cervical cancer

College of NursingCalayan Educational Foundation Inc.

CASE STUDY

Submitt ed to:

Submitt ed by:

Mr. Bernie Lechuga

Mhary Ann Margarette Amandy

Mara Jane AustriaPatrick Catausan

Abegail DaluzAlmira Garcia

Kirk Ivan HogoGwen Llagas

Yancey LastimadoShiela Marie ManaloJan Patrick Villamin

BSN III Group 3

Clinical Area:Institution:

Clinnical Case:

Medicine Ward Magsaysay District Hospital

Cervical Carcinoma

CASE INTRODUCTION

Part I

Summary/Synopsis of the Case/Disease

Patient X is a 58 year old man. He lives at Brgy. Mapulot Tagkawayan Quezon. He had a chief complaint of abdominal pain PTA. He was admitted to Quezon Medical Center by Dra Rosali Tayao, and had undergone the procedure of explore laparotomy last February 1, 2011 at around 3:50 am.

Summary/Synopsis of the Case/Disease

Explore Laparotomy is a large incision made into the abdomen. Exploratory laparotomy is used to visualize and examine the structures inside of the abdominal cavity.

Summary/Synopsis of the Case/Disease

Summary/Synopsis of the Case/Disease

An urinary tract infection (UTI) is an inflammation of the bladder due to infection with a microorganism.

UTI’s are more common in women because their urethras are short, making it easier for organisms to get from outside into the bladder.

CASE PROFILE

Part II

A. General Data

Name: Avendaño, Mary Grace AldeAge: 31 y/o Sex: Female Birthdate: August 15, 1979Address: Brgy. Sta. Maria Calauag, QuezonChief Complain: Vaginal BleedingDate of Admission: Feb. 18, 2011 Time of Admission: 6:15 pmAdmitting Physician: Dr. PerezDiagnosis: Cervical Cancer

B. HISTORY

Medica

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History of Present Illness: LMP: - Dec. 2003 on contraceptive with occasional spotting-Dec. 2010- profuse vaginal bleeding -Jan. 8-15- Admitted @ memorial, cervical biopsy done(result [?] )

B. HISTORY

Medica

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Patient Physical Exam on Admission:-IE – CX converted to 5-6 cm friable, hard mass

- Corpuscle enlarged- GAMT- P-nodular, almost fixed to PSW

B. HISTORY

Coarse in the Ward:On admission pt. was

handed to D5LR 1 Liter x 30 gtts/min, lap work-ups requested and done. Patient has referred and seen by gyne oncologist. Patient was sent home on 3rd HD with homemeds.

B. HISTORY During our shift, the patient suffered from abdominal pain due to enlargement of the liver as revealed by the radiologic report. She can’t move freely because of pain felt at her abdomen. She had generalized edema.

PHYSICAL ASSESSMENT( System Assessment )

Date:

Vital SignsBP- 100/70 mmHg

RR: 21 cpmPR: 88 bpm

Temperature: 36.8 ˚C

PHYSICAL ASSESSMENT( System Assessment )

A. General Appearance:

Weak and pale in appearancewith generalized edemaWith facial grimace

PHYSICAL ASSESSMENT( System Assessment )

B. Neurological:

Level of Orientation: 3/5Weak

PHYSICAL ASSESSMENT( System Assessment )

C. Cardiovascular:

Heart rate: 84 bpmPulse rate (Radial): 84 bpmc̅� capillary refill of 3-4 sec.

PHYSICAL ASSESSMENT( System Assessment )

D.Respiratory:

•No c̅omplaints of diffic̅ulty of breathing• with normal c̅hest expansion upon breathing•Respiratory rate : 22 c̅pm•Bronc̅hovesic̅ular sound heard upon ausc̅ultation

PHYSICAL ASSESSMENT( System Assessment )

F. Genitourinay:

Voids freely

PHYSICAL ASSESSMENT( System Assessment )

G. Musculoskeletal:

PHYSICAL ASSESSMENT( System Assessment )

H.Integumentary:

Slightly warmc̅� Poor skin turgorc̅� Generalized edema

PHYSICAL ASSESSMENT( System Assessment )

H. Integumentary:

Slightly warmc̅� Poor skin turgorc̅� Generalized edema

PHYSICAL ASSESSMENT( System Assessment )

I. Psycho/Social:

5y/o, female child, FilipinoconsciousFamily at bedsideCan’t participate to ADL

REVIEW OF SYSTEM

Part III

A. Normal Anatomy and Physiology

A little more than an inch long, the cervix is the narrow end of the uterus that opens into the upper part of the vagina. In pregnancy, the cervix helps hold the uterus closed. Several weeks prior to labor and childbirth, the cervix thins and begins to expand, or dilate. At delivery, the cervix opens completely to allow the movement of the baby through the birth canal.

The bulk of the cervix, or stroma, is formed by connective tissue. This is covered by a surface layer called the epithelium.

The epithelium is made up of two different types of cells. The epithelium of the endocervical canal (the inner surface of the cervix) is comprised of tall glandular cells that produce cervical mucus.

The epithelium on the outer aspect of the cervix that can be seen at the top of the vaginal canal (the ectocervix) is formed by layers of flat, disc-like cells called squamous cells. The area where the squamous cells meet the glandular cells is called the transformation zone.

The transformation zone is the area that is most susceptible to the changes that can lead to cancer. Cancer that resembles the squamous cells is called squamous cell carcinoma.

That that resembles the glandular cells is called adenocarcinoma. Of all invasive (invading neighboring tissue) cervical cancers that are diagnosed, roughly 80-90 percent are squamous cell carcinomas and most of the remaining are adenocarcinomas.

Several types of adenocarcinomas exist. Around 60% are endocervical adenocarcinomas, about 20% are adenosquamous (contain squamous-like elements), about 10% are endometrioid (resemble the cells that line the uterus), and about 10% are clear cell.

Other, more rare cancers of the cervix include cervical sarcoma, neuroendocrine tumors, cervical melanoma, adenoid carcinomas, and glassy cell carcinoma

B. Case Pathophysiology

PRECIPITATING FACTORS:• Dietary Lifestyle• Environment• Hygiene

PREDISPOSING FACTORS:• Age• Sex

Invasion of bacteria in the urinary tract

(bladder and urethra)

Delayed emptying of the

bladder

Voiding washes organisms out of

lower urinary tract

The host will diminished the defense mechanism of

the urinary system

Infection will no occur

Bacteria will multiply and the sterility of

the urine will quickly reestablish

Infection will occur

Inflammation and damage of urinary

tract

UTI

dysuria

oliguria

anuria

hesitancy

fever

Clinical Manifestation

Management

Part IV

A.MEDICAL

Cross- Matching Result Form

Patient’s Name: Mary Grace AvendañoBlood Type: ORH: positiveAge: 31 years oldWard: Hyacinth Sex: FemaleDate: Feb. 18, 2011 Bed #: 6Donor’s Name/ Serial No. : QMCH 6189-11

Transfusion Return

B.NURSING

At first glance I saw my patient crying with the SO at her bedside and in severe shallow breathing . According to the S.O. they brought the pt. to the hospital last July 11, 2010 because the patient

Reference and Bibliographies

PartIV

Plan of Care

PRIORITY NO.

NANDADIANOSTIC

STATEMENET

GOAL NURSING INTERVENTION

RATIONALE EVALUATION

1 NDx:

Acute pain related to infection or inflammation along the urinary tract.

Subjective data:“Lagi syang napapaiyak kapag umiihi” as verbalized by the SO.

Objective data:w/ facial grimace upon urination as verbalized by the SO.can’t void freelyrestlessnessSeems irritable

At the end of the shift, the patient will receive proper and good care that will lessen patients discomfort and pain.

1. Allowed verbalization of feelings and emotion

2. Assessed level of pain

3. Encouraged to have fluid intake

4. Provided therapeutic touch

1. Provide baseline data

2. Provide baseline data for evaluation of pain relief strategies

3. Promotes dilute urine and flushing of LUT

4. To participate and feel comfortable

Goal partially met as evidenced by verbalization of “medyo hindi na daw masakit ang kanyang pagihi” by the SO.

PRIORITY NO.

NANDADIANOSTIC

STATEMENET

GOAL Nsg Intervention Rationale Evaluation

1 5. Instructed SO to provide proper care to the patient

6. Provided instructions about recommended voiding pattern and hygienic practices

5. To lessen the pain with the help of her family

6. Delayed emptying of the bladder and poor hygiene may contribute to pain

PRIORITY NO.

NANDADIANOSTIC

STATEMENET

GOAL NURSING INTERVENTION

RATIONALE EVALUATION

2 NDx:

Imbalance nutrition less than body requirements related to inability to utilize nutrients to meet metabolic needs.

Subjective data:“Nawawalan sya ng ganang kumain” as verbalized by the SO.

Objective data:loss of appetiteslightly weak in appearanceTemp: 36.4C

At the end of nursing intervention, the client will display behaviors, lifestyle changes to regain and maintain an adequate nutritional intake.

1. Allowed verbalization of feelings

2. Auscultated bowel sound

3. Promoted pleasant and relaxing environment

4. Instructed SO, to give proper nutrition and proper hygiene

1. Provide baseline data

2. To evaluate degree of deficit

3. To enhance intake

4. It may affect the appetite and be comfortable

Goal partially met as evidenced by:

•Seen eating and taking food fairly

•Temp: 36.5C

•no further complaints

PRIORITY NO.

NANDADIANOSTIC

STATEMENET

GOAL NURSING INTERVENTION

RATIONALE EVALUATION

3 NDx:

Knowledge deficit related to unfamiliarity w/ information resources regarding to the condition and treatment

Subjective data:“Bakit ba nagkaroon ng ganitong sakit ang anak ko” as verbalized by the SO.

Objective data:seen pt. confused regarding to the certain procedureseen uncomfortable

At the end of nursing intervention, the patient with the SO will verbalized understanding about the condition and related treatment

1. Allowed verbalization of feelings

2. Provided quiet atmospheric and therapeutic environment w/o interruption

3. Provided access information for contact person

4. Discussed client perception of needs

1. Provide baseline data

2. This allows patient with the SO to concentrate more complete

3. To answer questions about the information

4. So that client feels respected

Goal partially met as evidenced by:

•Participate in a certain procedures

•Verbalization of knowing the pt. together w/ the SO about the disease condition

•Seen comfortable and relaxed

PRIORITY NO.

NANDADIANOSTIC

STATEMENET

GOAL NURSING INTERVENTION

RATIONALE EVALUATION

4 NDx:

Boredom related to prolonged hospitalization

Subjective data:“Nangungulit sya na gusto ng umuwi” as verbalized by the SO.

Objective data:AnxiousSeems worriedrestlessnessSlightly irritablew/ difficult in concentrating

At the end of the nursing intervention, the patient together with the SO will demonstrate ways on how to minimized feelings of boredom

1. Allowed verbalization of feelings and emotions

2. Assessed pt. degree of boredom

3. Instructed to do diversional activities such as talking to SO

4. Encouraged SO not to leave he patient

1. Provide baseline data

2. To evaluate anxiety

3. To divert mind from being anxious

4. It enhance therapeutic relationship and be comfortable

Goal partially met as evidenced by:

•Seen smiling

•Actively talking to SO

•Seen and relaxed and calm

•No further complaints

PRIORITY NO.

NANDADIANOSTIC

STATEMENET

GOAL Nsg Intervention Rationale Evaluation

4 5. Provided comfort measures such as quiet and calm environment

5. It enhance therapeutic relationship and be comfortable

Thank You!!!