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Case Study of Osteosarcoma and Pathologic Fracture of the Humerus

Submitted By: BSN III. "rago# "l$in Banaag#

rou! I

lady %aicel

Cordero# %arissa &imayacyac# 'y(a Formaran# )heny Hilario# )oe$en

Submitted *o: &r. %a. Purisima B. %acatangay &ean of College of Nursing# +N# %"N# Ph.&

OB),C*I-,S:

eneral Ob.ecti$es: To learn important information about bone tumors specifically

osteosarcoma, enabling the group gain deeper knowledge and understanding, towards giving a safe and quality nursing care for patients with said condition.

S!ecific Ob.ecti$es: /Nurse0centered ob.ecti$es To focus on bone tumors and give a brief discussion of fracture of the humerus. To review the anatomy and physiology of the affected area and to discuss the pathophysiology osteosarcoma including its predisposing factors. To outline and analyze the drug used by the patient in the course of treatment. To plan and carry out nursing interventions appropriate in the management of the disease. /Patient0centered ob.ecti$es To have an idea and be familiar about the risk bone tumors and bone fractures. To be able to gain insights about the condition enable to render an appropriate actions/management so that the patient will prevent further complications.

I. IN*+O&1C*ION

Bone Tumor is neoplasm in the skeletal system. They maybe primary or metastatic tumor from primary cancer elsewhere in the body. Metastatic Tumor are more common than primary bone tumor. There are two types of bone tumor the Benign Tumor and Malignant Bone Tumor. Benign bone tumor includes !steoma, "hondroma, "steochondroma and #iant "ell Tumor. This tumor tends to grow slowly and usually do not destroy the supporting or surrounding tissue or spread to other part of the body. Malignant bone tumor is an ill defined, lack sharp border and e$tend beyond the confines of the bone. There are several types of malignant bone tumor which includes !steosarcoma, %wing/s &arcoma and "hondroma.

!steosarcoma is an ancient disease that is still incompletely understood. The term sarcoma was introduced by the %nglish surgeon 'hon (bernalty in )*+, and was derived from #reek roots meaning fleshy e$crescene. -n )*+., the /rench surgeon (le$is Boyer first used the term osteochondroma. -t gross appearance was described )*,0 by Baron #uillaume 1upuytren as a whitish or reddish mass, lardaceous and firm at an early stage of the disease2 but presenting at a later period, points of softening, cerebriform matter, e$travasting blood and white or straw colored fluid of a viscid consistence in its interior. The incidence of osteosarcoma is slightly higher in males than females with males 3 ..4 per million per year5 and females 3,.. per million per year5. -t is very rare in young children 3+.. cases per million per year in children 6. years.5. -ncidence increases steadily with age, increasing more dramatically in adolescence, corresponding with the growth spurt. !steosarcoma is deadly form of musculoskeletal cancer that most commonly causes patients to die from pulmonary metastatis disease and which has . year survival rate of ).74+8.

/racture of the humerus represents 97.8 of all fractures it is related to bimodal age distribution. -t may occur in children due to accident resulting to in:ury or trauma to the bones and in elderly due to weakened bones which are prone to fracture when accidentally fall. /racture of the humerus can be described according to its location, it can be either, pro$imal, middle or distal third and its pattern spiral, transverse and comminuted. ( pathologic fracture is a broken bone caused by disease leading to weakness of the bone. This process is most commonly due to osteoporosis, but may also be due to other pathologies such as cancer, infection, inherited bone disorders,or a bone cyst. !nly a small number of conditions are commonly responsible for pathological fractures, including osteoporosis, osteomalacia, paget;s disease, osteitis, osteogenesis imperfecta, benign bone tumors and cysts, secondary malignant bone tumours and primary malignant bone tumours. /ragility fracture is a type of pathologic fracture that occurs as result of normal activities, such as a fall from standing height or less.This definition arises because a normal human being ought to be able to fall from standing height without breaking any bones, and a fracture therefore suggests weakness of the skeleton.

II. P"*I,N*2 P+OFI',

<ame =atient > =ermanent (ddress ? +.44 Bulihan, Bulacan Birthdate !ct. )) )@,. (ge A0 yrs. !ld <ationality /ilipino Beligion Boman "atholic 1ate of (dmission March ),, 4+)9 (dmitting 1iagnosis =rimary Bone Tumor C4 vertebra, <o neurologic deficit, pathologic fracture humerus D right arm

". Past History =atient > is a mother of three siblings. &he is a vendor, selling EkakaninF such as suman, puto, bibingka etc. (ccording to her in terms of nutrition she loves to eat vegetables, fruits, and meat however, she is not fond of drinking milk which might precipitate the occurrence of disruption in continuity of bone. (t the age of AA she notices a palpable mass on her back specifically lumbar 4 vertebra. Then last 1ecember 4+)4 she started to e$perience the signs and symptoms of bone tumor primary night time awakening due to the persistent pain on the affected area. =atient > is neither a known asthmatic nor had medications. &he claims to have no history of previous hospitalization or serious illness. B. Present History =atient > confined at =hilippine !rthopedic "enter having a chief complaint of pain in right arm and diagnosis of =rimary Bone Tumor C4 vertebra, <o neurologic deficit, pathologic fracture humerus D right arm. (t the time of admission the patient is conscious and coherent. (ccording to the patient fracture resulted from accident fall and broke her arm. The diagnosis e$am done to her are >7ray and MB-, in laboratory test, she undergone "B".

III. +,-I,3 OF S4S*,%S

I-. O+&ON2S F1NC*ION"' H,"'*H P"**,+N

Health Perce!tion Health %anagement Pattern The patient seeks consultation to her personal doctor, but sometimes she takes any medication which is prescribed by the doctor. Because of persistent pain, she was forced to go to the hospital and diagnosed of primary bone tumor. Nutritional %etabolic Pattern There is no restriction in the patientGs diet. &he usually includes fruits and vegetables in her diet, moreover, she is fond of eating high fat foods and she refused to drink milk. ,limination Pattern 1ue to her condition, the patient has indwelling /oley catheter. -n terms of bowel movement, it is irregular, she told us that she moved bowel every 4 79 days. "cti$ity ,5ercises Pattern The patient did not engage in any form of e$ercises, she considered household chores as a means of e$ercises. But since she was hospitalized, she was not able to perform any form of e$ercises and according to her there is numbness in her lower e$tremities leading to immobilization. Slee! +est Pattern The patient e$perienced disturbance in sleeping because of the pain especially at night. Cogniti$e Perce!tual Pattern &he can easily understand and interact with people. The patient was able to follow instructions as ordered by the physician2 however, she lacks knowledge regarding her condition.

Self Perce!tion Self Conce!t Pattern

&he is conscious and coherent upon interaction. 1ue to her condition, she was confined to bed and e$periencing difficulty in moving associated with numbness and weakness of lower e$tremities. +ole +elationshi! Pattern The patient has good relationship with the family members. (ccording to her daughter, she is a good mother. The family always support her financially and emotionally especially during hospitalization. Co!ing Stress *olerance Pattern &he used the power of praying/ prayer, rosary and bible to cope with daily stress. -alues6 Belief Pattern &he has a positive outlook in life. &he believe and still hoping for her condition to become better.

-. "N"*O%4 "N& PH4SIO'O 4

P"+*S OF *H, H1%,+1S

-,+*,B+"' CO'1%N

-I. P"*HOPH4SIO'O 4

OS*,OS"+CO%"

=B%1-&=!&-<# /("T!B& "hildren


Genetics Teenage growth spurt Benign bone tumors Injury/Trauma Metabolic and hormonal imbalance

=B%1-&=!&-<# /("T!B& (dults


High fat diet Lack of e ercise !moking "lcoholism Injury/Trauma Metabolic and hormonal imbalance

!&T%!BC(&T

1<( MHT(T-!<

M(C-#<(<T !&T%!BC(&T

=B!C-/%B(T-!< !/ (B<!BM(C !&T%!BC(&T /!BM(T-!< !/ -MM(THB% B!<%

=ain

&welling

Tenderness

-II. '"BO+"*O+4 +,S1'*S

H,%"*O'O 4 *,S*:
Blood Com!onent
Iemoglobin Iematocrit Ceucocytes "ount =latelet "ount

Normal -alues
))+ J ).* g/C +.90 J +.., g/C ,.. J )+ $ )+)/C ).+ J ,++ $ )+@/C

+esults
04 g/C +.49 9.4, ,@

'IPI& P+OFI',:
'i!id
Iemoglobin Iematocrit

Normal -alues
6 9. J *. mg/dC 6 )A+ mg/dC

+esults
4* )0)

PO*"SSI1% ',-,':
Potassium
K

Normal -alues
9.. J . meq/C

+esults
9.) meq/C

-III. &+1

S*1&4

7. B+"N& N"%,: Kalium 1urule


,N,+IC N"%,: =otassium "hloride %,CH"NIS% OF "C*ION Beplaces potassium and maintains potassium level. IN&IC"*ION: To prevent hypokalemia. CON*+"IN&IC"*ION: "ontraindicated in patient with severe renal impairement with oliguria, anuria, or with acute dehydration or other conditions linked to e$tensive tissue breakdown. "&-,+S, +,"C*ION: paresthesia of limbs, confusion, weakness #.- nausea, vomiting. abdominal pain, diarrhea. o %,*"BO'IC: hyperkalemia. o +,SPI+"*O+4: respiratory paralysis. N1+SIN CONSI&,+"*ION:

1rug is commonly used orally with potassium wasting diuretics to maintain potassium level. Monitor %"# and electrolyte level during therapy. Many adverse reaction may reflect hyperkalemia.

8. B+"N& N"%, /eosol


,N,+IC N"%, /errous &ulfate %,CH"NIS% OF "C*ION: =rovides elememtal iro, an essential component in the formation of hemoglobin. IN&IC"*ION: /or iron deficiency

CON*+"IN&IC"*ION: "ontraindicated in patient with peptic ulcer disease, regional enteritis or ulcerative colitis. "&-,+S, +,"C*ION: .I: nausea, epigastric pain, vomiting, constipation. Black stool, anore$ia. !ther temporarily stined teeth from suspension. N1+SIN CONSI&,+"*ION: "heck for constipation2 record color and amount of stool. #.- upset may be related to dose. Monitor hemoglobin level, hematocrit and reticulocyte count during therapy. Tell patient to take tablet with :uice or water but not with milk or antacid.

9. B+"N& N"%,: Tramadol


,N,+IC N"%,: Hltram %,CH"NIS% OF "C*ION: -nhibits the reuptake of serotonin and norepinephrine in "<&. IN&IC"*ION: Moderate to moderately severe pain CON*+"IN&IC"*ION: "ontraindicated in patient who have previously demonstrated hypersensitivity to tramadol, any other component of this product or opiods. "&-,+S, +,"C*ION: CNS: dizziness, headache, vertigo, seizures, an$iety. ,,N*: visual disturbance. .I: constipation, nause,a, vomiting, abdominal pain. S:IN: diaphoresis, pruritus and rash. N1+SIN CONSI&,+"*ION: (ssess type of location and intensity of pain before and 479hours 3peak5 administration.

(ssess B=, and BB before and periodically during administration. (ssess bowel function routinely. /or better analgesic effect, give drugs before onset of intense pain.

;. B+"N& N"%,: Cosec, =rilosec


,N,+IC N"%, !meprazole %,CH"NIS% OF "C*ION: -nhibits activity of acid 3proton5 pump and binds to hydrogen7potassium adenosine triphosphatase at secretory surface of gastric parietal cells to block formation of gastric acid. IN&IC"*ION: Treatment of gastroesophageal reflu$ disease. CON*+"IN&IC"*ION: "ontraindicated in patient hypersensitive to drug or its component. "&-,+S, +,"C*ION: CNS: dizziness, headache. #.- abdominal pain. "onstipation, diarrhea, nausea, vomiting. %1SC1'OS:,',*"': back pain, +,SPI+"*O+4: cough, upper respiratory tract infection. S:IN rash N1+SIN CONSI&,+"*ION:

-nstruct patient to take drugs 9+mins. before meals. "aution patient to avoid hazardous activities if he gets dizzy. Tell patient to swallow tablet or capsule whole anot to open, crush, or chew them.