
inability to pass stool could be aggravated by her prolonged levels of stress.
Furthermore, Zata is unresponsive to medication due to her weakened immune
system. Despite being subjected to PRN medications, she still struggles with a high pain
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score raging between 8 to 9 at night. Considering that she had lost weight in two weeks, it is
evident that the administered drugs are not efficiently reducing the effects of colon cancer.
Therefore, it will be prudent for the responsible clinical professionals to consider using
other medication approaches in Zata’s case.
Also, the information regarding Zata’s health is adequate and well presented. For
instance, Zata has a temperature of 37.8 degrees Celsius, which is beyond the average 36.5
degrees Celsius. With this information, a nurse can precisely relate the abnormal
temperature levels with fever. In the case study, it is also indicated that Zata has a pulse rate
of 72 coupled with 22 respirations per minute. Despite Zata’s pulse rate being within the
tolerance margins, her respiration levels are abnormal. Moreover, Zata’s blood pressure of
166/85 is way above the standard systolic and diastolic rates of 120/80 mmHg (Yeakel &
Logan, 2013). Therefore, the collected information calls for urgent medical interventions
since the related body organs are operating beyond the stipulated normal levels.
Blood is an essential tool in nursing since it highlights the severity of the targeted
illness. In the case study, Zata’s CEA levels are above 25ng/ml. Usually, a human body
operates under a normal CEA range of below 2.5ng/ml (Bagaria, Sood, Sharma & Lalwani,
2013). Therefore, the CEA levels harbored by Zata highlight the existence of a severe
metastatic illness. In this case, it could be a massive inflammation in the bowel region or an
extensive spread of cancer cells in the epithelium layers of the large intestine. Also,
considering that Zata’s neutrophils count is below 500/ mcl, she could be experiencing
adverse tissue damage (Bagaria et al., 2013). Usually, a low neutrophil count level indicates
that the body’s response to inflammatory signals is adversely diminished.
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CASE STUDY-NURSING
Nursing Problems
The case study presents three critical problems that are crucial in the nursing sector.
First, the presence of a poorly differentiated adenocarcinoma is a nursing problem that calls
for urgent medical intervention. However, controlling this stage of cancer is almost
impossible due to its ability to spread to other vital organs in the body. In the case study,
Zata was subjected to laparoscopic sigmoid colectomy after experiencing obstruction in her
colon. On undergoing a biopsy process, the results still revealed the presence of a poorly
differentiated adenocarcinoma. Based on the prognosis results, the sigmoid metastasis may
have spread to the kidney, lungs, and other vital body organs. The chemotherapy applied to
reduce kidney metastasis may not be successful due the high tendency of the organ to
develop secondary renocellular cancer (Dulskas et al., 2015). Therefore, the presence of a
poorly differentiated carcinoma is catastrophic since the clinical practitioners will have to
apply targeted radiotherapy and chemotherapy on the affected organs.
Reoccurrence of the colorectal cancer is another nursing problem evident in Zata’s
Case. The risk factors associated with the reemergence of cancer are numerous and
challenging to identify. After the tumor had been removed through surgery, Zata still
complained of being unable to open bowels. The situation illustrates that another tumor
may have developed hence blocking her colon. The case poses a significant nursing
challenge to the clinical professionals since they may have to carry out another diagnosis to
establish the alternative causative factors.
Zata’s unresponsiveness to the administered medication is a major nursing problem
evident in the case scenario. Overall, the treatment of colon cancer varies based on the
severity of the illness and the involved risk factors. Considering that Zata was subjected to
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medication, and even underwent a sigmoid colectomy, her health conditions is still
worsening. Therefore, the situation poses a significant challenge for clinical professionals
since they will have to devise new medication routines, which may be coupled with other
prognosis procedures.
Nursing Goals
The main objective in the treatment of sigmoid adenocarcinoma is to protect the
patient from its effects. However, the stipulated nursing goals should resonate with the legal
and ethical principles in nursing. This may include carrying out succinct prognosis,
assessment of the patient’s progress and the administration of suitable medications.
In the case scenario, the goal is to use appropriate equipment as a vital tool for
determining suitable treatment options. However, appropriate ethical provisions should be
followed. For instance, a nurse should discuss with the client regarding the feasibility of
any undertaken medication before its administration. This practice helps to improve the
moral understanding between the patient and the clinical officer.
A nurse should also aim to maintain high levels of professionalism and abide by the
legal rules governing nursing practice. For instance, the application of radiotherapy or
chemotherapy should be carried out within the legally certified conditions without
endangering the patient’s life. Furthermore, an evidence-based approach should be
embraced in seeking appropriate care for Zata. This may include evaluating the results
obtained in the treatment of similar cases in nursing and assessing their applicability in
Zata’s case.
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CASE STUDY-NURSING
Taking Action
Based on Zata’s health, conducting a fresh prognosis is a suitable intervention
strategy. Since the biopsy results indicate the existence of a poorly differentiated
adenocarcinoma, it is worth investigating the associated risk factors. This action is justified
by the adverse signs and symptoms harbored by the client. For instance, the existence of
CEA levels above 25ng/ml calls for a further investigation of the case. Therefore, the new
prognosis process may determine the extent of the illness, which consequently provides a
platform for devising appropriate treatment plans.
Moreover, chemotherapy can be a suitable action plan in the advanced stage of
colon cancer. Since Zata is in the fourth stage of sigmoid adenocarcinoma, chemotherapy is
the only alternative medication that can cushion her from adverse cancer effects. This action
is justified by Zata’s reduced neutrophils count which illustrates that her immune system is
no longer able to respond to inflammatory signals and the spread of cancer cells. Therefore,
killing cancer cells via chemotherapy is the only viable means of prolonging her life.
Evaluation
A thorough prognosis process provides useful blueprints of devising an appropriate
type of treatment for the illness. Based on the signs and symptoms exhibited by Zata, it is
evident that she is in the fourth stage of cancer where her body is unable to contain
carcinoma cells. Hence, killing cancer cells is the only viable option left. Despite
chemotherapy having adverse side effects, its benefits outweigh drawbacks. However, this
treatment procedure should incorporate radiotherapy and surgery for better results. The
intention of conducting chemotherapy is to interfere with the growth of cancer tumors and
replace them with healthy body tissues.
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Reflection
I find the intervention measures taken in Zata’s case being educative. Through the
experience, I have learned that it is vital for clinical professionals to carry out a thorough
prognosis process since the adopted treatment criteria depend on how cancer cells are
spread in the body. Also, I have realized that chemotherapy can guarantee better results if it
is coupled with surgery and radiotherapy. However, there is still a challenge when it comes
to curbing the reemergence of colon cancer and the management of a poorly differentiated
adenocarcinoma. Therefore, nurses should prioritize assessing all the possible risk factors to
cushion the patient from the reemergence of the disease. Based on the signs and symptoms
manifested in Zata’s case, the administration of chemotherapy, radiotherapy, and surgery
might improve her overall health.
Conclusion
In summary, sigmoid adenocarcinoma is manageable in its early stages. Once the
cells spread to the surrounding lymph nodes and organs its treatment becomes challenging.
The fourth stage of colon cancer is tragic since a patient manifests a weak immune system
coupled with the obstruction of the sigmoid area. The situation faced by Zata should be
used as a benchmark for future diagnosis and treatment of colon cancer. Since Zata faced
difficulties in opening the bowel, the application of chemotherapy and subsequent
radiotherapy is the best treatment approach to cancer. Therefore, if chemotherapy and
proper prognosis had not been conducted, Zata’s case would still be worsening.
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References
Bagaria, B., Sood, S., Sharma, R., & Lalwani, S. (2013). Comparative study of CEA and
CA19-9 in esophageal, gastric and colon cancers individually and in combination
(ROC curve analysis). Cancer biology & medicine, 10(3), 148.
Dulskas, A., Bagurskas, P., Sinkevicius, Z., & Samalavicius, N. E. (2015). Sigmoid
adenocarcinoma with metastases to the kidney: Report of a rare case and review of
the literature. Oncology letters, 10(2), 1191-1193.
Li, Q., Gan, L., Liang, L., Li, X., & Cai, S. (2015). The influence of marital status on stage
at diagnosis and survival of patients with colorectal cancer. Oncotarget, 6(9), 7339.
Munteanu, I., & Mastalier, B. (2014). Genetics of colorectal cancer. Journal of medicine
and life, 7(4), 507.
Yeakel, J. K., & Logan, B. K. (2013). Blood synthetic cannabinoid concentrations in cases
of suspected impaired driving. Journal of analytical toxicology, 37(8), 547-551.
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