CASE PRESENTATION(Nasopharyngeal Carcinoma)

RLE GROUP 9

ABIOG, Danah Franz B.

ABLAY, Irvin Phillip G.

AGANAN, Angelica Ann I.

ALCANTARA, Krislyn

ALARCON, Jade

AMANSE, Jotessa Maria Emerlita I.

Area of Exposure: MSH

Our Lady of Miraculous Medal Unit

INTRODUCTION

Nasopharyngeal carcinoma (NPC) is a cancer originating in the nasopharynx, the uppermost region of the pharynx or "throat", where the nasal passages and auditory tubes join the

remainder of the upper respiratory tract. NPC differs significantly from other cancers of the head and neck in its occurrence, causes, clinical behavior, and treatment. It is vastly more common in certain regions of East Asia and Africa than elsewhere, with viral, dietary and

genetic factors implicated in its causation.

It is classified as a malignant neoplasm, or cancer, arising from the mucosal epithelium of the nasopharynx, most often within the lateral nasopharyngeal recess or fossa of Rosenmuller.

There are three microscopic subtypes of NPC: a well-differentiated keratinizing type, a moderately-differentiated nonkeratinizing type, and an undifferentiated type, which typically

contains large numbers of non-cancerous lymphocytes (chronic inflammatory cells), thus giving rise to the name lymphoepithelioma. The undifferentiated form is most common, and is most

strongly associated with Epstein-Barr virus infection of the cancerous cells.

It most often affects people who are between 30 and 50 years of age. Men are more likely to have nasopharyngeal cancer than women. People are most likely to get this cancer if their

ancestors came from southern China, particularly Guangzhou or Hong Kong. People are also more likely to get this cancer if they 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 and roots) during early childhood may increase

the risk of getting this form of cancer.

PATIENT’S PROFILE

Name: Ms. 209

Age: 33

Sex: Female

Address: Pili, Camarines Sur.

Civil Status: Single

Occupation: Roman Catholic

Birth date: January 5, 1977

 

Ms. 209 used to be very physically active prior to the diagnosis of NPC (she usually works for about 16 hours 3x a week)

PATIENT’S HISTORYPrevious illness: NO HISTORY

Health History : Nasal congestion on the left side

TX Medication: Plasil

Past illness/ hospitalization

Sore throat

Epistaxis

Plaza Medica, BMC, Perpetual Help Manila

Allergies: None

DATE OF ADMISSION (V/S, CC WHY ADMITTED)

BP: 90/70 mmHg

Pulse rate: 65 bpm

RR: 20 bpm

Temperature: 36.4°C

Date of Admission: Feb, 21 2010 5:00pm

Room: MSH 209 MEDAL UNIT

Ms. 209 was admitted to the hospital for continuation of the CHEMOTHERAPY.

Attending Physician: Dr. Malanyaon

Gordon’s 11 Functional Health Pattern

A. Health Perception / Health management Pattern

As stated by Ms. 209, she has no vices such as alcohol, tobacco or drug. She is quiet conscious of his health lifestyle.

B. Nutritional Metabolic Pattern

Previously Ms. 209 has no difficulty in chewing and swallowing certain foods.

She likes to eat salt-preserved foods especially fish

C. Elimination Pattern

Ms. 209 has a normal bowel habits

D. Activity Exercise pattern

She is a Clinical Instructor in CSPC from Monday to Wednesday and a nurse on duty from Thursday to Saturday. She loves to work for a long time for she is a workaholic person and the breadwinner of their family.

Ms. 209 is currently not in pain. She has no past history of any illness she is independent to his grooming and other basic activities for herself.

E. Self- Rest Pattern

Ms. 209 has insufficient time for sleeping due to her fully loaded schedule. She almost stay until 12 midnight for preparation of her lecture that made her time insufficient to rest.

F. Sensory Perceptual Pattern

VISION: has a clear vision and is not wearing eye glasses and contact lenses

HEARING: Ms. 209 does not wear any hearing aid.

SMELL: She has difficulty in smelling due to her nasal congestion

TOUCH: No stated sensory problem

TASTE: Mrs. 209 has difficulty in tasting foods. She states that she only has one taste in all kinds of food she take.

G. Cognitive Pattern

Mrs. 209 actually has no difficulty in speaking but her throat becomes dry every time she talks for a long time.

. Role Relationship Pattern

• Ms. 209 is single and she is the financer of her family. She has a good relationship with her family

I. Self Perception- Self Concept Pattern

• Ms. 209 is conscious when it comes to herself especially her body appearance due to the effects of chemotherapy

• She is also wary of her hair loss due to the effects of the surgery but she has a positive outlook when it comes to herself.

J. Coping Stress Tolerance Pattern

• Ms. 209 states that she is regularly scanning her books to relieve stress and do other recreational activities such as exercise painting etc. to cope from stress.

K. Value Belief Pattern

• Religious preference is Roman Catholic. She has a strong faith in God.

Anatomy and Physiology

RESPIRATORY SYSTEM

The respiratory system consists of the nasal cavity, pharynx, larynx, trachea, bronchi, and lungs.

Upper respiratory tract refers to:

Nasal cavity, pharynx, and associated structures.

Lower respiratory tract refers to:

Larynx, trachea, bronchi, and lungs

In humans, inspiration and expiration usually takes place through the nose.

The diaphragm and the muscles of the thoracic wall accomplish respiratory movements.

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.

Sinuses The sinuses are small cavities that are lined with mucous membrane within the bones of the skull.

Pharynx The pharynx, or throat carries foods and liquids into the digestive tract and also carries air into the respiratory tract.

Larynx The larynx or voice box is located between the pharynx and trachea. It is the location of the Adam's apple, which in reality is the thyroid gland and houses the vocal cords.

Trachea The trachea or windpipe is a tube that extends from the lower edge of the larynx to the upper part of the chest and conducts air between the larynx and the lungs.

Lungs The lungs are the organ in which the exchange of gasses takes place. The lungs are made up of extremely thin and delicate tissues. At the lungs, the bronchi subdivides, becoming progressively smaller as they branch through the lung tissue, until they reach the tiny air sacks of the lungs called the alveoli. It is at the alveoli that gasses enter and leave the blood stream.

Bronchi

The trachea divides into two parts called the bronchi, which enter the lungs.

Bronchioles

The bronchi subdivide creating a network of smaller branches, with the smallest one being the bronchioles. There are more than one million bronchioles in each lung.

Alveoli

The alveoli are tiny air sacks that are enveloped in a network of capillaries. It is here that the air we breathe is diffused into the blood, and waste gasses are returned for elimination.

The "nasopharynx" is the highest portion of the throat, behind the nose. When we breathe through our nose, the air then goes into the nasopharynx. At the top of this area, close to the brain, is a special "sieve" (cribriform plate) where smells are made into nerve signals and conducted up into the brain to be recognized. Air breathed through the nose is "filtered" by the tonsil tissue in the lower nasopharynx; air carried germs are slammed directly into these tonsils and destroyed by the body's immune system. Cancer in the nasopharynx, while rare in America, is more common in the Orient.

Thus, problems in the nasopharynx can damage these nerves (which come from the brain and are called "cranial nerves") leading to eye or facial paralysis or blood distribution problems in the brain. The nose is in front of the nasopharynx and the throat is downward. The most dangerous places for the cancer to grow are upward and backward, that is into the brain. People usually go for long periods before the cancer is diagnosed, since many symptoms are much more often due to non-cancerous causes.

The nasopharynx is located behind the nose and is the upper part of the throat (also called the pharynx). The pharynx is a muscular tube about 5 inches long. It starts behind the nose and goes down to the neck to become part of the tube that divides to the esophagus (toward the stomach) and the trachea (toward the lungs). The upper 2/3 of the pharynx has an inner lining, or "mucosa" of a special type of cell, called "squamous” cells. 90% of cancers are "squamous cell carcinomas", while the remaining 5% are melanomas, lymphomas, and sarcomas. Air and food pass through the pharynx on the way to the windpipe (trachea) or the esophagus. The nostrils in the nose lead into the nasopharynx.

PATHOPHYSIOLOGY

DEFINITION

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the nasopharynx.

SIGNS AND SYMPTOMS:

-Anorexia -Shortness of breath

-Chest wall pain -Venous stasis

-Chest pain - Weight loss

-Hoarseness of voice -Distended neck veins

-Hyperglycemia -Atelectasis

-Hyperkalemia -Dyspnea

-Hyperetension

-Hypervolemia

-Immunosupression

-Osteoporosis

-Pneumonia

MEDICATIONS

Brand name: Plasil

Generic name: Metoclopramide

Classification: (Therapeutic) Antiemetic

Action

Physiologic mechanism

Decrease nausea and vomiting

Decrease symptoms of gastric stasis

Pharmacologic mechanism

Blocks Dopamine receptors in chemoreceptor trigger zone of the CNS

Stimulates motility of the upper Gastrointestinal tract and accelerates gastric emptying.

Indication

Management of esophageal reflux

Treatment and prevention of postoperative nausea and vomiting

Contraindication

Gastrointestinal hemorrhage, mechanical obstruction or perforation, pheochromocytoma, epileptics.

Nursing considerations

Assess patient for nausea, vomiting, abdominal distention, and bowel sounds before and after administration

May cause drowsiness

Advise patient to avoid concurrent use of alcohol and other CNS depressant while taking this medication.

Advise patient to notify health care professional immediately if involuntary movement of eyes, face or limbs occurs.

Adverse Reactions

Restlessness, drowsiness, fatigue and lassitude. Extrapyramidal symptoms, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, rash including urticaria, bowel disturbances, increased prolactin level, and gastroparesis.

NURSING CARE PLANS

Disturbed Energy Field

Asssessment Nursing Diagnosis

Scientific Explanation

Objectives Implementation

Rationale Evaluation

Subjective

Malaen an sakuyangpagmate, as verbalized by the patient

Objective

appears weak

low tone speech

compromised concentration

Disturbed energy field related to slowing of energy flow as manifested by the patient appears weak, with low tone speech, and with compromised concentration secondary to illness.

Disruption of the flow of energy surrounding a person’s being that results in a disharmony of the body, mind, and/or spirit.

After 5 hours of nursing intervention, the patient will verbalize a sense of relaxation as evidenced by the patient appears strong, high toned speech and the ability to concentrate.

Establish rapport

Monitor vital signs

Encourage patient to eat foods rich in carbohydrates

Advise patient to take adequate fluid intake

Allow patient to have a period or time of independency

To promote interaction

For obtaining baseline data

To increase the level of energy

To avoid dehydration

To strengthen her inner resources

After 5 hours of nursing intervention the patient :

Showed and verbalized sense of relaxation and well being.

Displayed reduction in severity and frequency of symptoms

DISCHARGE SUMMARY

Medications Exercise Treatment Health Teaching

Out Patient Diet Spiritual/Social/Sexual

Maintenance of Plasil 10mg TID.

Have a regular 30 min exercise regularly

Massage Therapy-to relieve stress and to relax the patient.

Follow faithfully the prescribed medicine.

Chemotherapy, in its most general sense, is the treatment of

Disease by chemicals,especially by killing micro-organisms or cancerouscells.

Radiotherapy, Radiotherapy is the use of high energy x-rays and similar rays (such as electrons) to treat disease. Radiotherapy works by destroying the cancer cells in the treated area.

Prevention

Teach the client to cut back in the amount of salt-cured foods and preserved meats.

Teach the right nutritious food especially the importance of taking the iron with regards to her present condition.

To have a proper hygiene to proper wellness.

Continue the remaining 3 cycles of chemotherapy then have her follow up check up after 3 months.

Religiously take the prescribed medicines.

DAT

(Diet as tolerated)

Maintaining dietary nutritional needed for the patient

Always pray for the guidance of the Lord. Spiritual health affects the wellness of an individual greatly. Strengthen relationship with Lord by showing love and respect to the people around you.

Take time for yourself when you need it.

Support Network.

REFERENCES

Nurses Pocket Guide 11th Edition

Nurses Handbook of Health Assessment 6th Edition

MIMS 115th Edition 2008

Internet

• www.wikipedia.com

• www.medscape.com

• www.google.com