case study of Brian Jon sort answer questions

Case study:

Brian Jones (aged 50) presented to his GP with a nine month (9/12) history of a change in his bowel habits, abdominal pain and fatigue. His GP ordered Faecal Occult Blood testing which confirmed the presence of blood in Brian’s stool. Following this, Brian’s GP referred him to a gastrointestinal specialist. The specialist recommended Brian have a colonoscopy. During the colonoscopy, a biopsy was taken of a lesion located in Brian’s rectum. The biopsy results confirmed a Stage IIA rectal carcinoma. Brian was admitted to hospital for an abdomino-perineal resection and the formation of a colostomy.
Brian returned to the surgical ward postoperatively. On his return, Brian has
a patient controlled analgesia (PCA) infusion of 50mgs of Morphine in 50ml NaCl running at 4mL/hr, 0.9% NaCl (Sodium Chloride) IVI running at 125mL/hr via an IVC in his left arm,
a sigmoid colostomy with a small amount of haemoserous fluid evident,
2 x Haemovac drains in situ on suction with 100mls frank blood in total, a nasogastric (NG) tube in situ on free drainage with 4/24 aspirations, an indwelling urinary catheter (IDC) with 50mls of urine output, regular medications ordered
o • ?metronidazole (Flagyl) IVI 500mgs in 100mLs 8/24
o • ?paracetamol (Panadol) 1g IVI 6/24,
o • ?enoxaparin (Clexane) 40mgs sub cutanously daily, and
o • ?metoclopramide (Maxalon) 10mgs 8/24 PRN.
_____________________________________________________________________

Question 1 – (300 words)
Describe the pathogenesis of Brian’s colorectal cancer from the initial cellular mutation to the diagnosis of stage 2A colorectal cancer.
Guide to answer this question1:-
Pathogenesis – the disease process from the aetiology – stimulus – trigger – leading to changes of cellular structure and function
Carcinogenesis – the process by which normal cells are transferred into cancer (malignant) cells
Not one single event – rather a series of events
? describe the series of events that transformed a normal cell into the structure of a stage 2A tumour in Brian’s rectum

Question 2 – (300 words)
Describe two (2) modifiable and three (3) non-modifiable risk factors for colorectal cancer and explain how these risk factors may have contributed to the development of Brian’s colorectal cancer.
Guide to answer this question2:-
• describe individual risk factors for the development of colorectal cancer and identify whether these risk factors are modifiable or non-modifiable
• explain the role of each of these risk factors in the series of events that transforms a normal cell to Brian’s colorectal cancer

Question 3 – (150 words)
1. a) Describe the action and mechanism of action of metronidazole (Flagyl) in relation to its administration to Brian.
2. b) Describe the action and mechanism of action of Morphine in relation to its administration to Brian.
Guide to answer this question3:-
• Drugs may have many actions.
• To respond successfully to this question, you must relate the appropriate action(s) of each drug to Brian and the details of the case study.
• The mechanism of action of a drug is how the drug achieves its action – how the drug interacts with the pathophysiology that is occurring, or may occur, to achieve its desired outcome?
Question 4 – (250 words)
Discuss the nursing responsibilities with associated rationales in relation to administering Morphine to Brian.
Guide to answer this question4:-
• The nursing responsibilities associated with the administration of any medication are based on
• legal responsibilities
• responsibilities that arise from the knowledge of the desired effects, and actual and potential adverse/undesired effects of the drug
• A rationale in this context is the reason why the nurse would perform a particular action
• Remember to relate to Brian and the details in the case study
• NOTE – you are Not required to discuss the nursing responsibilities related to the management of a patient controlled analgesia (PCA) in your response to this question – focus only on the drug