Nasopharyngeal Carcinoma Undifferentiated Type Stage IVA

A Case Study

February 10, 2015

TABLE OF CONTENTS I. Introduction

II. Objectives

III. Patients Profile

IV. Anatomy and Physiology

V. Pathophysiology

VI. Laboratory Examination Results

VII. Gordons Assessment

VIII. Nursing Care Plans

IX. Drug Study

X. Discharge Planning

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 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.

II. OBJECTIVESNurse-Centered

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.

Patient Centered

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

Nationality: Filipino

Religion: Baptist

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.

PHYSICAL ASSESSMENT

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:

GENERAL SURVEY

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

SAO2: 98

NUTRITIONAL STATUS

Upon admission, Mrs. Bu Cool was placed on a regular diet.

SKIN> Pallor noted.

> Good skin turgor in both upper and lower extremities; the skin returns to its previous state immediately after being tented.

> warm moist skin, no active dermatoses.

HAIR

> Hair is black and is evenly distributed.> Silky and smooth hair.

> No areas of hair loss noted.

> Thick hair strands.

NAILS

> Trimmed clean nails.

> Concave shaped; with a nail plate angle of about 160 degrees.

> Smooth in texture.

> Intact epidermal lining around the nails.

> Capillary Refill Test less than 3 seconds.

SKULL AND FACE

> Rounded (normocephalic and symmetrical with frontal, parietal and occipital prominences).

> Head size is appropriate to body size.

> No nodules or masses upon palpation.

EYES AND VISION

> Eyebrows and eyelashes are evenly distributed.

> Eyelids are intact.

> Sclera appears white.

> Pale conjunctiva.

> No discharges and discoloration noted.

> Blink reflex intact.

EARS AND HEARING

> Ears are symmetrical in size and in line with the outer canthus of the eyes.

> Color of ears is the same with the facial skin.

> No discharges and foul odor noted upon inspection.

> Pinna and ear canal are clean.

> Auricles are firm and recoil to previous state when folded.

> No nodules or masses noted upon palpation.

NOSE AND SINUSES

> Symmetric and straight.

> No watery discharges.

> Has a slow uneven breathing pattern.

> No tenderness masses and pain noted upon palpation.

> Oxygen inhalation attached.

OROPHARYNX (Mouth and Throat)

> Dry and pale lips noted upon inspection.

> Tongue is able to move freely

>slightly difficulty swallowing> Good oral hygiene.

NECK

> Jugular vein is not visible.

> Muscles are equal in size with the head centered.

> Slow muscle movement.

> Lymph nodes are not palpable.

CARDIOVASCULAR AND PERIPHERAL SYSTEM

> Skin color of palm of the hand and feet is pink.

> Pink nail beds upon inspection.

> Symmetric pulse volumes, full pulsations of peripheral pulses.

> Heart rate is 92 beats per minute.

> Blood Pressure is 110/70 mmHg.

> (Vital signs taken during the time of assessment on February 2, 2015 at 7:00 am).

Respiratory System

> Chest is symmetric.

> Skin and chest wall are intact and has uniform temperature.

> No tenderness and masses noted upon palpation.

> Regular breathing pattern

> Presence wheezing and crackles sound upon auscultation.

> Full and symmetric chest wall expansion.

BREAST AND AXILLAE

> Breasts are symmetrical in size; color is the same as with the abdomen.

> Both nipples are symmetrical in size.

> No discharges noted.

> No tenderness, masses, and nodules noted upon palpation.

ABDOMEN

> Abdominal skin is intact.

> Distended abdomen noted.

> Audible bowel sound upon auscultation.

> Abdominal dullness upon percussion.

MUSCULOSKELETAL

> Posture is good, able to stand straight and can walk alone properly but slowly.

> Movement of muscles is weak.

> Muscles in the upper extremities are weak.

NEUROLOGIC

> Patient has times of looking in the distance and is slow in response when a question asked.

> Patient was able to answer well when asked of her complete name, birth date and age.

URINARY SYSTEM

> Patient usually urinates 5 times a day.

REPRODUCTIVE SYSTEM

> The patient refused to be assessed with her external reproductive organ but she verbalized that she has minimal vaginal bleeding and complain of pain when secretions are expelled.

REVIEW OF SYSTEM

Integumentary System

The patient has no history of bruises in both upper and lower extremities.

Head

The patient had no history of any form of head injuries.

Eyes

Patient had no history of any eye problems.

Ears and Hearing

Patient had no history of smelly discharges on both ears, and no complaints of hearing impairment.

Breast and Axillae

The patient had no history of breast nodules, no enlargement, no tenderness, no pain and unusual discharges.

Respiratory System

The patient experienced slow irregular breathing patterns.

Cardiovascular System

The patient has a history of hypertension.

Genitourinary System

The patient had no history of any genital problems. Usually urinates 5 times a day.

Gastrointestinal System

The patient had no history of difficulty in defecation.

Musculoskeletal System

Patient has no history of joint pain.

Neurologic System

Patient had no history of any major mental problems but had episodes of mental absences.IV.ANATOMY AND PHYSIOLOGY

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 voice box) 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.

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 'broncho pulmonary 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 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:

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.

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.

Non-Modifiable 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

Modifiable 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 presence of 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. Difficulty in swallowing condition caused by the compression of the esophagus. Chronic Cough caused by sputum production brought by the irritation of the bronchioles. 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. Immunosuppression 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.V. PATHOPHYSIOLOGY

Schematic Diagram (Book-based)

SCHEMATIC DIAGRAM (CLIENT-CENTERED)

VI. DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnostic / Laboratory ProceduresDate Ordered

Date Results inIndications or PurposesResultsNormal ValuesAnalysis and Interpretation of results

1. Hematology test

Date ordered:

Febuary 2, 2015

Date of Results:

February 2, 2015

to see the hemoglobin content in the red blood cells

Blood Typing: O

Rh: (+)

Hemoglobin: 90 gms/L

Hematocrit: 0.30 gms/L

WBC count:

15.19 x 10^9/L

Segmenters: 0.90

Lymphocytes:

0.04

Monocytes: 0.06

Eosinophils; 0.00

Basophils

MCV: 76.6 fL

MCH: 23.9 pg

MCHC: 31

RDW: 16.11

Platelet count: 399 x 10^9 g/L

120-160 g/L

0.37 0.43 g/L

4-10 x 10^9 /L

0.55 - 0.65

0.25 - 0.35

0.03 - 0.06

0.02 - 0.04

0.00 - 0.01

80 - 100 fL

26 - 32 pg

32 - 36 g/dL

11.0 - 15.0

130.0 - 400.0 x 10^9 g/LThe blood type of the patient is Type O.

The patient is Rh+.

The result indicated that the hemoglobin (the iron-containing part of blood that carries oxygen to cells) level of the patient is very low, which may lead to secondary anemia.

The level of white blood cell count is very high since there are invading pathogens due to her condition.

The number of Segmenters is higher than the normal range.

The number of Lymphocytesis very low than the normal level.

The number of monocytes is within the normal range.

The eosinophils count is lower than the normal range.

The basophils count is on the normal range

The platelet count is within the normal range; therefore, there are no clotting complications that may occur.

2. Urinalysis

Date ordered:

February 2, 2015

Date of Results:

February 2, 2015

to determine signs of infections and abnormal bleeding.Color:

Dark yellow

Transparency:

Slightly turbid

PH: 6

SP Gravity:

1.010

Sugar: negative

Protein: negative

RBC: 2-5

Pus cells: 2-6

Epithelial cells:

few

Amorphous Urates: few

Mucus threads:

few

VII. GORDONS ASSESSMENT

A. Health Perception and Management

Patient can recall being completely immunized

Visits a doctor for consultation Takes OTC drugs and herbal medicationsB. Nutrition/Metabolism

Eats more of fruits and vegetables Eats dried /preserved fish Eats her meals three times a day

No allergies on foods

C. Elimination

Voids usually five times a day

Urine color is dark yellow

Defecates usually once a day during morning

D. Activity/Exercise

Patient does household chores

Able to bathe herself

She does simple exercises such as arm exercises by means of shaking and stretching

E. Sexuality/Reproductive

Married

A mother of 3 children

No history of STDs

F. Cognitive/Perceptual

Oriented to people, time and place

Responds to stimuli verbally and physically Able to read and write

College graduate In normal thought process

G. Roles/Relationship

Married

With 3 children

Well-supported by the family

Loves her family so much

H. Self Perception/Self-Concept

Hopeful to be relieve and treated

Manages to practice healthy lifestyle

I. Value/Belief

A Baptist Has a strong faith in God

Attends Sunday mass

J. Coping/Stress

No traumatic events experienced before

Copes up with problems by talking about it with the family and finds ways to resolve it together

K. Sleep/Rest

No difficulties in sleeping

Have enough rest intervals

L. Medication History

Herbal medications before admission

IX. NURSING CARE PLAN

1. Ineffective Airway Clearance

AssessmentNursing DiagnosisScientific

ExplanationObjectivesNursing InterventionsRationaleEvaluation

Subjective cues:

"Nahihirapan ako huminga pag nag sasalita ako" as verbalized by the patient.Objective cues:

Dyspnea Restlessness Use of accessory muscle Cough Nasal flaring Prolonged expiratory phase With Vital Signs taken:BP:100/60 mmHgPR: 92bpmRR: 18cpmT: 36.7 C SAO2: 97

In effective airway clearance r/t tissue necrosis located in nasal area AEB dyspnea, restlessness, use of accessory muscle, cough, and nasal flaringIneffective airway clearance is the inability to clear secretions or obstruction from the respiratory tract to maintain a clear airway in which partial of complete blockage of the breathing tubes to the lungs. Obstruction of the airway can be due to diffecrent causes including foreign bodies, allergic reactions, infections, anatomical abnormalities and trauma. The onset of respiratory distress may be sudden with caugh. There is often agitation in the early stage of airway obstruction.After 3 hours if NI, patient will be able to verbalize understanding of cause and therapeutic management regimen and demonstrate behaviors to improve or maintain clear airway.1. Establish rapport

2. Position head to facilitate airway

3. Elevate head of bed

4. Encourage deep breathing and caughing exercise.

5. Increase fluid intake

6. Support reduction/cessation of smoking1.To get the trust of the patient.

2.To maintain open airway in at rest or compromised individual

3.To take advantage of gravity decreasing pressure on the diaphragm and enhancing drainage.

4.To maximize effort in expectorating secretions

5.Hydration can help liquefy viscous secretions and improve secretion clearance.

6.To improve lung functionThe patient shall have verbalized an understanding of the cause and therapeutic management regimen and demonstrate behaviors to improve or maintain clear airway.

2. Impaired Physical Mobility

AssessmentNursing DiagnosisScientific

ExplanationObjectivesNursing InterventionsRationaleEvaluation

Subjective cues:

"Ang sakit ng katawan ko pag gumagalaw ako." as verbalized by the patient.

Objective cues:

with limited movements limited ability to perform gross/fine motor skills with difficulty turning with slowed movementsWith Vital Signs take:

BP:100/60 mmHgPR: 92bpmRR: 18cpmT: 36.7 C SAO2: 97

physical mobility related to decrease muscle strength a manifested by the patient's limited movements, limited ability to perform gross/fine motor skills, difficulty turining, 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 movements affects the performance of most activities of daily living(ADLs.)After 3 hours of nursing intervention, the patient. will be able to participate in ADLs and desired activities as evidenced by an increase in the patient's movements, ability to perform gross/fine motor skills, can turn easily, and an increase in motor agility.1. Establish rapport

2. Monitor and record vital signs

3. Advise patient to have adequate rest

4. Encourage patient to eat food rich in carbohydrates.

5. Advise patient to do deep breathing.

6. Advise patient to have adequate fluid intake.

7. Encourage patient to rest between activities.

8. Encourage patient to engage in ROM exercise.1. To gain cooperation

2. For baseline data.

3. To regain strength.

4. To increase energy level.

5. To promote energy.

6. To prevent dehydration.

7. To promote energy and regain strength.

8. To reduce fatigue.The patient shall have participated in ADLs and desired activities as evidenced by an increase in the patient's movements, ability to perform gross/fine motor skills, can turn easily, and an increase in motor agility.

3. Fatigue

AssessmentNursing DiagnosisScientific

ExplanationObjectivesNursing InterventionsRationaleEvaluation

Subjective cues:

"Nanlalambot ako." as verbalized by the patient.

Objective cues:

appears weak decrease ability in performing activities with compromised concentration With Vital Signs take:

BP:100/60 mmHgPR: 92bpmRR: 18cpmT: 36.7 C SAO2: 97Fatigue 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 on both acute and chronic illness, it may have protective function that keeps the person from sustaining injury from overwork in a weekend 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 evidence by the patient appears strong, an increase in the ability to perform activities, and has the ability to concentrate fully.1. Establish rapport.

2. Monitor and record vital signs.

3. Encourage patient to sit instead of standing in performing activities.

4. Advise patient to have adequate rest.

5. Encourage patient to perform ROM exercise.

6. Encourage patient to eat carbohydrates containing food.

7. Encourage patient to do focus breathing.

1. To gain cooperation

2. For baseline data.

3. To conserve energy

4. To regain strength.

5. To reduce fatigue.

6. To increase energy level.

7. To promote energy.

The patient shall have verbalized an understanding regarding the health teachings on how to conserve energy as evidence by the patient appears strong, an increase in the ability to perform activities, and has the ability to concentrate fully.

X. DRUG STUDY

Name of drugs

Generic name

Brand nameDate Ordered, Date taken, date changes, D/CRoute of Admin. Dosage and frequency of administration.General actionIndications/ purposesClients response to medication with actual side effect

Generic name:

Co-AmoxiclavBrand name:

AmoclavDO: 02/01/15DT: 02/01/15

625 mg/cap 1 cap BID POInhibits enzymes involve information of peptidoglycan layer of bacterial cell wall

No effect on human cell wall bactericidal; only works on dividing bacteria

Well absorb enter ally

Use in treating lower respiratory tract infection, Otitis media, sinusitis, skin and soft tissue infection, and UTI.The patient is still within medication course due to her WBC result of 15.19.

Generic name:

EPOBrand name:

DO: 02/01/15DT: 02/01/15

XI. DISCHARGE PLANNING

MEDICATION:

Instructed to:

Take medications as prescribed by the physician

Ensure the right route in taking the medications

Take the medications on time and without lapse

EXERCISE:

Instructed to:

Do exercises within limits

Avoid the strenuous ones

Active range of motion exercises

Deep breathing exercise

TREATMENT:

Instructed to:

Follow the prescribed treatment regime

Comply with the laboratory examination

Comply with the diagnostic examinations

HYGIENE:

Encouraged to bathe daily

Instructed to do proper hand washing prior to and after handling the patient

OUTPATIENT ORDERS:

Encouraged to have frequent medical visits

Taught to report such as difficultly of breathing and decrease level of consciousness

Provided with oral and written information regarding this discharge plan

DIET:

Instructed to:

Diet as tolerated

Low fat Abide by the limited intake of salty foods

Consume high fiber diet in order to prevent constipation

Avoid processed foods

Increased fluid intake except coffee, alcohol and soda

NON-MODIFIABLE 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

MODIFIABLE 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

Formation of benign bronchial epithelium tissue

Transformation benign tissue to neoplastic tissue

Nasopharyngeal Cancer

Wheezing

Irritation and obstruction of airway

Invasion of mediastinum

Compression of the esophagus

Shortness of breath

Difficulty in swallowing

Anorexia

Weight Loss