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INTRODUCTION: • Cancer of the ovaries (ovarian carcinoma) develops most often in women aged 50 to 40. This cancer eventually develops in about 1 of 70 women. It is the second most common gynecological cancer. However, more women die of ovarian cancer than of any other gynecological cancer. • The risk of this cancer is higher in industrialized countries because the diet tends to be high in fat. Risk is increased for women who were unable to become pregnant, who had their first child late in life,
who started menstruating early or who reached menopause late. Risk is also increased for women who have a family history of cancer of the uterus, breast or large intestine (colon). Ovarian cancer causes the affected ovary to enlarge. In young women, enlargement of an ovary is likely to be caused by a non-cancerous fluid-filled sac (cyst). However, after menopause, an enlarged ovary is often a sign of ovarian cancer. Many women have no symptoms until the cancer is advanced.
If ovarian cancer is suspected or confirmed, surgery is performed to remove the mass and to determine how far the cancer has spread. • Diagnosis of ovarian cancer starts with a physical examination (including pelvic examination) a blood test (for CA-125) and transvaginal UTZ. The Diagnosis must be confirmed with surgery to inspect the abdominal fluid.
PROFILE: • Name: Ms. E.P • Address: Pob. Ward 1 Minglanilla, Cebu • Sex: Female • Birth Date: July 10, 1966 • Age: 45 Status: Single Religion: Roman Catholic • Occupation: Self-employed
HISTORY OF PRESENT ILLNESS 2 years PTA patient noted to have abdominal enlargement with no associated symptoms. No consult done. Condition tolerated until 1 month PTA when patient was told to have check-up regarding her abdominal enlargement. Transrectal ultrasound was done which showed multiple, solid heterogenous masses within the myometrium. Menarche at 13 years old, subsequent cycle are regular, 3-6 day duration, soaking 2-3 pads/day, negative dysmenorrhea.
She was diagnosed with papillary serous cystadenocarcinoma of the ovary stage IIIC with metastasis to the uterine serosa, both fallopian tubes or ovaries, omentum and peritoneal fluid, had surgery in November 2010.
LAB FINDINGS Date: 08-02-10
DRUG STUDY NAME OF DRUG: Dexamethasone CLASSIFICATION: Glucocorticoid, anti-inflammatory INDICATION: can be used for all conventional indications for glucocorticoids. Dexamethasone produces considerable pressure relief in the event of cerebral edema or raised intracranial pressure of a different origin. It is also very efficient as an antiemetic agent in strongly emetogenic chemotherapy.
ADVERSE EFFECT: -malaise -headache -vertigo -hypotension -thromboembolism -n/v -abdominal distention -muscle pain -osteoporosis -facial edema -wait gain
CONTRAINDICATION: -Existing gastrointestinal ulceration -Cushing’s syndrome -Severe forms of heart insufficiency -Severe Hypertension -Uncontrolled DM -Systemic Tuberculosis -Severe Systemic viral, bacterial and fungal infection -Pre-existing angle glaucoma -Osteoporosis
DRUG INTERACTION: -NSAIDs and alcohol: increase risk of G.I ulceration -Mineralocorticoids: increase risk of hypertension -Oral anti diabetic drugs and insulin: anti diabetic therapy may have to be adjusted NURSING RESPONSIBILITIES: -Monitor I&O of patient -observe the patient or peripheral edema, steady weight gain, rales or cracles or dyspnea -Administer with meals, to minimize GI irritation
-Educate patient to take missed doses as soon as remembered, unless almost time for the next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed dose. -Instruct patient to avoid people with known infection and contagious illnesses as corticosteroids causes immunosuppression.
NAME OF DRUG: Paclitaxel DOSE, ROUTE, FREQUENCY: 241 mg in PNSS x 3 hr. CLASSIFICATION: Antineoplastic ACTION: is part of a group of anti-cancer drugs that works by killing the tumor cells as they grow and multiply. INDICATION: For the treatment of carcinoma of the ovary or breast alone or in combination. ADVERSE EFFECT: -light headed, dizzy -anemia
-neutropenia -high levels of some liver enzymes -rash/flushing -Nausea an vomiting -diarrhea -hair loss -muscle aches -heart attack -liver damage -pain/swelling at the site of injection
CONTRAINDICATION: Patients who have a history of severe hypersensitivity reactions to paclitaxel or other drugs formulated in cremorphor EL (polyethoxylated castor oil). DRUG INTERACTION: Can potentially interact with other medications some of the medicines that may lead to paclitaxel interactions include: -certain antibiotics/antifungal -certain anticonvulsant -Doxorubicin
-Gemfibrozil -Live vaccinations -Protease inhibitors NURSING RESPONSIBILITIES: -Tell patient to promptly report pain or burning at injecton site -Explain that temporary hair loss may ocuur -Tell thrombocytopenic patient to avoid activities that can cause injury -instruct neutropenic patient to minimize in function risk by by avoiding crowds , plants and vegetables.
NAME OF DRUG: Carboplatin Dose, Route, Frequency:854 inD5W 250cc x 30 mins. CLASSIFICATION: Platinum- containing antineoplastic agent. ACTION: Is an alkylating agent which binds covalently to DNA. It modifies the cell cycle by interfering with DNA structure and function. ADVERSE EFFECT: -thrombocytopenia -central neurotoxicity -leukopenia -peripheral neuropathies -anemia -ototoxicity -nausea -alopecia -vomiting -cardiac failure
SIDE EFFECTS: -difficulty of breathing -swelling of the lips, tongue -kidney damage -decreased bone marrow function -blood problems -extreme fatigue -fever -chills -bloody stools
CONTRAINDICATION: -pregnancy -lactation -allergy to other platinum compounds -severe bone marrow depression DRUG INTERACTION: -Increased risk of ototoxicity when used with aminoglycosides. -Instruct patient to report s/s of allergic response and other adverse reactions. -advise pt. to report unusual bleeding or bruising
-Urge patient to avoid activities that can cause injury. -provide dietary counselling and refer patient to dietitian as needed.
NURSING DIAGNOSIS: High risk for infection related t inadequate secondary defense immunosuppression NURSING GOAL: After 1 day of rendering nursing intervention patient will remain free from infection as would manifest normal vital signs. NURSING INTERVENTION/RATIONALE -Observe and report signs of infection such as redness, warmth, discharge and increased body temperature. With the onset of infection the immune system is activated an signs of infection appear.
-Carefully wash and pat dry skin, including skinfold areas. Use hydration and moisturization. Dry skin can lead to inflammation, excoriations and possible infection episodes. -Encourage a balanced diet, emphasizing proteins to feed the immune system. Immune function is affected by protein intake; the balance between omega 6 and omega-3 fatty acid intake and adequate amounts of vitamins A,C and E the minerals zinc and iron. A deficiency of these nutrients puts the client at an increased risk of infection.
-Encourage adequate rest. To booster the immune system. -Encourage fluid intake. Fluid intake helps thin secretion and replace fluid lost during fever. NURSING EVALUATION: After 1 day of rendering nursing intervention patient remains free from infection as would manifest normal vital signs. -Goal met
NURSING ASSESSMENT: Subjective: “Hindi naakomasyadong nag eexercisekasimabilisakongmapagodlalonapagnagchechemotherapyako.” verbalized by the patient. Objectives: -inability to maintain usual routines. -lack of energy -decrease performance
NURSING DIAGNOSIS: Fatigue related to altered body chemistry (side effects of chemotheray) as manifested by inability to maintain usual routines, lack of energy, decrease performance and verbalization of “Hindi naakomasyadong nag eexercisekasimabilisakongmapagodlalonapagnagchechemotherapyako.”
NURSING GOAL: After 8 hrs. of rendering nursing intervention patient will report improved sense of energy, perform ADLs with assistance as necessary and participate in desired activities at level of ability. NURSING INTERVENTION: -Recommend scheduling activities for periods when client has most energy. Plan care to allow for rest periods. Planning allows client to be active during times when energy level is higher, which may restore a feeling of well being and a sense of control.
-Encourage patient to do whatever possible, such as take short walks. Prevents severe deconditioning and may conserve strength increase stamina and enable patient to become more active. -Monitor physiological response to activity such as changes in BP. Respiratory rate or heart rate. Tolerance varies greatly, depending on the stage of the disease process, nutrition state, fluid balance -Encourage nutritional intake. Adequate intake of nutrients is necessary to meet and build energy.
NURSING EVALUATION: After 8 hrs. of rendering nursing intervention patient reports improved sense of energy, perform ADLs with assistance as necessary and participate in desired activities at level of ability. -Goal met
NURSING ASSESSMENT: Subjective: “Walanaakongbuhok, kalbonaako.” Verbalized by the patient Objective: -alopecia -wearing of wig
NURSING DIAGNOSIS: Body image disturbance may be related to structural changes(loss of hair) as manifested by alopecia and wearing of wig.
NURSING GOAL: After 1 day of rendering nursing intervention patient will verbalize understanding of body changes. NURSING INTERVENTION: -Encourage verbalization of feelings. Listen concerns to alleviate anxiety. -Explain patient that loss of hair is side effect of chemotherapy. So that patient will be educated about the side effect. -Convey feelings of acceptance. Provide emotional feelings.
-Encourage patient to look and touch affected body part. To begin to incorporate changes into body image.. NURSING EVALUATION: After 1 day of rendering nursing intervention patient will verbalize understanding of body changes.
Risk Factors: -celibacy -lifestyle -dysmenorrhea -exposure to asbestos -stress -diet high in saturated fat Hyperstimulation of ovaries Hyperstimulation of ovaries Hyperstimulation of ovaries Increased estrogen
Abnormal proliferation of follicle Follicles fails to ovulate Increased pelvic pressure Lower quadrant pain Cyst grow in size
Increased cell division Fatigue & sense of heaviness in the pelvis Mutation occurs from the center surface of ovary Urinary frequency
Spreads rapidly intraperitoneally Peritoneal carcinoma
MEDICAL MANAGEMENT: Surgery – to remove the tumor Chemotherapy- To kill cancer cells and to control recurrence of tumor growth after surgery. Zofran- used to prevent nausea and vomiting associated with chemotherapy Carboplatin- initial treatment of advance ovarian carcinoma.
