CRITICAL THINKING SUMMARY

Student: _Kassie Herp______________________ Clinical Group/Day: ___Mon. 7a7p_______________

Patient Diagnosis: Ascending Colon Cancer_________________________
Age: 64 _____

Patient

Patient Allergies: erythromyocin, ileostomy restricted

foods____________________________________
MEDICAL DIAGNOSIS that pt was diagnosed with upon admission to the hospital,
including dx that were added after admission: planned resection of right colon
laproscopically, laparotomy exploration_____
PAST MEDICAL DIAGNOSIS: Found on History and Physical in chart, or upon interview
with pt:
Sleep apnea, hyperlipidemia, hypertension, claudication, arthritis of back, arthritis
of the knee, diabetes
mellitus_____________________________________________________________________________
PATHOPHYSIOLOGY of ADMISSION MEDICAL DIAGNOSIS: (not quoted, but YES
APA cited)
Cancer of the colon located between the cecum and the transverse colon. Begins as
small, noncancerous clumps called adenomatous polyps which can become
cancer___________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
SYMPTOMS typically seen with this diagnosis include: (not quoted, but YES
APA cited)
Change in bowel habits, rectal bleeding, blood in stool, persistent abdominal
discomfort, feeling like you cant empty, weakness or fatigue, unexplained weight
loss_____________________________________
_____________________________________________________________________________________
PATIENTS SYMPTOMS: How do they differ or are similar to expected symptoms?
Abdominal discomfort, fatigue, differs a little bit because part of the colon was
already removed
______________________________________________________
____________________
_____________________________________________________________________________________
NUTRITIONAL ASSESSMENT: (helpful site is www.eatright.org)
Pt HEIGHT: 158_________
Index):60__________

Pt WEIGHT: 150_________

Pt BMI (Body Mass

What BMI Category does your pt. fall into? (Underweight, Normal, Overweight,
Obese):obese________

How much weight would this pt have to gain/lose to have a normal BMI? 200 lb/90
kg ______________
How could pt achieve this? Exercise more, change eating habits, maintain healthier
diet
_____________________________________________________________________________________
WHAT AGE /PSYCHOSOCIAL RELATED CONCERNS does your pt have? Generativity
vs. stagnation. Patient cant nurture or create a positive change because of her
illness currently, not allowing her to meet psychosocial needs._
____________________________

CRITICAL THINKING SUMMARY

NURSING DIAGNOSIS/OBJECTIVES/INTERVENTIONS
#1 NURSING DIAGNOSIS (including R/T): _imbalanced nutrition r/t obstruction by
tumor___________
DEFINING CHARACTERISTICS (S/SX) that support pt diagnosis: abdominal pain, lack
of interest in food, inability to digest
food.________________________________________________________________
OBJECTIVE/PATIENT OUTCOME for this diagnosis: consume adequate nutrition in 2
weeks__________
NURSING INTERVENTIONS that will assist the pt to resolve the above dx or to meet
objectives:
#1: monitor food intake with 3 day food diary and consult dietician
_______________________
#2: provide companionship at meal time to encourage eating
____________________________
#3: monitor food intake with percentage of food servings eaten
________________________
----------------------------------------------------------------------------------------------------------------------------------------#2 NURSING DIAGNOSIS (including R/T): Excess fluid volume r/t excess fluid
intake_________________
DEFINING CHARACTERISTICS (S/SX) that support pt diagnosis: altered electrolytes,
decreased hemoglobin,
edema____________________________________________________________________
OBJECTIVE/PATIENT OUTCOME for this diagnosis: remain free of edema in 1
months_____________
NURSING INTERVENTIONS that will assist the pt to resolve the above dx or to meet
objectives:
#1: monitor intake and output every 8 hours at meal time and catheter and ostomy
changes_________

#2: monitor BUN, creatinine, serum osmolality everyday in the morning

_____________________
#3: provide ordered care for extremities on for 1 hr. off for 30 mins. Exercises every
2 hours _________
----------------------------------------------------------------------------------------------------------------------------------------COMPLICATIONS: If pt condition were to worsen, what would be the most likely
reason and why?
Retained to much fluid, failing to intervene and not using diuretics could cause
kidney
failure______________________________________________________________________________
_
What symptoms would pt exhibit if this happens? Jaundice, nausea, vomiting
symptoms often
nospecific___________________________________________________________________________
__
What nursing interventions would you exercise and what Dr. orders would you
anticipate?
Administering diuretics and dialysis treatemtns to help rid the body of extra fluid
_____________
_____________________________________________________________________________________
Patients Medications/Doses: circle those meds that you anticipated with this
diagnosis:
_____________________________________________________________________________________
_____________________________________________________________________________________

ANALYSIS OF DIAGNOSTIC TESTS

Diagnostic / Lab Test

Patient Value

Na (sodium)

145

134-146

K+ (potassium) 3.4-5.0

3.6

Chloride

102

98-112

CO2 (serum) 22-32

37

Anion Gap 4-15

Analysis of Value

Depression of the respiratory center

related to impaired elimination

Phosphorus 2.5-4.5
Urea nitrogen (bun)
Cr (creatinine)

8-20

0.5-1.1

24

Diabetes related to decreased renal

excretion

0.63

Glucose

65-99

153

Diabetes, glucose intolerance

Calcium

8.6-10.4

7.8

Inadequate nutrition related to

ileostomy
Magnesium

1.6-2.5

2.1

Albumin

3.5-5.0

1.0

Bili Total

0.2-1.0

0.4

Alk Phos

30-120

188

AST

10-40

24

ALT

10-40

30

B Natiuretic Peptide (BNP)

0-99

WBC (White Blood count)

4-10.8

Hgb (Hemoglobin)

12-16

9.3

140-400

147

PT / INR

9.3-12 / 0.9-1.2

15.3/1.5

7.35-7.45

ABG: pCO2
ABG: pO2

67

75-100

99

22-32

40

ABG: O2 Hmg

94-97

Fluid retention

Poor fat absorption related to

ileostomy

7.40

35-45

ABG: HCO3

Related to cancer of the colon

7.08

Platelet

ABG: ph Art

Hypoalbuminemia related to poor

nutrition related to colon cancer and
ileostomy

Excess fluid

Excess fluid

96.6

Blood Cultures (Microbiology)

negative
UA (urinalysis)
Cat Scan (CT)
CXR (Chest X-Ray)
Please list any Misc labs; i.e. D-Dimer Quant 0-500, Hct 37-47, Influenza A or B, CDiff, MRSA, AFB
Medications
Insulin aspart: corrective mealtime, antidiabetic, hormones lowers blood glucose
control of hyperglycemia in diabetes. Adverse reactions- hypoglycemia, bruritis,
erythema. Check blood sugar prior, calculated carb coverage
Metoprolol: 25 mg PO bid, antianginals, beta blocker, hypertension, angina pectoris.
Contraindicated pulmonary edema. Adverse reactions- fatigue, weakness, erectile
dysfunction. Check BP and pulse, check to see if taken Viagra. Get up slowly.
Tigecycline: 50 mg IVPB q12hr, antiinfectives, intraabdominal infections,
contraindicated in diabetic foot infection, adverse reactions- nausea and vomiting,
monitor bowel function, monitor for signs of superinfection.

Dorzolamide timolol: ophthalmic 1 drop OU bid, betablocker, reduces, intraocular

pressure, adverse reactions- bitter taste in mouth, itching, blurriness, reports of
bacterial keratitis.
Hydraliazine: 75 mg, PO tid, antihypersentives, vasodialtor, hypertension, adverse
reactions- tachycardia, sodium retention, drug induced lupus syndrome, take with
meals and monitor BP and Pulse
Psyllium: 1 packet PO bid, laxative, constipation, adverse reactions- cramps nausea,
vomiting, mix right before administration, abdominal distention, color amount,
consistency of stool
Quetiapine: antipsychotic, depression, adverse reactions- dizziness, weight gain,
sweating, constipation, contraindicated in arrhythmias, monitor mental status
Heparin: 5000 units, subQ q8hr, anticoagulant, treat and prevent blood clots,
adverse reactions- rash, redness, at injection site, bluish colored, at risk for bleeding
Insulin glargine: 33 unites subQ qam, hormone diabetes, adverse reactionsheadache, hunger confusion, sweating, dont take if hypoglycemic
Micafungin: 100 mg IVPB daily, antibiotic, antifungal, treat infections, adverse
reactions-nausea vomiting, diarrhea, flushing, rash, symptoms of esophageal
candidiasis
Autazolamide: 250mg PO daily, carbonic anahydrase inhibitor glaucoma, adverse
reactions- nausea vomiting, diarrhea, flushing, rash, loss of blood sugar control
Asprin: 81 mg PO daily, salicylate, treat prevent MI strokes angina, dyspepsia,
nausea epigastric distress, at risk for bleeding
Losartan: 50 mg, PO daily, antihypertensives, hypertenstion and neuropathy,
adverse reactions-diarrhea, dizziness, fatigue, myalgia, assess BP, assess for
angioedema
Pantaprazole: 40 mg, PO daily, proton pump inhibitor, heartburn, weight changes,
adverse reactions- weight changes, nausea, vomiting, diarrhea, gas dizziness, do
not crush, break or chew.