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