Case Presentation: Endometrial Cancer

Case Presentation: Endometrial Cancer Group 2 Fhaye Kristine Kaye Lorenzo Daphne Barillo Christie Marie Barillo Joy Jamili Alevi Aguilar Venancio Navarro Faith Pacure Karen Dollopac

Area of Exposure: ASMGH-OB Gyne Ward PM Shift

Biographic Data Name: MJB Age: 43yo Sex: Female Civil Status: Single Address: Barbaza, Antique Birth place: Barbaza, Antique Birth date: July 7, 1966 Religion: Aglipayan Nationality: Filipino Date of Admission: September 17,2009 Attending Physician: Dr. Maria Ceilo S. Sansolis Admitting Diagnosis: Endometrial Cancer Informant: Client and AJB Relationship to the Client: Sister

This is the case of MJB, a 43 year-old female, single and a resident of Barbaza, Antique presently admitted at Angel Salazar Memorial General Hospital with the admitting diagnosis of Endometrial Cancer.

Overview What is Endometrial Cancer? Endometrial carcinoma is a kind of cancer that begins in your uterus. Only women have a uterus. So only women can get this kind of cancer. Carcinoma refers to cancer that begins in tissues that form linings throughout the body. The endometrium is the lining of the inside of the uterus. Endometrial carcinoma is a cancer that forms from the inner lining of the uterus. Throughout this section, we refer to it simply as endometrial cancer. Other kinds of cancer can form in the uterus as well. These are called uterine sarcomas. They are discussed in their own section. Endometrial cancer usually takes years to develop. It most often occurs in women who have already gone through menopause.

What causes Endometrial/Uterine cancer? The main cause of most endometrial cancer is too much of the hormone estrogen compared to the body's progesterone level. Estrogen makes the lining of the uterus (endometrium) grow thicker. Progesterone "opposes" estrogen-your progesterone level goes up then drops at the end of each menstrual cycle, making the thick endometrium layer shed away. This is what you know as menstrual bleeding. When there is too much estrogen in the body, progesterone can't do its job. The endometrium gets thicker and thicker. Over time, the endometrium cells can become cancerous. 

Chief Complaint: Abdominal pain and enlargement of the abdomen 2 weeks PTA.

History of the Present Health Concern Two weeks PTA, the patient had tolerable abdominal pain and mild cramps with enlargement of the abdomen. Patient did not take any medications to relieve the pain. Patient symptoms persisted, thus sought consultation and was advised for admission.

Past Health History client was fully immunized (1BCG,

The 3DPT, 3OPV, 3 Hepa B and 1measle vaccine). No known allergies, (-) for Bronchial Asthma, (-) for Hypertension, and (-) for Diabetes Mellitus. Patient is also known as an alcoholic drinker, consumes 2-3 bottles of beer a week. Last January 2007 the client, undergone surgical operation, the removal of uterine mass.

OB Gyne History The client had her first menstrual period (menarche) at the age of 15, with regular intervals lasting for 3-5 days consuming 2pads a day. Gravida-0 and Parity-0.

Physical Assessment A. General Survey: Height: 5’4” Respiratory Rate: 28 breaths/min (tachypnea)- due to venous obstruction Brachial Pulse: 145 beats/min (tachycardia)- physical signs of pain. Temperature/axilla: 37.9 degrees Celsius Blood Pressure: 140/100mmHg Level of Consciousness: lethargic (drowsy, response to question then fall asleep) with blunted affect.

B. Skin, hair, and Nails Assessment 1. Skin: tan, dry, and fairly hot to touch. Skin fold returns to place after 2-3 seconds. She was pale and cachexic (skin-bone results from the increase metabolic demand of the tumor). Minimal moles can be seen on the face. No edema of the face noted. 2. Hair: black, straight chin level and evenly distributed hair. (-) for Seborrheic dermatitis and Pediculusis capitis. No scalp lesions noted. 3. Nails: thick, hard, well-trimmed nails. The condition of the nail bed is smooth and firm. (-) for Clubbing or Beau’s lines.

C. Head and Neck Assessment Head: symmetric, round and in midline. No visible lesions noted. Neck: symmetric without masses, scars, pulsation, lymph nodes non-palpable. Trachea in midline. Thyroid gland non-palpable with strong bounding (+4) carotid pulse.

D. Eyes: protruded eyes without lesion or edema. Sclera is white without lesions noted. Eyebrows sparse with equal distribution. Pupil Equal, Round, Reactive to Light and Accommodation (PERRLA) . E. Ears: Lesion noted at the right auricle. (papule) F. Nose and Sinuses: external structure without deformity. Symmetrical and patent nares with no inflammation noted. Nasal septum midline without bleeding perforation or deviation. Frontal and maxillary sinuses non-tender.

G. Mouth and Pharynx: pale and dry lips. Cheilosis noted. H. Cardiac Assessment: no vibrations or pulsations noted. I. Breast Assessment: No discharges from the nipples. Non-tender and no dimpling or retraction noted. J. Abdominal Assessment: hard, tender abdomen. Abdominal girth of 85 cm and fundal height of 33 cm with palpable mass on the pelvic floor upon Internal Examination (IE). Visible veins noted due to abdominal distention. K. Genitourinary-reproductive Assessment: with palpable mass on the pelvic floor upon Internal Examination (IE). With minimal vaginal bleeding. Foley Catheter attached to urobag draining to a yellowish urine.

c Very severe abdominal pain r/t direct tumor involvement.

Planning

Nursing Intervention

Rationale

General: Independent: After days of 1.Perform pain hospital assessment each To rule out confinement, the time pain occurs. patient psychological Note specific worsening of Subjective Cues: attitude and physical location and underlying “Gabalik-balik sakit status will be able to intensity (0-10 scale) condition. kang akon busong” cope with the 2.Monitor vital signs. situation. Objective Cues: Dependent: Facial grimacing Specific: 1. Administer Pain scale=8/10 After 8H of medication as (very severe pain) nursing intervention, ordered and To relieve pain RR = 28 cpm patient will be able indicated especially PR = 145 bpm to: for the persistence of felt by the patient. BP = 140/100 mmHg 1. Tolerate pain and pain. (Tramadol will have a pain 25mg) Reference: Nursing Care scale of 4 Plans & Documentation ; 4th Edition; Linda Moyet (p579) 2. Have a vital signs within normal range.

Nursing Diagnosis Enlargement of the abdomen r/t Fluid accumulation in the peritoneal cavity occurs due to the direct pressure by the tumor or venous obstruction.

Planning

Nursing Intervention

Rationale

General: Independent: After days of 1.Monitor FH and 1. These hospital Abdominal girth measurements help confinement, the daily. detect fluid retention patient psychological and ascites. attitude and physical 2. Maintain bed rest. 2. Immobility status will be able to reduced the risk of cope with the 3. Monitor Intake andinjury. situation. Output (MIO). Subjective Cue: 3. Monitor losses “Gabahol akon Specific: 4. Monitor calculation busong kag wara rn After 8H of respiratory, bowel ako kamus-on halin nursing and bladder 4. Level cord kang sarang semana interventions, function. compression “ patient will be able influences to: respiratory Objective cues: (cervical), bowel 1.Enlargement of the 1.Report decrease in Dependent: (lumbar), and abdomen with abdominal size and bladder (lumbar) Fundal Height: fundal height 5. Administer functioning. 33cm medication as Abdominal Girth: 2. Defecate ordered. 85cm 5. Aids in the elimination of stool Reference: Nursing Care Plans & Documentation ; 4th Edition;

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