i

BALIAN COMMUNITY COLLEGE

SCHOOL OF MIDWIFERY

Balian Pangil, Laguna

Narrative Report

Related Learning Experiences (CHSM)

Barangay Mabato Asufre

Name of Area Assigned

Submitted by:

THRISKA RAVVEN S. RESURRECCION, RM

NAME

Submitted to:

MS. CORALYN TADY, RM – BSM

Professor

SY: 2021 – 2022

 ii

I.INTRODUCTION

A 23-year-old active female who makes an effort to succeed in life.

Eating street food, particularly "isaw" has been one of the methods he has found

to survive a day for meals while working in a factory in Batangas five days a

week for twelve hours.After three years, she is currently facing a fatal illness

that many of us have been terrified of. Rectal cancer is a disease in which

malignant (cancer) cells form in the tissues of the rectum. The rectum is part of

the body’s digestive system. The digestive system takes

in nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from

foods and helps pass waste material out of the body. The digestive system is

made up of the esophagus, stomach, and the small and large intestines.

The colon (large bowel) is the first part of the large intestine and is about 5 feet

long. Together, the rectum and anal canal make up the last part of the large

intestine and are 6-8 inches long. The anal canal ends at the anus (the opening of

the large intestine to the outside of the body).

I. PERSONAL AND SOCIAL HISTORY OF THE PATIENT

The patient has a busy life. She is a 23-year-old lady who doesn't worry

about her food habits or health. Due to her difficult circumstances, she survives

by purchasing street food, particularly barbeque, close to her place of

 iii

employment because it is convenient and affordable. She had no idea how much

of an influence that would have on her life. No one in her mother's or father's

family has ever had cancer, although they do have diabetes and high blood

pressure. Her age shows no signs of contracting the illness.The patient is living

an active life. Being a 23-year-old woman she doesn’t bother about her health

and eating habit. Because of a poor life she sustain her self with eating street

foods specifically barbecue near her work place because of it’s convenience and

a cheap price. Not knowing that it would have a great impact on her life. There

are no family history of any cancer but they have hypertension and diabetes on

her mother and father side. There is no hint of getting the disease on her age.

II. DIAGNOSIS

COLORECTAL CANCER stage II

III. PREDISPOSING FACTOR

A person with an average risk of colorectal cancer has about a 5% chance

of developing colorectal cancer overall. Generally, most colorectal cancers

(about 95%) are considered sporadic, meaning the genetic changes develop by

chance after a person is born, so there is no risk of passing these genetic

changes on to one’s children. Inherited colorectal cancers are less common

(about 5% to 10%) and occur when gene mutations, or changes, are passed
 iv

within a family from 1 generation to the next (see below). Another 10% to 15%

of colorectal cancers are diagnosed in people with a family history of colon or

rectal cancer but not a known inherited condition (see below). More often, the

cause of colorectal cancer is not known. However, the following factors may

raise a person’s risk of developing colorectal cancer:

 Age. The risk of colorectal cancer increases as people get older. Colorectal

cancer can occur in young adults and teenagers, but the majority of

colorectal cancers occur in people older than 50. For colon cancer, the

average age at the time of diagnosis for men is 68 and for women is 72. For

rectal cancer, it is age 63 for both men and women. Adults 65 and older

who are diagnosed with colorectal cancer face unique challenges,

specifically with regard to cancer treatment. Learn more about aging and

cancer.

It is important to note that while colorectal cancer is still diagnosed most

commonly in older adults, the incidence rate for colorectal cancer declined

by about 3.6% per year in adults 55 and older, based on the latest statistics.

Meanwhile, the incidence rate increased by 2% per year in adults younger

than 55. The increase is due in large part to rising numbers of rectal cancer.

About 11% of all colorectal diagnoses are in people under age 50. The
 v

reason for this rise in younger adults is not well known and is an active area

of research.

 Race. Black people have the highest rates of sporadic, or non-hereditary,

colorectal cancer in the United States. Colorectal cancer is also a leading

cause of cancer-related death among Black people. Black women are more

likely to die from colorectal cancer than women from any other racial group,

and Black men are even more likely to die from colorectal cancer than

Black women. The reasons for these differences are unclear. Because Black

people are more likely to be diagnosed with colorectal cancer at a younger

age, the American College of Gastroenterology suggests that Black people

begin screening with colonoscopies at age 45 (see Screening). Earlier

screening may find changes in the colon at a point when they are more

easily treated.

 Gender. Men have a slightly higher risk of developing colorectal cancer

than women.

 Family history of colorectal cancer. Colorectal cancer may run in the

family if first-degree relatives (parents, brothers, sisters, children) or many

other family members (grandparents, aunts, uncles, nieces, nephews,

grandchildren, cousins) have had colorectal cancer. This is especially true

when family members are diagnosed with colorectal cancer before age 60.
 vi

If a person has a family history of colorectal cancer, their risk of developing

the disease is nearly double. The risk further increases if other close

relatives have also developed colorectal cancer or if a first-degree relative

was diagnosed at a younger age.

About 5% to 6% of cases of colorectal cancer are associated with inherited

genetic mutations that increase the risk of cancer and affect the way that the

cancer is treated. This is why ASCO recommends that all people diagnosed

with colorectal cancer receive evaluation for inherited mutations. Evaluation

may include review of personal and family histories of cancer and molecular

testing of tumor tissue.

It is important to talk to your family members about your family’s history of

colorectal cancer. If you think you may have a family history of colorectal

cancer, talk with a genetic counselor before you have any genetic testing.

Only genetic testing can find out if you have a genetic mutation, and genetic

counselors are trained to explain the risks and benefits of genetic testing.
 vii

 Rare inherited conditions.Members of families with certain uncommon

inherited conditions have a higher risk of colorectal cancer, as well as other

types of cancer. These include:

 Lynch syndrome, also called hereditary nonpolyposis colorectal

cancer (HNPCC)

 Familial adenomatous polyposis (FAP)

 Attenuated familial adenomatous polyposis (AFAP), a subtype of

FAP

 Gardner syndrome, a subtype of FAP

 Juvenile polyposis syndrome (JPS)

 Muir-Torre syndrome, a subtype of Lynch Syndrome

 MYH-associated polyposis (MAP)

 Peutz-Jeghers syndrome (PJS)

 Turcot syndrome, a subtype of FAP and Lynch Syndrome

 Inflammatory bowel disease (IBD). People with IBD, such as ulcerative

colitis or Crohn’s disease, may develop chronic inflammation of the large

intestine. This increases the risk of colorectal cancer. IBD is not the same as
 viii

irritable bowel syndrome (IBS). IBS does not increase your risk of

colorectal cancer.

 Adenomatous polyps (adenomas). Polyps are not cancer, but some types

of polyps called adenomas can develop into colorectal cancer over time.

Polyps can often be completely removed using a tool during a colonoscopy,

a test in which a doctor looks into the colon using a lighted tube after the

patient has been sedated. Polyp removal can prevent colorectal cancer.

People who have had adenomas have a greater risk of additional polyps and

of colorectal cancer, and they should have follow-up screening tests

regularly

 Personal history of certain types of cancer. People with a personal

history of colorectal cancer previously or a diagnosis of ovarian

cancer or uterine cancer are more likely to develop colorectal cancer.

 Physical inactivity and obesity. People who lead an inactive lifestyle,

meaning no regular exercise and a lot of sitting, and people who

are overweight or obese may have an increased risk of colorectal cancer.

 Food/diet. Current research consistently links eating more red meat and

processed meat to a higher risk of the disease. Other dietary factors have

also been studied to see if they affect the risk of developing colorectal
 ix

cancer, but the data are less consistent on which diets or foods change a

person's risk of colorectal cancer.

 Smoking. Recent studies have shown that smokers are more likely to die

from colorectal cancer than nonsmokers. Learn more about quitting tobacco

use.

IV. LABORATORY TEST/ DIAGNOSTIC PROCEDURE

The following tests and procedures may be used:

 Physical exam and health history: An exam of the body to check ral signs

of health, including checking for signs of disease, such as lumps or

anything else that seems unusual. A history of the patient’s health habits

and past illnesses and treatments will also be taken.

 Digital rectal exam (DRE): An exam of the rectum. The doctor

or nurse inserts a lubricated, gloved finger into the lower part of the rectum

to feel for lumps or anything else that seems unusual. In women,

the vagina may also be examined.

 Whole abdominal ultrasound: Although not suitable as a first choice

screening procedure for colorectal cancer, routine abdominal ultrasound can

 x

detect even non-suspected colonic tumors, especially in the ascending colon.

Since the specificity of ultrasound is probably low, diagnosis must be

confirmed by X-ray and/or endoscopy.

 Computed tomography (CT or CAT) scan: A CT scan uses x-rays to

make detailed cross-sectional images of your body. This test can help tell if

colorectal cancer has spread to nearby lymph nodes or to your liver, lungs,

or other organs.

 Colonoscopy: A procedure to look inside the rectum and colon for polyps

(small pieces of bulging tissue), abnormal areas, or cancer.

A colonoscope is a thin, tube-like instrument with a light and a lens for

viewing. It may also have a tool to remove polyps or tissue samples, which

are checked under a microscope for signs of cancer. Colonoscopy. A thin,

lighted tube is inserted through the anus and rectum and into the colon to

look for abnormal areas.

 Biopsy: The removal of cells or tissues so they can be viewed under a

microscope to check for signs of cancer. Tumor tissue that is removed

during the biopsy may be checked to see if the patient is likely to have

the gene mutation that causes HNPCC. This may help to plan treatment.

 Immunohistochemistry: A laboratory test that uses antibodies to check for

certain antigens (markers) in a sample of a patient’s tissue. The antibodies

 xi

are usually linked to an enzyme or a fluorescent dye. After the antibodies

bind to a specific antigen in the tissue sample, the enzyme or dye is

activated, and the antigen can then be seen under a microscope. This type of

test is used to help diagnose cancer and to help tell one type of cancer from

another type of cancer.

 Carcinoembryonic antigen (CEA) assay: A test that measures the level of

CEA in the blood. CEA is released into the bloodstream from both cancer

cells and normal cells. When found in higher than normal amounts, it can

be a sign of rectal cancer or other conditions.

V. TREATMENT PROCEDURE

 Surgery

Surgery is the most common treatment for all stages of rectal cancer. The

cancer is removed using one of the following types of surgery:

 Polypectomy: If the cancer is found in a polyp (a small piece of

bulging tissue), the polyp is often removed during a colonoscopy.

 Local excision: If the cancer is found on the inside surface of

the rectum and has not spread into the wall of the rectum, the cancer

and a small amount of surrounding healthy tissue is removed.

 xii

 Resection: If the cancer has spread into the wall of the rectum, the

section of the rectum with cancer and nearby healthy tissue is removed.

Sometimes the tissue between the rectum and the abdominal wall is

also removed. The lymph nodes near the rectum are removed and

checked under a microscope for signs of cancer.

 Radiofrequency ablation: The use of a special probe with

tiny electrodes that kill cancer cells. Sometimes the probe is inserted

directly through the skin and only local anesthesia is needed. In other

cases, the probe is inserted through an incision in the abdomen. This is

done in the hospital with general anesthesia.

 Cryosurgery: A treatment that uses an instrument to freeze and

destroy abnormal tissue. This type of treatment is also called

cryotherapy.

 Pelvic exenteration: If the cancer has spread to other organs near the

rectum, the lower colon, rectum, and bladder are removed. In women,

the cervix, vagina, ovaries, and nearby lymph nodes may be removed.

In men, the prostate may be removed. Artificial openings (stoma) are

made for urine and stool to flow from the body to a collection bag.

After the cancer is removed, the surgeon will either:

 xiii

 do an anastomosis (sew the healthy parts of the rectum together,

sew the remaining rectum to the colon, or sew the colon to

the anus); Resection of the rectum with anastomosis. The rectum

and part of the colon are removed, and then the colon and anus are

joined.or

 make a stoma (an opening) from the rectum to the outside of the

body for waste to pass through. This procedure is done if the

cancer is too close to the anus and is called a colostomy. A bag is

placed around the stoma to collect the waste. Sometimes the

colostomy is needed only until the rectum has healed, and then it

can be reversed. If the entire rectum is removed, however, the

colostomy may be permanent.

 Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or

other types of radiation to kill cancer cells or keep them from growing.

There are two types of radiation therapy:

External radiation therapy uses a machine outside the body to send

radiation toward the cancer.

 xiv

Internal radiation therapy uses a radioactive substance sealed in

needles, seeds, wires, or catheters that are placed directly into or near the

cancer.

The way the radiation therapy is given depends on the type and stage of the

cancer being treated. External radiation therapy is used to treat rectal cancer.

Short-course preoperative radiation therapy is used in some types of rectal

cancer. This treatment uses fewer and lower doses of radiation than

standard treatment, followed by surgery several days after the last dose.

 Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of

cancer cells, either by killing the cells or by stopping the cells from dividing.

When chemotherapy is taken by mouth or injected into a vein or muscle,

the drugs enter the bloodstream and can reach cancer cells throughout the

body (systemic chemotherapy). When chemotherapy is placed directly in

the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the

drugs mainly affect cancer cells in those areas (regional chemotherapy).

Chemoembolization of the hepatic artery is a type of regional chemotherapy

that may be used to treat cancer that has spread to the liver. This is done by
 xv

blocking the hepatic artery (the main artery that supplies blood to the liver)

and injecting anticancer drugs between the blockage and the liver. The

liver’s arteries then carry the drugs into the liver. Only a small amount of

the drug reaches other parts of the body. The blockage may be temporary or

permanent, depending on what is used to block the artery. The liver

continues to receive some blood from the hepatic portal vein, which carries

blood from the stomach and intestine.

The way the chemotherapy is given depends on the type and stage of the

cancer being treated.

For more information, see Drugs Approved for Colon and Rectal Cancer.

Active surveillance

Active surveillance is closely following a patient's condition without

giving any treatment unless there are changes in test results. It is used

to find early signs that the condition is getting worse. In active

surveillance, patients are given certain exams and tests to check if the

cancer is growing. When the cancer begins to grow, treatment is given

to cure the cancer. Tests include the following:

 Digital rectal exam.

 MRI.
 xvi

 Endoscopy.

 Sigmoidoscopy.

 CT scan.

 Carcinoembryonic antigen (CEA) assay.

VI. PATIENT MANAGEMENT-MIDWIFERY CARE PLAN

INTERVENTION RATIONALE

Discuss with patient and relative how Aids in defining concerns to begin

the diagnosis and treatment are problem-solving process.

affecting the patient’s personal life,

home and work activities.

Acknowledge difficulties patient may Validates reality of patient’s feelings

be experiencing. Give information that and gives permission to take whatever

counseling is often necessary and measures are necessary to cope with

important in the adaptation process. what is happening.

Provide emotional support for patient Although some patients adapt or

and relative during diagnostic tests and adjust to cancer effects or side effects
 xvii

treatment phase. of therapy, many need additional

support during this period.

Monitor daily food intake; have patient Identifies nutritional strengths and

keep food diary as indicated. deficiencies.

Encourage patient to eat high-calorie, Metabolic tissue needs are increased

nutrient-rich diet, with adequate fluid as well as fluids (to eliminate waste

intake. Encourage use of supplements products). Supplements can play an

and frequent or smaller meals spaced important role in maintaining adequate

throughout the day. caloric and protein intake.

Control environmental factors (strong Can trigger nausea and vomiting

or noxious odors or noise). Avoid response.

overly sweet, fatty, or spicy foods.

Provide accurate, consistent Can reduce anxiety and enable patient

information regarding to make decisions and choices based

diagnosis and prognosis. Avoid on realities.

arguing about patient’s

perceptions of situation.

Deal with family members in a warm, Provides feelings of empathy and

 xviii

caring, respectful way. Provide promotes individual’s sense of worth

information (verbal and written), and and competence in ability to handle

reinforce as necessary. current situation.

 xix

VII. Drug Study

Generic Name Brand Indication Contraindicat Nursing Intervention

Name ion

Oxaliplatin Eloxatin, This medication is Contraindicate Assessment & Drug

Vexplati an antineoplastic d in patients Effects

n-20, agent, prescribed with severe

 Monitor for S&S
DBL, for colorectal lung problem
of
Meslatin cancer either alone and
hypersensitivity
or with other hypersensitivit
(e.g., rash,
medications. y.
urticaria,

erythema,

pruritis; rarely,

bronchospasm

and

hypotension).

Discontinue drug

and notify

physician if any
 xx

of these occur.

 Monitor insertion

site.

Extravasation

may cause local

pain and

inflammation

that may be

severe and lead

to complications,

including

necrosis.

 Monitor for S&S

of coagulation

disorders

including GI

bleeding,

hematuria, and

epistaxis.

 Monitor for S&S

 xxi

of peripheral

neuropathy (e.g.,

paresthesia,

dysesthesia,

hypoesthesia in

the hands, feet,

perioral area, or

throat, jaw

spasm, abnormal

tongue sensation,

dysarthria, eye

pain, and chest

pressure).

Symptoms may

be precipitated or

exacerbated by

exposure to cold

temperature or

cold objects.

 Lab tests: Before

 xxii

each

administration

cycle, monitor

WBC count with

differential,

hemoglobin,

platelet count,

and blood

chemistries

(including ALT,

AST, bilirubin,

and creatinine).

Monitor baseline

and periodic

renal functions.

 Do not apply ice

to oral mucous

membranes (e.g.,

mucositis

prophylaxis)
 xxiii

during the

infusion of

oxaliplatin as

cold temperature

can exacerbate

acute

neurological

symptoms.

Patient & Family

Education

 Use effective

methods of

contraception

while receiving

this drug.

 Avoid cold

drinks, use of

ice, and cover

exposed skin
 xxiv

prior to exposure

to cold

temperature or

cold objects.

 Do not drive or

engage in

potentially

hazardous

activities until

response to drug

is known.

 Report any of the

following to a

health care

provider:

difficulty

writing,

buttoning,

swallowing,

walking;
 xxv

numbness,

tingling or other

unusual

sensations in

extremities; non-

productive cough

or shortness of

breath; fever,

particularly if

associated with

persistent

diarrhea or other

evidence of

infection.

 Report promptly

S&S of a

bleeding disorder

such as black

tarry stool, coke-

colored or
 xxvi

frankly bloody

urine, bleeding

from the nose or

mucous

membranes.

 Do not breast

feed while taking

this drug without

consulting

physician.

Celecoxib Coxbitor, Hypersensitivi Assessment & Drug

CELEBREX is
RiteMed ty (including Effects
indicated
Celecoxi urticaria,
 Therapeutic
b, Osteoarthritis asthma,
effectiveness is
Celebrex (OA) angioneurotic
indicated by
, Coxid, edema) to
For the relief of joint
Celetor- celecoxib and
management of the pain.
200, other NSAIDs,
signs and  Lab tests:
 xxvii

Aubrex, symptoms of OA aspirin or Periodically

Rhea sulfonamides. monitor Hct and

Rheumatoid
Celecoxi Active peptic Hgb, liver
Arthritis (RA)
b, ulceration or functions, BUN

Celcoxx, For the gastrointestina and creatinine,

Coxidia, management of the l bleeding, and serum

Celcoxx, signs and inflammatory electrolytes.

Coxbitor, symptoms of RA bowel disease,  Monitor closely

Icox CHF (NYHA lithium levels

Juvenile
II-IV), when the two
Rheumatoid
established drugs are given
Arthritis (JRA)
ischaemic concurrently.

For the heart disease,  Monitor closely

management of the cerebrovascula PT/INR when

signs and r disease or used

symptoms of JRA peripheral concurrently

in patients 2 years arterial with warfarin.

and older disease.  Monitor for fluid

Treatment of retention and

Ankylosing
postoperative edema especially
 xxviii

Spondylitis (AS) pain in the in those with a

setting of history of
For the
CABG hypertension or
management of the
surgery. CHF.
signs and
Severe renal
symptoms of AS Patient & Family
(CrCl <30
Education
Acute Pain mL/min) and

hepatic (Child-  Avoid using

For the
Pugh class C celecoxib during
management of
or ≥10 score) the third
acute pain in adults
impairment. trimester of

Primary Pregnancy pregnancy.

Dysmenorrhea (3rd trimester)  Promptly report

and lactation. any of the

For the
following:
management of
unexplained
primary
weight gain,
dysmenorrhea
edema, skin rash.

 Stop taking

celecoxib and
 xxix

promptly report

to physician if

any of the

following occurs:

S&S of liver

dysfunction

including nausea,

fatigue, lethargy,

itching, jaundice,

abdominal pain,

and flulike

symptoms; S&S

of GI ulceration

including black,

tarry stools and

upper GI

distress.

 Do not breast

feed while taking

this drug.
 xxx

Capecitabine Captabin Capecitabine is Hypersensitivi Assessment & Drug

, Xeloda, used to help treat ty to Effects

Celabin, patients with capecitabine,

 Lab tests:
Capetero Dukes' C colon doxifluridine,
Monitor
, Caxeta cancer (colon 5-FU;
periodically CBC
500, cancer that has myelosuppress
with differential
Capetoso spread to lymph ion;
and liver
n, nodes in the area dihydropyrimi
functions
Capvex close to the colon), dine
including
after having dehydrogenase
bilirubin,
surgery. This (DPD)
transaminases,
medicine is also deficiency;
alkaline
used to treat females of
phosphatase.
metastatic childbearing
 Monitor
colorectal cancer age; active
carefully for
(cancer of the infection;
S&S of grade 2
colon or rectum jaundice;
or greater
that has spread to severe renal
toxicity:
other parts of the failure or
diarrhea >4
 xxxi

body). impairment; BMs/day or at

pregnancy night;
Capecitabine is
(category D); vomiting >1
also used together
lactation, time/24 h;
with docetaxel to
children <18 y. significant loss
treat metastatic
of appetite or
breast cancer
anorexia;
(breast cancer that
stomatitis; hand-
has spread to other
and-foot
parts of the body)
syndrome (pain,
in patients who
swelling,
have received other
erythema,
medicines (eg,
desquamation,
paclitaxel) but did
blistering);
not worked well, or
temperature =
in patients who
100.5° F; and
cannot receive
S&S of infection.
cancer medicines
 Withhold drug
anymore.
and immediately
Capecitabine
report S&S of
belongs to the
 xxxii

group of medicines grade 2 or

called greater toxicity.

antineoplastics  Monitor for

(cancer medicines). dehydration and

It interferes with replace fluids as

the growth of needed.

cancer cells, which  Monitor

are eventually carefully patients

destroyed by the with coronary

body. Since the artery disease for

growth of normal S&S of

cells may also be cardiotoxicity

affected by the (e.g., increasing

medicine, other angina).

side effects may

Patient & Family
also occur. Some of
Education
these may be

serious and must be  Report

reported to your immediately

doctor. significant
 xxxiii

This medicine is nausea, loss of

available only with appetite,

your doctor's diarrhea,

prescription. soreness of

tongue, fever of

100.5° F or

more, or signs of

infection.

Review patient

drug package

insert carefully

for more detail.

 Inform physician

immediately if

you become

pregnant.

Normix Rifaximin has Rifamycin Assessment & Drug

Rifaximin
multiple hypersensitivi
ty Effects
indications by the Rifaximin is
FDA: for the
 xxxiv

treatment of contraindicate  Withhold drug

patients (≥12 years
d in patients and notify
of age) with
with a history physician if
traveller's diarrhea
caused by of rifamycin symptoms
noninvasive strains
hypersensitivit worsen or
of Escherichia coli;
y, rifaximin last >48 h after
for the reduction of
overt hepatic hypersensitivit starting drug; an
encephalopathy
y, or alternative
recurrence in
hypersensitivit treatment should
patients ≥18 years
of age; and in May y to any of the be considered.
2015 it was
components of  Report promptly
approved for
rifaximin. the appearance of
irritable bowel
syndrome with C. difficile- blood in the
diarrhea (IBS-D)
associated stool.
treatment in adult
diarrhea,
men and women.
Patient & Family
diarrhea,
Education
fever,

pseudomemb  Report promptly

ranous colitis any of the

Rifaximin was following: fever;

 xxxv

not found to be difficulty

effective in breathing; skin

patients with rash, itching, or

diarrhea hives; worsening

complicated diarrhea during

by fever or after treatment

and/or blood or blood in the

in the stool or stool.

diarrhea due to  Do not breast

pathogens feed while taking

other than E. this drug without

coli. consulting

Discontinue physician.

rifaximin if

diarrhea

symptoms get

worse or

persist more

than 24 to 48

hours and
 xxxvi

consider

alternative

antibiotic

therapy. Do

not use

rifaximin in

patients where

Campylobacte

r jejuni,

Shigella sp., or

Salmonella sp.

may be

suspected as

causative

pathogens.

Rifaximin is

not effective in

cases of

travelers'

diarrhea due to
 xxxvii

Campylobacte

r jejuni. The

effectiveness

of rifaximin in

travelers'

diarrhea

caused by

Shigella sp.

and

Salmonella sp.

has not been

proven.

Consider

pseudomembr

anous colitis in

patients

presenting

with diarrhea

after

antibacterial
 xxxviii

use. Careful

medical

history is

necessary as

pseudomembr

anous colitis

has been

reported to

occur over 2

months after

the

administration

of antibacterial

agents. Almost

all

antibacterial

agents,

including

rifaximin,

have been
 xxxix

associated

with

pseudomembr

anous colitis

or C. difficile-

associated

diarrhea

(CDAD)

which may

range in

severity from

mild to life-

threatening.

Treatment

with

antibacterial

agents alters

the normal

flora of the

colon leading
 xl

to overgrowth

of C. difficile.

Hepatic

disease

Use caution

when

administering

rifaximin to

patients with

severe hepatic

disease (Child-

Pugh class C).

There is

increased

rifaximin

systemic

exposure in

patients with

severe hepatic

impairment.
 xli

Clinical trials

were limited to

patients with

MELD (Model

for End-Stage

Liver Disease)

scores less

than 25.

Geriatric

Clinical

studies with

rifaximin for

travelers'

diarrhea did

not include

sufficient

numbers of

patients aged

65 and older to

determine
 xlii

whether they

respond

differently

than younger

subjects. Other

reported

clinical

experience has

not identified

differences in

responses

between

geriatric and

younger

patients, but

greater

sensitivity of

some older

individuals

cannot be
 xliii

ruled out. The

federal

Omnibus

Budget

Reconciliation

Act (OBRA)

regulates

medication use

in residents

(e.g., geriatric

adults) of

long-term care

facilities

(LTCFs).

According to

OBRA, use of

antibiotics

should be

limited to

confirmed or
 xliv

suspected

bacterial

infections.

Antibiotics are

non-selective

and may result

in the

eradication of

beneficial

microorganism

s while

promoting the

emergence of

undesired

ones, causing

secondary

infections such

as oral thrush,

colitis, or

vaginitis. Any
 xlv

antibiotic may

cause diarrhea,

nausea,

vomiting,

anorexia, and

hypersensitivit

y reactions.

Pregnancy

There are no

available data

on rifaximin

use in human

pregnancy to

inform any

drug

associated

risks.

However,

because

systemic
 xlvi

absorption of

rifaximin after

oral

administration

is minimal,

rifaximin is

suggested as

an alternative

agent for

travelers'

diarrhea in

pregnant

women in

whom

quinolones are

contraindicate

d. Pregnant

women have a

higher risk of

experiencing
 xlvii

travelers'

diarrhea due to

decreased

gastric acidity

and increased

GI transit time,

and the

consequences

of fluid loss

may be more

severe (e.g.,

premature

labor,

shock). Terato

genic effects

were observed

in animal

reproduction

studies after

administration
 xlviii

of rifaximin to

pregnant rats

and rabbits

during

organogenesis

at doses

approximately

0.9 to 5 times

and 0.7 to 33

times,

respectively of

the

recommended

human doses

of 600 to

1,650 mg/day.

In rabbits,

ocular, oral

and

maxillofacial,
 xlix

cardiac, and

lumbar spine

malformations

were observed.

Ocular

malformations

were observed

in both rats

and rabbits at

doses that

caused

reduced

maternal body

weight gain.

Advise

pregnant

women of the

potential risk

to a fetus.

Breast-
 l

feeding

There is no

information

regarding the

presence of

rifaximin in

human milk,

the effects of

rifaximin on

the breast-fed

infant, or the

effects of

rifaximin on

milk

production.

Consider the

development

and health

benefits of

breast-feeding
 li

along with the

mother's

clinical need

for rifaximin

and any

potential

adverse effects

on the breast-

fed infant from

rifaximin or

from the

underlying

maternal

condition.
 lii

VIII. EVALUATION

After an intervention to the patient, the patient was able to:

1. Demonstrates behaviors/ lifestyle changes to recover and/or keep appropriate

weight.

2. Participate in specific interventions to stimulate appetite/ increase in dietary

intake.

3. Verbalize accurate information about diagnosis, prognosis and potential

complication at own level of readiness.

IX. LEARNING EXPERIENCE

Upon our stay in Barangay Mabato-Asufre in Pangil, Laguna, I realized

that the patient needed this kind of environment. The strong familial ties in this

community, the helpfulness of the neighbors, and the commitment and concern of

the barangay's medical staff inspire people to rise above any difficulties they may

encounter.Your passion of life and determination to live are supported by the

emotional experience of sharing and appreciating your family and community.

Extending the cooperation to other people is a method to make it stronger. Your

capacity to cope will increase and you'll be better able to fight for your life if you

share your life with others and get help or support from friends and family. Those

who must endure cancer can live as fully as possible by living in the present
 liii

rather than the past, setting reasonable objectives and being prepared to make

compromises, taking back control of their life and continuing to feel

independent and self-confident, attempting to overcome depressive thoughts and

feelings by actively helping others and oneself, and adopting a healthier diet and

regular exercise.
 liv

References:

https://www.cancer.gov/types/colorectal/patient/rectal-treatment-pdq#

https://www.cancer.net/cancer-types/colorectal-cancer/risk-factors-and-

prevention

https://www.saintlukeskc.org/health-library/exploratory-laparotomy

https://www.cancer.gov/types/colorectal/patient/rectal-treatment

https://nurseslabs.com/cancer-nursing-care-plans/14/

https://www.webmd.com/drugs/