Patient With Gastric Cancer

8/17/2019 Patient With Gastric Cancer

1/17

Ain Shams – University

Faculty of Nursing

2

nd

term Master2014

Case study aboutPatient with

"Gastric Cancer "

Preared !y"#

$afaa %amdy Mohammed atta

Under suervision of"#

Prof& 'r ( )lea

1


2/17

ObjectivesAt the end of this case study, I will be able to:

General objectives:

To provide the patient with high quality of care based on

accurate assessment & scientific nowledge!

"pecific objec ives:

#! To perform patient assessment!

$! To acquire nowledge about disease process and its

complication!

%! To accept acquire nowledge about disease process

and its complication!

! To gain nowledge about ideal nursing care plan for

this patient!

'! To establish goals or outcome criteria!

(! To implement the stated nursing care plan to

achieve e)pected outcomes!

*! To provide the patient health education

&rehabilitation after return to home!

2


3/17

+ut lines:

1& *easons of atient selection&

2& +ntroduction&

,& -idemiology&

4& )vervie. one the anatomy and hysiology of the affected system&

/& Patient 'emograhic data&

& Past and resent Medical history of current illness&

& omarison !et.een atient disease3 .hich already clinically

resent and .hat in the tet!oo5&

+ncluding 6he high#ris5 grou and age&

ommon site&

Predisosing factors 7auses8&

Patho hysiology&

linical Manifestations&

6he 'iagnostic -valuations&

'iagnostic rocedures&

9a!oratory +nvestigations&

6he comlications&

6he Management&

Medical Management&

Surgical Management&

Nursing Management&

8 omrehensive Nursing care lan for the atient for already

clinically eisted %ealth ro!lems&

8 *eha!ilitation rogram for this atient&

3


4/17

Reasons for patient selections:-

• 6he atient case .as critical3 reached to a serious comlicated

late stage of disease :ancer stages: and %e Needs for

comrehensive Nursing care more than other atient .as&

• + am interested in this atient;s 'iagnosis studying and

ma5ing a correlation !et.een the tet!oo5 and .hat really

.ith the atient case&

• 6he affected system :'igestive system :stomach: is more

sensitive human !ody art Need for secific consideration&

+ntroduction"

aosi?s

sarcomas83

@+S6s3 carcinoids3 and suamous cell carcinomas

2 distinct histologic su!tyes of gastric adenocarcinomas" intestinal3

diffuse

B +ntestinal tye – retained glandular structure3 more localiCed

B 'iffuse tye – no glandular structures3 more sread out

-idemiology

D $orld.ide" fourth most common cancer3 2nd leading cause of

cancer death

D +n the US" 14th most common cancer3 th most common cancer

death

D +ncidence of intestinal tye has declined raidly over the recent fe.

'ecadesE 'ue to invention of refrigerators3 .ith !etter food storage

and

*educed need for salt#!ased reservation&

4


5/17

D +ncidence of diffuse tye has declined more gradually

+ncidence of diffuse tye has declined more gradually

D +ncidence of distal gastric cancers has decreased3 !ut roimal

7cardiac8

ancers have increased 7some roose that these cancers are a

searate

-ntity3 more closely resem!ling arrett?s associated esohageal

adenocarcinoma8&

Overview on the anatomy and

physiology of the aected part

"stomach"

5


6/17

+t is located on the uer left uadrant of the a!dominal cavity to

the left of liver and in front of the sleen&

+t is a hollo. muscular organ&

Although it is a art of the alimentary canal3 it is not a tu!e !ut it isa sac etend from the esohagus to the duodenum of small

intestine&

6he stomach is consisting of three arts fundus3 !ody and ylorus&

+t has t.o shincters ardiac shincter .ith esohagus&

Pyloric shincter .ith duodenum&

+t has four layers :lining layers:&18 Mucous mem!rane contain glands3 .hich secrete 'igestive

Guice as esinogen and %cl&

6hose glands called gastric its&

28 Su! mucous coat3 .hich contain !lood caillaries and hold

layers together&

,8 Muscular layer .hich resonsi!le for eristalsis motion&

48 Fi!rous layer .hich line the eritoneum cavity&

6he stomach has mucosa aeared .rin5led3 folded .hen !e emty

called *uga .hich flattened out and !e eanded as the stomach is

filled .ith foods&

6he stomach store and mies food .ith gastric secretions as %cl&

Not only for 'igestion :rea5ing 'o.n to !e more a!sor!a!le

comonent mainly 'igestion of roteins and roduction of intrinsic

factor .hich needed for vit iC a!sortion in ileum:

+n addition3 aid in destruction of most ingested !acteria&

6he 'igestion rocess on the stomach influenced !y @astric

secretions and gastric motility .hich regulated !y#

a8 %ormonal *egulation"#

As @astrin .hich stimulated !y gastric distention !y food&

Stimulate gastric glands to increase secretion

6


7/17

)f gastric3 Guice mainly %cl&

+ncrease motility3 constriction of cardiac shincter

+n addition3 *elaation of yloric shincter&

!8 Neuron # *egulation"#

Para # symathetic :A cetyle choline:

Stimulated !y sight – smelling of foods3 che.ing

Alternatively3 stomach distention

Stimulate gastric gland to secrete gastric acids

And increase or decrease shincter tone&

c8 9ocal *egulator as %istamine" .hich stimulate gastric gland to

increase gastric acid roduction&

The patient Demographic Data:-

• Patient Name" Shehata Mohammed Mohammed&

• Age" 4 years& Se" Male&

• -ducation "+lliterate

• *eligious" Muslim

• )ccuation" farmer

• Marital status" Married and has three si!lings 72 sons and

daughter8&

• 'ate of admission" 10(4(2014&

• Admitted from" outatient deartment 7)P'8&

• Stay eriod" 1/ day&

-r.sent /istory :

• 'iagnosis( Present illness" Gastric Cancer •

7


8/17

• *easons of admission " :hief comlains:

B Severe a!dominal ain in left uer Huadrant&

B Persistent sever vomiting&

Associated signs and symtoms

Bloss of aetite&

B Pala!le gastric Mass&

BNoted mar5ed loss of .eight leading to cacheia&

Onset / Duration / Frequency:

The patient condition started from 8 months ago withpersistent vomiting then patient developed

Hematemesis (Fresh lood! with palpale gastric

"ass

Predisposing factors: diet rich with salted – smoked

food.

Low fruits Diet intake.Ecessive !eavy smoking for more than # years

$%eliving measures and its eect&

History :-

"edical:

-Diagnosis / Duration:

From 2 years ago the atient felt .ith sever ain in the left leg

com!ined e ale to .hite color of etremities and very .ea5

eriheral ulse on this lim!&

6 angiograhy .as made for the atient left lim!3 .hich .as

revealed .ith throm!otic occlusion of left eternal iliac ( left

common femoral artery&

8


9/17

:@astric arcinoma: too5 *evealed endoscoic iosy&

A!dominal #6 .as done *evealed !y

%eatic focal lesion&

Prostatic enlargement&

9eft *ectus sheath lioma&

Medical Diagnosis"#

Pyloric o!struction secondary to antral malignant mass

Metastatic to liver&

Alternatively3 @astric Adeno#carcinoma e liver Metastasis&

• 6he Medical staff 'ecided that the atient not fit for surgery3

chemotheray3 or *adiotheray&

And %e Need for alliative Medical care as

%ydration .ith continuous +&I fluids&

Antacids Medication and anti#emetics&

Pain 5illers As 6ramadol&

one scan&

Surgical"

Name of surgery ( 'urationJtonsillectomy at age of 1/yrs

Allergy history" N)JJJJJJJJJ

Family history" '&M&

#'iagnosis ( *elation" his mother&

9ife style ha!it" Diet rich .ith salted – smo5ed food&

9o. fruits 'iet inta5e&

-cessive %eavy smo5ing for more than 20 years

Patient?s hysical assessment

1- *esiratory system

sever dyspnea .

Mild pleural effusion with crackles chest sound.

9


10/17

2#ardio#vascular system

Anemia&

3#Periheral vascular asent femoral and dorsalis pedis pulses of

the left le!.

4"Neurological assessment se#er ack pain$ %ender upper dorsal

spine.

&rowsiness.

A!itation and irritailit'.

/#@astro#intestinal system"

(alpale enlar!ed stomach with succession splash )e#er e*cessi#e lackish #omitus.

+hronic constipation.

Mild hepatome!al' as ametasis to li#er.

6"Urinary system ,li!uria and d'suria.

#Musculos5eletal system Malaise and easil' fati!ailit'.

Moile with assistance of other

K# S5in assessment"

Boor s5in turger

Bale in color

Bhot and dry s5in


11/17

1,#

Mouth########################################################################

################

14# Nec5" short nec5 1/# Activity and rest" limited acti#it' due to a!e chan!e and his

illness.

'efinition of disease" a!normal and unregulated gro.th of thecells that ma5e u the stomach&

Comparison between patient disease,

which already clinically present and

what in the textbook:

7 1 8

% i g h

* i s 5

g r o u

Men have high incidence of

gastric cancer than .oman

6he occurance incidence

!et.een 40 0 years of age&

@astric cancer has high

incidence .ith atient has familialhistory of @+&6 cancers

Alternatively3 .ho has genetic

lia!ility as Mutation of :6umor

suressor gene:E

6he atient is 4 years

old

%e has No familial

%istory of cancer&

6here is No validated

chec5 u for genetic lia!ilityor Not&

11


12/17

7 2 8

o m m o n

s i t e

Pylorus or antrum and adeno

carcinoma&

@astric out let :Pyloric:

o!struction 2nd ry to

malignant antral Mass&

7 , 8

P

r e d i s

o s i n g

f a c t o r s

'iet high rich .ith salted

smo5ed – ic5led foods&

hronic +nflamation of the

stomach&

%elico#!acterial +nfection&

9o. fruits#vegeta!le diet

inta5e&

Perincious anemia&

achlorhydria&

Smo5ing&

@enetic lia!ility&

Previous su!total gas trectomy&

'iet high rich .ith salted

– smo5ed food&

9o. fruits 'iet inta5e&

-cessive %eavy smo5ing

for more than 20 years&

7 4 8 P a t h o #

h y s i o l o g y

B Most gastric cancers are Adeno#

carcinomas occur on any ortion

then infiltrated to the surrounding

mucosa&

B 6he liver – ancrease –

esohagus and duodenum are the

most affected sites at time ofdiagnosis&

B 6he atient has Adeno#

carcinoma Metastatic to the

liver&

12


13/17

7 / 8

l i n i c

a l

M a n i f

e s t a t i o

n

B -arly stage of gastric cancer

symtoms ain relieved !y

Antiacids as !enign ulcers&

B Progressive – late stage ofdisease symtoms are "#

'ysesia 7+ndigestion8&

Anoreia e early satiety&

$eight loss&

Severe a!dominal ain 7!loating

after meals8 Nausea – vomiting#constiation anemia&

B 6he atient had

develoed the rogressive

symtoms of gastric

cancer& Severe a!dominal ain&

Sever ecessive !lac5ish

vomiting&

9oss of aetite&

sever .eight loss

cacheia

hronic constiation&

Anemia&

Pala!le gastric Mass&

Malaise and easily

fatiga!ility&

'ro.siness&

'ysnea&

Agitation and irrita!ility&

7A8 B Physical eamination "#

Advanced gastric cancer may !e

.ith ala!le Mass&

Ascites and heato megaly as a

metastasis to liver&

Pala!le Nodules around

um!ilicus called Sister Marry

oseh;s Nodule are a sign of @+6

Malignancy&

7A8 B Patient has ala!le

gastric :uer left: Mass&

B Patient has Mild

%eatomegaly and Mild

leural effusion&

13


14/17

7 0 8 ' i a g n o s t i c e v a l u a t i o n s

78B 'iagnostic rocedures "#

18 -sohago – gastro – duodena –

scoy for iosy and cytology

.ashing&

28 arium #*ay of uer @&+&6

6ract&

,8 -ndo – scoic ultra sound

for limiting deth and lymh node

involvement&

48 omuted 6omograhy on

a!domen ( chest ( elvis

6o detect staging of gastric

cancer&

/8 one scan to detect Metastasis

to the one&

78 B -ndoscoic iosy .as

ta5en from atient3 .hich

referred .ith :gastric

carcinoma:&B Uer @+6 -ndoscoic

ultra sound *evealed .ith

gastric outlet o!struction 2

ry to Malignant antral

Mass&

B A!dominal &6 .as Made

*evealed .ith

%eatic focal lesion&

-nlarged rostate&

9eft *ectus sheeth

lioma&

78B 9a!oratory

+nvestigations"#

6umor Mar5ers as

Alha feto rotein&

ar!ohydrate antigen&

&&

9iver function and *enal

function&

oagulation rofile&

Arterial lood gases&

-lectrolytes +nvestigation&

+nvestigation *esults

$ #10O


15/17

7 8

o m l

i c a t i o n

B Metastasis to the surrounding

a!dominal organs as liver –

ancrease – esohagus – small

intestine&B Metastasis through lymhatic

system to the eritoneal cavity

then to 5idney or rain or ones&

B 6he t develoed

Metastasis to the liver

:heatic focal lesion:

15


16/17

7 K 8

M a n a

g e m e n

t

7A8 B Surgical Management "#

A total gastrectomy for

aresecta!le tumor on the Mid

ortion or !ody of the stomach&

6he enti5 stomach is removed

.ith lo.er ortion of esohagus

and suorting mesentery and

lymh nodes&

*econstruction of @&+&6

erformed !y Anastomosis

!et.een esohagus and Gugenum:esohago eGunostomy:

A radical su!total gastrectomy

is erformed for *esecta!le

tumor in the middle and distal

ortion of the stomach&

A roimal su!total

gastrectomy for *esecta!letumor in roimal ortion of

stomach or cardiac&

Palliative rocedures As gastric

or esohageal !yass (

@astrostomy ( GeGunostomy

alleviate symtoms as Nausea3

vomiting&

+f there is Metastasis to liver to

achieve !etter uality of life&

7A8 6he t had not made

7*eceived8 any surgical

+ntervention according the

medical staff oinion as heis not fit for any surgical

intervention&

16


17/17

78 B Medical Management "#

hemotheray "# if surgical

Not offer cure As alliative

single – agent chemo theraeutic

medication +nclude

Fluoro uracile

islatin :latinol:

Adriamycin& -toohos&

Mutamycin&

*adiotheray" # mainly used as

alliation for t .ith o!struction3

sever !leeding3 sever ain

secondary to tumor&

78 B 6he t hadn;t "#

receive any chemo#*adio

theray According to the

Medical staff oinion :6het is not fit for :hemo#

*adio theray:

17

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Patient With Gastric Cancer