Cancer

of the cervix is predominantly 90% squamous cell cancer and also includes adenocarcinomas. During the past 20 years, the incidence of invasive cervical cancer has decreased from 14.2 cases per 100,000 women to 7.8 cases per 100,000 women. It is less common than it once was because of early detection by the Pap test, but remains the second most common reproductive cancer in women. Each year, about 500,000 women worldwide are diagnosed with cervical cancer and more than 270,000 die from it.

Cervical cancer occurs most commonly between the ages of 30 and 45 years but can occur in women as young as 18 years. Risk factors include multiple sex partners, early age at first coitus, short interval between menarche and first coitus, sexual contact with men whose partners have had cervical cancer, exposure to HPV virus and smoking. In the Philippines, cervical cancer is the 2nd leading cancer site among women. An estimated 7,277 new cases of, and 3,807 deaths due to, cervical cancer are expected to occur every year. The incidence rate of cervical cancer in the Philippines is 10.1% per 100,000 women per year. It has crude mortality rate 4.1% per 100,000 women per year.

 Cervical

cancer is most often asymptomatic. When discharge, irregular bleeding, or bleeding after sexual intercourse occurs the disease may be advanced. Vaginal discharge gradually increases in amount, becomes watery, and finally is dark and foul smelling because of necrosis and infection of the tumor mass. Bleeding occurs at irregular Intervals between periods or after menopause, may be slight, and is usually noted after mild trauma. As disease continues, bleeding may persist and increase. Nerve involvement, producing excruciating pain in the back and legs, occurs as cancer advances and tissues outside the cervix are invaded, including the fundus and lymph glands anterior to the sacrum.

Extreme emaciation and anemia, often with fever due to secondary infection and abscesses in the lacerating mass, and fistula formation may occur in the final stage. Diagnosis may be made on the basis of abnormal Pap smear results, followed by biopsy results identifying severe dysplasia or carcinoma in situ (cancer has extended through the full thickness of the epithelium of cervix but not beyond). In its very early stages, invasive cervical cancer is found microscopically by Pap smear.

womans first Pap smear should be done 3 years after the first vaginal intercourse. After that, it should be done every year for 3 years. If the Pap smear test is negative for the consecutive 3 years, then it can be done every two or three years. In unmarried women who never had sexual activity in their life, Pap smear should be done at age 35. In later stages, pelvic examination may reveal a large, reddish growth or a deep ulcerating lesion. Prevention may include the following; vaccination such as Gardasil, a vaccine against HPV types 6, 11, 16 & 18 which is up to 98% effective, Cervarix has been shown to be 92% effective in preventing HPV strains 16 and 18 and is effective for more than four years.

HPV vaccines are targeted at girls and women of age 9 to 26 because the vaccine only works if given before infection occurs; therefore, public health workers are targeting girls before they begin having sex. The vaccines have been shown to be effective for at least 4 to 6 years, and it is believed they will be effective for longer, however the duration of effectiveness and whether a booster will be needed is unknown. . Condoms offer some protection against cervical cancer. Evidence on whether condoms protect against HPV infection is mixed, but they may protect against genital warts and the precursors to cervical cancer. They also provide protection against other STDs, such as HIV and Chlamydia, which are associated with greater risks of developing cervical cancer.

 It

may also be useful in treating potentially precancerous changes in the cervix. Exposure to semen appears to increase the risk of precancerous changes (CIN 3), and use of condoms helps to cause these changes to regress and helps clear HPV.[31] One study suggests that prostaglandin in semen may fuel the growth of cervical and uterine tumors and that affected women may benefit from the use of condoms. Disease may be staged based on the International Classification staging system or TNM classification to determine treatment as well as progress of the cancer.

Conservative treatments include cryotherapy (freezing with Nitrous oxide), laser therapy, loop electrosurgical excision procedure (LEEP) or conization (removing a coneshaped portion of cervix). Another is simple hysterectomy if invasion is less than 3mm. Radical trachelectomy is an alternative to hysterectomy. For invasive cancer, radical hysterectomy, radiation, or chemotherapy or a combination of these approaches may be used. For recurrent cancer, pelvic extraction is considered.

 Name:

Mrs. G. M. Age: 46 years old Sex: Female Civil status: Married Address: Brgy. Dalaw, Dinalupihan, Bataan Birthday: December 1, 1964 Place of Birth: Olongapo City, Zambales Religion: Roman Catholic Nationality: Filipino

 Date

of admission: July 12, 2011 Chief complaint: Body Weakness Admitting Diagnosis: Cervical Stage III-B Final Diagnosis: Cervical Stage III-B Admitting Physician: Dr. Ferdinand Bautista Attending Physician: Dr. James Torres

 Dorothea

Orem introduced Self-Care Deficit. Orem labels her self- care deficit theory of nursing as a general theory composed of three related theories: (1) the theory of self care, which describes why and how people care for themselves; (2) the theory of self care deficit, which describes and explains why people can be helped through nursing; and (3) the theory of nursing systems, which describes relationships that must be brought about and maintained for nursing to be produced.

According to her, Nursing is helping clients to establish or identify ways to perform self-care activities. If the client is highly dependent, there is a need for the nurse to assist and address the needs of the client. The theory of self care deficit is giving care to the patient who cant support. The demand of his daily living is often of the main care abilities of a nurse. Self-care activity promotes a persons well-being. It is performed by persons who are aware of the time frames on behalf of maintaining life, continuing personal development and healthy functional living. It is aimed toward making the clients perform selfcare activities in order to live independently, recovering from disease or injury.

 In

relation to our patient she is terminally ill causing her to be fully dependent with the nurses and her relatives. The nurse accomplishes patients therapeutic self- care, compensates for her inability to engage in self care and supports and protects the patient.

 Sister

Callista Roy introduces Adaptation Model. She viewed environment as conditions, circumstances, and influences that surrounds and effect the development and behavior of the person. Adaptation is defined as the process and outcome whereby thinking and feeling, as individual use conscious awareness and choice to create human and environmental integration. In this theory the environment serves as the source of a range of stimuli that will either threaten or promote the persons unique wholeness. It focuses on the patient and his adaptation in the environment on how they will survive, grow reproduce and master.

 Our

patients condition is terminal causing her to be confined in a new environment such as the hospital. It is up to her how she can cope up with the sudden change in environment. As stated by Roy, the individual must use conscious awareness in order to adapt. Kolcaba introduces the theory of comfort. According to her, nursing is the intentional assessment of comfort needs, design of comfort measures to address those needs, and reassessment of comfort levels after implementation compared to the previous baseline.

Katherine

 Assessment

and reassessment can be intuitive and or subjective, such as when the nurse asks if the patient is comfortable, or objective such as the observation of wound healing. She assumpted that human beings have holistic response to complex stimuli, comfort is a desirable holistic outcome that is germane to the discipline of nursing, human beings strive to meet their basic comfort needs or to have them met; it is an active endeavor, enhance comfort strengthens patients to engage in health seeking behaviors of their choice, patients who are actively engage in health seeking behaviors of their own are satisfied with their healthcare.

 Due

to the present condition of our patient her comfort level is altered, in order to meet her needs the nurse identify unmet comfort needs of their patients, design comfort measures to address those needs, and seek to enhance their patients comfort.

ACTIVITIES NUTRITION

BEFORE HOSPITALIZATION The patients height is 165 cm. and weight of 70kg. Her diet is consisting of 5 meals a day with 1-2 cups of rice, vegetables, fish and fruits. She drinks 6-8 glasses of water a day.

AFTER HOSPITALIZATION Her weight became 68kg because the patients nutrition was altered. She is receiving 0.9 NaCl/ PNSS with 1 ampule of Biomix at KVO rate. Loss of appetite, eating only 2 times a day if hungry. She only eats 5 spoons of the dish.

ACTIVITIES

BEFORE HOSPITALIZATION Mrs. G.M. has regular bowel movement and normal urination of amber colored urine and aromatic upon voiding. She is urinating at least 3 times a day.

AFTER HOSPITALIZATION The patients bowel movement was altered from regular it became 3days to 5 days before she will evacuate given the condition that she has eaten her meals. Her urination increases from 3 it became 6 times a day

ELIMINATION

ACTIVITIES HYGIENE

BEFORE HOSPITALIZATION She said that she takes a bath once a day and then give herself a sponge bath whenever shes done working.

AFTER HOSPITALIZATION During the whole period of confinement the patient has not take a bath, but she is receiving sponge bath and then changing of diaper. During the hospitalization she usually sleeps a lot all day.

REST AND SLEEP

She has a good sleeping pattern. She usually goes to bed at 10pm and wakes up 3am. She takes her nap at 2 to 5 in the afternoon.

BODY PART Head

TECHNIQUE Inspection

Scalp
Hair

Palpation
Inspection

Face

Inspection

Skin
Eyes

Inspection
Inspection

ANALYSIS FINDINGS Proportional to Normal body size No tenderness, Normal no lesion Fairly distributed, Due to aging hair covered with white and grayish strands, short in length Soft Due to present disease Extreme pallor, Due to present with edema disease Outer cantus Normal are in line with the auricle of the ear.

Eyelids Auricle

Inspection Inspection

Without swelling Symmetrical; in line with the outer cantus of the eyes, firm No tenderness pale Slightly pale

Normal Normal

Nose Lips Tongue Teeth Neck

Palpation Inspection Inspection Inspection Palpation

Normal Due to decreased hemoglobin Due to decreased hemoglobin

Complete, up and Normal down With cervical Due to present lymph node disease inflammation Equal chest expansion, symmetrical chest contour Normal

Chest

Inspection

Palpation

No masses or Normal lumps

Breath Sounds

Auscultation Lungs clear to Normal auscultation on inspiration and expiration Auscultation Soft gurgling sound Palpation Normal

Abdomen

Without lumps Normal or masses Symmetrical, no lumps Normal

Back

Inspection

Upper Extremities

Palpation

With edema on the right hand extending to the arm, with PNSS + biomix infused to the right hand, With edema on both extremities With tenderness Clean cut fingernails Refused

Due to immobility

Lower Extremities

Inspection

Due to present disease Due to edema Normal Refused

Palpation Fingernails Genitalia/ Buttocks Inspection Refused

HEMATOLOGY EXAM JULY 14, 2011

Normal Value Total RBC Total WBC Hemoglobin Hematocrit Platelet Count ESR 4-5 x10 g/L 5-10x 10 g/L 120-140 g/L 0.37-0.47 150-350-x10 g/ L m- 0-10 mm/m f- 0.20 mm/m 2-4 min 16.250 77.50 0.25 Result Differential count segmenters Stab Juvenile Lymphocytes Monocytes Eosinophils Basophils Malarial Smear Others Normal Value 0.40-0.60 0.01-0.05 0-0.01 0.20-0.40 0.02-0.08 0.10 Result 0.90

Clotting time

Bleeding time
Blood Typing Rh Typing

2-4 min
B Rh Positive

HEMATOLOGY Hematocrit is referred to as the percentage of red blood cells, while hemoglobin is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. Low hematocrit level results to low hemoglobin. Hematocrit and hemoglobin are decreased in cervical cancer due heavy vaginal bleeding leading to the suppression of erythropoiesis by inflammatory mediators as a response to the infection. Thus the presence of infection leads to leukocytosis or high levels of WBC. Segmented neutrophil are high during viral infections and as of this case, Human Papilloma virus infection and malignant neoplasm or carcinoma.. A low lymphocyte count indicates that the body's resistance to fight infection has been substantially lost and one may become more susceptible to certain types of infection.

HEMATOLOGY EXAM

JULY 18, 2011

Normal Value Total RBC Total WBC Hemoglobin Hematocrit Platelet Count ESR 4-5 x10 g/L 5-10x 10 g/L 120-140 g/L 0.37-0.47 150-350-x10 g/ L m- 0-10 mm/m f- 0.20 mm/m 2-4 min 2-4 min B Rh Positive 12.50 132.50 0.43 Result Differential count segmenters Stab Juvenile Lymphocytes Monocytes Eosinophils Basophils Malarial Smear Others Normal Value 0.40-0.60 0.01-0.05 0-0.01 0.20-0.40 0.02-0.08 0.25 Result 0.75

Clotting time Bleeding time Blood Typing Rh Typing

After having blood transfusion of 2 units of PRBC the patients hematocrit and hemoglobin becomes within the normal range as well as the lymphocytes. Segmenters and WBC count are just slightly deviated from the normal value.

URINALYSIS
JULY 14, 2011
Color: Yellow Transparency: Hazy Protein: +1 Sugar: Negative pH: 6.0 Casts Coarse Gran Fine Gran WBC Casts RBC Casts Crystal Calcium Oxalate Uric Acid Triple Phosphate

Specific Gravity: 1.010 Fatty Casts WBC: Loaded RBC: 10-20 Epithelial: Few Mucus Threads Bacteria: Moderate Pregnancy Test Test Pack Hyaline Casts Amorphous Debris Amorphous Urates: Few Others Trichomonas Vaginalis Fungi

 Urinalysis

is an essential procedure for patients undergoing hospital admissions or physical examinations. It is a useful indicator of a healthy or diseased state and has remained an integral part of the patient examination.

Non-modifiable factors Age (46) Gender (female) Early menarche Family history of cancer Early childbearing

Modifiable factors Lifestyle disease Low socioeconomic status

Exposure to HPV virus

Activation of immune response

Formation of abnormal cells in the cervix

Increase production of antibodies (WBC) leading to infection

(Carcinoma in situ) severe dysplasia in the epithelium of the cervix

fever

Carcinoma extends to both pelvic walls involving lower third of vagina

Obstruction of ureters by the tumor

Pain in the back and legs

Irregular bleeding, vaginal discharges

Hydronephrosis or non functioning kidney

Decreased hemoglobin and hematocrit

Edema

Anemia

dyspnea

Body weakness

pallor