Ovarian Cancer

A case study submitted to United Doctors Medical Center-OB WARD.

Members:

Gerhardt, MarissaLe, James AndrewMadurog, JoselitoMara, CindyMigue, Ronald BrianOng, Jael EstherPagela, Nicole JamesPangilinan, AyeshaPantaleon, AbegailPastorfide, Bryan Jayson

Group 39, section 3210

Clinical Instructor:

Ms. Dinah Perlas, RN

November 23, 2007

I. Objectives

1

II. Introduction 2

III. Theoretical Framework 3

Developmental Task

III. Identifying Data 4

IV. Medical History

5

V. Usual Pattern of Functioning

6

VI. Competencies

7

VII. Physical Assessment

8

VIII. Anatomy & Physiology

10

IX. Pathophysiology

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C o n t e n t s

Objectives

To learn the history and clinical presentation of Ovarian

Cancer.

To be able to assess the patient with Ovarian Cancer.

To be able to plan appropriate nursing interventions on the

above mentioned disease.

To understand the benefits and side effects of common

treatments for Ovarian Cancer.

To determine the right and proper management of a patient

with Ovarian Cancer

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Introduction

The diagnosis of the patient is Ovarian Cancer stage II. The group chose this case since it presents to be interesting. Such a stimulating circumstance encouraged the group to arrive at that decision.

Ovarian cancer is a heterogeneous group of malignancies that arises from the various cell types that comprise the organ. Ovarian cancer is the most common cause of cancer death from gynecologic tumors. Early disease causes minimal, nonspecific, or no symptoms. Therefore, most patients are diagnosed in an advanced stage. Overall, prognosis for these patients remains poor. Standard treatment involves aggressive debulking surgery followed by chemotherapy.

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Theoretical Framework

Jean Watson’s Human Caring Theory

Purpose:

- To help persons gain a higher degree of harmony within the mind, body and soul which generates self-knowledge, self-reverence, self-healing and self-care processes while increasing diversity.

CARATIVE FACTORS:

1. Humanistic-altruistic system of values2. Faith-hope3. Sensitivity to self and others4. Helping-trusting, human care relationship5. Expressing positive and negative feelings6. Creative problem-solving caring process7. Transpersonal teaching-learning8. Supportive, protective, and/or corrective mental, physical, societal, and

spiritual environment9. Human needs assistance10.Existential-phenomenological-spiritual forces

Developmental Task

The patient has a chief complain of abdominal enlargement last June 2007. And prior to this month, the patient was diagnosed with a stage 2 ovarian cancer. The patient undergoes a major operation, a TAHBSO surgery. Then after a month, she started having chemotherapy. Recently, she still had her chemotherapy, now for the fifth time. She will be back for her sixth chemotherapy after 21 days for her last one. But the patient states that she is uncertain of her progress, due to the doctors haven't told her yet about the progress of her chemotherapy as she said.

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Identifying Data

Personal Data

Name: J. L.Address: B-9 lot 24 Adelina I-B SPL.Age: 53Civil Status: WidowOccupation: Custom’s representativeReligion: CatholicNationality: Filipino

Date of admission: November 14, 2007Attending physician: Dr. R. delos ReyesChief Complaint: Abdominal enlargementDiagnosis: Ovarian Cancer II

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Medical History

A. History of Present Illness

The patient was admitted November 14, 2007 in United Doctors Medical Center. She underwent chemotherapy due to her ovarian cancer. She was instructed to be back after 21 days for another cycle of chemotherapy. After her session of chemotherapy, she experienced body malaise due to her chemotherapy. She is prone to infections because her WBC and RBC were below the normal level. That is also the reason why the patient was instructed to wear a mask to prevent the spread of microorganisms. She was on her 5 th

cycle of chemotherapy. Her vital signs were being monitored q 30 by the GPI because she is at the same time suffering for hypertension.

B. Past Medical History

(+) Asthma (-) Diabetes Milletus (-) cardiac Disease

C. Family Health History

The patient was positive of HPN for 5 years. There is also history of asthma and Diabetes Mellitus in the family.

D. Environmental History

The patient does not smoke neither drinks alcohol.

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Usual Pattern of Functioning

Before Hospitalization During Hospitalization1. Physical Activity

2. Rest and Sleep

3.Hygiene

4. Elimination a. Bowel

b. Bladder

5. Nutrition

She can walk, stand and do the household chores.

She has an adequate sleep.

She can maintain her proper hygiene on her own.

She has proper bowel elimination in her own without experiencing any pain.

She can eliminate urine in her own without experiencing any pain.

She can eat well on her own.

After chemotherapy, she experience body malaise but after a few hours she can walk and transfer to other position.

She’s not getting adequate sleep due to hospital disturbances like taking the vital signs and during her chemotherapy.

She can still maintain her proper hygiene with the assistance of her family.

Still she can do the proper elimination in her own.

Still she can do the proper urination in her own.

Still she can eat well on her own.

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Competencies

Criteria Actual Observation

1. Physical or motor competencies Patient appearance looks weak but he still manages to move his arms and legs slowly. He can also sit on a chair /bedside and was able to walk around and do the actual things she normally does.

2. Mental motor Emotional

Social

Spiritual

Sometimes she is emotional when talking to his immediate family regards to her health condition. Sometimes she even asked the nurse what will happened to her.

She can communicate nicely especially to the nurses/ student nurse. She can express what she feels and what she needs. She is easy to talk with especially when it regard to her health status.

She shows strong faith in God. She even spends time to pray and believe that God will continue to bless her and her family and believe in the power of prayer.

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Physical Assessment

Assessment Normal findings Present condition

Clients attitude Cooperative Cooperative

Clients mood Appropriate to situation Appropriate to situation

Clients overall hygiene and grooming

Clean and neat Clean and slightly neat

Skin Varies from light to deep brown; from ruddy pink; from yellow overtones to olive

Dry skin varies from light to deep brown

Hair Evenly distributed hair Hair loss or no hair

Head Rounded; smooth skull contour

Rounded

Ears Color same as facial skin, symmetrical and auricle aligned with outer cantus of eye

Color are same as facial skin, symmetrical

Nose Symmetric and straight, no discharge or flaring, uniform color, no lesions and air moves freely as the client breathes through the nares.

Symmetric and straight, uniform in color, no discharge, no lesions and the client breathes easily

Lips Uniform pink color, Slightly dark and can

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(darker in Mediterranean groups and dark-skinned clients), ability to purse lips

purse lips

Teeth and Gums Smooth, white ,shiny tooth enamel, pink gums(bluish or dark patches in dark-skinned clients)

White and shiny tooth enamel, slightly pink gums

Neck Muscles equal in size; head centered, coordinated, smooth movements with no discomforts

Muscles are equal in size, head centered

Lymph nodes Not palpable Not palpable

Abdomen Flat, rounded, or scaphoid

Rounded

Muscles Equal size on both sides of body

Equal size on both sides of body

bones No tenderness or swelling no deformities

No deformities and tenderness

Joints No tenderness or nodules, joints move smoothly

No swelling and tenderness

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Anatomy and Physiology

A. Ovaries

The two ovaries are small organs suspended in the pelvic cavity by ligaments. The suspensory ligament extends from each ovary to the lateral body wall, and the ovarian ligament attaches the ovary to the superior margin of the uterus.

An ovary is an egg-producing reproductive organ found in female organisms. It is often found in pairs as part of the vertebrate female reproductive system. Ovaries in females are homologous to testes in males. The term gonad refers to the ovaries in females and testes in males.

B. Uterus

The uterus or womb is the major female reproductive organ of most mammals, including humans. One end, the cervix, opens into the vagina; the other is connected on both sides to the fallopian tubes. The term uterus is commonly used within the medical and related professions, whilst womb is in more common usage.

The uterus is as big as medium-sized pear. It is oriented in the pelvic cavity with the larger, rounded part directed superior to the entrance of the uterine tubes is called the fundus.

Body – main part Cervix – narrower part, directly inferiorly. Uterine cavity – internal.

Uterine Wall

Serous layer (perimetrium) – outer layer. Muscular layer (myometrium) – middle layer.

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Endometrium –innermost layer.

C. Vagina

The vagina is the female organ of copulation and functions to receive the penis during intercourse. It also allows menstrual flow and childbirth. It extends from the uterus to the outside of the body.

D. External Genitalia

Vulva (pudendum)The external female genitalia consist of vestibule and its surrounding structures.

VestibuleThe space into which the vagina and urethra open.

Labia minoraA pair of thin, longitudinal skin folds.

ClitorisA small erectile structure.

PrepuceThe two labia minora unite over the clitoris to form this fold of skin.

Bartholin's glands (greater vestibular glands)Two glands located slightly below and to the left and right of the opening of the vagina in women. They secrete mucus to provide lubrication.

Labia majoraLateral to the labia minora, prominent, rounded folds of skin.

Mons pubisThe two labia majora unite anteriorly at an elevation of tissue over the pubic symphysis.

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Pathophysiology

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Cellular shedding into the peritoneal cavity

Implantation on the peritoneal surface

Tumor cells may block diaphragmatic lymphatics

Impairment of lymphatic drainage

Development of ascites

Local invasion of bowel and bladder

Transdiaphragmatic spread and seeding of the pleura with

pleural effusion

Frequency and/or urgency of urination

Change in bowel habits Bloating and/or a

feeling of fullness

Abdominal swelling and/or pain

Unexplained weight loss or gain

Laboratory & Diagnostic Procedures

Hematology

Date Released: November 15, 2007Result Normal value Significance

Hemoglobin 116 g/L 117-157 g/L Hematocrit 0.33 0.35-0.47 RBC 3.74 10 ^ g/L 3.80-5.20 10 ^ g/L WBC Monocyte Eosinophils Stab

0.110.000.12

0.02-0.100.01-0.040.05-0.10

ROW 0.16 0.11-0.14

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Drug Study

Generic Name

Brand NameTime/Route/Dose

Action Indication Contraindication Adverse Reactions

Ranitidine

Zantac/Q8/P.O./150 mg/tab.

Prevent and treat symptoms of heartburn associated with acid indigestion and sour stomach.

It decreases the amount of acid made in the stomach and to prevent stress ulcers, stomach damage from use of nonsteroidal anti-inflammatory medications (NSAIDs).

tell your doctor and pharmacist if you are allergic to ranitidine or any other medications.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention either of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin); and triazolam (Halcion). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

tell your doctor if you have or have ever had porphyria, phenylketonuria, or kidney or liver disease.

tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ranitidine, call your doctor.

headache constipation diarrhea upset

stomach vomiting stomach

pain

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Nursing Care Plan

15

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Discharge Planning

1. Identify things the client has done previously to cope successfully when feeling nervous/anxious.

2. Encourage client to develop an exercise/activity program; may be helpful in reducing level of anxiety by relieving tension.

3. Instruct client in techniques to protect the integrity of skin, care for lesions, and prevention of spread of infection.

4. Include client in decision-making process and problem-solving activities.

5. Provide information at client’s level of acceptance and in small pieces to allow easier assimilation. Clarify misconceptions. Reinforce explanations given by other health team members.

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