Colon Cancer Case Study

Patient Scenario
V.S., 82 year old female is admitted to rehab for colon resection related to colon cancer. Past medical history includes ulcerative colitis x 20+ years, hypothyroidism, hypertension, and dementia. Surgical history includes hysterectomy at age 63. Vital signs T 98.2, P91, BP136/81, R 18, O2 sat 96% room air, and denied any pain on admission. Patient is alert and oriented x1-2, needs frequent redirection. Lungs clear, breathing even and unlabored. S1S2 noted, no murmurs. Abdomen firm and distended, bowel sounds present in all 4 quadrants. Denies any constipation. Staples visible, incision clean, dry and intact. No redness, inflammation or drainage noted. JP drain patent, draining clear yellow fluid. No foul odor detected. Patient
"Ulcerative colitis is a chronic inflammatory disease that causes ulceration of the colonic mucosa..." (McCance & Huether, 2014, p.1440). The destruction of the mucosa leads to inflammation that begins a cascade and release of cytokines that are responsible for the disease symptoms (McCance & Huether, 2014). McCance and Huether described how the different cytokines released from cellular components such as neutrophils, lymphocytes, plasma cells, eosinophils, and mast cells affect the disease (2014). In addition to the cytokines that are released from the white blood cells that react to the inflammation, macrophages are also present. The activated macrophages function to manifest a fever and acute response (McCance & Huether, 2014). The inflammation that is caused ultimately affects the lining of the intestine and damages the barrier, creating a leak into the gut itself (McCance & Huether,
Type IV hypersensitivity involves the T cells which cause the release and attraction of cytokines that cause mucosal destruction (McCance & Huether, 2014). There are three types of abnormal T cells that are linked to this hypersensitivity: Tc, Tc1 and Tc17. McCance elaborates on the actions of these cells as being seek and destroyers to the body's cellular structure (2014). As these cells are attracted to the tissue, and release toxins that actively destroy the mucosal lining (McCance & Huether, 2014). In response to the destruction of the lining, edema and thickening can result in narrowing areas of the lumen (McCance &Huether, 2014). Also, when the disease is chronic with flare ups and remissions, the repeated remodeling of the colon can manifest into polyps (McCance & Huether, 2014). Ulcerative colitis can be very painful and is a chronic disease that patients have to