COLEGIO SAN AGUSTIN BACOLOD

COLLEGE OF HEALTH AND ALLIED PROFESSIONS

NURSING PROGRAM
B.S. Aquino Drive, Bacolod City
Contact Number: (034) 434 – 24 71 Local 162
Email Address: [email protected]

CASE STUDY:

COLECTOMY

PREPARED BY:
ROSHANNE DANICA J. VERGARA

SUBMITTED TO:
MARK ROY B. NAVARRO RN, MN

AREA:
METRO BACOLOD HOSPITAL AND MEDICAL CENTER

DATE:
NOVEMBER 28-19, 2023
WHAT IS COLECTOMY
Colectomy is a surgical procedure involving the removal of all or part of the colon, which is also
known as the large intestine. This procedure is typically performed to treat various conditions
affecting the colon, such as colorectal cancer, inflammatory bowel disease (Crohn's disease or
ulcerative colitis), diverticulitis, or other severe conditions.
Indications:
Colorectal Cancer- Colectomy is often indicated in cases of colorectal cancer to remove the
cancerous part of the colon. The extent of the surgery depends on the stage and location of the
tumor. It may involve a partial colectomy for localized tumors or a total colectomy for more
advanced cases.
Inflammatory Bowel Disease (IBD)- Conditions like Crohn's disease or ulcerative colitis may
necessitate colectomy when medical treatments fail to manage symptoms effectively. The goal is
to remove the diseased portion of the colon, providing relief from inflammation and improving
the patient's quality of life.
Diverticulitis- Severe cases of diverticulitis, characterized by inflammation or infection of small
pouches (diverticula) in the colon, may require colectomy. This is particularly true if
complications such as perforation or abscess formation occur.
Bowel Obstruction- Complete or recurrent bowel obstructions that cannot be resolved with
conservative measures may be an indication for colectomy to alleviate the obstruction and
restore normal bowel function.

Types of Colectomy
Total Colectomy- This involves the removal of the entire colon. It is typically performed in
cases of extensive colorectal cancer, severe inflammatory bowel disease affecting the entire
colon, or certain genetic conditions.
Partial Colectomy (Segmental Resection)- In this procedure, only a portion of the colon is
removed, leaving the rest intact. It is commonly performed for localized tumors, diverticulitis, or
other conditions where removal of a segment is sufficient.
Subtotal Colectomy- This entails the removal of a large portion of the colon, usually leaving a
small part of the colon intact. It may be considered in certain cases of inflammatory bowel
disease or extensive diverticulitis.
Proctocolectomy- This involves the removal of both the colon and the rectum. It is often
performed in cases of colorectal cancer that extends into the rectum or in severe cases of
ulcerative colitis.
OVERVIEW OF THE CASE
Daniel Padilla, a 55-year-old man, confronted the formidable challenge of stage II colorectal cancer,
characterized by abdominal pain, altered bowel habits, and rectal bleeding. Opting for a laparoscopic right
hemicolectomy, Daniel's surgical journey successfully curtailed the cancer's advancement.
Preoperative evaluations, including a CT scan, meticulously guided the surgical approach, ensuring
precision in tumor removal. Postoperative monitoring facilitated a smooth recovery, and Daniel's
emotional resilience was fortified with unwavering support from family and friends.
Post-surgery, Daniel's commitment to rehabilitation and advocacy for stage II colorectal cancer awareness
became integral. Regular follow-ups unveiled a positive response to treatment, solidifying an optimistic
prognosis despite the cancer's stage.
DIAGNOSIS: Stage II Colorectal cancer

PATHOPHYSIOLOGY
The pathophysiological cascade commenced with neoplastic changes in the cells lining the mucosa of
Daniel's ascending colon. A convergence of genetic predisposition, evident in his family history of
colorectal cancer, and environmental factors set the stage for the development of a tumor. Over time,
these mutated cells underwent uncontrolled growth, giving rise to a localized tumor within the colon wall.
Clinically, Daniel's symptoms materialized as a consequence of the tumor's impact on normal bowel
function. Intermittent abdominal pain, alterations in bowel habits, and rectal bleeding served as red flags,
prompting a diagnostic journey. Colonoscopy and imaging studies, including CT scans, played pivotal
roles in visualizing the tumor, determining its location, and establishing the staging necessary for
informed decision-making.
In the realm of stage II colorectal cancer, the tumor remains confined to the colon wall, without
infiltration into surrounding tissues or lymph nodes. This staging classification, a crucial aspect of
Daniel's diagnosis, informed the subsequent course of action.
Surgical intervention took the form of a laparoscopic right hemicolectomy, a meticulous procedure aimed
at removing the affected portion of Daniel's ascending colon. The surgeon's objective was clear —
complete excision of the tumor along with a margin of healthy tissue to ensure comprehensive removal.
Notably, this approach minimized postoperative pain, shortened hospital stay, and facilitated a quicker
recovery compared to traditional open surgery.
Lymph node assessment during the surgery held paramount importance. The extraction and examination
of nearby lymph nodes provided critical insights into the potential spread of the disease. In Daniel's case,
the absence of lymph node involvement and metastasis signaled a favorable prognosis, offering hope for a
successful recovery.

Beyond the physical aspects of the disease, Daniel's emotional journey played a significant role in his
overall experience. Coping with the psychological and emotional stressors associated with a cancer
diagnosis, he found support from family, friends, and potentially a mental health professional.
As Daniel continues on the path of recovery, regular monitoring remains imperative to detect any signs of
recurrence and assess the effectiveness of the treatment. His journey through the nuanced
pathophysiology of stage II colorectal cancer not only highlights the scientific intricacies of the disease
but also underscores the importance of a multidimensional approach, addressing both the physical and
emotional dimensions for comprehensive patient care.

ANATOMY AFFECTED
In Daniel Padilla's case of stage II colorectal cancer, the affected anatomy primarily involves the colon,
which is a crucial part of the digestive system. Let's delve into the specific anatomical details and their
meanings:
1. Ascending Colon:
- The ascending colon is a segment of the colon that travels upward on the right side of the abdomen. In
Daniel's case, this specific part of the colon was affected by the development of a tumor. The ascending
colon plays a vital role in absorbing water and electrolytes from the digested food, contributing to the
formation of feces.
2. Colon Wall:
- The tumor developed within the wall of the colon, indicating that the neoplastic changes originated in
the mucosal layer and progressed inward. The colon wall consists of several layers, including the mucosa,
submucosa, muscularis externa, and serosa. The exact layer affected by the tumor would be determined
during diagnostic procedures and surgical intervention.
3. Lymph Nodes:
- Lymph nodes are small, bean-shaped structures that play a crucial role in the immune system. In
colorectal cancer, the presence or absence of cancer cells in nearby lymph nodes is a key indicator of the
disease's spread. Lymph nodes act as filters, trapping and destroying harmful substances, including cancer
cells.
Understanding the affected anatomy provides insights into the specific challenges and interventions
required in Daniel's case. The anatomical location of the tumor influences the surgical approach, such as
the decision to perform a laparoscopic right hemicolectomy to address the ascending colon's localized
cancer. Additionally, lymph node assessment during surgery aids in determining the extent of the disease
and guiding postoperative care and monitoring.

HOW IT WAS DIAGNOSED

In Daniel Padilla's case of stage II colorectal cancer, the clinical diagnosis involves a comprehensive
process that combines medical history, physical examination, and various diagnostic tests.
1. Patient Presentation:
 - Daniel initially presented with symptoms such as intermittent abdominal pain, changes in bowel
habits, and rectal bleeding. These symptoms raised concerns about the possibility of an underlying
gastrointestinal issue, prompting further investigation.
2. Medical History:
- Gathering a detailed medical history is a crucial step in the clinical diagnosis. In Daniel's case, the
presence of a family history of colorectal cancer and occasional episodes of diverticulitis provided
important contextual information, contributing to the overall assessment of risk factors.
3. Physical Examination:
- A physical examination was conducted to assess Daniel's overall health and to identify any abdominal
tenderness or palpable masses. The examination helps in localizing the source of symptoms and
determining the extent of the issue.
4. Diagnostic Imaging:
Colonoscopy: Given the symptoms and risk factors, a colonoscopy was likely performed. This
procedure involves the insertion of a flexible tube with a camera into the colon to directly visualize the
interior. During colonoscopy, the presence of a tumor in the ascending colon could be identified.
CT Scan: Computed tomography (CT) imaging is often employed to provide detailed images of the
abdominal region. In Daniel's case, a CT scan would help determine the size and location of the tumor, as
well as assess whether it had spread to surrounding structures or lymph nodes.
5. Biopsy:
- A biopsy is a definitive diagnostic step. Tissue samples from the tumor, obtained during the
colonoscopy, are sent to a pathology laboratory for analysis. This allows for confirmation of the cancer
diagnosis and provides information about the tumor's characteristics, such as its type and stage.
6. Staging:
- Once the diagnosis is confirmed, staging is crucial. Staging determines the extent of the cancer's
spread and guides treatment decisions. In Daniel's case, the localized nature of the tumor within the
ascending colon indicated stage II colorectal cancer.

NURSING RESPONSIBILITIES
1. Preoperative Care:
Patient Education: Provide comprehensive information about the surgical procedure, including what to
expect before, during, and after the surgery. Discuss the purpose of the surgery, potential complications,
and the expected recovery process.
Bowel Preparation: Assist in ensuring the patient follows the prescribed bowel preparation regimen to
clear the colon before surgery. This may involve dietary restrictions and/or laxatives.
Psychosocial Support: Address any anxiety or concerns Daniel may have about the surgery. Encourage
open communication and provide emotional support.
2. Intraoperative Support:
Patient Advocacy: Advocate for Daniel's well-being in the operating room, ensuring adherence to
safety protocols and proper positioning. Communicate any pertinent patient information to the surgical
team.
Infection Control: Monitor and maintain aseptic techniques in the operating room to minimize the risk
of surgical site infections.
Communication: Keep the patient's family informed about the progress of the surgery and expected
duration. Offer reassurance and support.
3. Postoperative Care:
Monitoring Vital Signs: Regularly monitor Daniel's vital signs, including blood pressure, heart rate,
respiratory rate, and temperature, to detect any signs of complications.
Pain Management: Administer prescribed pain medications and assess pain levels. Collaborate with
Daniel to manage pain effectively while considering any potential side effects.
Wound Care: Monitor the surgical incisions for signs of infection or complications. Provide wound
care and educate Daniel on proper care techniques.
Fluid and Nutrition Management: Ensure proper hydration and nutrition. Monitor fluid intake, assess
bowel sounds, and collaborate with the dietitian to advance the diet as tolerated.
Mobility and Ambulation: Encourage and assist with early ambulation to prevent complications such
as blood clots and promote overall recovery.
4. Post-discharge Care:
Patient Education: Provide detailed instructions for postoperative care, including wound care,
medication management, and signs of potential complications. Review dietary guidelines and activity
restrictions.
Follow-up Appointments: Ensure that Daniel understands the importance of attending follow-up
appointments for ongoing monitoring and assessment of recovery.

TREATMENT

Independent Nursing Interventions:

1. Pain Management:
- Assess Daniel's pain levels regularly.
- Administer prescribed pain medications as per the pain management plan.
- Implement non-pharmacological pain relief measures, such as positioning, relaxation
techniques, and heat therapy.
2. Wound Care:
- Monitor the surgical incisions for signs of infection, such as redness, swelling, or discharge.
- Provide appropriate wound care, ensuring cleanliness and adherence to sterile techniques.
- Educate Daniel on proper wound care procedures to promote healing and prevent
complications.
3. Fluid and Nutrition Management:
- Monitor and record fluid intake and output.
- Assess bowel sounds and initiate a plan for advancing the diet as tolerated.
- Collaborate with the dietitian to ensure Daniel receives adequate nutrition postoperatively.
4. Mobility and Ambulation:
- Encourage and assist with early ambulation to prevent complications like blood clots.
- Implement strategies to enhance mobility, such as range of motion exercises, as appropriate.
- Educate Daniel on the importance of gradual physical activity to promote overall recovery.
5. Emotional Support:
- Provide emotional support and a therapeutic presence.
- Encourage open communication about fears, concerns, and emotional well-being.
- Facilitate access to counseling or support groups for additional emotional support.

Collaborative Nursing Interventions:

1. Collaboration with Surgeon:

- Communicate any changes in Daniel's condition or signs of complications promptly to the
surgical team.
- Collaborate with the surgeon to ensure adherence to the postoperative care plan and any
specific recommendations.
2. Collaboration with Physical Therapists:
- Work with physical therapists to develop and implement a rehabilitation plan.
- Collaborate on strategies to enhance mobility and strength, tailored to Daniel's postoperative
condition.
3. Collaboration with Dietitian:
- Collaborate with the dietitian to ensure Daniel receives a nutritionally balanced diet that
aligns with his recovery needs.
- Monitor for any nutritional deficiencies and implement interventions as recommended by the
dietitian.
5. Collaboration with Home Health Services:
- Facilitate collaboration with home health services for ongoing care and monitoring once
Daniel is discharged.
- Ensure seamless transition and coordination of care between the hospital and home healthcare
providers.