case study osteosarcoma

8/12/2019 Case Study Osteosarcoma

1/15

General Objectives:

The purpose of this study is to enhance and gain knowledge, to develop communication

and nursing skills, to provide privacy and maintain confidentiality of the patient and to apply theright attitudes of the student nurses in rendering and giving care to the patient with

Osteosarcoma, its importance and implication.

Specific Objectives:

nderstand condition of Osteosarcoma and associate it with the patient through the

introduction of the case.

To illustrate the !natomy and "hysiology of the affected organ or the part of the body.

To discuss the pathophysiology of the disease.

To be clinically aware of the clinical manifestation and its complication.

To develop an effective skill on how to plan and manage proper care in patient with

Osteosarcoma.

To correlate the laboratory result to its normal value.

To provide the client nursing care plan and discharge plan to assure client#s total wellness

during his hospitali$ation up to the time of his hospital discharge.

%. %ntroduction

!. &ackground of the study

a. %ncidence, race, gender, age, ratio, and proportion

Incidence

Osteosarcoma is the si'th leading cancer in children and eighth in adults.

Race

%ncidence rates for osteosarcoma in .S. patients are estimated at (.) per

million per year in the general population, with a slight variation between

individuals of black, *ispanic, and white ethnicities +.-, .(, and . permillion per year, respectively.

Gender

%t is slightly more common in males +(. per million per year/ than in

females +.) per million per year/ because men has more physical activitiesthan women that makes them more at risk in having bone diseases.

Age

Osteogenic sarcoma is the si'th leading cancerin children under age 0(.

Osteogenic sarcoma affects )) children under age 1) and ()) adults +most

between the ages of 0(23)/ every year.

Ratio
http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Cancer


2/15

!ppro'imately 043 of the 5)) will die each year, or about 3)) a year. !

second peak in incidence occurs in the elderly, usually associated with

underlying bone pathology such as "aget6s disease, medullary infarct, or priorirradiation.

Proportion of originating parts

There is a preference for origination in the metaphysealregion of tubular

longbones, with 17 occurring in the femur, 057 in the tibia, and 0)7 in thehumerus. !bout -7 of all cases occur in the skull and jaw, and another -7 in

the pelvis.

b. 8ationale for choosing the case

The group decided to choose Osteosarcoma because it is one of the

special cases in the "hilippine Orthopedic 9enter and based on our

research it is the si'th leading cancer in children under age fifteen, mostlikely between 0(23) years old.

c. Significance of the studies

The significance of this study is to enhance knowledge, to develop

skills and to apply the right attitudes of the student nurse in rendering and

giving care to the patient with Osteosarcoma, its importance and

implication. This study will serve as guidelines in assessing and providing

nursing care to patient with the same problem or disease.

d. Scope of limitation of the study

The study would only focus on Osteosarcoma which is indicative

to the client#s health condition and its underlying nursing care relevant for

the client within the two week duty at "hilippine Orthopedic 9enter.

e. 9onceptual and ;ursing Theory

Theoretical etastatic

9ancer cells have spread from bone in which the cancer began to

other parts of the body.

3. 8ecurrent

9ancer cells has come back after it has been treated, it may come

back in the tissues where it first started or it may come back in other

parts of the body.

9auses
http://en.wikipedia.org/wiki/Paget's_disease_of_bonehttp://en.wikipedia.org/w/index.php?title=Medullary_infarct&action=edit&redlink=1http://en.wikipedia.org/wiki/Irradiationhttp://en.wikipedia.org/wiki/Metaphysishttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Neoplasmhttp://en.wikipedia.org/wiki/Paget's_disease_of_bonehttp://en.wikipedia.org/w/index.php?title=Medullary_infarct&action=edit&redlink=1http://en.wikipedia.org/wiki/Irradiationhttp://en.wikipedia.org/wiki/Metaphysishttp://en.wikipedia.org/wiki/Bonehttp://en.wikipedia.org/wiki/Neoplasm


3/15

The causes of osteosarcoma are not known. Several research groups are

investigating cancer stem cells and their potential to cause tumors but no research

has been proven. 8esearchers believed that it can be genetically transmitted.

Symptoms

>any patients first complain of pain that may be worse at night, and mayhave been occurring for some time. %f the tumor is large, it can appear as a

swelling. There is edema due to dilatation of vessels in the overlying skin. The

affected bone is not as strong as normal bones and may fracture with minor

trauma +a pathological fracture/ that limits motion. &one mass may be diagnosed

after the pathologic fracture. ?S8 +erythrocyte sedimentation rate/ and S!"

+serum alkaline phosphatase/.

@iagnosisThe route to osteosarcoma diagnosis usually begins with an '2ray,

continues with a combination of scans +9T scan, "?T scan, bone scan,>8%/ and

ends with a surgical biopsy. >!8B

!. G?;?8!= @!T! "8Or. Boung Guy!ddress: (0 !nonas ?'t. Sta. >esa >anila

&irthday: @ecember 0, 0553

&irth "lace: ;ueva ?cija

;ationality: "=!%;T

&one mass at lateral part of the right thigh associated with pain and

swelling.

9. ;8S%;G *%STO8B

0. *%STO8B O< "8?S?;T %==;?SS

One month prior to admission, the patient has palpable mass at the lateral part of the right

thigh and had undergone manipulation hilot thrice. The patient verbali$ed that Ddati sumasakit
http://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/CT_scanhttp://en.wikipedia.org/wiki/PET_scanhttp://en.wikipedia.org/wiki/MRIhttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Malignanthttp://en.wikipedia.org/wiki/Benignhttp://en.wikipedia.org/wiki/Orthopedic_oncologisthttp://en.wikipedia.org/wiki/Orthopedic_oncologisthttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/CT_scanhttp://en.wikipedia.org/wiki/PET_scanhttp://en.wikipedia.org/wiki/MRIhttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Biopsyhttp://en.wikipedia.org/wiki/Malignanthttp://en.wikipedia.org/wiki/Benignhttp://en.wikipedia.org/wiki/Orthopedic_oncologisthttp://en.wikipedia.org/wiki/Orthopedic_oncologist


4/15

na talaga pero nawawala din tapos nung naaksidente ako sa pagbibisikleta din na nawala Eyung

sakit...F

!. 9hildhood %llness

2chicken po', measles, fever, cough and cold, and mumps&. %mmuni$ation2fully immuni$ed

9. !llergies

2no allergies noted@. !ccidents

2with previous vehicular accident

?. *ospitali$ations2once hospitali$ed due to a minor accident before being

referred at the "hilippine Orthopedic 9enteredications used or currently taking

2@olcet, 9ephale'inG. @omestic Travel

2ith no domestic travel

@. %=B *%STO8B

?. SO9%!= *%STO8B2%;9=@? T*?O8%?S !;@ G8OT* !;@

@?H?=O"">?;T

"SB9*OSO9%!= T*?O8B !99O8@%;G TO ?8%I ?8%ISO;

ST!G? !G? 9?;T8!=

T!SI

%;@%9!TO8S O?;T

"arameters ;ormal


6/15

pain and appears like a

swelling2with Steinmann pin

inserted at the distal

third of femurJ with

balanced skeletaltraction

2with limited range ofmotion

pin and balanced

skeletal traction

!bdomen 2 no abdominal

distention2 flat rounded

abdomen

2symmetrical contour2 no surgical incisions

*. "!TT?8;S O<


7/15

get tired

%ndependent

C 9ognitive4"erceptuala. Orientation

b. 8esponsiveness

Oriented to

time, place

and person 8esponds to

verbal andphysical

stimuli

C 8oles48elationship

a. !s a son

b. !s a brother

c. !s a boyfriendd. !s an

employee and

employer

*as a good

relationship

with his

parents,

siblings,girlfriend

and friends

C Self "erception4 Self

9oncept

C 9oping4 Stress

C Halues4 &eliefs

%. =!&O8!TO8B @%!G;OST%9 ?L!>

*ematology

9omponent 8esult ;ormal8ange

%nterpretation %mplication ;ursingresponsibilities

*emoglobin 03) 01M20-3 g4l ;ormal hen thehemoglobin

falls below

0)g4dl in

women or01g4dl in men,

an anemia is

presence.

*ematocrit ).3 ).3M2).( &elow

;ormal

! decrease in

*ematocritlevel seen in

massive or

prolonged

blood loss,anemia,

leukemia, an

e'cessive rapidintravenous

fluid

administration.*ematocrit

level is

elevated inconditions that

cause an

increase in the

percentage of


8/15

red cells in the

blood.

=eukocyte 00.) .(20)' g4l !bnormal ! rise in the

&9 is usuallycaused by

conditions thatstimulate thebone marrow to

produce white

blood cells to

fight offinvading

organisms. !

fall in the whitecell count

usually

indicates thatbone marrow

depression is

occurring,because of

increases of

to'ic

chemicals.

Differential

Count

Segmenters ).M1 ).()2).-3 ;ormal=ymphocytes ).05 ).1)2).) Hiral infections

are the primary

causes of an

increase in the

lymphocytecount. @ecrease

in lymphocytes

is associatedwith *odgkin#s

disease, lupus

erythematosus,burns, trauma,

and the

administration

ofcorticosteroids.

>onocytes ).)- ).))2).)M They may beincreased in

viral, bacterial,

and parasiticinfections,

collagendiseases, andsome malignant

hematological

disorders.

@ecreases haveno significance

in relation to


9/15

disease.

?osinophils ).)0 ).))2).)( ;ormal !n increase in

the eosinophil

count may becaused by a

hyperimmuneor allergicreaction where

there is an

antigen2

antibodyresponse. !

decrease in

?osinophilsmay be

associated with

congestiveheart failure,

infectious

mononucleosis,9ushing#s

syndrome, and

aplastic and

perniciousanemias.

8eticulocytes ).(217

"latelet count 1) 0()2))'

0)Ng4l

;ormal @ecreased

platelet countsmay be seen in

newborns

during the firstfew days of life

or in women

during the two

weeks prior tothe onset of

menstruation.

%ncreases may

be seen inindividuals

living at highaltitudes or

following

intense

physicale'ercise

>9H -( -1251 ;ormal @ecreases inthe >9H are

present in the

followinganemias:

pernicious

anemia, irondeficiency

anemia,

thalassemia, in

the anemias


10/15

associated with

chronic bloodloss. %ncreases

are associated

with liver

deseases,alcoholism,

folate orvitamin &01

deficiencies, or

sprue.

>9* 3) 1-231 ;ormal !bnormal

values are

related tosevere anemic

condition. !n

increase occurswith

macrocytic

anemia and adecrease with

microcytic

anemia.

>9*9 3 3123- ;ormal @ecreases in

>9*9 occur

with thefollowing

anemias: irondeficiencyanemia,

thalassemia,

and macrocytic

anemia. !nincrease

indicates that

spherocytosis ispresent.

Coagulation

Studies"rothrombintime

0(.0 0020(seconds hen the

"rothrombin

content of the

blood isdecreased, the

"rothrombin

time is said tobe prolonged in

the clotting

ability of theblood is

diminished.

One of themost common

causes of an

increased

"rothrombin


11/15

time is the

presence ofmedically

prescribed

anticoagulants

in the blood.7 !ctivity -M.3

%;8 0.0

!ctivated "* 35.3 1121

seconds

&lood type D!&F

8* typing "ositive

+K/

9"8

Semi2

uantitative

9"8

3 mg4= P mg4l

8&9>orphology

?S8 esternGen. >ethod

=ess than0(

9lotting time

+ =ee and

hite/

(20(

minutes

&leeding time

+%vy#s>ethod/

02M minutes

Q. %>"8?SS%O;4@%!G;OS%S

"athologic fracture secondary to primary bone tumor probably malignant

to consider osteosarcoma.

%%%. 9=%;%9!= @%S9SS%O; O< T*? @%S?!S?

0. !;!TO>B !;@ "*BS%O=OGB

The skeletal system provides support and protection, allows body movements, stores

minerals and fats, and is the site of blood cell production.


12/15

. %rregular bones

2include the vertebrae and facial bones, with shapes that do not readily fit into three other

categories.

There are two kinds of bone tissue:

0. 9ompact bone

2 is the hard material that makes up the shaft of long bones and the outside

surfaces of other bones.

1. Spongy bone

2 consists of thin, irregularly shaped plates called trabeculae, arranged in a

latticework network.

"arts of the long bones:

0. @iaphysis

2a long tubular portion of long bones, it is composed of compact bone tissue. %t has the

medullary cavity or marrow cavity, an open area within the diaphysis, the adipose tissue

inside the cavity stores lipids and forms the yellow marrow.

1. ?piphysis

2the e'panded end of a long bone.

3. >etaphysis

2is the area where the diaphysis meets the epiphysis. %t includes the epiphyseal line, a

remnant of cartilage from growing bones.

=ayers of bone tissue:

0. "eriosteum

2is the membrane covering the outside of the diaphysis +and epiphyses where

articular cartilage is absent/. %t contains osteoblasts +bone2forming cells/, osteoclasts+bone2destroying cells/, nerve fibers, and blood and lymphatic vessels. =igaments andtendons attach to the periosteum.

1. ?ndosteum

2is the membrane that lines the marrow cavity.


13/15

1. "!T*O"BS%O=OGB +&OOI &!S?@ !;@ 9=%?;T &!S?@/

"!T*O"*BS%O=OGB +client based/

3. @8G ST@B

;ame of

the @rug

!ction %ndication @osage and

"reparation

!dverse reaction ;ursing

9onsideration

9ephale'in %nhibits

bacterial

cell wall

synthesis.>ost

effectiveagainstrapidly

growing

organisms.

0st

generation:

Often used

in clientsallergic to

penicillin.Gram2positive

organisms

andmoderate

activity

againstgram2

negative

organisms.

1ndgeneration:

Gram2

negativeorganisms.

3rd

generation:

G%: nausea,

vomiting,

diarrhea

%ncrease in

glucose

values

!naphyla'is

may occurJalcohol may

cause

vomiting

;ephroto'ic

ity

Thrombocyt

openia

>onitor

&9

counts,

cultures,and "T.

!ssess&; and

creatininelevels in

clients with

renalimpairment

.

>onitor

HS, % and

O, and

undesirable

effects.

%f client is

diabetic,

monitor

glucoselevels.


14/15

>ostly

gram2negative

organisms.

th

generation:gram2

negativeand gram2

positive

organisms.

8!;I%;G QST%?;T @%!G;OS%S "=!;;%;G %;T?8H?;T%O; 8!T%O;!=? ?H!=!T%O;

Subjective:

D !t the

end of

nursing

intervention

patient

will

!t the end of nursing

intervention patient

!SS?SS>?;T @%!G;OS%S "=!;;%;G %;T?8H?;T%O; 8!T%O;!=? ?H!=!T%O;

Subjective:

D !t the

end of

nursinginterven

tion

!t the end of

nursingintervention

patient


15/15

patient

will

@. @%S9!*8G? "=!;

>2 >edications

a. !dvise patient to take the medicine continuously at home.

b. !lways check the e'piration date of the medicine before taking.?2 ?nvironment 4 ?'ercise

a. >aintain a Auiet, clean and calm environment for easy and good

recovery of the patient.

b. "rovide safety measure to promote safe environment and individual

safety.

c. "lace bedside urinals near patient#s bed for easy access when nature

calls.

T2 Treatmenta. >aintain body alignment as much as possible using pillow or safety

straps to secure proper position.

b. !dvise patient to avoid lifting heavy objects and use of too much force

to prevent more serious injury.

c. %nstruct to perform static isometric Auadriceps e'ercises.

*2 *ealth Teachinga. !void strenuous activities.

b. !dvice SO to assist patient maintain proper personal hygiene.

c. ?'plain the importance of e'ercise on both e'tremities.d. %nstruct to do deep breathing and coughing e'ercises.

e. !dvise to always keep back dry.O2 Out "atient 8eferral 9heck2 up

a. !fter discharge, advice patient to come back to specified date said by

the patient.@2 @iet

a. *igh protein and rich in vitamin 9 foods to promote healing.

b. 8egular calcium intake for fast bone recovery.

case study osteosarcoma

Documents