Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA
A Case Study
February 10, 2015
TABLE OF CONTENTS I. Introduction
III. Patients Profile
IV. Anatomy and Physiology
VI. Laboratory Examination Results
VII. Gordons Assessment
VIII. Nursing Care Plans
IX. Drug Study
X. Discharge Planning
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 and roots) 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 layperson and a rare case that a nurse would encounter. Acquisition of cognitive knowledge regarding the topic would enable there searchers in providing optimum care for clients suffering such and in delivering appropriate interventions that would promote health and wellness for the client.
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.
After the completion of this case study, the nurse will be able to:
1. Understand the current statistics and latest trend regarding Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA
2. Describe factually, the personal and pertinent family history of the patient and relate it to the present condition.
3. Perform comprehensive physical assessment.
4. Trace the book-based and client-centered pathophysiology of Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA
5. Determine the predisposing and precipitating factors and the signs and symptoms and relate to the disease process.
6. Enumerate and describe the diagnostic and laboratory procedures as well as the nursing responsibilities in relation to the disease condition
7. Enumerate the different treatment modalities and their indication specifically for the patients condition.
8. Identify the pharmacologic treatment provided to the patient, relate the actions of each drug with the disease process and evaluate the patients response to the medications given.
9. Identify nursing diagnoses, formulate short-term and long-term goals, carry out appropriate interventions and evaluate the plan.
10. Appraise the effectiveness of medical and surgical nursing management in treating the patient.
11. List the preventive measure for the occurrence of Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA for the benefit of the general public.
After the completion of this case study, the patient will be able to:
1. Report understanding of the disease process.
2. Understand the indications of the different diagnostic procedures and medical management involved in her care.
3. Cooperate with the necessary medical and nursing interventions.
4. Adhere with the health teachings provided.
5. Understand the different ways of health promotion and prevention in relation to the disease condition.
6. Demonstrate improved conditions as evidenced by absence of further complications.
III. PATIENTS PROFILEName: Mrs. Ilong
Age: 31 years old
Birthday: July 9, 1983
Civil Status: Married
Date Admission: February 1, 2015
Time of Admission: 8:30 AM
Chief Complaint's: Consultation for Radiotherapy
Initial Diagnosis: Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA (T2N2MX) s/p 7 sessions of Radiotherapy.
Final Diagnosis: Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA (T2N2MX) s/p (28 sessions); s/p ChemotherapyHISTORY OF PAST ILLNESS
Mrs. Ilongs did not have any problems at the time of her birth. Her immunization record is complete. According to Mrs. Ilong she is not allergic to any drugs, foods or other environmental agents. She never experienced allergic rhinitis. As stated by Mrs. Ilong, her last check-up was done last March 2014 when she experienced hearing loss. Two weeks after her check-up she experienced epistaxis and difficulty in breathing. She undergone biopsy and it was shown that she has tumor in the nose and it is stage II. Mrs. Ilong, did not take any medications in the month of June. Due to the persistence of the symptoms, she sought consultation last September 23, 2014, when she was first admitted at the nearest hospital in Western Visayas, with a chief complaint of difficulty in breathing and hearing. Prior to this, she undergone Radiotherapy last December 8, 2014 and Chemotherapy last January 23, 2015.
HISTORY OF PRESENT ILLNESS
Mrs. Ilong is not known hypertensive, not known diabetic. History of present illness started six months ago prior to admission when patient experienced hearing loss, bilateral. No other associated signs and symptoms noted. Due to persistence of the symptoms patient sought consultation at a private hospital in Iloilo, where patient was noted to have nasopharyngeal mass. Biopsy was done revealing nasopharyngeal carcinoma. Mrs. Ilong underwent seven sessions of Radiotherapy. Then she was referred to the Institution for completion of radiotherapy.
Physicians Physical Assessment done by the Resident on Duty (February 1, 2015, lifted from the patient's chart)
Height: 50 (160cm)
Weight: 38 kg
Vital Signs as follows:
T: 36.7 C PR: 92bpm RR: 18cpm BP: 100/60 mmHg SAO2: 97PHYSICAL ASSESSMENT:
Mrs. Ilong, Assessed/received patient lying on bed, awake, conscious, responsive, and coherent. With the following vital signs:Temperature: 37 C
Heart rate: 92 bpm
Respiratory rate: 20 bpm
Blood Pressure: 100/60 mmHg
Upon admission, Mrs. Bu Cool was placed on a regular diet.
SKIN> Pallor noted.
> Good skin turgor in both upper and lower extremities;