case presentation: endometrial cancer

Case Presentation:

Endometrial Cancer Group 2

Fhaye Kristine Kaye LorenzoDaphne Barillo

Christie Marie BarilloJoy Jamili

Alevi Aguilar Venancio Navarro

Faith PacureKaren Dollopac

Area of Exposure: ASMGH-OB Gyne WardPM Shift

Biographic DataName: MJBAge: 43yoSex: FemaleCivil Status: SingleAddress: Barbaza, AntiqueBirth place: Barbaza, AntiqueBirth date: July 7, 1966Religion: AglipayanNationality: FilipinoDate of Admission: September 17,2009Attending Physician: Dr. Maria Ceilo S. SansolisAdmitting Diagnosis: Endometrial CancerInformant: Client and AJBRelationship to the Client: Sister

This is the case of MJB, a 43 year-old female, single and a resident of Barbaza, Antique presently admitted at Angel Salazar Memorial General Hospital with the admitting diagnosis of Endometrial Cancer.

OverviewWhat is Endometrial Cancer?

Endometrial carcinoma is a kind of cancer that begins in your uterus. Only women have a uterus. So only women can get this kind of cancer. Carcinoma refers to cancer that begins in tissues that form linings throughout the body. The endometrium is the lining of the inside of the uterus. Endometrial carcinoma is a cancer that forms from the inner lining of the uterus. Throughout this section, we refer to it simply as endometrial cancer. Other kinds of cancer can form in the uterus as well. These are called uterine sarcomas. They are discussed in their own section. Endometrial cancer usually takes years to develop. It most often occurs in women who have already gone through menopause.

What causes Endometrial/Uterine cancer?

The main cause of most endometrial cancer is too much of the hormone estrogen compared to the body's progesterone level. Estrogen makes the lining of the uterus (endometrium) grow thicker. Progesterone "opposes" estrogen-your progesterone level goes up then drops at the end of each menstrual cycle, making the thick endometrium layer shed away. This is what you know as menstrual bleeding. When there is too much estrogen in the body, progesterone can't do its job. The endometrium gets thicker and thicker. Over time, the endometrium cells can become cancerous.

Chief Complaint:

Abdominal pain and enlargement of the abdomen 2 weeks PTA.

History of the Present Health Concern

Two weeks PTA, the patient had tolerable abdominal pain and mild cramps with enlargement of the abdomen. Patient did not take any medications to relieve the pain. Patient symptoms persisted, thus sought consultation and was advised for admission.

The client was fully immunized (1BCG, 3DPT, 3OPV, 3 Hepa B and 1measle vaccine). No known allergies, (-) for Bronchial Asthma, (-) for Hypertension, and (-) for Diabetes Mellitus. Patient is also known as an alcoholic drinker, consumes 2-3 bottles of beer a week. Last January 2007 the client, undergone surgical operation, the removal of uterine mass.

Past Health History

OB Gyne History

The client had her first menstrual period (menarche) at the age of 15, with regular intervals lasting for 3-5 days consuming 2pads a day. Gravida-0 and Parity-0.

Physical Assessment

A. General Survey:Height: 5’4”Respiratory Rate: 28 breaths/min (tachypnea)- due to

venous obstruction Brachial Pulse: 145 beats/min (tachycardia)- physical

signs of pain.

Temperature/axilla: 37.9 degrees Celsius

Blood Pressure: 140/100mmHgLevel of Consciousness: lethargic (drowsy, response

to question then fall asleep) with blunted affect.

B. Skin, hair, and Nails Assessment1. Skin: tan, dry, and fairly hot to touch. Skin

fold returns to place after 2-3 seconds. She was pale and cachexic (skin-bone results from the increase metabolic demand of the tumor). Minimal moles can be seen on the face. No edema of the face noted.

2. Hair: black, straight chin level and evenly distributed hair. (-) for Seborrheic dermatitis and Pediculusis capitis. No scalp lesions noted.

3. Nails: thick, hard, well-trimmed nails. The condition of the nail bed is smooth and firm. (-) for Clubbing or Beau’s lines.

C. Head and Neck AssessmentHead: symmetric, round and in

midline. No visible lesions noted.Neck: symmetric without

masses, scars, pulsation, lymph nodes non-palpable. Trachea in midline. Thyroid gland non-palpable with strong bounding (+4) carotid pulse.

D. Eyes: protruded eyes without lesion or edema. Sclera is white without lesions noted. Eyebrows sparse with equal distribution. Pupil Equal, Round, Reactive to Light and Accommodation (PERRLA) .E. Ears: Lesion noted at the right auricle. (papule)F. Nose and Sinuses: external structure without deformity. Symmetrical and patent nares with no inflammation noted. Nasal septum midline without bleeding perforation or deviation. Frontal and maxillary sinuses non-tender.

G. Mouth and Pharynx: pale and dry lips. Cheilosis noted.H. Cardiac Assessment: no vibrations or pulsations noted. I. Breast Assessment: No discharges from the nipples. Non-tender and no dimpling or retraction noted. J. Abdominal Assessment: hard, tender abdomen. Abdominal girth of 85 cm and fundal height of 33 cm with palpable mass on the pelvic floor upon Internal Examination (IE). Visible veins noted due to abdominal distention. K. Genitourinary-reproductive Assessment: with palpable mass on the pelvic floor upon Internal Examination (IE). With minimal vaginal bleeding. Foley Catheter attached to urobag draining to a yellowish urine.

c Planning Nursing Intervention Rationale

Very severe abdominal pain r/t direct tumor involvement.

Subjective Cues:“Gabalik-balik sakit kang akon busong”

Objective Cues:Facial grimacingPain scale=8/10 (very severe pain)RR = 28 cpmPR = 145 bpmBP = 140/100 mmHg

Reference: Nursing Care Plans & Documentation ; 4th Edition; Linda Moyet (p579)

General: After days of hospital confinement, the patient psychological attitude and physical status will be able to cope with the situation.

Specific: After 8H of nursing intervention, patient will be able to:1. Tolerate pain and will have a pain scale of 42. Have a vital signs within normal range.

Independent:1.Perform pain assessment each time pain occurs. Note specific location and intensity (0-10 scale)2.Monitor vital signs.

Dependent:1. Administer medication as ordered and indicated especially for the persistence of pain. (Tramadol 25mg)

To rule out worsening of

underlying condition.

To relieve pain felt by the patient.

Nursing Diagnosis Planning Nursing Intervention Rationale

Enlargement of the abdomen r/t Fluid accumulation in the peritoneal cavity occurs due to the direct pressure by the tumor or venous obstruction.

Subjective Cue:“Gabahol akon busong kag wara rn ako kamus-on halin kang sarang semana “

Objective cues:1.Enlargement of the abdomen withFundal Height: 33cmAbdominal Girth: 85cm

Reference: Nursing Care Plans & Documentation ; 4th Edition; Linda Moyet (p576-577)

General: After days of hospital confinement, the patient psychological attitude and physical status will be able to cope with the situation.

Specific: After 8H of nursing interventions, patient will be able to:

1.Report decrease in abdominal size and fundal height

2. Defecate

Independent:1.Monitor FH and Abdominal girth daily.

2. Maintain bed rest.

3. Monitor Intake and Output (MIO).

4. Monitor respiratory, bowel and bladder function.

Dependent:

5. Administer medication as ordered.

1. These measurements help detect fluid retention and ascites.2. Immobility reduced the risk of injury.

3. Monitor losses calculation

4. Level cord compression influences respiratory (cervical), bowel (lumbar), and bladder (lumbar) functioning.

5. Aids in the elimination of stool

thank you!