URDANETA CITY, PANGASINAN

COLLEGE OF NURSING
Submitted by:
Razel Ann N. Espenida
Submitted to:
Mrs. Maribel Murillo
Clinical Instructor
Genera Data
!" Patient#$ Name: A.M.
%" Addre$$: Leyte, Philippines
&" Date o' Admi$$ion: Noveber !", !#$% &:$' p
(" Dr. in )*ar+e: (r. Ed)ard *ay I. +alao
," Dia+no$i$: ,steosarcoa pro-ial .ibia
Nur$in+ -i$tory
& onths prior to adission, patient noticed a ass on her ri/ht le/ and 0elts pain a0ter a traua on her lo)er e-treity. A0ter % onths, the ass
becoes bi//er. .hey decided to brin/ her in a private clinic and )ere then advised to /o to hostipal 0or ore e-ainations. .hey )ent to P,C and
)as then advised 0or con0ineent.
Pat*o.*y$ioo+y
Predisposing factors
Age
1istory o0 traua to the lo)er
e-treity
0oration o0 osteiod
tissue
Activation o0
the onco/ene
utation o0 the
(NA,
leads to a
deactivation o0 the
suppressor or /ene
ali/nant osteoblast that leads
to proli0eration o0
abnoralosteoblasts.
uncontrolled /ro)th o0 the
tuor in the bone and
there0ore overcro)din/o0 the
bone
/Laboratory E0amination$
Ty.e o' E0amination: CO1PLETE 2LOOD COUNT 3!4!&4!(
CO1PONENT RESULTS NOR1AL 5ALUES SIGNIFICANCE
1eo/lobin $#& $!# 2 $3# /4L Indicates aneia and heolytic reaction
Platelet '"! $'# 2 3'#-$# /4L Increase in leu5eia and in response to in0ection,
dehydration
1eatocrit #.%! #.%6 2 #.36 /4L Indicates aneia and heolytic reaction
leu5ocytes $#.$6 3.' 2 $#-$# /4L Noral
se/enters .'# .'#7#."# /4L Noral
overcro)din/ also causes
pressure inside the bone 0
suppression o0 red bone
arro) )hich leads to
decreased production o0
blood cells
decreased in 89C
Aneia
Cause o0 pain and 0ractures.
osteosarcoa
lo)ered in0ection resistance
Lyphocyte #.%' #.!# 2 #.3# /4L Noral
Monocyte #.#" #.#! 2 #.#6/4L Noral
Eosinophil #.#6 #.#! 2 #.#6/4L Noral
!!4%64!&
CO1PONENT RESULTS NOR1AL 5ALUES SIGNIFICANCE
1eo/lobin $$! $!# 2 $3# /4L Indicates aneia and heolytic reaction
Platelet 3#6 $'# 2 %'#-$# /4L Increase in leu5eia and in response to in0ection and
dehydration
1eatocrit #.%& #.%6 2 #.36 /4L Indicates aneia and heolytic reaction
leu5ocytes $!.3% 3.' 2 $#-$# /4L Mai indicate in0ection
se/enters .6% .'#7#."# /4L May indicate in0ection
Lyphocyte #.$3 #.!# 2 #.3# /4L (ecrease in response to the etastases o0 the tuor
Monocyte #.#% #.#! 2 #.#6/4L noral
Eosinophil #.## #.#! 2 #.#6/4L (ecrease in response to the etastases o0 the tuor
TEST RESULTS NOR1AL SIGNIFICANCE
P.. $3.& secs $$7$' Noral
Activated P.. !%.: !373' Noral
E+R $6 ;!# Noral
Clottin/ tie ".$' secs '7$' Noral
9leedin/ tie $3.& secs $$7$' Noral
A<L Phosphate $,3%& &37&33 Increases due to the rapid /ro)th o0 the tuor
+L(1 '&" !!'73'# Increases due to the rapid /ro)th o0 the tuor
+odiu $3#." $%'7$36 Noral
potassiu 3.$# %.'7'.% Noral
Calciu !.%" !.#!7!.& Noral
Chlorine $#! :67$#" Noral
CT S)an De) !7,%3!&
Multiple A-ial, sa/ittal and coronal o0 the chest )ere obtained
.here are ultiple varisized pulonary nodules seen scattered in both lun/ 0ields
.he lar/est easures $.6 - $." c in the le0t upper lobe
No pleural e00usion is identi0ied
1eart is not enlar/ed
=reat vessels are unrear5able
No lytic blastic osseous chan/es identi0ied
Im.re$$ion: Multiple >arisized Pulonary Nodules
Si+ni'i)an)e: .he tuor easures $.6 on the le0t upper lobe on the pro-ial tibia consider a etastatic process
C*e$t 89ray
.he lun/ 0ields are clear
.he cardiac silhouette appears noral in size and con0i/uration
>ascular pattern and /reat vessels are unrear5able
.he sulci, hei diaphra/atic lea0lets are intact
Im.re$$ion: essentially noral chest
Si+ni'i)an)e: no coplications noted
Tro)ar 2io.$y:
1i)ro$)o.i) E0amination
Microsections disclose neoplastic tissue 0ra/ents sho)in/ plori0eratin/ splinded cells )ith hyperchroatic pleoorphic nuclei surrounded by abundant osteiod
atri- )ith calci0ication. Entrapped tuor cells are noted.
E-tensive necrosis are noted
Im.re$$ion: ,steosarcoa
Si+ni'i)an)e: (ead tissue )ere noted and dia/nosed as osteosarcoa
1edi)a and $ur+i)a mana+ement
Aputation4rotation plasty
Coplete reoval o0 cancer
+ur/ical resection on the necrotic part
Neoad*uvant Cheotherapy 0ollo)ed by sur/ical resection be0ore the sur/ery to shrin5 the tuor
Methotre-ate )ith leucovorin rescue, intra7arterial cisplatin, adiaycin, i0os0aide
Mi0a0urtide a0ter sur/ey to reove the tuor and to/ether )ith Cheotherapy to 5ill reainin/ cancer cells
Anti7eetics
?il/rasti4pe/0il/rasti help )ith 89C count and neutrophil count
9. and erythropoetin al0a help )ith aneia
hydration
NCP
A$$e$$ment Dia+no$i$ Pannin+ Inter:ention Rationae E:auation
Sub;e)ti:e:
>erbalization o0
pain at the
aputated area
.hrobbin/ pain
at the rate o0
&4$#
Ob;e)ti:e$:
=uardin/
behavior
?acial /riace
5ita Si+n$:
RR7!3
PR7:%
.ep. %".#
9P: $$#4"#
Acute pain related to
tissue and nerve
traua secondary to
aputation
A0ter $ hour o0
nursin/ interventions,
the patient@s pain )ill
be decreased 0ro
&4$# to !4$#
$. Per0or a
coprehensive
assessent o0 pain to
include location
,characteristics, onset,
duration, 0reAuency,
Auality, intensity or
severity, and precipitatin/
0actors o0 pain
!. Position the client to
her co0ortable position
%. Per0or rela-ation
techniAue such as deep
breathin/ e-ercises
3.provide )rin5led 0ree
linen
'.Provide Auiet and cal
environent
&.encoura/e to per0or
diversional activities such
as listenin/ to usic
". Adinister prescribed
anal/esic and anti7
in0laatory edications
Pain is sub*ective
e-perience and ust
be described by client
in order to plan 0or
e00ective treatent.
.o provide co0ort and
rela-ation.
.o provide co0ort and
rela-ation.
.o prevent pressure
sores
Co0orts the patient
.o divert the attention
0ro pain
Produce anal/esia
and reduce
in0laation and 0ever
by inhibitin/ the
production o0
prosta/landins.
=oal et
A0ter $ hour o0
nursin/
interventions, the
patient@s pain )as
able to decreased
0ro &4$# to !4$#
Dru+ Study
Generi) Name: Celeco-ib
2rand Name: celebre-
Ca$$i'i)ation: N+AI(@s
Do$a+e: !## /. ,(
Indi)ation: 0or ild7oderate pain and also 0or i0laation
1e)*ani$m o' A)tion Ad:er$e E''e)t Contraindi)ation Side E''e)t Nur$in+ Con$ideration
E-hibits anti7in0laatory
activities by selectively
inhibitin/ cycloo-y/enase7!
reduced appetite .
s)ellin/ o0 the ars and
le/s due to retention o0 0luid.
Blcers
9leedin/
liver 0ailure
Contraindi)ated <it*
*y.er$en$iti:ity to dru+
>oitin/
nausea
diarrhea
dizziness

=position the patient to a
sei70o)ler@s position to
prevent aspiration
C client to have a oral
care4outh)ash
Ctell client to eat hi/h 0iber
diet.)ash hands a0ter bo)el
activity.
Cencoura/e client to have a
adeAuate rest periods