Symptoms And Signs of Colorectal Cancer Assignment Paper

Symptoms And Signs of Colorectal Cancer Assignment Paper

H&P for Complicated Patient

9/21/2020 FNP Student H&P 11:00

CC: Mr. Fayez is a 68- year old African American, retired accountant, who presented to the ER because “I have been having and on and off abdominal pain since the last month.”

HPI: Mr. Fayez has a lifestyle that is considered to be generally healthy since he exercises on a daily basis and gets routine physical exams every six months. When he he was getting back from his morning jog, as he always did first thing in the morning, he started to feel a sharp pain in his abdomen along with considerable discomfort. After taking a couple of aspirin, the discomfort started to subside. Mr. Gonzalez went about his day as usual, but he subsequently developed a hematochezia. His symptoms persisted at least twice weekly for the rest of the month.  He adopted a diet that was healthier for him and did not include lactose, and he still took analgesics as he needed. Symptoms And Signs of Colorectal Cancer Assignment Paper

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He does not take any new drugs and has not altered any of the routines that he participates in on a daily basis. Gastritis and abdominal and pelvic pain have been documented in his medical history. He claims that he has never had bouts of constipation, diarrhea, nausea, or vomiting in the past.

Since the symptoms first appeared, he has kept up with his normal morning workout regimen, but he is experiencing an increasing amount of exhaustion. He switched to a better diet for the month, but did not see much of a change in his health as a result.

PMH:

1. Generalized anxiety disorder, diagnosed in 2006
2. Type 2 diabetes
3. Pericarditis in 2010, hospitalized for 4 days
4. Appendectomy in 1992
5. Gout in the late 90’s
6. Rheumatoid arthritis in knees and hands
7. Hypertension

Medications

1. Alprazolam 4 mg once daily for Generalized anxiety disorder
2. Metformin 500 mg once daily for type 2 diabetes
3. Febuxostat 100 mg to 200 mg as needed for gout
4. Celecoxib 10 mg bid for Rheumatoid arthritis
5. Norvasc 100 mg daily for hypertension Symptoms And Signs of Colorectal Cancer Assignment Paper

Allergies– penicillin (rash)

FHx-

Father – died of a car accident at age 63 

Mother – died of stroke at age 84, history of breast cancer.

 Sister – aged 62 with hypertension and high cholesterol

Sister – 58 with Gerd and type 2 diabetes

 Son- 36 with anxiety disorder

Daughter – 33 and in good health

 Daughter – 28 and in god health

SHx- He was born in Ghana but has spent the last half century residing in the United States. He has been divorced for close to twenty years now. He worked in accounting before he retired. At the moment, he shares his home with his son and his granddaughter. A daily workout lasting around half an hour is a part of his routine. His hobbies include boat riding and reading. He admits to drinking alcohol mostly on weekends with friends. Denies ever having used tobacco or illegal substances. Symptoms And Signs of Colorectal Cancer Assignment Paper

ROS– Reports fatigue. Denies fever or chills, weight changes, or appetite changes since the past month

Denies eye problems, vision changes, hearing changes, or headaches

Denies chest pain, irregular heartbeat or shortness of breath

Reports upper abdominal pain and bloody stool

PE- Mr Fayez is a thin, African American male, with no acute distress. He is alert and oriented.

Vitals- T 98.0 BP 128/76, supine, 125/73; standing P 72, regular, supine; 69 standing R 18, unlabored, O2 sat- 98% (RA)

HEENT: anicteric sclera

Neck: No JVD, no lymphadenopathy, strong carotid pulses, no bruits

Pulmonary: Lungs clear to auscultation

Cardiac: regular rate and rhythm, S1, S2 clear to auscultation, no gallops or murmurs

Abd- flat, non-distended, tenderness noted. Normoactive bowel sounds, soft; no hepatosplenomegaly, no masses or bruits
Rectal- normal sphincter tone, heme +, small amount melena in vault, prostate small and symmetric.

Neuro: alert and oriented x3. CN II-XII grossly intact. Normal, symmetric reflexes Strength normal, normal gait.

Skin- wrinkles noted on neck and face, no lesions, rash, or masses

Lab data /Diagnostic studies

Platelets count 224 Symptoms And Signs of Colorectal Cancer Assignment Paper

Hgb at 14.3

RBC count 4.49

WBC count 6.8

WBC count 6.7

 

Colonoscopy: 0.6 cm size tumor noted in transverse colon

CBC: indicates a normal white blood cell count, but a low hematcit indicates anemia. This may be consistent with the rectal blood noted above (and confirmed by testing the stool for occult blood).

MMR Status – Cancer of stage II, which has spread to the outer walls of the gut but has not yet continued to spread and has not damaged the lymph nodes.

Problem list /Differentials

1. Colon cancer
2. Irritable bowel syndrome
3. Diverticular Disease

 

Assessment/Plan:

Mr. Fayez is a 68 yo man with RUQ and LUQ pain that is acute in onset, rectal bleeding, fatigue, and is in the setting of an abnormal colonoscopy, meaning that he might be suffering from a disease like colon cancer, irritable bowel syndrome, or diverticular disease. Symptoms And Signs of Colorectal Cancer Assignment Paper

1. Colon cancer- The presence of abdominal pain, hematochezia, fatigue and a family history of cancer point to this diagnosis. The development of tumorous growths in the large intestine is what leads to the development of colon cancer. In its initial stages, colon cancer often does not manifest any symptoms; nevertheless, signs and manifestations of the illness may become more obvious as the disease advances (Recio-Boiles & Cagir, 2021). If a person has symptoms in the early stages of the disease, they may include blood in the stool, a change in the frequency or type of bowel movements, stomach discomfort, exhaustion and weakness, anemia caused by intestinal bleeding, and unexplained weight loss (Holtedahl et al., 2021).

Capecitabine 1250 mg/m2 PO BID for 2 weeks, followed by a 1-week rest period. Laparoscopic transverse colectomy done to remove the malignant portion of the colon. Close monitoring of the patient, followed by an Oncotype Dx Colon Cancer Test to check for a return of the disease. Between 20 and 30 percent of such individuals will have a recurrence of their tumor. Urge patient to engage in clinical trials.

2. Irritable bowel syndrome- The patient’s history of recurrent bouts of severe stomach pain is consistent with this diagnosis. Rectal bleeding is also common and is often brought on by small tears in the anus brought on by feces being lodged there (Weaver et al., 2017). In addition, irritable bowel syndrome is linked to an increased risk of developing extraintestinal symptoms, with fatigue being one of the most often reported and concerning of these.

Prescribe Alosetron 0.5 mg PO BID. A blood test to identify potential health issues, such as celiac disease. Examination of a sample of the patient’s stool to look for infections and conditions that cause inflammation of the gut. Patient education on how to control symptoms via changes in diet, lifestyle, and stress management. Symptoms And Signs of Colorectal Cancer Assignment Paper

3. Diverticular Disease- The patient’s complaint of abdominal pain could suggest diverticular disease. This diagnosis is further supported by the presence of abdominal tenderness in the upper abdomen. However, RUQ/LUQ pain is less common in this disease. In most cases, this condition does not cause any symptoms; however, if the diverticula become inflamed or infected, this may lead to fever and abdominal pain (Piscopo & Ellul, 2020).

Prescribe Metronidazole 750 mg PO TID for 5 to 10 days, Ibuprofen 400 mg every 4 hours as needed. Encourage patient to follow a low-fiber diet or a liquid diet. Symptoms And Signs of Colorectal Cancer Assignment Paper