ANDRES BONIFACIO COLLEGE

SCHOOL OF NURSING
College Park, Dipolog City

Care of A Patient with

OVARIAN
CANCER

Submitted by:

Submitted to:

Nursing IV Students
Ms. ALEGADO, Dwine Clarilou L.
Mr. LOPEZ, Christian Christopher D.

Mrs. ALVAR, Ma. Cindy O., RN, MN

Clinical Instructor

ANDRES
BONIFACIO January
COLLEGE
Date Submitted:
INSTITUTIONAL VISION AND MISSION

11, 2017
VISION:

A center of excellence in instruction, research, technology, extension, athletics and arts.

MISSION:
We commit to provide affordable quality education with values in industry, intelligence, integrity and undertake relevant
research and socially-responsive community service using innovative technologies.

School of Nursing Mission

The School of Nursing shall generate, competent, safe and compassionate professional nurses committed to:
a. Practice high standards of nursing care utilizing research and evidence-based practices that are culturally appropriate
and sensitive.
b. Active involvement in local, national and global issues affecting nursing, peoples health and the environment.
c. Ongoing holistic growth and development of the self and others.

Table of Contents
I.

Learning Objectives

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II.

Introduction

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III.

Anatomy and Physiology

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10

11

IV.

Diagnostic Tests

13

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12

V.

Treatment Options

VI.

Pathophysiology

VII.

Nursing Care Plans

VIII.

Related Articles

IX.

Bibliography

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I.

19

21

27

33

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13

28

34

Learning Objectives

General Objectives:
At the end of the Case Presentation, the Learners shall improve their understanding, increase their knowledge, enhance their independent
and collaborative skills and manifest desirable attitude in providing immediate and holistic care to patients with Ovarian Cancer.

Specific Objectives:
Within 1 hour, the listeners will be able to:
1. Identify what is Ovarian Cancer
2. Identify factors that can lead to Ovarian Cancer
3. Identify signs and symptoms of Ovarian Cancer
4. Review the Anatomy and Physiology of the Ovary and the Reproductive System

5. Discuss the disease process and its pathophysiology effectively.

6. Enumerate the manifestations of the disease appropriately.
7. Identify and discuss its appropriate management effectively.
8. Learn new updates related to Ovarian Cancer.

OVARIAN CANCER

II. INTRODUCTION
Ovarian cancer is a disease in which, depending on the type and stage of the disease, malignant (cancerous) cells are found inside, near, or
on the outer layer of the ovaries. An ovary is one of two small, almond-shaped organs located on each side of the uterus that store eggs, or germ
cells, and produce female hormones estrogen and progesterone.
Cancer Basics
Cancer develops when abnormal cells in a part of the body (in this case, the ovary) begin to grow uncontrollably. This abnormal cell growth is
common among all cancer types.
Normally, cells in your body divide and form new cells to replace worn out or dying cells, and to repair injuries. Because cancer cells
continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to create new abnormal
cells, forming a tumor. Tumors can put pressure on other organs near the ovaries.

Cancer cells can sometimes travel to other parts of the body, where they begin to grow and replace normal tissue. This process, called
metastasis, occurs as the cancer cells move into the bloodstream or lymph system of the body. Cancer cells that spread from other organ sites
(such as breast or colon) to the ovary are not considered ovarian cancer. Cancer type is determined by the original site of the malignancy.
What is the general outlook for women diagnosed with ovarian cancer?

In women ages 35-74, ovarian cancer is the fifth leading cause of cancer-related deaths. An estimated one woman in 75 will develop ovarian
cancer during her lifetime. The American Cancer Society estimates that there will be over 22,280 new cases of ovarian cancer diagnosed this year
and that more than 14,240 women will die from ovarian cancer this year.
In the Philippines, cancer of the ovary is 12th overall, and ranks 5th among females. An estimated 2,032 cases will occur in 1998. Incidence
increase starting at age 40.
When one is diagnosed and treated in the earliest stages, the five-year survival rate is over 90 percent. Due to ovarian cancer's non-specific
symptoms and lack of early detection tests, about 20 percent of all cases are found early, meaning in stage I or II. If caught in stage III or higher,
the survival rate can be as low as 28 percent. Due to the nature of the disease, each woman diagnosed with ovarian cancer has a different profile
and it is impossible to provide a general prognosis.

Types of Ovarian Cancer

There are more than 30 different types of ovarian cancer, which are classified by the type of cell from which they start. Cancerous ovarian
tumors start from three common cell types:
Surface Epithelium - cells covering the outer lining of the ovaries
Germ Cells - cells that are destined to form eggs
Stromal Cells - Cells that release hormones and connect the different structures of the ovaries
Epithelial Tumors - Epithelial ovarian tumors develop from the cells that cover the outer surface of the ovary. Most epithelial ovarian tumors
are benign (noncancerous). There are several types of benign epithelial tumors, including serous adenomas, mucinous adenomas, and Brenner
tumors. Cancerous epithelial tumors are carcinomas - meaning they begin in the tissue that lines the ovaries. These are the most common and
most dangerous of all types of ovarian cancers, accounting for 85 to 90 percent of all cancers of the ovaries. Unfortunately, almost 70 percent of
women with the common epithelial ovarian cancer are not diagnosed until the disease is advanced in stage.
There are some ovarian epithelial tumors whose appearance under the microscope does not clearly identify them as cancerous. These are
called borderline tumors or tumors of low malignant potential (LMP tumors).
Germ Cell Tumors - Ovarian germ cell tumors develop from the cells that produce the ova or eggs. Most germ cell tumors are benign (noncancerous), although some are cancerous and may be life-threatening. The most common germ cell malignancies are maturing teratomas,
dysgerminomas, and endodermal sinus tumors. Germ cell malignancies occur most often in teenagers and women in their twenties. Today, 90
percent of patients with ovarian germ cell malignancies can be cured and their fertility preserved.
Stromal Tumors - Ovarian stromal tumors are a rare class of tumors that develop from connective tissue cells that hold the ovary together
and those that produce the female hormones, estrogen and progesterone. The most common types are granulosa-theca tumors and Sertoli-Leydig
cell tumors. These tumors are quite rare and are usually considered low-grade cancers, with approximately 70 percent presenting as Stage I
disease (cancer is limited to one or both ovaries). Granulosa cell tumors (GCTs) are considered stromal tumors and include those composed of
granulosa cells, theca cells, and fibroblasts. GCTs account for approximately 2 percent of all ovarian tumors.
Primary Peritoneal Carcinoma. The removal of one's ovaries eliminates the risk for ovarian cancer, but not the risk for a less common
cancer called Primary Peritoneal Carcinoma. Primary Peritoneal Carcinoma is closely related to epithelial ovarian cancer, which is the most
common type. It develops in cells from the peritoneum (abdominal lining) and looks the same under a microscope. It is similar in symptoms,
spread, and treatment.
Stages of Ovarian Cancer

Once diagnosed with ovarian cancer, the stage of a tumor can be determined during surgery, when the doctor can tell if the cancer has
spread outside the ovaries. There are four stages of ovarian cancer - Stage I (early disease) to Stage IV (advanced disease). The treatment plan
and prognosis (the probable course and outcome of the disease) will be determined by the stage of the cancer.
The following describes the various stages of ovarian cancer:

Grades of Ovarian Cancer

Tumor grade is not the same as the cancer stage. Grade (G), describes how healthy the cancer cells look when viewed under a microscope. The
doctor compares the cancerous tissue with healthy tissue. Healthy tissue is made up of many types of cells grouped together. If the cancer looks
like the healthy tissue with different cell groupings, it is called differentiated or a low-grade tumor. If the tissue looks very different, it is called
poorly differentiated or a high-grade tumor. The cancers grade may help the doctor predict how quickly the cancer will spread. It also helps
determine a treatment plan decision.
The following is a description of tumor grades:
GX: The grade cannot be evaluated
GB: The tissue is considered borderline cancerous. This is commonly called low malignant potential (LPM).
G1: The tissue is well-differentiated (contains many healthy looking cells)
G2: The tissue is moderately differentiated (more cells appear abnormal than healthy)
G3 to G4: The tissue is poorly differentiated or undifferentiated (more cells appear abnormal, and lack normal tissue structures)

Signs and Symptoms of Ovarian Cancer

Ovarian cancer is difficult to detect, especially, in the early stages. This is partly due to the fact
that the ovaries, two small, almond-shaped organs on either side of the uterus, are deep within the
abdominal cavity. The following are often identified by women as some of the signs and symptoms of
ovarian cancer:
Bloating symptoms
Pelvic or abdominal pain
Trouble eating or feeling full quickly
Feeling the need to urinate urgently or often

Other symptoms of ovarian cancer can include:

Fatigue
Upset stomach or heartburn
Back pain
Pain during sex
Constipation or menstrual changes
If symptoms are new and persist for more than two weeks, it is recommended that a woman see her doctor, and a gynecologic oncologist
before surgery if cancer is suspected.
Persistence of Symptoms
When the symptoms are persistent, when they do not resolve with normal interventions (like diet change, exercise, laxatives, rest) it is
imperative for a woman to see her doctor. Persistence of symptoms is key. Because these signs and symptoms of ovarian cancer have been
described as vague or silent, only approximately 19 percent of ovarian cancer is diagnosed in the early stages. Symptoms typically occur in
advanced stages when tumor growth creates pressure on the bladder and rectum, and fluid begins to form.

Ovarian Cancer Risk Factors

All women are at risk
Symptoms exist - they can be vague, but usually get more intense over time
Early detection increases survival rate
A Pap test DOES NOT detect ovarian cancer
Ovarian cancer risk factors include:
Genetic predisposition

 Personal or family history of breast, ovarian, or colon cancer

Increasing age
Infertility
While the presence of one or more risk factors may increase a woman's chance of developing ovarian cancer, it does not necessarily mean that
she will get the disease. A woman with one or more risk factors should be extra vigilant in watching for early symptoms.

Recommendations
Current recommendations for management of women at high risk for ovarian cancer are summarized below:
Women who appear to be at high risk for ovarian cancer should undergo genetic counseling and, if the risk appears to be substantial, may
be offered genetic testing for BRCA1 and BRCA2.
Women who wish to preserve their reproductive capacity can undergo screening by transvaginal ultrasonography every six months, although
the efficacy of this approach is not clearly established.
Oral contraceptives should be recommended to young women before they embark on a planned family.
Women who do not wish to maintain their fertility, or who have completed their family, may undergo prophylactic bilateral salpingooophorectomy. The risk should be clearly documented, preferably established by BRCA1 and BRCA2 testing, before surgery. These women
should be counseled that this operation does not offer absolute protection because peritoneal carcinomas occasionally can occur after
bilateral oophorectomy.
Since BRCA1 and BRCA2 gene mutations also increase the risk of developing breast cancer, annual mammography screening is suggested,
beginning at age 25.
Women with a documented HNPCC Syndrome, also known as Lynch Syndrome, should undergo periodic screening mammography,
colonoscopy, and endometrial biopsy.

III.

ANATOMY AND PHYSIOLOGY

The Ovaries and Reproductive System

The ovaries are part of a woman's reproductive system. The reproductive system
is made up of the:
Vagina

 Womb or uterus (which includes the cervix)

Fallopian tubes
Ovaries
There are 2 ovaries, one on each side of the body. The ovaries produce an egg each
month in women of childbearing age.
The ovaries and fertility
Women are able to have children between puberty (when the periods start) and the
menopause (or change of life, when the periods stop). The age when periods start and stop
varies a great deal.
In the middle of each menstrual cycle (midway between periods), an egg travels
down one of the fallopian tubes and into the womb. The lining of the womb gets thicker
and thicker, ready to receive the fertilised egg. If this egg is not fertilised by sperm, the
thickened lining of the womb is shed as a period. Then the whole cycle begins again.

Ovarian hormones
The ovaries also produce the female sex hormones. These are
Estrogen
Progesterone
The ovaries produce these hormones throughout the years when women can become pregnant. The hormones control the menstrual cycle. As
you get older and closer to menopause, the ovaries make less and less of these hormones and periods eventually stop.
More recently doctors have learned that ovarian hormones also help to protect the heart and bones and maintain brain and immune system
health.
The ovaries also produce a small amount of the male hormone testosterone. It is not completely clear what role testosterone has in women. But
doctors think it helps with muscle and bone strength. And it may have a role in a womans sex drive (libido).

Ovarian cysts
In young women the ovaries are about 3cm long. After the menopause they tend to shrink. Doctors cannot usually feel the ovaries during a
medical examination, except in young, thin women. Some women have cysts on their ovaries. Cysts are fluid filled sacks. They are not usually
cancerous.
In women of childbearing age, small cysts develop in the ovary every month as an egg develops. This is normal and they usually disappear
without treatment within a few months. You should have tests if the cysts:

Are there for longer than normal

Are unusually large
Cause symptoms
Develop when you are past your menopause

IV. Diagnostic Tests

Most women with ovarian cancer are diagnosed with advanced-stage disease (Stage III or IV). This is because the symptoms of ovarian
cancer, particularly in the early stages, often are not acute or intense, and present vaguely. In most cases, ovarian cancer is not detected during
routine pelvic exams, unless the doctor notes that the ovary is enlarged. The sooner ovarian cancer is found and treated, the better a woman's
chance for survival. It is important to know that early stage symptoms can be difficult to detect, though are not always silent. As a result, it is
important that women listen to their bodies and watch for early symptoms that may present.
Did You Know?
The Pap test does not detect ovarian cancer. It determines cervical cancer.
Screening Tests
Although there is no consistently-reliable screening test to detect ovarian cancer, the following tests are available and should be offered to
women, especially those women at high risk for the disease:

 Pelvic Exam: Women age 18 and older should have a mandatory annual vaginal exam. Women age 35 and older should receive an annual
rectovaginal exam (physician inserts fingers in the rectum and vagina simultaneously to feel for abnormal swelling and to detect
tenderness).
Transvaginal Sonography: This ultrasound, performed with a small instrument placed in the vagina, is appropriate, especially for women
at high risk for ovarian cancer, or for those with an abnormal pelvic exam.
CA-125 Test: This blood test determines if the level of CA-125, a protein produced by ovarian cancer cells, has increased in the blood of a
woman at high risk for ovarian cancer, or a woman with an abnormal pelvic examination.
While CA-125 is an important test, it is not always a key marker for the disease. Some non-cancerous diseases of the ovaries can also
increase CA-125 levels, and some ovarian cancers may not produce enough CA-125 levels to cause a positive test. For these reasons the CA-125
test is not routinely used as a screening test for those at average risk for ovarian cancer.
Positive Tests
If any of these tests are positive, a woman should consult with a gynecologic oncologist, who may conduct a CT scan and evaluate the test
results. However, the only way to more accurately confirm an ovarian cancer diagnosis is with a biopsy, a procedure in which the doctor takes a
sample of the tumor and examines it under a microscope.

V. TREATMENT OPTIONS
Ovarian Cancer Treatment Options
SURGERY
Surgery to remove the cancerous growth is the most common method of diagnosis and therapy for ovarian cancer. It is best performed by a
qualified gynecologic oncologist.
Most women with ovarian cancer will have surgery at some point during the course of their disease, and each surgery has different goals.
There are three techniques:
Initial Surgery
Second-look Surgery

 Additional Debulking Surgery or Surgery for Recurrent Cancer

Initial Surgery
Usually performed by laparotomy, a surgery that involves a vertical (up and down) incision in the abdomen that is large enough to allow the
surgeon to look inside the body and remove cancerous tissue.
Sometimes debulking is included, which is the removal of all visible cancer. In addition, it also involves removal of one or both ovaries and
fallopian tubes (salpingo-oopharectomy) and often the removal of the uterus (hysterectomy). It is important to have a gynecologic oncologist
perform the surgery. They specialize in cancers of the female reproductive organs and are specially trained to do the surgery needed. Research
has shown that women with ovarian cancer, who are treated by a gynecologic oncologist, tend to fare much better than those who are not.
Goals:
Obtain an accurate surgical diagnosis, which is important when deciding which treatment plan will work best
Determine how far the cancer has spread ("staging" the cancer)
Obtain a sample of the tumor, which will be examined by a pathologist (a doctor who specializes in diagnosing a disease by looking at
the cells under a microscope)
Debulking to remove as much of the cancer tissue as possible
Optimal debulking of the tumor in women with bulky disease can improve the outcome
Second-look Surgery
Second-look surgery is a follow-up for women whose cancer responds to chemotherapy (not performed routinely) which include a
laparotomy and laparoscopy. They are:
Surgeries using fiberoptic scopes and tubes
Less invasive (can be performed through small, one-inch incisions in the abdomen)
Goals:
To determine whether any cancer remains in the abdominal cavity that will require further treatment
The role of second-look surgery in disease management is evolving. This technique might be replaced by other, less-invasive
assessment methods.

Additional Debulking Surgery or Surgery for Recurrent Cancer

Goals:
To reduce cancer symptoms and improve the efficacy of chemotherapy
To remove measurable disease after a reasonable disease-free interval
To remove bowel or ureteral obstruction
CHEMOTHERAPY
Before treatment begins, it is important to understand how chemotherapy works. Chemotherapy is the treatment of cancer using chemicals
designed to destroy cancer cells or stop them from growing. The goal of chemotherapy is to cure cancer, shrink tumors prior to surgery or
radiation therapy, destroy cells that might have spread, or control tumor growth.
Chemotherapy is typically given at a cancer center, hospital, or doctor's office. Most chemotherapy drugs are given in one of the following
ways:

By mouth - Swallowing a pill that the doctor prescribes

As a shot - Injected by a needle into an artery or muscle
Intravenously - Given directly into the veins through a needle called an IV (intravenous) injection
IP (intraperitoneal) - In ovarian cancer, another way to administer chemotherapy is IP, through a catheter, which is placed in the
peritoneal cavity and targeted to that area

The dosage and frequency that chemotherapy is prescribed may vary from once a day, once a week, or even once a month, depending on
the cancer type and the chemotherapy. It also depends on the length of time that research has shown produces the best results for the particular
cancer type.

RADIATION
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Please note that this therapy is rarely used in the treatment
of ovarian cancer in the United States. It is more often used in other parts of the body where cancer has spread.

External Beam Radiation Therapy

This procedure uses a machine outside the body with a beam focused on the area of the body where recurrent ovarian cancer has been
found. This is the main type of radiation therapy used to treat ovarian cancer. These treatments are usually given five days a week for several
weeks. Each radiation session only lasts a few minutes. The radiation passes through the skin and other tissues before it reaches the tumor, which
can cause side effects.
Common side effects include:
Skin irritation skin may look and feel sunburned, blister and/or peel at the site of the treatment
Fatigue
Nausea, vomiting, and diarrhea
These side effects will start to improve once treatment is finished. Any changes to the skin will change over time, usually returning to normal
about 12 months after treatment ends. It is important to discuss all side effects with the healthcare team. There may be ways to relieve some of
the associated pain or irritation.
Although there are other radiation therapy procedures, external beam radiation therapy is the only one that is currently used in the
treatment for ovarian cancer.

COMPLEMENTARY THERAPIES
Some women with ovarian cancer turn toward the wholebody approach of complementary therapy to enhance their fight against the
disease, as well as to relieve stress and lessen side effects, such as fatigue, pain, and nausea.
Complementary therapies are diverse practices and products that are used along with conventional medicine. Many women have tried and
benefited from the complementary therapies listed below. Speaking with other women, in addition to the healthcare team, can suggest the
therapies that may be most helpful and appropriate for each womans lifestyle.
Complementary therapies include:

 Acupuncture
Aromatherapy
Herbal Medicine
Massage
Meditation
Qi Gong (cheeGUNG)
Stress Reduction
Yoga, Tai Chi
Safe Use of Complementary Therapy
There are questions about most complementary therapies that have not yet been answered through well designed scientific studies, such as
clinical trials. Before beginning any complementary therapy, it is important to discuss the approach with your healthcare team and complementary
therapy practitioner.
Complementary vs. Alternative Medicine
People are often confused about the difference between complementary therapies and alternative medicine. As discussed in this section,
complementary medicine makes use of non- conventional therapies such as acupuncture, yoga and meditation. Alternative medicine, on the other
hand, refers to a treatment method that is used in place of standard treatment. By definition, alternative treatments are not integrated as part of
conventional medicine. Caution should be given to alternative treatments in combination with standard therapies. It is important that doctors are
informed about all medications being considered.
CLINICAL TRIALS
Clinical trials are research studies designed to find ways to improve health and cancer care. Each study tries to answer scientific questions
and to find better ways to prevent, diagnose, or treat cancer. Many women undergoing treatment for ovarian cancer choose to participate in
clinical trials. Through participation in these trials, patients may receive access to new therapy options that are not available to women outside the
clinical trial setting.
What is an ovarian cancer clinical trial and why should a patient consider participating?
Clinical trials are comprehensive, controlled studies that help to prevent, diagnose, and determine new treatment options for ovarian cancer.
What are the stages of a clinical trial?
Clinical trials are broken down into 4 separate categories:

Prevention - These trials test new interventions that may lower the risk of developing certain types of cancer. Most cancer prevention trials
involve healthy people who have not had cancer; however, they often only include people who have a higher than average risk of developing a
specific type of cancer. Some cancer prevention trials involve people who have had cancer in the past; these trials test interventions that may help
prevent the return (recurrence) of the original cancer or reduce the chance of developing a new type of cancer. This is an important distinction for
ovarian cancer as it has a significantly high rate of recurrence.
Treatment - These trials test the effectiveness of new treatments or new ways of using current treatments in people who have cancer. The
treatments tested may include new drugs or new combinations of currently used drugs, new surgery or radiation therapy techniques, and vaccines
or other treatments that stimulate a persons immune system to fight cancer. Combinations of different treatment types may also be tested in
these trials.
Screening - Used to find new ways to detect cancer, especially in the early stages.
Quality of Life - Explore ways to improve quality of life for cancer patients.
Clinical Trial Phases
Clinical trials are done in three or four separate phases. This allows the researchers the opportunity to ask and answer questions that
provides reliable information and protects the patient.

Phase I Evaluates how the drug should be given, what dosage is appropriate and has a very limited number of patients registered for
the trial.
Phase II Enrolls additional patients, continues evaluation of effectiveness and safety of drug. Focuses on specific cancers.
Phase III Enrollment of large numbers of participants, tests the effectiveness of the drugs or combination of drugs, or surgical
techniques against the standard treatment. Patients are usually put into a minimum of two groups: one is the standard group and the
other a new random group (know as randomization).
Phase IV Optional Focuses on longterm effectiveness and side effects of drug or treatment post approval. Phase IV is held over a
long period of time.

Information to Keep in Mind:

o Clinical trials are only open to people who meet very specific medical requirements; not every person is eligible for each clinical trial.
o Clinical trial participants can be among the first to receive new treatments before they hit the market. However, these treatments are under
investigation and may have potential side effects.
o It is a participants right to withdraw from a clinical trial at any time.

o For many women with ovarian cancer, especially those experiencing resistant or recurrent ovarian cancer, investigational treatments may be
able to offer new hope. There are also frontline clinical trials for those who are newly diagnosed.
o It is advisable to bring along a family member or friend to learn about the process of the clinical trial. They will be able to take notes and ask
questions if the patient is too overwhelmed.

VII. NURSING CARE PLANS

Nursing Diagnosis: Fatigue related to altered body chemistry
ASSESSMENT
Subjective:

DESIRED
OUTCOME

After 5 days of
nursing and
Kapoy naman ko. collaborative
Ganahan unta ko interventions, the
kung mas daghan client will:
pa
akong
sa
pagpahuway,
as 1. express different
verbalized by the methods and
client.
activities on how to
alleviate fatigue
Objective:
2. participate in
recommended
- not enough energy treatment program
for daily activities
- chemotherapy

NURSING INTERVENTIONS

RATIONALE

Independent:
1. identify presence of physical and
psychological disease states

- to assess causative
factors

EVALUATION
After 5 days of nursing
and collaborative
interventions, the goal
was fully met. The
client was able to:

2. note daily patterns

3. evaluate need for individual
assistance/ assistive device

- helpful in determining
pattern of activities
- to determine impact on
life

4. measure physiological response to

activities like changes in blood
pressure, heart and respiratory rate
- to determine degree of
fatigue
5. establish realistic activity goals
with client
- enhances commitment
6. plan care to allow individually
to promoting optimal
adequate rest periods. Schedule
outcomes
activities for periods when client has
the most energy.
- to maximize participation

1. express different
methods and activities
on how to alleviate
fatigue
2. participate in
recommended
treatment program

7. instruct in stress-management
skills of visualization and relaxation
Dependent:
1. refer to physical/occupational
therapy for programmed daily
exercise and activities
2. refer to counselling

- to assist client to cope

with fatigue and manage
within individual limits of
ability
- to maintain/increase
strength and muscle tone
and to enhance sense of
well-being
- to promote wellness

Nursing Diagnosis: Activity Intolerance related to generalized weakness secondary to underlying disease
process
ASSESSMENT
Subjective:
Dali ra ko kapuyon
karon, tan-aw nako
kinahanglan ug
saktong kusog para
mabuhat ang mga
sige nakong
buhaton, as
verbalized by the
client.
Objective:

DESIRED
OUTCOME
After 5 days of
nursing
intervention, the
client will state
understanding of
and willingness to
cooperate in
maximizing activity
level.

NURSING INTERVENTIONS

RATIONALE

Independent:
1. note presence of factors
contributing to fatigue

- to identify causative
factors

2. evaluate current limitations

3. have patient perform self-care
activities. Begin slowly and increase
daily, as tolerated.
4. provide emotional support and
encouragement

- limited movement
5. note treatment-related factors,
such as side effects/interactions of
medications

- provide comparative
baseline
- activities will help
patient regain health
- to help improve patients
self-concept and
motivation to perform
activities of daily living
- to identify precipitating
factors

6. adjust activities
7. plan care with rest periods
between activities

- to prevent overexertion
- to reduce fatigue

8. assist with activities and provide

clients use of assistive devices

- to protect client from

injury

9. encourage client to maintain

positive attitude; suggest use of
relaxation techniques

- to enhance sense of wellbeing

EVALUATION
After 5 days of nursing
intervention, goal was
met, as evidenced by
clients ability to state
understanding of and
willingness to
cooperate in
maximizing activity
level.

Nursing Diagnosis: Imbalanced Nutrition less than body requirements r/t inability to digest food because
of
ASSESSMENT
Subjective:

physiological and physical factors

DESIRED
OUTCOME
After 5 days of
nursing

NURSING INTERVENTIONS
Independent:

RATIONALE

EVALUATION
After 5 days of nursing
interventions, the

Wala koy gana

mukaon, as
verbalized by the
client.
Objective:
- weight from 55 kg to
53.6 kg
- weakness
- constipation
- pale conjunctiva
- restlessness

interventions, the
client will be able
to:
1. demonstrate
progressive weight
gain
2. be free of signs
of malnutrition
3. verbalize
understanding of
causative factors
4. demonstrate
behaviors and
lifestyle changes to
regain or maintain
appropriate weight

1. determine the ability to chew,

swallow and taste
2. ascertain understanding of
individual nutritional needs
3. assess weight, body build
strength
4. note total daily intake
5. encourage to choose foods that
are appealing
6. weigh weekly and document
results

- it can be the factor that

can affect ingestion of
nutrients
- to determine what
information to provide to
the client
- provide comparative
baseline
- to reveal changes that
should be made in clients
dietary intake
- to stimulate appetite

client was able to:

1. demonstrate
progressive weight
gain
2. be free of signs of
malnutrition
3. verbalize
understanding of
causative factors
4. demonstrate
behaviors and lifestyle
changes to regain or
maintain appropriate
weight

- to monitor effectiveness
of dietary plan

Dependent:
1. consult the dietitian as necessary

- for long term needs

Nursing Diagnosis: Risk for Infection related to pharmaceutical agents and immunosuppresion
ASSESSMENT
Subjective:
Gikan lang ko sa
pagpachemo, as
verbalized by the
client.
Objective:

DESIRED
OUTCOME
After 5 days of
nursing and
collaborative
interventions, the
patient will be able
to understand how
to recognize early
signs and

NURSING INTERVENTIONS
Independent:
1. monitor WBC count
2. wash hands before doing any
procedure
3. teach patient how to properly

RATIONALE

EVALUATION

After 5 days of nursing

and collaborative
- elevated total WBC count interventions, the goal
indicates infection
was fully met; as
- to decrease transfer of
evidenced by patients
pathogens
understanding on how
to recognize early
- hand washing prevents
signs and symptoms of

- inadequate
immunity
- underwent
chemotherapy
- increased
environmental
exposure
- IV devices
attached
- underwent
invasive procedure

symptoms of
infection to allow
for prompt
treatment and to
remain free from it.

wash hands before and after meals

and after using bathroom, bedpan or
urinal
4. instruct patient to report incidents
of loose stools or diarrhea
5. provide reverse isolation as
indicated
6. monitor visitors/caregivers
7. review individual nutritional
needs, appropriate exercise program
and need for rest

spread of pathogens to
other objects and food
- diarrhea or loose stools
may indicate need to
discontinue or change
antibiotic therapy
- reduce risk of crosscontamination
- to prevent exposure of
client
- to promote wellness

Dependent:
1. assist with medical procedures

- to reduce existing factors

2. administer and monitor

medication regimen and note
clients response

- to determine
effectiveness of therapy
and presence of side
effects

infection to allow for

prompt treatment and
to remain free from it.

VIII. RELATED ARTICLES

2 Life-Saving Ovarian Cancer Symptoms to Pay Attention to
Angeli Kakade
Fear of cancer can lead women to ignore symptoms and delay doctor's visits, but there are a couple of early indicators you don't want to
leave unchecked.
Women can stay ahead of cancer by paying attention to their bodies. When it comes to ovarian cancer, there are two symptoms that women
should pay specific attention to.
Persistent abdominal bloating and frequent urination, reports one female doctor at Northwestern University. Although she admits there are
several signs of ovarian cancer and that bloating and frequent urination are vague symptoms, she also says that a majority of women who have
ovarian cancer report having these two problems.
The amount these symptoms occur is also important.
With at least 21,000 new cases of ovarian cancer diagnosed just last year, according to the American Cancer Society, it's important to notice
bodily changes, understand your family's health history and voice concerns to your doctor.

These steps can lead to early detection, which is a huge variable in surviving and living with cancer.
Site: http://www.aol.com/article/lifestyle/2017/01/10/2-life-saving-ovarian-cancer-symptoms-to-pay-attention-to/21652101/

New Clinical Trial Combines Two Methods to Defeat Ovarian Cancer

Few women know they have it until it's too late
By Michele Sequeira January 09, 2017
Fewer than half of women diagnosed with ovarian cancer live for five years or more. Sarah Adams, MD, a cancer doctor at the UNM
Comprehensive Cancer Center, hopes a new therapy that delivers a one-two punch to cancer cells will change this outcome.
In a new clinical trial Adams is treating women whose ovarian cancer results from mutated BRCA genes with a drug that kills the ovarian
cancer cells and another that boosts the immune system in response to the dying cancer cells.
Ovarian cancer has unclear symptoms and no screening tests that catch it in its early stages. Often, it spreads to other organs before a
woman even knows she has it. Surgery and chemotherapy can help women at the beginning of their treatment, and this gave Adams the idea for
her new approach.
As a gynecologic oncologist, Adams performs surgery and prescribes chemotherapy for women with cancers of the female reproductive
organs. Adams has also conducted research suggesting that women with BRCA-related ovarian cancer respond better to some chemotherapy
drugs.
Previous research has shown that other chemotherapy drugs not only kill cancer cells but also make the immune system more sensitive to them.
Adams new treatment combines these approaches into what she thinks may be a powerful way to win against ovarian cancer.
Everyone carries a set of genes for BRCA, each of which contains the instructions to produce a protein. BRCA proteins help DNA to repair
itself when both of its strands break and split the molecule in two. But if the BRCA genes are mutated the resulting proteins dont work properly
and the cell cant repair its DNA. It will die unless it can resort to other repair methods.

Cells with mutated BRCA genes turn to a DNA-repair protein called PARP. Adams therapy uses a PARP inhibitor, a drug that keeps the PARP
protein from its repair work. If you knock out BRCA, Adams says, the cell can still live. If you knock out PARP, the cell can still live. But if you
knock out both, the cell dies.
The PARP inhibitor does not affect non-cancerous cells because they have working BRCA proteins to repair DNA. Its specific to cancer cells,
so its nicely targeted and theres minimal toxicity, Adams says. The therapy is also easy to dispense. Its a pill that people take orally, she
says.
Adams therapy combines the PARP inhibitor with a specific antibody (a protein that attaches to a target cell). The antibody helps an immune
cell, called a T-cell, to find and devour ovarian tumor cells. Untreated ovarian tumors often produce chemical signals that keep T-cells away. But
the antibody-PAPR inhibitor combination alerts the entire immune system to the ovarian cancer cells.
Once the immune system finds ovarian cancer cells, it can rid the body of them if the PARP inhibitor doesnt kill them first. And because
the immune system can remember how to respond to ovarian cancer cells, it continues to rid the body of them if the cancer tries to come back.
Adams hopes that this will provide women long-lasting protection.
The clinical trial is currently open to women with BRCA1 or BRCA2 mutations who have a higher risk of getting breast and ovarian cancers
and may have relatives who had these cancers at young ages.
In pre-clinical studies, this combination therapy eliminated tumors and helped mice to live longer. The clinical trial now makes the therapy
available to women with BRCA gene mutations whose ovarian cancer has returned.
Im very excited about the results weve seen so far, Adams says. I hope that this regimen can achieve long-term benefit for women with
ovarian cancer.
Site: http://hscnews.unm.edu/news/new-clinical-trial-combines-two-methods-to-defeat-ovarian-cancer

Fallopian tubes may have big role in ovarian cancer fight

By Jocelyn Wiener, Kaiser Health News
Updated: December 20, 2016
Two thin tubes that connect the ovaries to the uterus have assumed an outsize role in the battle against ovarian cancer.
Research increasingly points to the likelihood that some of the most aggressive ovarian cancers originate in the fallopian tubes. Most doctors
now believe there is little to lose by removing the tubes of women who are done bearing children -- and potentially much to gain in terms of
cancer prevention.
The stakes in this research are high. Ovarian cancer is the deadliest of gynecologic cancers, killing 14,000 women a year in the United
States. It is often diagnosed in the late stages, when it is more difficult to treat.
Routine screening tests to identify it early largely have been discredited. Earlier this fall, the U.S. Food and Drug Administration released a
statement recommending against their use. For that reason, prevention is particularly important.
"It's a really interesting topic and it's practice-changing," said Dr. Noelle Cloven, a gynecologic oncologist with Texas Oncology in Fort Worth.
"Any opportunity to decrease the risk of ovarian cancer or improve our understanding of ovarian cancer, I'm in support of that. It's a terrible
disease."
The risks associated with the removal of the fallopian tubes -- known as salpingectomy -- appear to be minimal, according to a study by Kaiser
Permanente Northern California, which was published this summer in the journal Obstetrics & Gynecology. (Kaiser Health News is not affiliated with
Kaiser Permanente.)
Between June 2013 and May 2014, nearly 73 percent of the women in the study had their fallopian tubes removed while undergoing a
routine hysterectomy. Just two years earlier, fewer than 15 percent of a comparable group had. The large increase yielded no difference in surgical
outcomes. And operating times and blood loss were slightly improved for patients whose fallopian tubes were removed.
Dr. Bethan Powell, senior author of the study and a gynecologic oncology surgeon with Kaiser Permanente, said the fallopian tubes until
recently have been "a neglected region." As a result, when women were undergoing hysterectomy -- the removal of the uterus and cervix -- the
tubes were often left behind.
"Nobody thought it made any difference which side you put your clamp on," Powell said. "If there are health benefits to leaving the ovary, we
should leave the ovary. But there's no reason we should leave the tube."

In recent years, two medical societies have issued statements about the importance of removing the fallopian tubes. In 2013, the Society of
Gynecologic Oncology developed a clinical practice statement recommending the removal of both fallopian tubes as "a viable approach to prevent
ovarian cancer."
In 2015, the American College of Obstetricians and Gynecologists recommended that surgeons discuss the potential cancer prevention
benefits of the procedure with their patients.
While it's now recommended that patients have their tubes removed during a routine hysterectomy, doctors are still wrestling with more
complicated scenarios.
Jennifer Klute, 35, a speech-language pathologist in Napa, Calif., was diagnosed breast cancer in 2015. She'd first noticed a lump while
breastfeeding her daughter, Genevieve, and doctors initially reassured her that the lump was probably related to that.
Then the lumps multiplied. Biopsies were ordered. Klute received the dreaded phone call, and cut short a family vacation to Nebraska. Klute
had a family history of breast cancer and a genetic test revealed a BRCA1 mutation. Women who are positive for the BRCA1 mutation have a 39
percent likelihood of developing ovarian cancer, in addition to a 55 to 65 percent likelihood of developing breast cancer.
It's recommended that women with the mutation have their fallopian tubes and ovaries removed between the ages of 35 and 40, as actress
Angelina Jolie did in 2015. Jolie earlier had a preventive double mastectomy.
Removal of the ovaries has significant cancer prevention benefits -- both for ovarian and breast cancer. But it also carries real consequences,
particularly for younger women like Klute. The ovaries regulate hormones and their removal plunges women into early menopause and increases
their risk of osteoporosis, cardiovascular disease and dementia.
Klute had chemotherapy, radiation and a double mastectomy. Once she recovered, her doctor recommended she have her fallopian tubes
and ovaries removed. Klute requested a second opinion and ended up meeting with Powell. Klute told Powell that while she had a family history of
breast cancer, she didn't have one of ovarian cancer.
Klute wondered whether she might delay the removal of her ovaries for a few more years. She didn't plan to have more children, but she
knew keeping her ovaries a little longer could reduce her risk of other health problems.
Powell knew that leaving the ovaries in high-risk women is "not recommended and not standard" at this point. But she was willing to discuss
the idea with Klute, who eventually opted to keep her ovaries for a little longer. She knows they'll eventually need to go.
Not all doctors feel comfortable offering such a choice to their high-risk patients. Dr. Jill Whyte, a gynecologic oncologist at Northwell Health
on Long Island, is waiting for more data before she's willing to recommend it.

Cloven, the gynecologic oncologist in Texas, also said she would be nervous taking that approach unless the patient was "really motivated"
and understood the risks of delays. Even then, Cloven said she would prefer that a patient choose that option only if participating in a clinical trial.
Nevertheless, Lisa Schlager, vice president of community affairs and public policy for Facing Our Risk of Cancer Empowered, a non-profit
advocacy group devoted to hereditary ovarian and breast cancers, said she thinks more doctors are recommending the approach as an interim
step for high-risk women in their 30s.
"If you want to have children and don't want to be plunged into surgical menopause, the options are: do nothing, do imperfect screening, or
in-between," she said. "That in-between is salpingectomy."
In Klute's case, she said the salpingectomy itself was easy: Powell made a small laparoscopic incision to remove the tubes. Klute had a little
nausea after she woke and couldn't lift Genevieve for a few weeks. But the pain was manageable.
She's now enrolled in two clinical studies and has submitted her information to the National Salpingectomy Registry.
"I think that's super important," Klute said. "The more knowledge we have, the more informed decisions we can make -- and the greater the
outcomes for individuals with cancer."
Site: http://edition.cnn.com/2016/12/20/health/salpingectomy-ovarian-cancer-fallopian-tubes/

IX. BIBLIOGRAPHY
http://www.aol.com/article/lifestyle/2017/01/10/2-life-saving-ovarian-cancer-symptoms-to-pay-attention-to/21652101/
https://www.cancer.gov/types/ovarian/patient/ovarian-prevention-pdq#section/all
http://www.cancer.org/cancer/ovariancancer/
www.cancerresearchuk.org
http://edition.cnn.com/2016/12/20/health/salpingectomy-ovarian-cancer-fallopian-tubes/
http://hscnews.unm.edu/news/new-clinical-trial-combines-two-methods-to-defeat-ovarian-cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712711/
http://ovarian.org/about-ovarian-cancer/what-is-ovarian-cancer/faqs