osteosarcoma case study

8/13/2019 Osteosarcoma case study

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Case Study of Osteosarcoma

and Pathologic Fracture

of the Humerus

Submitted By: BSN – III. rou! I

"rago# "l$in

Banaag# lady %aicel

Cordero# %arissa

&imayacyac# 'y(a

Formaran# )heny

Hilario# )oe$en

Submitted *o:

&r. %a. Purisima B. %acatangay

&ean of College of Nursing# +N# %"N# Ph.&

OB),C*I-,S:



eneral Obecti$es:

To learn important information about bone tumors specifically

osteosarcoma, enabling the group gain deeper knowledge and understanding,

towards giving a safe and quality nursing care for patients with said condition.

S!ecific Obecti$es:

/Nurse0centered obecti$es

To focus on bone tumors and give a brief discussion of fracture of

the humerus.

To review the anatomy and physiology of the affected area and to

discuss the pathophysiology osteosarcoma including its predisposing

factors.

To outline and analyze the drug used by the patient in the course of

treatment.

To plan and carry out nursing interventions appropriate in the

management of the disease.

/Patient0centered obecti$es

To have an idea and be familiar about the risk bone tumors and bone

fractures.

To be able to gain insights about the condition enable to render an

appropriate actions/management so that the patient will prevent

further complications.

I. IN*+O&1C*ION



Bone Tumor is neoplasm in the skeletal system. They maybe primary or

metastatic tumor from primary cancer elsewhere in the body. Metastatic Tumor are more

common than primary bone tumor. There are two types of bone tumor the Benign Tumor

and Malignant Bone Tumor. Benign bone tumor

includes !steoma, "hondroma, "steochondroma

and #iant "ell Tumor. This tumor tends to grow

slowly and usually do not destroy the supporting or

surrounding tissue or spread to other part of the

body. Malignant bone tumor is an ill defined, lack

sharp border and e$tend beyond the confines of the

bone. There are several types of malignant bone

tumor which includes !steosarcoma, %wing/s

&arcoma and "hondroma.

!steosarcoma is an ancient disease that is still incompletely understood. The term

sarcoma was introduced by the %nglish surgeon 'hon (bernalty in )*+ and was derived

from #reek roots meaning fleshy e$crescene. -n )*+, the rench surgeon (le$is Boyer

first used the term osteochondroma. -t gross appearance was described )*0 by Baron

#uillaume 1upuytren as a whitish or reddish mass, lardaceous and firm at an early stage

of the disease2 but presenting at a later period, points of softening, cerebriform matter,

e$travasting blood and white or straw colored fluid of a viscid consistence in its interior.

The incidence of osteosarcoma is slightly higher in males than females with males

3 .4 per million per year5 and females 3. per million per year5. -t is very rare in young

children 3+. cases per million per year in children 6 years.5. -ncidence increases

steadily with age, increasing more dramatically in adolescence, corresponding with the

growth spurt. !steosarcoma is deadly form of musculoskeletal cancer that most

commonly causes patients to die from pulmonary metastatis disease and which has year

survival rate of )74+8.



racture of the humerus represents 978 of all

fractures it is related to bimodal age distribution. -t

may occur in children due to accident resulting to

in:ury or trauma to the bones and in elderly due to

weakened bones which are prone to fracture when

accidentally fall. racture of the humerus can be

described according to its location, it can be either,

pro$imal, middle or distal third and its pattern spiral,

transverse and comminuted.

( pathologic fracture is a broken bone caused by disease leading to weakness of

the bone. This process is most commonly due to osteoporosis, but may also be due to

other pathologies such as cancer, infection, inherited bone disorders,or a bone cyst. !nly

a small number of conditions are commonly responsible for pathological fractures,

including osteoporosis, osteomalacia, paget;s disease, osteitis, osteogenesis imperfecta,

benign bone tumors and cysts, secondary malignant bone tumours and primary malignant

bone tumours.

ragility fracture is a type of pathologic fracture that occurs as result of normal

activities, such as a fall from standing height or less.This definition arises because a

normal human being ought to be able to fall from standing height without breaking any

bones, and a fracture therefore suggests weakness of the skeleton.

II. P"*I,N*2 P+OFI',



<ame =atient >

=ermanent (ddress ? +44 Bulihan, Bulacan

Birthdate !ct. )) )@

(ge A0 yrs. !ld

<ationality ilipino

eligion oman "atholic

1ate of (dmission March ), 4+)9

(dmitting 1iagnosis =rimary Bone Tumor C4 vertebra, <o neurologic deficit,

pathologic fracture humerus D right arm

". Past History

=atient > is a mother of three siblings. &he is a vendor, selling EkakaninF such as

suman, puto, bibingka etc. (ccording to her in terms of nutrition she loves to eat

vegetables, fruits, and meat however, she is not fond of drinking milk which might

precipitate the occurrence of disruption in continuity of bone. (t the age of AA she notices

a palpable mass on her back specifically lumbar 4 vertebra. Then last 1ecember 4+)4 she

started to e$perience the signs and symptoms of bone tumor primary night time

awakening due to the persistent pain on the affected area.

=atient > is neither a known asthmatic nor had medications. &he claims to have

no history of previous hospitalization or serious illness.

B. Present History

=atient > confined at =hilippine !rthopedic "enter having a chief complaint of

pain in right arm and diagnosis of =rimary Bone Tumor C4 vertebra, <o neurologic

deficit, pathologic fracture humerus D right arm. (t the time of admission the patient is

conscious and coherent. (ccording to the patient fracture resulted from accident fall and

broke her arm. The diagnosis e$am done to her are >7ray and M-, in laboratory test, she

undergone "B".

III. +,-I,3 OF S4S*,%S



I-.O+&ON2S F1NC*ION"' H,"'*H P"**,+N



Health Perce!tion – Health %anagement Pattern

The patient seeks consultation to her personal doctor, but sometimes she takes any

medication which is prescribed by the doctor. Because of persistent pain, she was forced

to go to the hospital and diagnosed of primary bone tumor.

Nutritional %etabolic Pattern

There is no restriction in the patientGs diet. &he usually includes fruits and

vegetables in her diet, moreover, she is fond of eating high fat foods and she refused to

drink milk.

,limination Pattern

1ue to her condition, the patient has indwelling oley catheter. -n terms of bowel

movement, it is irregular, she told us that she moved bowel every 4 79 days.

"cti$ity – ,5ercises Pattern

The patient did not engage in any form of e$ercises, she considered household

chores as a means of e$ercises. But since she was hospitalized, she was not able to

perform any form of e$ercises and according to her there is numbness in her lower

e$tremities leading to immobilization.

Slee! – +est Pattern

The patient e$perienced disturbance in sleeping because of the pain especially at

night.

Cogniti$e – Perce!tual Pattern

&he can easily understand and interact with people. The patient was able to follow

instructions as ordered by the physician2 however, she lacks knowledge regarding her

condition.

Self – Perce!tion – Self – Conce!t Pattern



&he is conscious and coherent upon interaction. 1ue to her condition, she was

confined to bed and e$periencing difficulty in moving associated with numbness and

weakness of lower e$tremities.

+ole – +elationshi! Pattern

The patient has good relationship with the family members. (ccording to her

daughter, she is a good mother. The family always support her financially and

emotionally especially during hospitalization.

Co!ing – Stress *olerance Pattern

&he used the power of praying/ prayer, rosary and bible to cope with daily stress.

-alues6 Belief Pattern

&he has a positive outlook in life. &he believe and still hoping for her condition to

become better.

-. "N"*O%4 "N& PH4SIO'O4



P"+*S OF *H, H1%,+1S



-II. '"BO+"*O+4 +,S1'*S

=%1-&=!&-<# ("T!&

"hildren• Genetics

• Teenage growth

spurt

• Benign bone tumors

• Injury/Trauma

• Metabolic and

hormonal imbalance

=%1-&=!&-<# ("T!&

(dults• High fat diet

• Lack of eercise

• !moking

• "lcoholism

• Injury/Trauma

• Metabolic and

!&T%!BC(&T

1<( MHT(T-!<

M(C-#<(<T !&T%!BC(&T

=!C-%(T-!< ! (B<!M(C

!M(T-!< ! -MM(TH%

=ain &welling Tenderness



H,%"*O'O4 *,S*:

Blood Com!onent Normal -alues +esults

Iemoglobin ))+ J )* g/C 04 g/C

Iematocrit +.90 J +. g/C +.49

Ceucocytes "ount . J )+ $ )+)/C 9.4

=latelet "ount )+ J ++ $ )+@/C @

'IPI& P+OFI',:

'i!id Normal -alues +esults

Iemoglobin 6 9 J * mg/dC 4*

Iematocrit 6 )A+ mg/dC )0)

PO*"SSI1% ',-,':

Potassium Normal -alues +esults

K 9. J meq/C 9.) meq/C

-III. &+1 S*1&4



7.B+"N& N"%,: Kalium 1urule

,N,+IC N"%,: =otassium "hloride

%,CH"NIS% OF "C*ION eplaces potassium and maintains potassium level.

IN&IC"*ION: To prevent hypokalemia.

CON*+"IN&IC"*ION: "ontraindicated in patient with severe renal impairementwith oliguria, anuria, or with acute dehydration or other conditions linked to e$tensive

tissue breakdown.

"&-,+S, +,"C*ION: paresthesia of limbs, confusion, weakness #.- nausea,

vomiting. abdominal pain, diarrhea.

o %,*"BO'IC: hyperkalemia.

o +,SPI+"*O+4: respiratory paralysis.

N1+SIN CONSI&,+"*ION:

• 1rug is commonly used orally with potassium wasting diuretics to maintain

potassium level.

• Monitor %"# and electrolyte level during therapy.

• Many adverse reaction may reflect hyperkalemia.

8.B+"N& N"%, eosol

,N,+IC N"%, errous &ulfate

%,CH"NIS% OF "C*ION: =rovides elememtal iro, an essential component in

the formation of hemoglobin.

IN&IC"*ION: or iron deficiency



CON*+"IN&IC"*ION: "ontraindicated in patient with peptic ulcer disease,

regional enteritis or ulcerative colitis.

"&-,+S, +,"C*ION: .I: nausea, epigastric pain, vomiting, constipation.Black stool, anore$ia. !ther temporarily stined teeth from suspension.


• "heck for constipation2 record color and amount of stool.

• #.- upset may be related to dose.

• Monitor hemoglobin level, hematocrit and reticulocyte count during

therapy.

• Tell patient to take tablet with :uice or water but not with milk or antacid.

9.B+"N& N"%,: Tramadol

,N,+IC N"%,: Hltram

%,CH"NIS% OF "C*ION: -nhibits the reuptake of serotonin and norepinephrine

in "<&.

IN&IC"*ION: Moderate to moderately severe pain

CON*+"IN&IC"*ION: "ontraindicated in patient who have previouslydemonstrated hypersensitivity to tramadol, any other component of this product or

opiods.

"&-,+S, +,"C*ION:

CNS: dizziness, headache, vertigo, seizures, an$iety.

,,N*: visual disturbance.

.I: constipation, nausea, vomiting, abdominal pain.

SIN: diaphoresis, pruritus and rash.


• (ssess type of location and intensity of pain before and 479hours 3peak5

administration.



• (ssess B=, and before and periodically during administration.

• (ssess bowel function routinely.

• or better analgesic effect, give drugs before onset of intense pain.

;.B+"N& N"%,: Cosec, =rilosec

,N,+IC N"%, !meprazole

%,CH"NIS% OF "C*ION: -nhibits activity of acid 3proton5 pump and binds to

hydrogen7potassium adenosine triphosphatase at secretory surface of gastric parietal cells

to block formation of gastric acid.

IN&IC"*ION: Treatment of gastroesophageal reflu$ disease.

CON*+"IN&IC"*ION: "ontraindicated in patient hypersensitive to drug or itscomponent.

"&-,+S, +,"C*ION:

CNS: dizziness, headache. #.-abdominal pain. "onstipation, diarrhea,

nausea, vomiting.

%1SC1'OS,',*"': back pain,

+,SPI+"*O+4: cough, upper respiratory tract infection.

SIN rash


• -nstruct patient to take drugs 9+mins. before meals.

• "aution patient to avoid hazardous activities if he gets dizzy.

• Tell patient to swallow tablet or capsule whole anot to open, crush, or chew them.

osteosarcoma case study

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