8/14/2019 Case Study (Nasopharyngeal Cancer)
1/31
I. Introduction
Brief Description of the Disease Condition
The body is made up of many types of cells. Normally, cells grow, divide and die. Sometimes,
cells mutate (change) and begin to grow and divide more quickly than normal cells. Rather than
dying, these abnormal cells clump together to form tumors. If these tumors are malignant
(cancerous), they can invade and kill your body's healthy tissues. From these tumors, cancer
cells can metastasize (spread) and form new tumors in other parts of the body. By contrast,
benign (noncancerous) tumors do not spread to other parts of the body. Nasopharyngeal (say:
"nay-zo-fair-in-gee-al") cancer is a malignant tumor that develops in the nasopharynx (say:
"nay-zo-fair-inks"). The nasopharynx is the area where the back part of your nose opens into
your upper throat. This is also where tubes from your ears open into your throat.
Nasopharyngeal cancer is rare. It most often affects people who are between 30 and 50 years of
age. Men are more likely to have nasopharyngeal cancer than women. You are most likely to get
this cancer if you or your ancestors came from southern China, particularly Canton (now called
Guangzhou) or Hong Kong. You are also more likely to get this cancer if you are from a country
in Southeast Asia, like Laos, Vietnam, Cambodia or Thailand. No one knows for sure what
causes nasopharyngeal cancer. Eating salt-preserved foods (like fish, eggs, leafy vegetables androots) during early childhood may increase the risk of getting this form of cancer. The Epstein-
Barr virus may also make a person more likely to get nasopharyngeal cancer. This is the same
virus that causes infectious mononucleosis (also called "mono"). You may also inherit a
tendency to get nasopharyngeal cancer.
Reason for Choosing the Case
Nasopharyngeal Cancer is one of the unusual terms for a lay person and a rare case that a nurse
would encounter. Acquisition of cognitive knowledge regarding the topic would enable the
researchers in providing optimum care for clients suffering such and in delivering appropriate
interventions that would promote health and wellness for the client.
1
8/14/2019 Case Study (Nasopharyngeal Cancer)
2/31
Statistics (Global and Local)
Cancer of the nasopharynx is a rare neoplasm in most countries. However, it occurs at high
frequencies in China and Southeast Asia. The highest incidence rates in the SEER regions occur
among the Chinese. Rates are also high in Vietnamese and Filipino men, two groups that
include persons of Chinese heritage. Incidence rates of nasopharyngeal cancer are also available
for black, Hispanic and white men and for white women in the SEER areas. There were too few
nasopharyngeal cancers diagnosed between 1988 and 1992 in the other racial/ethnic groups to
provide meaningful incidence rates.
The average annual age-adjusted incidence rate of nasopharyngeal cancer in Chinese men, 10.8
per 100,000, is 1.4 times greater than that of Vietnamese men and nearly 2.8 times greater than
that of Filipino men. In fact, the rate among Filipino men, although relatively high, is the same
as that for Chinese women. Rates of one per 100,000 and lower occur in black men, Hispanic
and non-Hispanic white men and non-Hispanic white women.
The United States mortality rates for cancer of the nasopharynx reflect patterns similar to those
for SEER incidence rates. Mortality is highest in Chinese, lower in Filipinos and lowest among
blacks, Hispanics and non-Hispanic whites. No mortality rates are currently available for
Vietnamese. Incidence-to-mortality rate ratios vary, with Chinese and Filipinos having higher
incidence relative to mortality (2.3 for men in both groups and 3.2 for Chinese women) than
other groups (ranging from about 1.7 for white Hispanic men to two for non-Hispanic white
men). Incidence and mortality rates for nasopharyngeal cancer increase through the oldest age
group, although the small number of cases precluded the calculation of reliable rates for many
populations.
The major modifiable risk factor identified for cancer of the nasopharynx is the consumption of
Cantonese salted fish, which is a common food item eaten from early infancy onward by groups
with high risk of this disease. Other possible risk factors include extensive exposures to dusts
and smoke and regular consumption of other fermented foods. The role of Epstein-Barr virus in
the development of nasopharyngeal cancer continues to be explored.
2
8/14/2019 Case Study (Nasopharyngeal Cancer)
3/31
Nurse-centered Objectives:
The group aims:
to have a better understanding about the causes of nasopharyngeal cancer.
to determine the medical and surgical treatment that has given to the disease entity.
to perform well our role as student nurses in the treatment and achieving the optimum
level of health of the patient.
to enhance our nursing skills most importantly focusing on promotive and preventive
nursing measures.
3
8/14/2019 Case Study (Nasopharyngeal Cancer)
4/31
II. Nursing Assessment
Personal Data
Mr. Split, 74 years old, married and a father of 7 children. Offspring of Mr. and Mrs. Choco
Split, he was born on December 31, 1934 in Angeles Pampanga, and at this point in time, he
resides in Timog Park, Angeles. He is a Filipino-born citizen. He was admitted last September
18, 2008 in Angeles Medical Center (AMC).
Mr. Split is a jeepney operator and he is the sole provider for their means of living. His children,
mostly married, some are presently unemployed and contribute to the burden on financial matters
to the family of orientation.
Mr. Split has a lifestyle of eating food that should or not allowed to him such as foods that are
high amounts in sugar and low density cholesterol. Besides that Mr. Split is also attached to
cigarette smoking. He also worked as a painter of houses for living for the past 20 years.
History of Past Illness
Mr. Splits last check-up was done 3 years ago and was diagnosed to have nasopharyngeal
cancer. Prior to this, he has also been diagnosed to have Diabetes Mellitus Type 1 and PulmonaryTuberculosis. According to his daughter, his first admission in the hospital was September 18,
2008.
History of Present Illness
One (1) month PTA, Mr. Split experienced difficulty of breathing, and anorexia lasting for 1
week. A week PTA, he still experienced difficulty of breathing, and anorexia associated plus
muscle weakness with easy fatigability but still he did not seek medical attention. A day PTA, he
still experienced the same signs but this time he decided to seek medical attention.
4
8/14/2019 Case Study (Nasopharyngeal Cancer)
5/31
Family Health Illness History
Mr. Split
5
Legend:
= Male = Diabetes Mellitus = Tuberculosis
= Female = Cancer = Deceased
8/14/2019 Case Study (Nasopharyngeal Cancer)
6/31
III.Physical Examination
Angeles Medical Center (AMC) (September 18, 2008)
Upon admission:
(+) body weakness accompanied by difficulty of breathing and anorexia.
Physical Examination:
Drowsy, coherent, afebrile, in respiratory distress, pale palpable conjunctiva, (+) irregular
mass on nasal area, (+) rales, no murmur, normal abdominal bowel sounds, pale nail bed,
weak pulses.
1st Assessment (September 20, 2008)
General Appearance:
Received pt in a fowlers position with contraptions. Pt is with body odor and with minimal foul
breath odor. Pts speech is slightly incomprehensive.
Vital Signs:
T: 36.4 C RR: 29 cpm
PR: 87 bpm BP: 120/80 mmHg
Physical Assessment:
Integument
Noted dryness
Presence of tattoo in the right arm
Poor skin turgor
Capillary refill test: delayed return in pink color (3 seconds)
Presence of scars on the lower extremities
Head
Hair generally white
Presence of patches of hair loss
6
8/14/2019 Case Study (Nasopharyngeal Cancer)
7/31
8/14/2019 Case Study (Nasopharyngeal Cancer)
8/31
8/14/2019 Case Study (Nasopharyngeal Cancer)
9/31
IV.Diagnostic and Laboratory Procedures
Procedures done to the Client
Nursing responsibilities:
9
Diagnostic/
Laboratory
Procedures
Date Ordered/
Date Result(s)
Released
Indication(s)/
Purposes(s)Result(s)
Normal Values
(units used in the
hospital)
Analysis and interpretation of results
Blood Chemistry 09/18/08
09/19/08
To assess a wide
range of conditionsand the function of
organs. Often, blood
tests check
electrolytes, the
minerals that help
keep the body's fluid
levels in balance, and
are necessary to help
the muscles, heart,
and other organs
work properly. To
assess kidney
function and blood
sugar, blood tests
measure other
substances.
Hct > 32.7
Platelet Count > 759
Hgb (Hemoglobin)>9.5
WBC (White Blood
Cells)>27.9
Lymhocytes > 10
Granulocytes > 90%
Glucose (FBS) > 138.6
BUN > 13.72
Creatinine > 0.78
Potassium > 3.6
Sodium > 143
@m: 40.0 54.0
@m: 140 - 440
@m: 14 18 g/dl
@m: 4.3 10.0 x 1/l
@m: 28.0 48.0
@m: 44.2 80.2(x 10/1)
@76 - 111 mg/dl
@7 - 21 mg/dl
@0.5 - 1.69 mg/dl
@3.5 - 5.0
@136 - 145 mmo/L
Hematocrit level as shown are below the
standard values.Platelet count is above the average level.
Hemoglobin level is lower than the
established normal values.
White blood cells are higher than the
usual amount.
Lymphocytes are below the average
levels.
Granulocytes are beyond the normal
values.
Glucose levels in the patients body are
within normal values.
Results show that BUN is at averagelevels.
Result shows that creatinine are at
normal values.
Potassium is at the normal values.
Result shows that sodium levels are
within regular values.
8/14/2019 Case Study (Nasopharyngeal Cancer)
10/31
inform patient on the procedure to be done. Explain the details on what and how the procedure is going to be administered.
let client sign a waiver or a consent before starting the procedure.
provide the best possible nursing care for the patient who is to undergo a procedure.
inform patient that the test would be done for the better of the patients condition.
inform the patient with the results of the procedure done, explain the implications of each result, client has the right to know.
Nursing Responsibilities:
Inform the patient about the procedure
Ask the patient to remove any radiopaque objects (jewelry, belts, or metal buttons).
Assist patient to wear a gown.
Assist patient when positioning.
10
Diagnostic/ Laboratory
ProceduresIndication(s)/ Purposes(s)
Normal Values
(units used in the hospital)Analysis and interpretation of results
Chest X-ray Commonly used to detect
abnormalities in the lungs, but
can also detect abnormalities in
the heart, aorta, and the bones of
the thoracic area. Metallic
objects, such as jewelry are
removed from the chest and neck
areas for a chest x-ray to avoid
interference with x-ray
penetration and improve
accuracy of the interpretation.
Minimal Pulmonary Tuberculosis on left lateral
portion of the lungs
8/14/2019 Case Study (Nasopharyngeal Cancer)
11/31
Note pertinent findingssuch as the presence of a pacemaker or an artificial joint.
11
8/14/2019 Case Study (Nasopharyngeal Cancer)
12/31
V. The Patient and His Illness
Anatomy and Physiology of the Human Respiratory System
The respiratory system consists of all the organs
involved in breathing. These include the nose, pharynx,
larynx, trachea, bronchi and lungs. The respiratory
system does two very important things: it brings
oxygen into our bodies, which we need for our cells to
live and function properly; and it helps us get rid of
carbon dioxide, which is a waste product of cellular
function. The nose, pharynx, larynx, trachea and
bronchi all work like a system of pipes through which
the air is funneled down into our lungs. There, in very
small air sacs called alveoli, oxygen is brought into the bloodstream and carbon dioxide is
pushed from the blood out into the air. When something goes wrong with part of the respiratory
system, such as an infection like pneumonia, it makes it harder for us to get the oxygen we need
and to get rid of the waste product carbon dioxide. Common respiratory symptoms include
breathlessness, cough, and chest pain.
The Upper Airway and Trachea
When you breathe in, air enters your body through
your nose or mouth. From there, it travels down
your throat through the larynx (or voicebox) and
into the trachea (or windpipe) before entering your
lungs. All these structures act to funnel fresh air
down from the outside world into your body. The
upper airway is important because it must always
stay open for you to be able to breathe. It also helps
to moisten and warm the air before it reaches your
lungs.
12
8/14/2019 Case Study (Nasopharyngeal Cancer)
13/31
The Lungs
The lungs are paired, cone-shaped organs which take up most of the space in our chests, along
with the heart. Their role is to take oxygen into the body, which we need for our cells to live and
function properly, and to help us get rid of carbon dioxide, which is a waste product. We each
have two lungs, a left lung and a right lung. These are divided up into 'lobes', or big sections of
tissue separated by 'fissures' or dividers. The right lung has three lobes but the left lung has only
two, because the heart takes up some of the space in the left side of our chest. The lungs can also
be divided up into even smaller portions, called 'bronchopulmonary segments'.
These are pyramidal-shaped areas which are also separated from each other by membranes.
There are about 10 of them in each lung. Each segment receives its own blood supply and air
supply.
Air enters your lungs through a system of pipes called the bronchi. These pipes start from the
bottom of the trachea as the left and right bronchi and branch many times throughout the lungs,
until they eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli
are where the important work of gas exchange takes place between the air and your blood.
Covering each alveolus is a whole network of little blood vessel called capillaries, which are
very small branches of the pulmonary arteries. It is important that the air in the alveoli and the
blood in the capillaries are very close together, so that oxygen and carbon dioxide can move (or
diffuse) between them. So, when you breathe in, air comes down the trachea and through the
bronchi into the alveoli. This fresh air has lots of oxygen in it, and some of this oxygen will
travel across the walls of the alveoli into your bloodstream. Travelling in the opposite direction is
carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you need to live, and
get rid of the waste product carbon dioxide.
Blood Supply
The lungs are very vascular organs, meaning they receive a very large blood supply. This is
because the pulmonary arteries, which supply the lungs, come directly from the right side of your
heart. They carry blood which is low in oxygen and high in carbon dioxide into your lungs so
13
8/14/2019 Case Study (Nasopharyngeal Cancer)
14/31
that the carbon dioxide can be blown off, and more oxygen can be absorbed into the
bloodstream. The newly oxygen-rich blood then travels back through the paired pulmonary veins
into the left side of your heart. From there, it is pumped all around your body to supply oxygen
to cells and organs.
The Pleurae
The lungs are covered by smooth membranes that
we call pleurae. The pleurae have two layers, a
'visceral' layer which sticks closely to the outside
surface of your lungs, and a 'parietal' layer which
lines the inside of your chest wall (ribcage). The
pleurae are important because they help you
breathe in and out smoothly, without any friction.
They also make sure that when your ribcage
expands on breathing in, your lungs expand as
well to fill the extra space.
The Diaphragm and Intercostal Muscles
When you breathe in (inspiration), your muscles need to work to fill your lungs with air. The
diaphragm, a large, sheet-like muscle which stretches across your chest under the ribcage, does
much of this work. At rest, it is shaped like a dome curving up into your chest. When you breathe
in, the diaphragm contracts and flattens out, expanding the space in your chest and drawing air
into your lungs. Other muscles, including the muscles between your ribs (the intercostal muscles)
also help by moving your ribcage in and out. Breathing out (expiration) does not normally
require your muscles to work. This is because your lungs are very elastic, and when your
muscles relax at the end of inspiration your lungs simply recoil back into their resting position,
pushing the air out as they go.
The Respiratory System and Ageing
The normal process of ageing is associated with a number of changes in both the structure and
function of the respiratory system. These include:
14
8/14/2019 Case Study (Nasopharyngeal Cancer)
15/31
Enlargement of the alveoli. The air spaces get bigger and lose their elasticity, meaning
that there is less area for gases to be exchanged across. This change is sometimes referred
to as 'senile emphysema'.
The compliance (or springiness) of the chest wall decreases, so that it takes more effort to
breathe in and out.
The strength of the respiratory muscles (the diaphragm and intercostal muscles)
decreases. This change is closely connected to the general health of the person.
All of these changes mean that an older person might have more difficulty coping with increased
stress on their respiratory system, such as with an infection like pneumonia, than a younger
person would.
15
8/14/2019 Case Study (Nasopharyngeal Cancer)
16/31
Pathophysiology (Book-based and Client-centered)
Definition of the Disease
Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the
nasopharynx.
Predisposing Factors
People who are between 30 and 50 years of age
Men are more likely to have nasopharyngeal cancer than women
Chinese or Asian ancestry
Hereditary
Precipitating Factors
Eating salt-preserved foods (like fish, eggs, leafy vegetables and roots) during early
childhood
Cigarette smoking
Alcohol abuse
Poor Oral Hygiene
Long Term Sun Exposure
Occupational Exposure (chemicals esp. asbestos)
Signs and Symptoms with Rationale
Anorexia is a decreased sensation of appetite caused by the complications of compression
of the esophagus.
Atelectasis is a collapse of lung tissue affecting part or all of one lung because of presenceof fluid in the lungs.
Chest pain pain caused by the obstruction of the vena cava.
Chest wall pain pain caused by the invasion of the pleural cavity irritating nerve fibers.
Chronic Cough caused by sputum production brought by the irritation of the bronchioles.
16
8/14/2019 Case Study (Nasopharyngeal Cancer)
17/31
Difficulty in swallowing condition caused by the compression of the esophagus.
Distended neck veins caused by the obstruction of the vena cava.
Dyspnea caused by the invasion of the pleural space.
Facial, arm, and trunk swelling caused by the obstruction of the vena cava.
Hemoptysis is the expectoration of blood caused by lesions in the blood vessels.
Hoarseness of voice caused by the irritation of the laryngeal nerve.
Hyperglycemia a manifestation caused by Cushings syndrome.
Hyperkalemia a manifestation caused by Cushings syndrome.
Hypertension a manifestation caused by Cushings syndrome.
Hypervolemia a manifestation caused by Cushings syndrome.
Immunosupression a manifestation caused by Cushings syndrome.
Osteoporosis caused by high levels of cortisol.
Pneumonia condition caused by the invasion of the pleural space and it is characterized
by inflammation and abnormal alveolar filling with fluid.
Shortness of breath caused by the irritation and obstruction of airway.
Venous stasis caused by the obstruction of the vena cava.
Weight loss caused by dysphagia and the metastases in the liver.
Note: Items marked in RED were experienced by the client.
17
8/14/2019 Case Study (Nasopharyngeal Cancer)
18/31
Schematic Diagram (Book-based)
18
Predisposing Factors:
People who are between 30 and 50 years of age
Men are more likely to have nasopharyngeal cancer
than women
Chinese or Asian ancestry Hereditar
Precipitating Factors:
Eating salt-preserved foods (like fish, eggs, leafy
vegetables and roots) during early childhood
Cigarette smoking
Alcohol abuse Poor Oral Hygiene
Long Term Sun Exposure
Occu ational Ex osure chemicals es . asbestos
Nasopharyngeal Cancer/Lung Cancer
Chronic cough
Osteoporosis
Atelectasis
Chest wall pain
Irritation and obstruction of airway
CushingsSyndrome
Immunosupression
Hypertension
Hyperglycemia
Hypervolemia
Hyperkalemia
Pleural Effusion
Squamous Cell Carcinoma Small Cell Carcinoma Adenocarcinoma Large Cell Carcinoma
Sputumroduction
Invasion of theleural cavit
Pneumonitis
Hemoptysis
Pneumonia
Anorexia
Formation of benign bronchial
e ithelium tissue
Transformation benign
tissue to neoplastic tissue
Weight Loss
Shortness ofbreath
Wheezing
Lesions erode tothe blood vessels
Compression ofthe esophagus
Difficulty inswallowin
Hoarsenessof voice
Irritation of thelaryngeal nerve
Metastases tothe liver
Triggering of painrece tors
Shortness ofbreath
Dyspnea
Vena cavasyndrome
Facial, arm, andtrunk swellin
Distendedneck veins
Chest pain
Venous stasis
Synthesis ofbioactive products
Invasion of themediastinum
8/14/2019 Case Study (Nasopharyngeal Cancer)
19/31
Schematic Diagram (Client-centered)
19
Predisposing Factors:
People who are between 30 and 50 years of age
Men are more likely to have nasopharyngeal cancer
than women
Chinese or Asian ancestry Hereditar
Precipitating Factors:
Eating salt-preserved foods (like fish, eggs, leafy
vegetables and roots) during early childhood
Cigarette smoking
Alcohol abuse Poor Oral Hygiene
Long Term Sun Exposure
Occu ational Ex osure chemicals es . asbestos
Nasopharyngeal Cancer/Lung Cancer
Formation of benign bronchial
e ithelium tissue
Transformation benign
tissue to neoplastic tissue
Chronic cough(September 20,
2008
Irritation and obstruction of airwaySputum
roduction
Shortness of
breath
Wheezing
Anorexia(August 2008)
Weight Loss
Compression of
the esophagus
Difficulty in
swallowinHoarseness of voiceSe tember 20, 2008
Irritation of the
laryngeal nerve
Invasion of the
mediastinum Chest wall pain(September 20, 2008)
Invasion of the
leural cavit
Triggering of
ain rece tors
8/14/2019 Case Study (Nasopharyngeal Cancer)
20/31
VI.The Patient and His Care
Medical Management
a. IVFs, BT, NGT feeding, Nebulization, TPN, Oxygen Therapy, etc.
Medical Management
Treatment
Date Ordered, Date
Performed, Date
Changed/ D/C
General DescriptionIndication(s) or
Purpose(s)
Clients Response to
the treatment
D5LRS Date ordered:09/18/08
Date started:
09/18/08
Lactated Ringer's solution is a solutionthat is isotonic with blood and intended
for intravenous administration. It is a
nonpyrogenic solution for fluid and
electrolyte replenishment and caloric
supply in a single dose container for
intravenous administration.
Severe dehydration,hypovolemia, replace ECF
loss, shock, diabetic
ketoacidosis
Responded positively
D5NSS Date ordered:
09/18/08
Date started:
09/18/08
Isotonic sodium chloride with a 5%
dextrose. It is typically the first fluid
used when dehydration is severe
enough to threaten the adequacy of
blood circulation and is the safest fluid
to give quickly in large volumes.
mediacations, flush, maintain patency
of intravenous access device
Replaced extracellular fluid
volume, hyponatremia,
diabetic ketoacidosis,
diluent for
Responded positively
D5NM Date ordered:
08-19-08Date performed:
08-19-08
Have a greater concentration of solutes
than plasma.It is the solution that draw fluid out of
the intracellular and interstitial
compartments into the vascular
compartment, expanding vascular
volume
To supply fluid and
electrolyte balance for thepatients need.
It is also used as a passage
way in giving medication
to the patient.
Complies positively
Oxygen therapy Date ordered:
09-18-08
Date performed:
09-18-08
Changed:
09-19-08
09-20-08
Oxygen therapy is
being prescribed for clients with mild or
severe anemia because of their blood
has a reduced capacity for oxygen
Helps to prevent tissue
hypoxia and lessens the
workload of the heart as it
struggles to compensate for
the lower hb level
Complies positively
20
8/14/2019 Case Study (Nasopharyngeal Cancer)
21/31
IVF
Nursing Responsibilities:
Select venipuncture site.
Clean site using circular motion from inner to outer with alcohol.
Apply tourniquet.
Anchor vein by stretching skin; insert bevel up to 20 30 degree angle.
Watch for blood return in flashback chamber of the catheter.
Advance needle another inch; then advance catheter into the vein until hub is at the venipuncture site.
Stabilize the catheter and release tourniquet.
Remove needle stylet and attach tubing or saline lock to catheter hub. Flush with saline to verify patency.
Secure catheter and apply sterile dressing (gauze or transparent) to site.
Oxygen Therapy
Nursing Responsibilities:
Explain the procedure to the patient.
Check the doctors order.
Monitor the clients vital signs.
Check equipment patency.
Instruct the client and visitors about the hazard
21
8/14/2019 Case Study (Nasopharyngeal Cancer)
22/31
b. Pharmacotherapy
Name of drugs
Generic Name/ Brand Name
Date Ordered, Date taken/Given,
Date Changed/ D/ C
Dosage, Frequency
and Route
General Action, Mechanism
of Action
Clients Response to the
Medication
Cefuroxime
(Zegen)
Date ordered:
09/18/08
Date started:
09/18/08
750 mg IV q8 Haematopoietic Agents
Second generation
cephalosporins that inhibits
cell-wall synthesis, promoting
osmotic instability; usually
bactericidal.
The client responded well to
the medication
Nursing Responsibilities:
Observe 10 Rs of drug administration.
Before administration, ask patient if he is allergic to penicillins.
Name of drugs
Generic Name/ Brand Name
Date Ordered, Date taken/Given,
Date Changed/ D/ C
Dosage, Frequency
and Route
General Action, Mechanism
of Action
Clients Response to the
Medication
Piperacillin Na, Tazobactam Na
(Piptaz)
Date ordered:
09/18/08
Date started:
09/18/08
2.25 g IV infusion q8 Penicillin
Inhibits cell-wall synthesis
during bacterial multiplication.
The client responded well to
the medication
Nursing Responsibilities:
Observe 10 Rs of drug administration.
Name of drugs
Generic Name/ Brand Name
Date Ordered, Date taken/Given,
Date Changed/ D/ C
Dosage, Frequency
and Route
General Action, Mechanism
of Action
Clients Response to the
Medication
Human Insulin
(Humulin R)
Date ordered:
09/18/08
10 units SQ stat Antidiabetics The client responded well to
the medication
22
8/14/2019 Case Study (Nasopharyngeal Cancer)
23/31
Date started:
09/18/08
Increases glucose transport
across muscle and fat cell
membranes and reduce glucose
level. Helps convert glucose to
glycogen; triggers amino acid
uptake and conversion to
protein in muscle cells;
stimulates triglyceride
formation and inhibits release
of free fatty acids from adipose
tissue; and stimulateslipoprotein lipase activity,
which converts circulating
lipoproteins to fatty acids.
Nursing Responsibilities:
Ask the patient if she/he ever had any allergic reaction with Tranexamic Acid.
Name of drugs
Generic Name/ Brand Name
Date Ordered, Date taken/Given,
Date Changed/ D/ C
Dosage, Frequency
and Route
General Action, Mechanism
of Action
Clients Response to the
Medication
Epoetin
(Renogen)
Date ordered:
09/19/08
Date started:
09/19/08
4, 000 units SQ today Haematopoietic Agent
Mimics effect of erythropoietin.
Functions as a growth factor
and as a differentiating factor,enhancing RBC production.
The client responded well to
the medication
Nursing Responsibilities:
Ask patient if he/she ever had allergy to Mefenamic acid
Ask patient if he/she has a history of heart attack, stroke or blood clot.
Name of drugs Date Ordered, Date taken/Given, Dosage, Frequency General Action, Mechanism Clients Response to the
23
8/14/2019 Case Study (Nasopharyngeal Cancer)
24/31
Generic Name/ Brand Name Date Changed/ D/ C and Route of Action Medication
Methyldopa hydrochloride
(D50-50)
Date ordered:
09/18/08
Date started:
09/18/08
1 vial IV Anti-Hypertensive
Unknown. Thought to inhibit
the central vasomotor centers,
thereby decreasing sympathetic
outflow to the heart, kidneys,
and peripheral vasculature.
The client responded well to
the medication AEB a
decrease in blood pressure
from 140/90 to 120/80.
Nursing Responsibilities:
Ask patient if he/she is allergic to FeSO4
Ask the patient if he/she is taking any other drugs
Ask the patient if he/she had multiple blood transfusions
c. Diet
Type of DietDate Ordered/ Date Started/
Date Changed
Indication(s) or
Pupose(s)General Description
Clients Response & or reaction
to the Activity
Diet as Tolerated DO: 08-18-08 Maintaining dietary
nutrition needed for
the patient.
Is ordered when the patients
appetite/ ability to eat and
tolerated for certain foods may
change.
Complies positively
Nursing Responsibilities:
Provide oral hygiene before and after meal.
Advise client to take nutritious foods especially foods rich in iron
24
8/14/2019 Case Study (Nasopharyngeal Cancer)
25/31
VII.Nursing Care Plans
Ineffective Airway Clearance
Assessment Nursing DiagnosisScientific
ExplanationObjectives
Nursing
InterventionsRationale Evaluation
Subjective cues:
"Magkasakit yaknyan mangisnawa
nang, lalu na pag
sasabi ya" as
verbalized by the
SO
Objective cues:
Dyspnea
Restlessness
Use of accessory
muscle
Cough
Nasal flaring
Prolonged
expiratory phase
Ineffective airway
clearance r/t tissuenecrosis located in
nasal area AEB
dyspnea,
restlessness, use of
accessory muscle,
cough, and nasal
flaring.
Ineffective airway
clearance is theinability to clear
secretions or
obstruction from the
respiratory tract to
maintain a clear
airway in which
partial or complete
blockage of the
breathing tubes to
the lungs.
Obstruction of the
airway can be due to
different causes
including foreign
bodies, allergic
reactions, infections,
anatomicalabnormalities and
trauma. The onset of
respiratory distress
may be sudden with
cough. There is
often agitation in the
early stage of
airway obstruction.
After 3 hours of NI,
pt will be able toverbalize
understanding of
cause and
therapeutic
management
regimen and
demonstrate
behaviors to
improve or maintain
clear airway.
Establish rapport
Position head to
facilitate airway
Elevate head of
bed
Encourage deep-
breathing and
coughing exercise
Increase fluid
intake
Support
reduction/cessatio
n of smoking
To get the trust of
the pt.
To open or
maintain open
airway in at-rest or
com promised
individual
To take advantage
of gravity
decreasing
pressure on the
diaphragm and
enhancing
drainage
To maximize
effort in
expectorating
secretions Hydration can
help liquefy
viscous secretions
and improve
secretion
clearance
To improve lung
function
25
8/14/2019 Case Study (Nasopharyngeal Cancer)
26/31
Impaired Physical Mobility
Assessment Nursing DiagnosisScientific
ExplanationObjectives
Nursing
InterventionsRationale Evaluation
Subjective cues:
Magkasakit kung
gagalo, as
verbalized by the
patient.
Objective cues:
with limited
movements
limited ability to
perform gross/fine
motor skills
with difficulty
turning
with slowed
movements
Impaired physical
mobility related to
decreased muscle
strength a
manifested by the
patients limited
movements, limited
ability to perform
gross/fine motor
skills, difficulty
turning, and slowed
movements.
Impaired physical
mobility is
limitation in
independent,
purposeful physical
movement of the
body or of one or
more extremities.
Mobility is also
related to body
changes from aging.
Reduction in muscle
strength and
function, stiffer and
less mobile joints
affecting balance
can significantly
compromise the
mobility of elderly
patients.
Restricted
movement affects
the performance ofmost activities of
daily living (ADLs.)
After 3 hours of
nursing intervention,
the pt. will be able
to participate in
ADLs and desired
activities as
evidenced by an
increase in the pt.s
movements, ability
to perform
gross/fine motor
skills, can turn
easily, and an
increase in motor
agility.
establish rapport
monitor and
record VS
advise pt. to haveadequate rest
encourage pt to eat
foods rich in
carbohydrates
advise pt. to do
deep breathing
advise pt. to take
adequate fluid
intake
encourage pt. to
rest between
activities
encourage pt. to
engage in ROM
exercise
to gain
cooperation
for baseline data
to regain strength
to increase energy
level
to promote energy
to prevent
dehydration
to promote energy
and regain
strength
to reduce fatigue
26
8/14/2019 Case Study (Nasopharyngeal Cancer)
27/31
Fatigue
Assessment Nursing DiagnosisScientific
ExplanationObjectives
Nursing
InterventionsRationale Evaluation
Subjective cues:
Medyu
mangalambut ku,
as verbalized by the
patient.
Objective cues:
appears weak
decreased ability
in performing
activities
with compromised
concentration
Fatigue related to
poor physical
condition as
manifested by the
patient appears
weak, a decreased
ability in
performing
activities, and
compromised
concentration.
An overwhelming
sustained sense of
exhaustion and
decreased capacity
for physical and
mental work at
usual level
Fatigue is a
subjective complaint
with both acute and
chronic illnesses. In
an acute illness
fatigue may have a
protective function
that keeps the
person from
sustaining injury
from overwork in a
weakened condition.
As a common
symptom, fatigue is
associated with a
variety of physical
and psychological
conditions.
After 3 hours of
nursing intervention,
the patient will
verbalize an
understanding
regarding the health
teachings on how to
conserve energy as
evidenced by the
patient appears
strong, an increase
in the ability to
perform activities,
and has the ability to
concentrate fully.
Establish rapport
Monitor and
record vital signs
Encourage pt. tosit instead of
standing in
performing
activities
Advise pt. to have
adequate rest
Encourage pt. to
perform ROM
exercises
Encourage pt. to
eat carbohydrates-
containing food
Encourage pt. to
do focus breathing
to gain
cooperation
for baseline data
to conserve energy
to regain strength
to reduce fatigue
to increase energy
level
to promote energy
27
8/14/2019 Case Study (Nasopharyngeal Cancer)
28/31
Chronic Pain
Assessment Nursing DiagnosisScientific
ExplanationObjectives
Nursing
InterventionsRationale Evaluation
Subjective cues:
"Mahigit neng pilan
banwa ing keng
arung na" as
verbalized by the
SO
Objective cues:
Facial mask
Self-focusing
Reduced
interaction with
people
Guarding behavior
restlessness
Chronic pain r/t
Chronic physical
disability AEB
facial grimace, self-
focusing, guarding
behavior and
restlessness
Chronic pain is
unpleasant sensory
and emotional
experience arising
from actual or
potential tissue
damage or described
in terms of such
damage, constant or
recurring without an
anticipated or
predictable end and
duration of greater
than 6 months.
Chronic pain may
be classified as
chronic malignant
pain or chronic
nonmalignant pain.
In the former, the
pain is associated
with a specific cause
such asnasopharyngeal
cancer. A tumor that
presses on bones,
nerves, or organs
can cause pain.
After 4 hours of NI,
the patient
verbalizes
acceptable level of
pain relief and
ability to engage in
desired activities.
Establish rapport
Evaluate pain
behaviors
Encourage pt to
take medicine
religiously
Note lifestyle
effect of pain such
as depression
Assist client to
learn breathing
techniques
to gain
cooperation
to determine
client's response to
chronic situation to lessen pt's
suffering from his
chronic pain
to know the
contributing factor
of his chronic pain
condition
to assist in muscle
and generalized
relaxation
28
8/14/2019 Case Study (Nasopharyngeal Cancer)
29/31
Disturbed Energy Field
Assessment Nursing DiagnosisScientific
ExplanationObjectives
Nursing
InterventionsRationale Evaluation
Subjective cues:
Balamu pane kung
mapagal
panamdaman, as
verbalized by the
patient.
Objective cues:
appears weak
low tone speech
compromised
concentration
Disturbed energy
field related to
slowing of energy
flow as manifested
by the pt. appears
weak, with low tone
speech, and with
compromised
concentration
secondary to illness.
Disruption of the
flow of energy
surrounding a
persons being that
results in a
disharmony of the
body, mind, and/or
spirit.
After 3 hours of
nursing intervention,
the pt. will verbalize
a sense of relaxation
as evidenced by the
pt. appears strong,
high toned speech
and the ability to
concentrate.
establish rapport
monitor and
record VS
advise pt. to haveadequate rest
encourage pt. to
eat foods rich in
carbohydrates
advise pt. to do
deep breathing
advise pt. to take
adequate fluid
intake
encourage pt. to
rest between
activities
allow pt. to have
period of
independency
to gain
cooperation
for baseline data
to regain strength
to increase energy
level
to promote energy
to prevent
dehydration
to promote energy
and regain
strength
to strengthen own
inner resources
29
8/14/2019 Case Study (Nasopharyngeal Cancer)
30/31
VIII.Discharge Plan
Topic: How to achieve health and wellness.
Time allotment: 1 hour
Venue: At the Eastwing of AMC; room 207
Objective Content Time Allotment Teaching Strategy Evaluation
After 1 hour of health
teachings, the patient
will be able to verbalize
understanding regarding
topics that are given.
Teaching
patient:
the right
nutritious
food
especiallythe
importance
of takingiron with
regards to
her present
condition.
to have an
adequate
exercise
every day
to have a
proper
hygiene topromote
wellness.
20 mins.
15 mins.
15 mins.
Discussion
----------
30
8/14/2019 Case Study (Nasopharyngeal Cancer)
31/31
IX.Learning Derived
Comparatively, our rotation in Angeles Medical Center is much different from the previous
rotations we had. Since it is a private hospital, all of us experienced the so called culture shock
because we just had our duties from government/district hospitals. The setting in AMC is much
ideal considering the more advanced facilities and equipments it has.
The hospital staff is able to balance consideration and appropriate interventions to each and
every patient.
We have learned that the clients status in life should not be the basis of our fullness in rendering
services to them. After all, everyone deserves a fair treatment whatever aspect it may be.
Top Related