General Objectives:

The purpose of this study is to enhance and gain knowledge, to develop communication
and nursing skills, to provide privacy and maintain confidentiality of the patient and to apply the
right attitudes of the student nurses in rendering and giving care to the patient with
Osteosarcoma, its importance and implication.
Specific Objectives:
nderstand condition of Osteosarcoma and associate it with the patient through the
introduction of the case.
To illustrate the !natomy and "hysiology of the affected organ or the part of the body.
To discuss the pathophysiology of the disease.
To be clinically aware of the clinical manifestation and its complication.
To develop an effective skill on how to plan and manage proper care in patient with
Osteosarcoma.
To correlate the laboratory result to its normal value.
To provide the client nursing care plan and discharge plan to assure client#s total wellness
during his hospitali$ation up to the time of his hospital discharge.
%. %ntroduction
!. &ackground of the study
a. %ncidence, race, gender, age, ratio, and proportion
Incidence
Osteosarcoma is the si'th leading cancer in children and eighth in adults.
Race
%ncidence rates for osteosarcoma in .S. patients are estimated at (.) per
million per year in the general population, with a slight variation between
individuals of black, *ispanic, and white ethnicities +,.-, ,.(, and .., per
million per year, respectively.
Gender
%t is slightly more common in males +(.. per million per year/ than in
females +..) per million per year/ because men has more physical activities
than women that makes them more at risk in having bone diseases.
Age
Osteogenic sarcoma is the si'th leading cancer in children under age 0(.
Osteogenic sarcoma affects .)) children under age 1) and ()) adults +most
between the ages of 0(23)/ every year.
Ratio
!ppro'imately 043 of the 5)) will die each year, or about 3)) a year. !
second peak in incidence occurs in the elderly, usually associated with
underlying bone pathology such as "aget6s disease, medullary infarct, or prior
irradiation.
Proportion of originating parts
There is a preference for origination in the metaphyseal region of tubular
long bones, with .17 occurring in the femur, 057 in the tibia, and 0)7 in the
humerus. !bout -7 of all cases occur in the skull and jaw, and another -7 in
the pelvis.
b. 8ationale for choosing the case
The group decided to choose Osteosarcoma because it is one of the
special cases in the "hilippine Orthopedic 9enter and based on our
research it is the si'th leading cancer in children under age fifteen, most
likely between 0(23) years old.
c. Significance of the studies
The significance of this study is to enhance knowledge, to develop
skills and to apply the right attitudes of the student nurse in rendering and
giving care to the patient with Osteosarcoma, its importance and
implication. This study will serve as guidelines in assessing and providing
nursing care to patient with the same problem or disease.
d. Scope of limitation of the study
The study would only focus on Osteosarcoma which is indicative
to the client#s health condition and its underlying nursing care relevant for
the client within the two : week duty at "hilippine Orthopedic 9enter.
e. 9onceptual and ;ursing Theory
Theoretical <ramework
f. 8elated literature of the study
Osteosarcoma, also known as osteogenic sarcoma is a malignant
neoplasm arising from bone cells which are undifferentiated and capable of %t is
forming bone, cartilage and collagenous tissue.
Stages of Osteosarcoma
0. =ocali$ed
9ancer cells have not spread beyond the bone.
1. >etastatic
9ancer cells have spread from bone in which the cancer began to
other parts of the body.
3. 8ecurrent
9ancer cells has come back after it has been treated, it may come
back in the tissues where it first started or it may come back in other
parts of the body.
9auses
The causes of osteosarcoma are not known. Several research groups are
investigating cancer stem cells and their potential to cause tumors but no research
has been proven. 8esearchers believed that it can be genetically transmitted.
Symptoms
>any patients first complain of pain that may be worse at night, and may
have been occurring for some time. %f the tumor is large, it can appear as a
swelling. There is edema due to dilatation of vessels in the overlying skin. The
affected bone is not as strong as normal bones and may fracture with minor
trauma +a pathological fracture/ that limits motion. &one mass may be diagnosed
after the pathologic fracture. ?S8 +erythrocyte sedimentation rate/ and S!"
+serum alkaline phosphatase/.
@iagnosis
The route to osteosarcoma diagnosis usually begins with an '2ray,
continues with a combination of scans +9T scan, "?T scan, bone scan, >8%/ and
ends with a surgical biopsy. <ilms are suggestive, but bone biopsy is the only
definitive method to determine whether a tumor is malignant or benign. The
biopsy of suspected osteosarcoma should be performed by a Aualified orthopedic
oncologist.
Treatment
The main goal of medical and surgical management for
osteosarcoma is to destroy or remove the tumor. This goal may be attained
by surgical e'cision +amputation/, hormonal therapy with the use of
radiation, chemotherapy and bone grafting using bone fi'ators.
%%. 9=%;%9!= S>>!8B
!. G?;?8!= @!T! "8O<%=?
;ame: >r. Boung Guy
!ddress: (0 !nonas ?'t. Sta. >esa >anila
&irthday: @ecember 0,, 0553
&irth "lace: ;ueva ?cija
;ationality: <ilipino
8eligion: 8oman 9atholic
@ate of !dmission: !pril (, 1)0)
!dmitting @iagnosis: "athologic <racture secondary to 0C &one Tumor
probably malignant to consider Osteosarcoma
!dmitting "hysician: @r. Sanidad
&. 9*%?< 9O>"=!%;T
&one mass at lateral part of the right thigh associated with pain and
swelling.
9. ;8S%;G *%STO8B
0. *%STO8B O< "8?S?;T %==;?SS
One month prior to admission, the patient has palpable mass at the lateral part of the right
thigh and had undergone manipulation hilot thrice. The patient verbali$ed that Ddati sumasakit
na talaga pero nawawala din tapos nung naaksidente ako sa pagbibisikleta din na nawala Eyung
sakit...F
!. 9hildhood %llness
2chicken po', measles, fever, cough and cold, and mumps
&. %mmuni$ation
2fully immuni$ed
9. !llergies
2no allergies noted
@. !ccidents
2with previous vehicular accident
?. *ospitali$ations
2once hospitali$ed due to a minor accident before being
referred at the "hilippine Orthopedic 9enter
<. >edications used or currently taking
2@olcet, 9ephale'in
G. @omestic Travel
2Gith no domestic travel
@. <!>%=B *%STO8B
?. SO9%!= *%STO8B2%;9=@? T*?O8%?S !;@ G8OGT* !;@
@?H?=O"">?;T
"SB9*OSO9%!= T*?O8B !99O8@%;G TO ?8%I ?8%ISO;
ST!G? !G? 9?;T8!=
T!SI
%;@%9!TO8S O<
"OS%T%H?
8?SO=T%O;
%;@%9!TO8S
O<
;?G!T%H?
8?SO=T%O;
!dolescents 0120- years old %dentity vs. 8ole
9onfusion
?stablishing
relationship
with
opposite
se'.
<idelity to
friends.

!ccording to this theory adolescents had

!99O8@%;G TO S%G>;@ <8?@
ST!G? !G? 9*!8!9T?8%ST%9S %>"=%9!T%O;
Genital 0321) years old
!ccording to this theory, the
<. ?;H%8O;>?;T4=%H%;G 9O;@%T%O;
The environment where he lives can be found near main road. This place
has many motor vehicles that can be seen either in the street or road. The place is
slightly congested.
G. "*BS%9!= !SS?SS>?;T
"arameters ;ormal <indings !ctual <indings %nterpretations
General !ppearance 2 9lean in appearance
and well groomed
2 9ooperative
2 Slightly thin 2 9lient loss of wt due
to decrease in appetite
Skin 2Gith good skin
turgor
*air 2 ?venly distributed
hair
2 Thick *air
;ails 2 Gith good capillary
refill of 021 seconds
2 with pinkish nail
beds
2with clean and short
nails
Skull and face 2 mouth uniform
consistencyJ absence
of nodules and
masses
2 rounded smooth
skull contour
2 symmetrical facial
movement
?yes 2 no eye discharge
2with anicteric sclera
2eyebrows hair
evenly distributed4
skin intact
2+K/ blink refle'
2with pinkish
conjunctiva
2 Gith slightly pale
conjunctiva
2 @ue to poor sleeping
habits
?ars 2auricle color same as
facial skin
2auricle are mobile
firm and not tender
2able to hear on both
ears
2no edema and
discharge
>outh 2pinkish lips
2without missing
teeth
2with symmetrical
contour
>usculoskeletal
+pper and =ower
e'tremities/
2 symmetrical
2no atrophy
2 with full range of
motion
2with a big scar at
right wrist
2 with palpable and
fi'ed bone mass at the
lateral part of the right
thigh associated with
2 scar is due to
previous vehicular
accident
2with limited range of
motion due to
insertion of Steinmann
pain and appears like a
swelling
2with Steinmann pin
inserted at the distal
third of femurJ with
balanced skeletal
traction
2with limited range of
motion
pin and balanced
skeletal traction
!bdomen 2 no abdominal
distention
2 flat rounded
abdomen
2symmetrical contour
2 no surgical incisions
*. "!TT?8;S O< <;9T%O;%;G
<unctional *ealth
"attern
&efore
*ospitali$ation
@uring
*ospitali$ation
%nterpretation
C *ealth management
pattern

C ;utritional4
>etabolic
a. ;umber of
meals per day
b. !ppetite
c. Glass of water
per day
d. &ody built
e. *eight and
weight
3 times a day
with very
good appetite
eight glasses
of water
with normal
body built
3 times a day
with slightly
poor appetite
C ?limination
a. <reAuency of
urination
b. !mount of
urine per day
c. <reAuency of
bowel
movement
d. 9onsistency of
the feces
e. !mount
defecated per
day
<our times a
day
=arge in
amount
Twice a dayJ
every
morning and
at night
<ormed and
sometimes
scattered

C !ctivity and ?'ercise

a. ?'ercise
b. <atigability
c. !@=
Gith active
e'ercise
daily
"laying
basketball
everyday
;ot easily

get tired
%ndependent
C 9ognitive4"erceptual
a. Orientation
b. 8esponsiveness
Oriented to
time, place
and person
8esponds to
verbal and
physical
stimuli

C 8oles48elationship
a. !s a son
b. !s a brother
c. !s a boyfriend
d. !s an
employee and
employer
*as a good
relationship
with his
parents,
siblings,
girlfriend
and friends

C Self "erception4 Self
9oncept

C 9oping4 Stress
C Halues4 &eliefs
%. =!&O8!TO8B @%!G;OST%9 ?L!>
*ematology
9omponent 8esult ;ormal
8ange
%nterpretation %mplication ;ursing
responsibilities
*emoglobin 03) 01M20-3 g4l ;ormal Ghen the
hemoglobin
falls below
0)g4dl in
women or
01g4dl in men,
an anemia is
presence.
*ematocrit ).3, ).3M2).(. &elow
;ormal
! decrease in
*ematocrit
level seen in
massive or
prolonged
blood loss,
anemia,
leukemia, an
e'cessive rapid
intravenous
fluid
administration.
*ematocrit
level is
elevated in
conditions that
cause an
increase in the
percentage of
red cells in the
blood.
=eukocyte 00.,) ..(20)' g4l !bnormal ! rise in the
G&9 is usually
caused by
conditions that
stimulate the
bone marrow to
produce white
blood cells to
fight off
invading
organisms. !
fall in the white
cell count
usually
indicates that
bone marrow
depression is
occurring,
because of
increases of
to'ic
chemicals.
Differential
Count
Segmenters ).M1 ).()2).-3 ;ormal
=ymphocytes ).05 ).1)2)..) Hiral infections
are the primary
causes of an
increase in the
lymphocyte
count. @ecrease
in lymphocytes
is associated
with *odgkin#s
disease, lupus
erythematosus,
burns, trauma,
and the
administration
of
corticosteroids.
>onocytes ).)- ).))2).)M They may be
increased in
viral, bacterial,
and parasitic
infections,
collagen
diseases, and
some malignant
hematological
disorders.
@ecreases have
no significance
in relation to
disease.
?osinophils ).)0 ).))2).)( ;ormal !n increase in
the eosinophil
count may be
caused by a
hyperimmune
or allergic
reaction where
there is an
antigen2
antibody
response. !
decrease in
?osinophils
may be
associated with
congestive
heart failure,
infectious
mononucleosis,
9ushing#s
syndrome, and
aplastic and
pernicious
anemias.
8eticulocytes ).(217
"latelet count 1). 0()2.))'
0)Ng4l
;ormal @ecreased
platelet counts
may be seen in
newborns
during the first
few days of life
or in women
during the two
weeks prior to
the onset of
menstruation.
%ncreases may
be seen in
individuals
living at high
altitudes or
following
intense
physical
e'ercise
>9H -( -1251 ;ormal @ecreases in
the >9H are
present in the
following
anemias:
pernicious
anemia, iron
deficiency
anemia,
thalassemia, in
the anemias
associated with
chronic blood
loss. %ncreases
are associated
with liver
deseases,
alcoholism,
folate or
vitamin &01
deficiencies, or
sprue.
>9* 3) 1-231 ;ormal !bnormal
values are
related to
severe anemic
condition. !n
increase occurs
with
macrocytic
anemia and a
decrease with
microcytic
anemia.
>9*9 3, 3123- ;ormal @ecreases in
>9*9 occur
with the
following
anemias: iron
deficiency
anemia,
thalassemia,
and macrocytic
anemia. !n
increase
indicates that
spherocytosis is
present.
Coagulation
Studies
"rothrombin
time
0(.0 0020(
seconds Ghen the
"rothrombin
content of the
blood is
decreased, the
"rothrombin
time is said to
be prolonged in
the clotting
ability of the
blood is
diminished.
One of the
most common
causes of an
increased
"rothrombin
time is the
presence of
medically
prescribed
anticoagulants
in the blood.
7 !ctivity -M.3
%;8 0.0.
!ctivated "* 35.3 1121.
seconds
&lood type D!&F
8* typing "ositive
+K/
9"8
Semi2
Ouantitative
9"8
3, mg4= P, mg4l
8&9
>orphology
?S8 Gestern
Gen. >ethod
=ess than
0(
9lotting time
+ =ee and
Ghite/
(20(
minutes
&leeding time
+%vy#s
>ethod/
02M minutes
Q. %>"8?SS%O;4@%!G;OS%S
"athologic fracture secondary to primary bone tumor probably malignant
to consider osteosarcoma.
%%%. 9=%;%9!= @%S9SS%O; O< T*? @%S?!S?
0. !;!TO>B !;@ "*BS%O=OGB
The skeletal system provides support and protection, allows body movements, stores
minerals and fats, and is the site of blood cell production.
<our types of bone tissue:
0. =ong bones
2 are longer than they are wide, most of the bones of the upper and lower limbs are long
bones. ?'amples of long bones are the femur, tibia, and fibula of the leg, the humerus,
radius, and ulna of the arm, and the phalanges of the fingers and toes.
1. Short bones
2are appro'imately are broad as they are long, such as the bones of the wrist and ankles.
3. <lat bones
2have a relatively thin and flattened shape.
.. %rregular bones
2include the vertebrae and facial bones, with shapes that do not readily fit into three other
categories.
There are two kinds of bone tissue:
0. 9ompact bone
2 is the hard material that makes up the shaft of long bones and the outside
surfaces of other bones.
1. Spongy bone
2 consists of thin, irregularly shaped plates called trabeculae, arranged in a
latticework network.
"arts of the long bones:
0. @iaphysis
2a long tubular portion of long bones, it is composed of compact bone tissue. %t has the
medullary cavity or marrow cavity, an open area within the diaphysis, the adipose tissue
inside the cavity stores lipids and forms the yellow marrow.
1. ?piphysis
2the e'panded end of a long bone.
3. >etaphysis
2is the area where the diaphysis meets the epiphysis. %t includes the epiphyseal line, a
remnant of cartilage from growing bones.
=ayers of bone tissue:
0. "eriosteum
2is the membrane covering the outside of the diaphysis +and epiphyses where
articular cartilage is absent/. %t contains osteoblasts +bone2forming cells/, osteoclasts
+bone2destroying cells/, nerve fibers, and blood and lymphatic vessels. =igaments and
tendons attach to the periosteum.
1. ?ndosteum
2is the membrane that lines the marrow cavity.
1. "!T*O"BS%O=OGB +&OOI &!S?@ !;@ 9=%?;T &!S?@/
"!T*O"*BS%O=OGB +client based/
3. @8G ST@B
;ame of
the @rug
!ction %ndication @osage and
"reparation
!dverse reaction ;ursing
9onsideration
9ephale'in %nhibits
bacterial
cell wall
synthesis.
>ost
effective
against
rapidly
growing
organisms.
0
st

generation:
Often used
in clients
allergic to
penicillin.
Gram2
positive
organisms
and
moderate
activity
against
gram2
negative
organisms.
1
nd

generation:
Gram2
negative
organisms.
3
rd

generation:
G%: nausea,
vomiting,
diarrhea
%ncrease in
glucose
values
!naphyla'is
may occurJ
alcohol may
cause
vomiting
;ephroto'ic
ity
Thrombocyt
openia
>onitor
G&9
counts,
cultures,
and "T.
!ssess
&; and
creatinine
levels in
clients with
renal
impairment
.
>onitor
HS, % and
O, and
undesirable
effects.
%f client is
diabetic,
monitor
glucose
levels.

>ostly
gram2
negative
organisms.
.
th

generation:
gram2
negative
and gram2
positive
organisms.

<or %H
administrat
ion refer to
drug
circular for
specific
procedure.

%H. ;8S%;G "8O9?SS

!. =O;GT?8> O&Q?9T%H?S
The study aims to
&. "8%O8%T%R?@ =%ST ;8S%;G "8O&=?>
"8O&=?> 8!;I%;G QST%<%9!T%O;
9. ;8S%;G 9!8? "8O9?SS
!SS?SS>?;T @%!G;OS%S "=!;;%;G %;T?8H?;T%O; 8!T%O;!=? ?H!=!T%O;
Subjective:
D
!t the
end of
nursing
interven
tion
patient
will
!t the end of nursing
intervention patient
!SS?SS>?;T @%!G;OS%S "=!;;%;G %;T?8H?;T%O; 8!T%O;!=? ?H!=!T%O;
Subjective:
D
!t the
end of
nursing
interven
tion
patient
will
!t the end of nursing
intervention patient
!SS?SS>?;T @%!G;OS%S "=!;;%;G %;T?8H?;T%O; 8!T%O;!=? ?H!=!T%O;
Subjective:
D
!t the
end of
nursing
interven
tion
!t the end of
nursing
intervention
patient
patient
will
@. @%S9!*8G? "=!;
>2 >edications
a. !dvise patient to take the medicine continuously at home.
b. !lways check the e'piration date of the medicine before taking.
?2 ?nvironment 4 ?'ercise
a. >aintain a Auiet, clean and calm environment for easy and good
recovery of the patient.
b. "rovide safety measure to promote safe environment and individual
safety.
c. "lace bedside urinals near patient#s bed for easy access when nature
calls.
T2 Treatment
a. >aintain body alignment as much as possible using pillow or safety
straps to secure proper position.
b. !dvise patient to avoid lifting heavy objects and use of too much force
to prevent more serious injury.
c. %nstruct to perform static isometric Auadriceps e'ercises.
*2 *ealth Teaching
a. !void strenuous activities.
b. !dvice SO to assist patient maintain proper personal hygiene.
c. ?'plain the importance of e'ercise on both e'tremities.
d. %nstruct to do deep breathing and coughing e'ercises.
e. !dvise to always keep back dry.
O2 Out "atient 8eferral 9heck2 up
a. !fter discharge, advice patient to come back to specified date said by
the patient.
@2 @iet
a. *igh protein and rich in vitamin 9 foods to promote healing.
b. 8egular calcium intake for fast bone recovery.