Professional Documents
Culture Documents
Carcinoma
Undifferentiated Type
Stage IVA
A Case Study
TABLE OF CONTENTS
I. Introduction
II. Objectives
III. Patients Profile
IV. Anatomy and Physiology
V. Pathophysiology
VI. Laboratory Examination Results
VII. Gordons Assessment
VIII. Nursing Care Plans
IX. Drug Study
X. Discharge Planning
I. INTRODUCTION
Brief Description of the Disease Condition
The body is made up of many types of cells. Normally, cells grow, divide
and die. Sometimes,cells mutate (change) and begin to grow and divide more
quickly than normal cells. Rather than dying, these abnormal cells clump together
to form tumors. If these tumors are malignant (cancerous), they can invade and
kill your body's healthy tissues. From these tumors, cancer cells can metastasize
(spread) and form new tumors in other parts of the body. By contrast, benign
(noncancerous) tumors do not spread to other parts of the body. Nasopharyngeal
(say:"nay-zo-fair-in-gee-al") cancer is a malignant tumor that develops in the
nasopharynx (say:"nay-zo-fair-inks"). The nasopharynx is the area where the
back part of your nose opens into your upper throat. This is also where tubes
from your ears open into your throat. Nasopharyngeal cancer is rare. It most
often affects people who are between 30 and 50 years of age. Men are more
likely to have nasopharyngeal cancer than women. You are most likely to get this
cancer if you or your ancestors came from southern China, particularly Canton
(now called Guangzhou) or Hong Kong. You are also more likely to get this
cancer if you are from a country in Southeast Asia, like Laos, Vietnam, Cambodia
or Thailand. No one knows for sure what causes nasopharyngeal cancer. Eating
salt-preserved foods (like fish, eggs, leafy vegetables and roots) during early
childhood may increase the risk of getting this form of cancer. The Epstein-Barr
virus may also make a person more likely to get nasopharyngeal cancer. This is
the same virus that causes infectious mononucleosis (also called "mono"). You
may also inherit a tendency to get nasopharyngeal cancer.
Reason for Choosing the Case
Nasopharyngeal Cancer is one of the unusual terms for a layperson and a rare
case that a nurse would encounter. Acquisition of cognitive knowledge regarding
the topic would enable there searchers in providing optimum care for clients
from early infancy onward by groups with high risk of this disease. Other possible
risk factors include extensive exposures to dusts and smoke and regular
consumption of other fermented foods. The role of Epstein-Barr virus in the
development of nasopharyngeal cancer continues to be explored.
II. OBJECTIVES
Nurse-Centered
After the completion of this case study, the nurse will be able to:
1. Understand the current statistics and latest trend regarding Nasopharyngeal
Carcinoma Undifferentiated Type Stage IVA
2. Describe factually, the personal and pertinent family history of the patient and
relate it to the present condition.
3. Perform comprehensive physical assessment.
4. Trace the book-based and client-centered pathophysiology of
Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA
5. Determine the predisposing and precipitating factors and the signs and
symptoms and relate to the disease process.
6. Enumerate and describe the diagnostic and laboratory procedures as well as
the nursing responsibilities in relation to the disease condition
7. Enumerate the different treatment modalities and their indication specifically
for the patients condition.
8. Identify the pharmacologic treatment provided to the patient, relate the
actions of each drug with the disease process and evaluate the patients
response to the medications given.
Mrs. Ilongs did not have any problems at the time of her birth. Her
immunization record is complete. According to Mrs. Ilong she is not allergic to
any drugs, foods or other environmental agents. She never experienced allergic
rhinitis. As stated by Mrs. Ilong, her last check-up was done last March 2014
when she experienced hearing loss. Two weeks after her check-up she
experienced epistaxis and difficulty in breathing. She undergone biopsy and it
was shown that she has tumor in the nose and it is stage II. Mrs. Ilong, did not
take any medications in the month of June. Due to the persistence of the
symptoms, she sought consultation last September 23, 2014, when she was first
admitted at the nearest hospital in Western Visayas, with a chief complaint of
difficulty in breathing and hearing. Prior to this, she undergone Radiotherapy last
December 8, 2014 and Chemotherapy last January 23, 2015.
HISTORY OF PRESENT ILLNESS
Mrs. Ilong is not known hypertensive, not known diabetic. History of
present illness started six months ago prior to admission when patient
experienced hearing loss, bilateral. No other associated signs and symptoms
noted. Due to persistence of the symptoms patient sought consultation at a
private hospital in Iloilo, where patient was noted to have nasopharyngeal mass.
Biopsy was done revealing nasopharyngeal carcinoma. Mrs. Ilong underwent
seven sessions of Radiotherapy. Then she was referred to the Institution for
completion of radiotherapy.
PHYSICAL ASSESSMENT
Physicians Physical Assessment done by the Resident on Duty (February 1,
2015, lifted from the patient's chart)
Height: 50 (160cm)
Weight: 38 kg
Vital Signs as follows:
T: 36.7 C
PR: 92bpm
RR: 18cpm
SAO2: 97
PHYSICAL ASSESSMENT:
GENERAL SURVEY
Mrs. Ilong, Assessed/received patient lying on bed, awake, conscious,
responsive, and coherent. With the following vital signs:
Temperature: 37 C
Heart rate: 92 bpm
Respiratory rate: 20 bpm
Blood Pressure: 100/60 mmHg
SAO2: 98
NUTRITIONAL STATUS
Upon admission, Mrs. Bu Cool was placed on a regular diet.
SKIN
> Pallor noted.
> Good skin turgor in both upper and lower extremities; the skin returns to its
previous state immediately after being tented.
> warm moist skin, no active dermatoses.
HAIR
> Hair is black and is evenly distributed.
> Silky and smooth hair.
> No areas of hair loss noted.
> Thick hair strands.
NAILS
> Trimmed clean nails.
> Concave shaped; with a nail plate angle of about 160 degrees.
> Smooth in texture.
> Intact epidermal lining around the nails.
> Capillary Refill Test less than 3 seconds.
SKULL AND FACE
> Rounded (normocephalic and symmetrical with frontal, parietal and occipital
prominences).
> Head size is appropriate to body size.
> No nodules or masses upon palpation.
EYES AND VISION
> Eyebrows and eyelashes are evenly distributed.
> Eyelids are intact.
NECK
> Jugular vein is not visible.
> Muscles are equal in size with the head centered.
> Slow muscle movement.
> Lymph nodes are not palpable.
CARDIOVASCULAR AND PERIPHERAL SYSTEM
> Skin color of palm of the hand and feet is pink.
> Pink nail beds upon inspection.
> Symmetric pulse volumes, full pulsations of peripheral pulses.
> Heart rate is 92 beats per minute.
> Blood Pressure is 110/70 mmHg.
> (Vital signs taken during the time of assessment on February 2, 2015 at
7:00 am).
Respiratory System
> Chest is symmetric.
> Skin and chest wall are intact and has uniform temperature.
> No tenderness and masses noted upon palpation.
> Regular breathing pattern
> Presence wheezing and crackles sound upon auscultation.
> Full and symmetric chest wall expansion.
BREAST AND AXILLAE
> Breasts are symmetrical in size; color is the same as with the abdomen.
> Both nipples are symmetrical in size.
> No discharges noted.
> No tenderness, masses, and nodules noted upon palpation.
ABDOMEN
> Abdominal skin is intact.
> Distended abdomen noted.
> Audible bowel sound upon auscultation.
> Abdominal dullness upon percussion.
MUSCULOSKELETAL
> Posture is good, able to stand straight and can walk alone properly but
slowly.
> Movement of muscles is weak.
from the blood out into the air. When something goes wrong with part of the
respiratory system, such as an
infection
like
pneumonia,
it
Common
symptoms
breathlessness,
respiratory
include
cough,
and
chest pain
chest. The lungs can also be divided up into even smaller portions, called
'broncho pulmonary segments'. These are pyramidal-shaped areas which are
also separated from each other by membranes. There are about 10 of them in
each lung. Each segment receives its own blood supply and air supply.
Air enters your lungs through a system of pipes called the bronchi. These
pipes start from the bottom of the trachea as the left and right bronchi and branch
many times throughout the lungs, until they eventually form little thin-walled air
sacs or bubbles, known as the alveoli. The alveoli are where the important work
of gas exchange takes place between the air and your blood. Covering each
alveolus is a whole network of little blood vessel called capillaries, which are very
small branches of the pulmonary arteries. It is important that the air in the alveoli
and the blood in the capillaries are very close together, so that oxygen and
carbon dioxide can move (or diffuse) between them. So, when you breathe in, air
comes down the trachea and through the bronchi into the alveoli. This fresh air
has lots of oxygen in it, and some of this oxygen will travel across the walls of the
alveoli into your bloodstream. Travelling in the opposite direction is carbon
dioxide, which crosses from the blood in the capillaries into the air in the alveoli
and is then breathed out. In this way, you bring in to your body the oxygen that
you need to live, and get rid of the waste product carbon dioxide.
Blood Supply
The lungs are very vascular organs, meaning they receive a very large
blood supply. This is because the pulmonary arteries, which supply the lungs,
come directly from the right side of your heart. They carry blood which is low in
oxygen and high in carbon dioxide into your lungs so that the carbon dioxide can
be blown off, and more oxygen can be absorbed into the bloodstream. The newly
oxygen-rich blood then travels back through the paired pulmonary veins into the
left side of your heart. From there, it is pumped all around your body to supply
oxygen to cells and organs.
The Pleurae
The lungs are covered
by smooth membranes that we
call pleurae. The pleurae have
two layers, a'visceral' layer
which sticks closely to the
outside surface of your lungs,
and a 'parietal' layer which lines
the inside of your chest wall
(ribcage). The pleurae are
important because they help
you breathe in and out
smoothly, without any friction.
They also make sure that when
your ribcage expands on
breathing in, your lungs expand as well to fill the extra space.
The Diaphragm and Intercostal Muscles
When you breathe in (inspiration), your muscles need to work to fill your
lungs with air. The diaphragm, a large, sheet-like muscle which stretches across
your chest under the ribcage, does much of this work. At rest, it is shaped like a
dome curving up into your chest. When you breathe in, the diaphragm contracts
and flattens out, expanding the space in your chest and drawing air into your
lungs. Other muscles, including the muscles between your ribs (the intercostal
muscles) Also help by moving your ribcage in and out. Breathing out (expiration)
does not normally require your muscles to work. This is because your lungs are
very elastic, and when your muscles relax at the end of inspiration your lungs
simply recoil back into their resting position, pushing the air out as they go.
Hereditary
Modifiable Factors
Eating salt-preserved foods (like fish, eggs, leafy vegetables and roots) during
early childhood
Cigarette smoking
Alcohol abuse
Poor Oral Hygiene
Long Term Sun Exposure
Occupational Exposure (chemicals esp. asbestos)
Signs and Symptoms with Rationale
Chest wall pain pain caused by the invasion of the pleural cavity irritating
nerve fibers.
Facial, arm, and trunk swelling caused by the obstruction of the vena
cava.
V. PATHOPHYSIOLOGY
Schematic Diagram (Book-based)
Cigarette smoking
Alcohol abuse
Hereditary
Occupational Exposure
chemicals
esp.
asbestos
Formation
of benign
bronchial
epithelium tissue
Nasopharyngeal Cancer
Compression of the
esophagus
Difficulty in swallowing
Anorexia
Weight Loss
Diagnostic /
Laboratory
Procedures
Date
Ordered
Indications or
Date
Purposes
1.
Results in
Date
Hematology
ordered:
test
Febuary
2,
of
content in the
red blood cells
Results:
February
see
Normal Values
hemoglobin
2015
Date
to
Results
Rh: (+)
Hemoglobin:
gms/L
2,
part
2015
of
blood
that
carries
Hematocrit:
gms/L
WBC count:
4-10 x 10^9 /L
15.19 x 10^9/L
Segmenters: 0.90
0.55 - 0.65
Lymphocytes:
0.25 - 0.35
0.04
Monocytes: 0.06
0.03 - 0.06
Eosinophils; 0.00
0.02 - 0.04
Basophils
0.00 - 0.01
MCV: 76.6 fL
80 - 100 fL
MCH: 23.9 pg
26 - 32 pg
MCHC: 31
32 - 36 g/dL
RDW: 16.11
11.0 - 15.0
Platelet
10^9 g/L
2. Urinalysis
to
Date
ordered:
February
determine Color:
signs
2,
infections
of Dark yellow
and
2015
Date
2015
Transparency:
bleeding.
Slightly turbid
of
Results:
February
abnormal
PH: 6
2,
SP Gravity:
1.010
Sugar: negative
Protein: negative
RBC: 2-5
Pus cells: 2-6
Epithelial cells:
few
Amorphous
Urates: few
Mucus threads:
few
B. Nutrition/Metabolism
No allergies on foods
C. Elimination
D. Activity/Exercise
E. Sexuality/Reproductive
Married
A mother of 3 children
No history of STDs
F. Cognitive/Perceptual
College graduate
G. Roles/Relationship
Married
With 3 children
H. Self Perception/Self-Concept
I. Value/Belief
A Baptist
J. Coping/Stress
Copes up with problems by talking about it with the family and finds ways
to resolve it together
K. Sleep/Rest
No difficulties in sleeping
L. Medication History
Assessment
ako clearance r/t tissue clearance is the NI, patient will rapport
Nursing
Objectives
Explanation
Interventions
In effective airway Ineffective airway After 3 hours if 1. Establish
Subjective cues:
"Nahihirapan
Scientific
Nursing Diagnosis
ako"
as nasal
area
AEB secretions
to
or verbalize
obstruction
able
from understanding
airway
in management
flaring
partial of regimen
Dyspnea
Restlessnes
complete
Use
accessory
muscle
Cough
of
which
the
airway
be
have verbalized an
maintain
understanding
the
facilitate airway
at
therapeutic
3. Elevate head of
rest
or
cause
compromised
management
individual
regimen
3.To
take
of
and
and
demonstrate
behaviors
to
gravity
improve
or
to
decreasing
maintain
clear
or
pressure on the
of the patient.
open airway in
and bed
demonstrate
2. Position head to
2.To
Evaluation
Rationale
advantage
diaphragm
enhancing
drainage.
of
and
airway.
Nasal flaring
due to diffecrent
4.To
Prolonged
causes including
effort
expiratory
foreign
phase
allergic reactions,
With
Vital
Signs taken:
BP:100/60
mmHg
PR: 92bpm
RR: 18cpm
T: 36.7 C
SAO2: 97
bodies,
infections,
expectorating
deep breathing
secretions
and caughing
exercise.
5.Hydration can
anatomical
help
abnormalities and
viscous
respiratory
liquefy
5. Increase fluid
secretions
intake
improve
and
secretion
distress may be
sudden
in
4. Encourage
clearance.
with
6.To
caugh. There is
improve
lung function
often agitation in
the early stage of
airway
6. Support
obstruction.
reduction/cessatio
n of smoking
maximize
Assessment
Subjective cues:
"Ang
sakit
katawan
physical
ko
by patient's
Objective cues:
with
gross/fine
limited skills,
movements
limited purposeful
turining,
nursing rapport
the
For desired
and
activities
participate
data.
an increase in the
in signs
and
patient's
as patient to have
movements, ability
3. To regain to
strength.
skills,
from the
easily,
patient's 4. Encourage
motor skills
in
with difficulty
strength
and perform
turning
function,
stiffer gross/fine
muscle ability
patient to eat
to food rich in
turn patient to do
can
and
motor
turn
an
carbohydrates.
skills, 5. Advise
perform
gross/fine
body an increase in
joints
ADLs
as evidenced by
gross/fine
movements
2.
participated
baseline
3. Advise
is
have
with slowed
cooperation
in
and Mobility
Evaluation
Rationale
1. To gain The patient shall
in intervention,
the patient.
is of
verbalized
Nursing
Objectives
Explanation
Interventions
mobility Impaired physical After 3 hours 1. Establish
gumagalaw
as
Scientific
Nursing Diagnosis
5. To promote
energy.
agility.
balance
take:
significantly
increase
BP:100/60
compromise
mmHg
mobility of elderly
patient to have
PR: 92bpm
patients.
adequate fluid
RR: 18cpm
Restricted
intake.
T: 36.7 C
movements
SAO2: 97
affects
in
6. To prevent
6. Advise
dehydration.
7. To promote
the
7. Encourage
energy
of
patient to rest
regain
most activities of
between
strength.
daily living(ADLs.)
activities.
performance
and
8. To reduce
fatigue.
8. Encourage
patient to
engage in
ROM exercise.
3. Fatigue
Assessment
Nursing Diagnosis
Objective cues:
Nursing
nursing rapport.
Evaluation
Rationale
1. To gain The patient shall
cooperation
weak
activities,
decrease
compromised
in concentration.
an record vital
and understanding
work
and usual
is
For regarding
baseline
health
data.
on
how
the
teachings
how
conserve
3. Encourage
a teachings
subjective
signs.
2.
at regarding the
level. health
Fatigue
have verbalized an
understanding
appears capacity
appears
ability
sense of
physical sustained
by condition
the patient.
Objectives
Explanation
Interventions
Fatigue related to An overwhelming After 3 hours 1. Establish
Subjective cues:
as
Scientific
to
energy
as evidence by the
on patient to sit
3.
to instead of
conserve
strong, an increase
energy
in the ability to
appears
performing
activities
as performing
perform activities,
with
illness,
by activities.
compromise
have
function
concentratio
from
it
protective the
patient
that appears
to
4. Advise
an patient to have
injury
With Vital Signs
may evidence
standing in
To patient
overwork
from ability
in
a perform
to
5. Encourage
fully.
4. To regain
strength.
concentrate
take:
weekend
BP:100/60
condition.
mmHg
common
PR: 92bpm
RR: 18cpm
is associated with
6. Encourage
T: 36.7 C
patient to eat
6. To increase
SAO2: 97
physical
carbohydrates
energy level.
As
variety
5. To reduce
fatigue.
to concentrate exercise.
of
and
psychological
containing
conditions.
food.
7. Encourage
7. To promote
patient to do
energy.
focus
breathing.
X. DRUG STUDY
Name of drugs
Generic name
Brand name
Date Ordered,
Date taken,
date changes,
Route of Admin.
Dosage and
frequency of
General action
Indications/
purposes
Clients response to
medication with actual
side effect
Generic name:
Co-Amoxiclav
Brand name:
Amoclav
D/C
DO: 02/01/15
DT: 02/01/15
administration.
625 mg/cap 1 cap
BID PO
Inhibits enzymes
involve
information of
peptidoglycan
layer of bacterial
cell wall
No effect on
human cell wall
bactericidal; only
works on dividing
bacteria
Well absorb enter
ally
Use in
treating lower
respiratory
tract infection,
Otitis media,
sinusitis, skin
and soft
tissue
infection, and
UTI.
Generic name:
EPO
Brand name:
DO: 02/01/15
DT: 02/01/15
EXERCISE:
Instructed to:
TREATMENT:
Instructed to:
HYGIENE:
OUTPATIENT ORDERS:
DIET:
Instructed to:
Diet as tolerated
Low fat
Abide by the limited intake of salty foods
Consume high fiber diet in order to prevent constipation
Avoid processed foods
Increased fluid intake except coffee, alcohol and soda