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URDANETA CITY, PANGASINAN COLLEGE OF NURSING Submitted by: Razel Ann N. Espenida Submitted to: Mrs. Maribel

URDANETA CITY, PANGASINAN COLLEGE OF NURSING

URDANETA CITY, PANGASINAN COLLEGE OF NURSING Submitted by: Razel Ann N. Espenida Submitted to: Mrs. Maribel

Submitted by:

Razel Ann N. Espenida

Submitted to:

Mrs. Maribel Murillo Clinical Instructor

General Data

  • 1. Patient’s Name: A.M.

  • 2. Address: Leyte, Philippines

  • 3. Date of Admission: November 27, 2013 6:15 pm

  • 4. Dr. in charge: Dr. Edward jay I. Salao

  • 5. Diagnosis: Osteosarcoma proximal Tibia

Nursing History

6 months prior to admission, patient noticed a mass on her right leg and felts pain after a trauma on her lower extremity. After 3 months, the mass

becomes bigger. They decided to bring her in a private clinic and were then advised to go to hostipal for more examinations. They went to POC and was then advised for confinement.

Pathophysiology

Predisposing factors Age History of trauma to the lower extremity Activation of mutation of the DNA,
Predisposing factors
Age
History of trauma to the lower
extremity
Activation of
mutation of the
DNA,
the oncogene
leads to a
deactivation of the
suppressor or gene
malignant osteoblast that leads to proliferation of abnormalosteoblasts.
malignant osteoblast that leads
to proliferation of
abnormalosteoblasts.
formation of osteiod tissue
formation of osteiod
tissue

uncontrolled growth of the tumor in the bone and therefore overcrowdingof the bone

decreased in WBC lowered infection resistance overcrowding also causes pressure inside the bone f Cause of
decreased in WBC lowered infection resistance overcrowding also causes pressure inside the bone f Cause of

decreased in WBC

lowered infection resistance
lowered infection resistance
overcrowding also causes pressure inside the bone f Cause of pain and fractures.
overcrowding also causes
pressure inside the bone f
Cause of pain and fractures.
suppression of red bone marrow which leads to decreased production of blood cells Anemia
suppression of red bone
marrow which leads to
decreased production of
blood cells
Anemia
osteosarcoma
osteosarcoma

*Laboratory Examinations

Type of Examination: COMPLETE BLOOD COUNT 01/13/14

COMPONENT

RESULTS

NORMAL VALUES

SIGNIFICANCE

Hemoglobin

106

120 – 140 g/L

Indicates anemia and hemolytic reaction

Platelet

572

150 – 450x10 g/L

Increase in leukemia and in response to infection, dehydration

Hematocrit

0.32

0.38 – 0.48 g/L

Indicates anemia and hemolytic reaction

leukocytes

10.18

4.5 – 10x10 g/L

Normal

segmenters

.50

.50-0.70 g/L

Normal

 
 

Lymphocyte

0.35

0.20 – 0.40 g/L

Normal

Monocyte

0.07

0.02 – 0.08g/L

Normal

Eosinophil

0.08

0.02 – 0.08g/L

Normal

11/27/13

 

COMPONENT

RESULTS

NORMAL VALUES

SIGNIFICANCE

Hemoglobin

112

120 – 140 g/L

Indicates anemia and hemolytic reaction

Platelet

408

150 – 350x10 g/L

Increase in leukemia and in response to infection and

 

dehydration

 

Hematocrit

0.36

0.38 – 0.48 g/L

Indicates anemia and hemolytic reaction

leukocytes

12.43

4.5 – 10x10 g/L

Mai indicate infection

segmenters

.83

.50-0.70 g/L

May indicate infection

Lymphocyte

0.14

0.20 – 0.40 g/L

Decrease in response to the metastases of the tumor

Monocyte

0.03

0.02 – 0.08g/L

normal

Eosinophil

0.00

0.02 – 0.08g/L

Decrease in response to the metastases of the tumor

 
 

TEST

RESULTS

NORMAL

SIGNIFICANCE

PTT

14.6 secs

11-15

Normal

Activated PTT

23.9

24-45

Normal

ESR

18

<20

Normal

Clotting time

7.15 secs

5-15

Normal

 

Bleeding time

14.6 secs

11-15

Normal

AKL Phosphate

1,436

64-644

Increases due to the rapid growth of the tumor

SLDH

567

225-450

Increases due to the rapid growth of the tumor

 

Sodium

140.7

135-148

Normal

potassium

4.10

3.5-5.3

Normal

Calcium

2.37

2.02-2.6

Normal

Chlorine

102

98-107

Normal

CT Scan Dec 16,2013

Multiple Axial, sagittal and coronal of the chest were obtained There are multiple varisized pulmonary nodules seen scattered in both lung fields The largest measures 1.8 x 1.7 cm in the left upper lobe No pleural effusion is identified Heart is not enlarged Great vessels are unremarkable No lytic blastic osseous changes identified

Impression: Multiple Varisized Pulmonary Nodules Significance: The tumor measures 1.8 on the left upper lobe on the proximal tibia consider a metastatic process

Chest X-ray

The lung fields are clear The cardiac silhouette appears normal in size and configuration Vascular pattern and great vessels are unremarkable The sulci, hemi diaphragmatic leaflets are intact

Impression: essentially normal chest Significance: no complications noted

Trocar Biopsy:

Microscopic Examination

Microsections disclose neoplastic tissue fragments showing ploriferating splinded cells with hyperchromatic pleomorphic nuclei surrounded by abundant osteiod matrix with calcification. Entrapped tumor cells are noted. Extensive necrosis are noted Impression: Osteosarcoma Significance: Dead tissue were noted and diagnosed as osteosarcoma

Medical and surgical management

Amputation/rotation plasty

Complete removal of cancer

Surgical resection on the necrotic part

Neoadjuvant Chemotherapy followed by surgical resection before the surgery to shrink the tumor

Methotrexate with leucovorin rescue, intra-arterial cisplatin, adiamycin, ifosfamide

Mifafurtide after surgey to remove the tumor and together with Chemotherapy to kill remaining cancer cells

Anti-emetics

 

Filgrastim/pegfilgrastim help with WBC count and neutrophil count

BT and erythropoetin alfa help with anemia

hydration

 

NCP

 

Assessment

Diagnosis

Planning

Intervention

Rationale

Evaluation

 

Subjective:

Acute pain related to

After 1 hour of

  • 1. Perform a

Pain is subjective

Goal met

Verbalization of

tissue and nerve

nursing interventions,

comprehensive

experience and must

After 1 hour of

pain at the amputated area Throbbing pain

trauma secondary to amputation

the patient’s pain will be decreased from 6/10 to 2/10

assessment of pain to include location ,characteristics, onset,

be described by client in order to plan for effective treatment.

nursing interventions, the patient’s pain was

at the rate of

duration, frequency,

 

able to decreased

6/10

quality, intensity or

from 6/10 to 2/10

Objectives:

severity, and precipitating

Guarding

factors of pain

behavior

 

To provide comfort and

To provide comfort and

Facial grimace

Vital Signs:

RR-24

PR-93

  • 2. Position the client to

her comfortable position

  • 3. Perform relaxation

technique such as deep

relaxation.

relaxation. To prevent pressure

Temp. 37.0

breathing exercises 4.provide wrinkled free

sores

BP: 110/70

 
 

linen 5.Provide quiet and calm

Comforts the patient

environment 6.encourage to perform diversional activities such

To divert the attention from pain

as listening to music

Produce analgesia

  • 7. Administer prescribed

analgesic and anti-

and reduce inflammation and fever

inflammatory medications

by inhibiting the production of prostaglandins.

Drug Study

 

Generic Name: Celecoxib Brand Name: celebrex Classification: NSAID’s Dosage: 200 mg. OD Indication: for mild-moderate pain and also for iflammation

Mechanism of Action

Adverse Effect

Contraindication

Side Effect

Nursing Consideration

Exhibits anti-inflammatory

reduced appetite .

Contraindicated with

Vomiting

>position the patient to a

activities by selectively inhibiting cyclooxygenase-2

swelling of the arms and legs due to retention of fluid.

hypersensitivity to drug

semi-fowler’s position to prevent aspiration

nausea

> client to have a oral

Ulcers

Bleeding

care/mouthwash

liver failure

diarrhea

>tell client to eat high fiber diet.wash hands after bowel activity.

dizziness

>encourage client to have a adequate rest periods