INTRODUCTION

“The more severe the pain or illness, the more severe

will be the necessary changes. These may involve
breaking bad habits or acquiring some new and better
ones”.
-Peter McWilliams

Endometrial cancer is the growth of abnormal

cells in the lining of the uterus. The lining is called the
endometrium. Endometrial cancer is also called cancer
of the uterus, or uterine cancer. Endometrial cancer
usually occurs in women older than 50. The good news
is that it is usually cured when it is found early. And
most of the time, the cancer is found in its earliest
stage, before it has spread outside the uterus.
 The most common cause of endometrial
cancer is having too much of the hormone
estrogen compared to the hormone
progesterone in the body. This hormone
imbalance causes the lining of the uterus to get
thicker and thicker. If the lining builds up and
stays that way, then cancer cells can start to
grow. Women who have this hormone
imbalance over time may be more likely to get
endometrial cancer after age 50.Most
endometrial cancers develop over a period of
years and may arise from less serious problems
such as endometrial hyperplasia. Although the
majority of endometrial cancers occur in
postmenopausal women, up to 25% may occur
before menopause. The survival rate for all
 In the Philippines, cancer of the cervix is
still the most frequent gynecological
malignancy; it far exceeds cancer of the ovary
and cancer of the endometrium. If we consider
all cancers affecting our women, it runs second
exceeded only by cancer of the breast. If we
consider all cancers affecting both sexes, it
ranks fourth exceeded by cancer of the lungs,
cancer of the breast, and cancer of the liver. In
the 1998 Philippine Cancer Facts and Estimates,
it was predicted that about 4,536 new cases of
cancer of the cervix would be seen and about
2,204 deaths from this malignancy would occur.
At the Philippine General Hospital, the
country’s leading referral center for cancer,
about 600 new cases are seen every year. The
We have targeted perhaps less than 10% of
our susceptible women.Sociocultural factors,
economic factors, and other government
priorities have been blamed for this and health
resources limited as they are have been
directed to control of communicable diseases,
safe motherhood, and promotion of children’s
health.
We chose this case because we know
this case would help us a lot in rendering
quality and efficient nursing care and services
to the client needs, to help client alleviate
sufferings and to serve as a tool to increase
OBJECTIVES

General Objectives

As part of our course competency, we aim to

gain more knowledge regarding Endometrial Cancer
to provide us understanding its pathophysiology;
and how to deal with patients who are suffering from
this disease. Through this case study, nursing
students will be able to gain knowledge about
endometrial caner. They will be able to impart their
knowledge and develop skills and attitude in terms
of providing proper nursing management.
Specific Objectives:
1. To have an overview regarding Endometrial cancer;
2. To analyze patient's profile and his past and
present health status;
3. To evaluate patient's physical appearance and
recognize clinical manifestation of the disease;
4. To interpret diagnostic and laboratory examinations
to relate it to the disease process;
5. To analyze the anatomical part and function of the
organ affected specifically the uterus;
6. To explore the predisposing factors that lead to the
development of the Endometrial cancer;
7. To discuss how the disease progressed and
advanced in the body;
8. To utilize and prioritize client's immediate needs to
create effective nursing care plan;
9. To enumerate and analyze the drugs that have
been prescribed to the patient;
 Patient’s Profile

Name: Patient X
Age: 60 years old
Address: San Roque Rosario, Batangas
Civil status: Widow
Nationality: Filipino
Sex: Female
Religion: Roman Catholic
Date of Admission: January 27, 2009
Time: 1:50 pm
Chief complaint: Vaginal bleeding
Admitting Diagnosis: T/C Endometrial
Carcinoma G4P4
Attending Physician: Dr. Jun Berberabe
A. Past Health History
Patient X is fully-immunized and has no allergies
in any drugs or animals. She has no serious illness and
it was her first time to be hospitalized. patient X is
using self-medication by over-the-counter drugs
whenever she is having fever or in pain.
B. Family History
Patient X is 60 years old. Her husband died last
December 13, 2008 because of heart attack. She has
4 children. The eldest is happily married with one
daughter, the two are working and the youngest is still
studying. Her family doesn’t have any history of
diseases such as hypertension, diabetes mellitus etc.
C. Personal History
Patient X loves to cook delicious foods for the
family and washes their clothes everyday. She is
healthy enough to do all the household chores. After
finishing all the tasks, she’s having bonding with her
D. Social History
The patient said that her family has a closed
family ties. Every Sunday they go to church
together and after they eat out, go to some places
to relax or sometimes they just decided to stay at
home watching television or sharing different
stories. Patient X doesn’t finished her studies
because of financial problem but she graduated at
elementary. Since she is already 60yrs old she is
not working anymore. She just stays at home and
take good care of her grand daughter. Her 3
children works for the family and supports her.
Community services are available at their
community but it’s quite far at their house.

E. Psychological History
The patient doesn’t have any problems
except for financial but her children are earning but
Body Part Method Findings Diagnosis
Skin Inspection Generally uniform in color Normal
except in areas exposed
to the sun, areas of lighter
pigmentation (palms, lips,
nail beds) in dark skinned
clients

No lesions Normal
Palpation Normal body temperature Normal

When pinched, skin goes Normal. Due to

back slowly aging skin
Head
Skull Inspection Rounded (normocephalic Normal
& symmetrical, with
frontal, parietal, and
occipital prominences),
smooth skull contour

Palpation Smooth, uniform Normal

consistency, absence of
nodules and masses
Scalp Inspection No lesions Normal
Absence of seborrhea Normal
Hair Inspection Evenly distributed hair Normal
Thick hair Normal
Silky, resilient hair Normal
Flaking Abnormal; due to
poor hygiene
Face Inspection Symmetric facial features Normal
Symmetric facial Normal
movements
No lesions Normal
Eyes
Eyebrows Inspection Hair evenly distributed Normal
Symmetrically aligned Normal
Eyelids Inspection Skin intact; no discharge; noNormal
discoloration
Conjunctiva Inspection Transparent; capillaries Normal, yellowish
evident, sclera appears sclera is normal in
yellow dark-skinned
clients
Pupils Inspection Illuminated pupil constricts Normal
(direct response)
Chest and Inspection Anteroposterior to transverse Normal
Lungs diameter in ratio of 1:2
Chest symmetric Normal
Palpation Skin intact, uniform in Normal
temperature

Chest wall intact, no Normal

tenderness, no masses
Auscultation Vesicular & bronchovesicular Normal
breath sounds
Breast Inspection Rounded shape, slightly Normal
unequal in size, generally
symmetric
Uniform in color Normal
Palpation No tenderness; no masses Normal
Ears Inspection Auricle’s color is the same as Normal
facial skin
Symmetrical Normal
Auricle is aligned with outer Normal
canthus of eye
Palpation Mobile, firm & not tender, pinna Normal
recoils after it is folded
Nose Inspection Symmetric & straight Normal
No discharge or flaring Normal
Uniform in color Normal
Palpation Not tender; no lesions Normal
Mouth
Lips Inspection Uniform dark color Normal; dark colored lips
is normal in dark skinned
clients
Teeth Inspection Missing teeth Abnormal; due to maybe
poor hygiene or ageing

Brown discoloration of Abnormal; due to poor

enamel (may indicate hygiene
staining or the
presence of caries)

Gums Inspection Dark patches in gums Normal; dark patches in

gums is normal in dark
skinned clients
Tongue Inspection Central position Normal
Brown pigmentation Normal
in tongue on tongue
borders in dark-
skinned clients
Hard palate Inspection Pinkish in color Normal

No sores Normal
Soft Palate Inspection Pinkish in color Normal
No inflammation Normal
Symmetrically aligned Normal
Neck Inspection Muscles equal in size; head Normal
centered
Muscle stiffness Abnormal; due
to generalized
weakness and
ageing
Palpation Lymph nodes not palpable Normal
Central placement of trachea in Normal
midline of neck
Abdomen Inspection Unblemished skin Normal

Uniform in color Normal

Palpation Flat, rounded abdomen Normal

Soft to touch/ no tenderness Normal

Lower Inspection Uniform in color Normal

Extremities

No lesions Normal
Uniform in temperature Normal

Genitalia R E F U S E D
Anatomy and Physiology
Female reproductive system (human)

The female reproductive system contains two

main parts: the uterus, which act as the receptacle for
the male's sperm, and the ovaries, which produce the
female's egg cells. These parts are internal; the vagina
meets the external organs at the vulva, which includes
the labia, clitoris and urethra. The vagina is attached
to the uterus through the cervix, while the uterus is
attached to the ovaries via the Fallopian tubes. At
certain intervals, the ovaries release an ovum, which
passes through the Fallopian tube into the uterus.

If, in this transit, it meets with sperm, the sperm

penetrate and merge with the egg, fertilizing it. The
fertilization usually occurs in the oviducts, but can
happen in the uterus itself. The zygote then implants
itself in the wall of the uterus, where it begins the
 The ova are larger than sperm and are generally
all created by birth. Approximately every month, a
process of oogenesis matures one ovum to be sent
down the Fallopian tube attached to its ovary in
anticipation of fertilization. If not fertilized, this egg is
flushed out of the system through menstruation.

Vagina
The vagina is a fibromuscular tubular tract
leading from the uterus to the exterior of the body in
female mammals, or to the cloaca in female birds and
some reptiles. Female insects and other invertebrates
also have a vagina, which is the terminal part of the
oviduct.

The vagina is the place where semen from the

male is deposited into the female's body at the climax
Cervix
The cervix is the lower, narrow portion of the
uterus where it joins with the top end of the vagina. It
is cylindrical or conical in shape and protrudes
through the upper anterior vaginal wall.
Approximately half its length is visible; the remainder
lies above the vagina beyond view.

Uterus
The uterus or womb is the major female
reproductive organ of humans. One end, the cervix,
opens into the vagina; the other is connected on both
sides to the fallopian tubes .

The uterus is a pear-shaped muscular organ. Its

major function is to accept a fertilized ovum which
becomes implanted into the endometrium, and
derives nourishment from blood vessels which
Oviducts
The Fallopian tubes or oviducts are two
very fine tubes leading from the ovaries of female
mammals into the uterus.
On maturity of an ovum, the follicle and the ovary's
wall rupture, allowing the ovum to escape and enter
the Fallopian tube. There it travels toward the
uterus, pushed along by movements of cilia on the
inner lining of the tubes.
This trip takes hours or days. If the ovum is
fertilized while in the Fallopian tube, then it normally
implants in the endometrium when it reaches the
uterus, which signals the beginning of pregnancy.
Ovaries
The ovaries are the place inside the
female body where ova or eggs are produced.
The process by which the ovum is released is
called ovulation. The speed of ovulation is
periodic and impacts directly to the length of a
menstrual cycle.

After ovulation, the ovum is captured by

the oviduct, after traveling down the oviduct to
the uterus, occasionally being fertilized on its
way by an incoming sperm, leading to
pregnancy and the eventual birth of a new
human being.

The Fallopian tubes are often called the

 PATHOPHYSIOLOGY

Exogenous Estrogen taken by post menopausal women

Excessive Estrogen Stimulation

Excessive proliferation of cells in the endometrium (endometrial hyperplasia)

Infiltration in the inner lining of the uterus (endometrium)

Thickening of endometrial wall

Tumor fills the anterior uterus and extends to surrounding structures

 Anemia Palpable mass

ain/ discomfort in lower abdomen

Weight lossPainless vaginal bleedin

 ASSESSMENT NURSING SCIENTIFIC PLANNING
DIAGNOSIS EXPLANATION

Subjective: Acute pain Pain is a complex, After 30 minutes

“ Masakit pa ang related to break inmultidimensional of nursing
pinag- operahan the skin integrity experience. Post intervention, the
ko.” secondary to post operative surgical patient will be
Objective: operation in the site pain results reduced the pain
6 pain rating endometrium. from the from 6 to 1 pain
scale destruction of rating scale.
Paleness nerves and tissue
Restless during the surgery
Facial grimace because the skin
Guarding has nerve endings
behavior and special
Decreased ability receptors which
to provides sensory
concentrate and perception for
any stimuli.
 INTERVENTION RATIONALE
•Determined possible causes of pain. .
•Accepted client’s description of pain. •To know the affected body part that
•Instructed patient to splint her needs immediate manage-ment.
surgical incision site when coughing •Pain is a subjective experience and
•Positioned patient in comfortable cannot be felt by others.
position and provide privacy. •To reduce pressure in the incision
•Provided patient a clean and safe site, thus, reduce pain.
environment. •To facilitate comfort and reduces
•Diverted patient’s attention to a embarrass-ment and anxiety for more
lighter topic using therapeutic effective coping.
communi-cation. •Facilitates comfort and decrease
•Encouraged to limit movement. hazards and prevents harbor of
microorga-nisms, thus prevents
infection.
•Reduces anxiety and perceptions of
pain.
•To decrese metabolic demand and
prevent fatigue.
 EVALUATION

After 30 minutes of nursing interventions,

the patient’s pain is reduced from 6 to 4
pain rating scale.
 Name of Classification / Indication Side Effect
Drug Action

Ferrous Hematinics Iron GI: nausea,

Sulfate Provides Deficiency epigastric pain,
elemental iron, As a vomiting,
an essential supplement constipation, black
component in the during stool, diarrhea,
formation of pregnancy anorexia
hemoglobin
Other: temporarily
stained teeth from
liquid forms
 Contraindication Nursing Monitoring
Responsibilities Parameters
Contraindicated with patients Tell patients to May yield false-
with hemosiderosis, primary take tablets positive guaiac
hemocromatosis hemolytic with juice test results. May
anemia (unless patient also (preferably decrease uptake
has iron deficiency anemia) orange juice) of technetium-
peptic ulceration, ulcerative or water, but 99m and
colitis, or regional enteritis not with milk or interfere skeletal
and in those receiving blood antcids imaging.
transfusions.
Instruct
Use cautiously on long-term
patients not to
basis.
crashed or
chew
extentded-
release forms. .
 Name of Drug Classification / Action Indication
Ceftriaxone Cephalosporins Uncomplicated
Sodium 3rd generation gonoccocal
cephalosporin that vulvocaginitis
inhibits cell-wall UTI; lower respiratory
synthesis, promoting tract, gynecologic,
osmotic instability, bone or joint, intra-
usually bactericidal abdominal, skin, skin
structure infection;
septicemia
Meningitis
Perioperative
prevention
Acute bacterial otitis
media
 Side Effect
CNS: fever, headache,
dizziness
CV: phlebitis
GI: pseudomembranous colitis,
diarrhea
GU: genital pruritus,candidiasis
Hematologic:
eosinophilialeukopenia
Skin: pain, induration,
tenderness at injection site,
rash, pruritus
Other: hypersentivity reactions,
serum sickness
Contraindication
Contraindicated in patients
hypersensitive to drug or
other cephlorporins
Use cautiously in patients
hypersensitive to penicillin
because of possibility of
cross-sensitivity with other
beta-lactam antibiotics
Use cautiously in
breastfeeding women and in
patientds with history of colitis
and renal insufficiency
 Nursing Responsibilities Monitoring Parameters

Tell patient to report May increase alkaline

adverse reaction promptly phosphatase, ALT, AST,
Instruct patient to report bilirubin, BUN, and LDH
discomfort at IV insertion levels
site May increase eosinophil and
platelet counts. May
decrease WBC count
 Name of Drug Classification / Action Indication
Diphenhydramine Antihistamines Rhinitis, allergy
Hydrochloride Competes with symptoms, motion
histamine for h1- sickness,
receptor sites. Parkinson disease
Prevents, but doesn’t
reverse, histamine
mediated responses,
particularly those of the
bronchial tubes, GI
tract, uterus and blood
vessels
 Side Effect
CNS: drowsiness, sedation,
sleepiness, dizziness, seizures
CV: hypotension, tachycardia
EENT: diplopia, blurred vision,
nasal congestion, tinnitus
GI: dry mouth, nausea, epigastric
distress
GU: dysuria, urine retention
Contraindication
Contraindicated in patients
hypersensitive to drug;
newborns; premature
neonates; breastfeeding
women; patients with angle-
closure glaucoma, stenosing
peptic ulcer
Avoid use in patients taking
MAO inhibitors
Children younger than age
12 should use drug only as
directed by prescriber
 Nursing Responsibilities Monitoring Parameters
Instruct patient to take May decrease hemoglobin level
drugs 30mins before travel and hematocrit
to prevent motion sickness May decrease granulocyte and
platelet counts
Inform patient that
sugarless gum, hard May prevent, reduce, or mask
candy or ice chips may positive result in diagnostic skin
relieve dry mouth test
Name of Drug Classification / Indication Side Effect
Action
Paracetamol NSAID Mild pain or Hematologic:
Thought to reduce fever hemolytic anemia,
analgesia by leucopenia,
blocking pain neutropenia,
impulses by pancytopenia
inhibiting Hepatic: jaundice
sysnthesis of Skin: rash,
prostaglandin in urticaria
the CNS.
 Contraindication Nursing Responsibilities
Contraindicated in patients Tell patients to consult prescriber
hypersensitive to drug before giving drug to children
younger than age 2

Use cautiously in patients Advise parents that drug is only

with long-term alcohol use for short-term use; urge them to
because therapeutic doses consult prescriber if giving to
cause hepatotoxicity in children for longer than 5days or
these patients adults longer than 10 days
 Monitoring Parameters
May decrease glucose and hemoglobin levels
and hematocrit

May decrease neutrophil, WBC, RBC, and

platelet counts
 PROGNOSIS

The patient is still confined in

the hospital for continues treatment.
Patient X is under observation after
undergoing an operation called
extrafascial hysterectomy of removal
right pelvic lymph node.
DISCHARGE PLANNING

M – Provide the family with assistance in planning and

providing aspects of care. The family is advised to
continue regular intake of home meds that were
prescribed by the physician.
– Reinforce importance of medical compliance to
patient and its relatives; its time, frequency, duration,
dosage and route.
– Advise to report unusual manifestations and
adverse reactions of drugs to physician.

E – Instruct the patient’s watcher to provide calm,

non-stressful with normal room and body temperature
environment.
– Instruct to maintain a clean and safe
T – Instruct the relatives of the patient the
modification of home environment to facilitate the
challenge of living with an illness.

H – Explain to the patient’s relatives regarding

patient’s disease and its manifestations.
– Discuss possible complications of the disease
and its signs and symptoms.
– Advise the relatives to assist patient in
maintaining personal hygiene and emphasized the
importance of daily hygiene, such as perineal care and
sponge bath.
– Discuss with the family the home treatment for
cancer to help manage the side effects that may
accompany endometrial cancer or cancer treatment
such as chemotherapy.
O – Inform relatives regarding importance of
compliance on follow-up check-up.
– Instruct the patient and relatives to have a
follow-up check-up for monitoring her condition.

D – Advise the patient to eat variety of nutritious

foods that can help her to regain his strength
– Encourage the patient to have healthy habits
such as eating a balanced diet and getting enough
sleep and exercise to help control symptoms

S – Encourage the patient’s relatives to seek spiritual

support
– Encourage the patient to hold her faith to God.
 ACKNOWLEDGEMENT
We want to extend our deepest gratitude and
appreciation to the people who helped us in the
pursuit of this case study.

First, to our family for always being there to

guide us and support us all the way.

To our clinical instructor, Mrs. Zaraspe, for the

kindness and selflessness she showed us in imparting
her ideas.

To our fellow group mates, who shared the

journey with us in making this case study.

To the patient and his relatives, for always

opening their hearts and doors whenever we need
them.
 BIBLIOGRAPHY

Books:
Abel, Steven R. and Antonawich, Lynn M., Nursing
2008 Drug Handbook, Lippincott Williams and Wilkins, 2008,
pp. 63-70
Bare, Brenda G. and Smeltzer, Suzanne C. et al.,
Textbook of Medical – Surgical Nursing, Lippincott Williams
and Wilkins, 2008, pp. 567 and 756
Burns, Mary V. Pathophysiology (A Self-Instructional
Program), Appleton and Lange, 1998, pp. 174-175
Doenges, Marilyn E., Moorhouse, Mary F. and Murr,
Alice C., Nursing Care Plans (7th edition), FA Davis
Company: Philedelphia
Porth, Carol M. Essentials of Pathophysiology,
Lippincott Williams and Wilkins, 2005, pp. 475-477
Thank You!