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University of the East Ramon MagsaysayMemorial Medical Center Inc.

#64 Aurora Boulevard, Barangay Dona Imelda, Quezon City, Philippines 1113

In partial fulfillment of

Summer Enhancement 2014

NURSING CARE PROCESS

Submitted to:

Ma’am Janelle Castro 

Submitted by:

Susmiran, Michelle Anne C.

N3-A3

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INTRODUCTION

This is a case of a 53 year old female that was diagnosed with Gastric Adenocarcinoma. Gastric

cancer is the one of the most common cancer in the world after lung and is a major cause of mortality and

morbidity. Through a marked reduction has been observed in the incidence of gastric carcinoma in in

 North America and Western Europe in the last 50 years, 5-year survival rates are rates are less than 20%,as most patients present late and are unsuitable for curative, radical surgery.

Gastric cancer can develop in any part of the stomach and may spread throughout the stomach

and to other organs: particularly the esophagus, lungs, lymph nodes, and the liver. Stomach cancer causes

about 800,000 deaths worldwide. Comes from several Hystological types of Gastric Cancer of which

adenocarcinoma is by far the most frequent. Sarcomas and Lymphomas can also occur.

EPIDEMIOLOGY

Gastric cancer is one of the most common cancers worldwide. Approximately 22,220 patients are

diagnosed annually in the United States, of whom 10,990 are expected to die. Global, country-specific

incidence rates are available in the World Health Organization  GLOBOCAN database. 

Gastric cancer used to be the leading cause of cancer deaths in the world until the 1980s when it

was overtaken by lung cancer. The worldwide incidence of gastric cancer has declined rapidly over the

recent few decades. Part of the decline may be due to the recognition of certain risk factors such as H.

 pylori and other dietary and environmental risks. However, the decline clearly began before the discovery

of H. pylori. The decline first took place in countries with low gastric cancer incidence such as the United

States (beginning in the 1930s), while the decline in countries with high incidence like Japan was slower.

In the United Kingdom, there was a consistent decline in incidence of gastric cancer, with a reduction in

RR from 1.14 in 1971 to 1975 to 0.84 in 1996 to 2009 in men, and 1.18 in 1971 to 1975 to 0.81 in 1996 to

2009 in women. In China, the decline was less dramatic than other countries; despite an overall decrease

in gastric cancer incidence, an increase has been observed in the oldest and the youngest group, and a less

remarkable decline has been observed among women than in men. Of note is that the age of onset of

developing gastric cancer in Chinese population is younger than that in the West. In the United States,

risk factors for noncardia gastric cancer include male gender, non-white race, and older age. Between

1977 and 2009, the incidence rate for noncardia gastric cancer in the United States declined among all

race and age groups except for whites aged 29 to 39 years for whom it increased. The rise in incidence of

noncardia gastric cancer among those at 25 to 39 years is noteworthy since this may signal the

introduction of new environmental factors.

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Demographic Profile

Patient’s name: L.F. 

Address: 1571 Morales St. Lolomboy, Bucaue Bulacan.

Age/Gender: 53 years old/Female

 Nationality: FilipinoReligion: Roman Catholic

Marital Status: Married

Educational Attainment: Elementary graduate

Occupation: House wife

Chief Complaint: 11th cycle of chemotherapy

Source of liability: Patient herself of good reliability

Date of admission: May 03, 2014

Admitting Diagnosis: Gastric Adenocarcinoma, Poorly Differentiated Stage III-B

Attending Physician: Dr. Isauro Guiang, MD.

PRESENT HEALTH HISTORY

12 months PTA, patient’s symptoms of epigastric pain worsened noting a 7/10  and are now

associated with nausea and vomiting, and vomitus is described as the food eaten prior to the episode.

Patient then sought consult after 2 week and had endoscopy with shaved a mass in the intestine. She has

 been known to have Gastric Carcinoma, poorly differentiated stage III-B. Patient was then advised to

have surgery and then after that 2 weeks, she was admitted to the UERM hospital and underwent total

gastrectomy roux-en-y esophagojejunostomy. After the operation, patient and significant other noted

weight loss from 55-35kg but no other complications were revealed.

8 months PTA, patient started her chemotherapy treatment and at present is on the 11th cycle of

the chemotherapy. Patient noted to have nausea, vomiting, weakness, diarrhea, and polyuria after

treatment but these symptoms reveal spontaneously every time she is about to start her succeeding cycles.

On the day of admission, the patient was admitted to the UERM Hospital for the 11th cycle chemotherapy

(5FU).

PAST HEALTH HISTORY

Patient L.F. has vaccinated completely during her childhood times. She had experienced chicken pox as

well as measles with unrecalled date. She had underwent some surgeries such as Hemmorrhoidectomy

(2006); Cholecystectomy (2012); Total Gastrectomy and Roux-en-y Esophagojejunostomy (2013) in

UERM hospital.

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Gastric

AdenocarcinomaDiabetes

Mellitus

Type 2

Lung Cancer

Lung

Cancer

FAMILY HISTORY

Male Female Patient Deceased

SOCIAL HISTORY

Patient L.F. is a non-smoker individual and a non-beverage drinker. She is an elementarygraduate who is a plain housewife who has been living together with her husband but her son lives with

his own family. She is financially supported by her husband and son. The patient’s family supports her all

throughout the process of this chemotherapy. Their house is made of semi-concrete with 3 occupants as

the patient stated.

DEVELOPMENTAL HISTORY

Care: Generativity vs. Stagnation (Middle adulthood, 25-64, or 40-64 years)

- Aging speeds up during this time, and it is characterized by further vision problems, hearing loss,and the end of reproductive capability for women, known as menopause. 

-  During middle age the primary developmental task is one of contributing to society and helping

to guide future generations. When a person makes a contribution during this period, perhaps by

raising a family or working toward the betterment of society, a sense of gene rativity- a sense of

 productivity and accomplishment- results. In contrast, a person who is self-centered and unable or

unwilling to help society move forward develops a feeling of stagnation- a dissatisfaction with the

relative lack of productivity.

Unrecalled Unrecalled

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-  Central tasks of middle adulthood

-  Help growing and grown children to be responsible adults.

-  Relinquish central role in lives of grown children.

-  Create a comfortable home.

-  Adjust to physical changes of middle age.

- 

ACTIVITIES OF DAILY LIVING

Patient L.F. wakes up early at 4:00 in the morning. Do her all house hold chores accompanied by

her husband sometimes. Cleaning the house is her priority in every morning upon waking up in the

morning. Sometimes she waters the plant as well. After all the morning chores, she prepares their lunch

and does before and after meal chores but sometimes due to weakness, she is unable to accomplish them.

She usually has her afternoon nap but in irregular sleep pattern and then upon wakeing up, she’ll watch

her favorite TV show on television until dinner time comes. 9:00 pm is her regular time in sleeping.