SURIGAO EDUCATION CENTER
College of Allied Medical Sciences
Nursing Department
Km 2 Brgy. Luna, Surigao City
CASE STUDY OF
CACHEXIA/ SQUAMOUS
CELL CARCINOMA, TONGUE
PRESENTED BY:
GROUP 1
INTRODUCTION
Squamous cell carcinoma of the oral tongue (SCCOT) is one of the most prevalent tumors of the tongue and neck region.
Squamous cells are the flat, skin like cells that cover the lining of the mouth, nose, larynx, thyroid and throat. Squamous cell
carcinoma is the name for a cancer that starts in these cells. Cancer is when abnormal cells start to divide and grow in an
uncontrolled way. More than 90% of malignant tumors diagnosed in the oral cavity are Oral Squamous Cell Carcinomas (OSCC) whose
preferred location is the tongue. Classically, this disease has affected men preferentially, although recent studies suggest that trends
are changing and the proportion of women with OSCC is increasing. In addition, the prevalence of oral cancer is also determined by
some risk factors as alcohol consumption and tobacco. Currently, the Tumor, Node, Metastasis (TNM) classification is employed to
defined tumor stage and based on this guide specific treatments are established. However, 5-year-survival does not exceed 50% of
cases. The objective of this study is to determine whether a histological risk pattern indicative of higher recurrence might be present
in T1-T2 tumors located in the anterior two thirds of the tongue. (Yamini Ranchod, Ph.D., M.S. — By Erica Hersh — Updated on March
30, 2019)
INTRODUCTION
Patient C, a 73-year-old man from Kasilak, Poblacion Tubod, Surigao del Norte was admitted on May
16, 2023 at 12:05 p.m with a chief complaint of body malaise and loss of appetite that he has been suffering
that noted for five months due to inability to eat solids and pain in swallowing, and was later diagnosed with
Squamous cell carcinoma of the tongue at Surigao Medical Center under the supervision of Dr. Victor Dumagas.
We chose this case because we want to know why men are most likely to suffer from squamous cell
carcinoma of the tongue and we are curious about the disease process itself. We want to educate them on how
to prevent ourselves not to have this oral problem in the future and we are particularly interested in digging
into squamous cell carcinoma of the tongue.
REVIEW OF RELATED LITERATURE
• Squamous cell carcinoma, mostly malignant, is the most common primary carcinoma of oral cavity
accounting for more than 90% of all tumors, whereas metastatic tumors to oral cavity account for 1%-1.5%
of all tumors. Oral cancer is referred to as a subgroup of head and neck malignant neoplasms affecting the
lips, the anterior two-thirds of tongue, the salivary glands, the gingiva, the floor of the mouth, the oral
mucosal surface and the palate, with the tongue being the most common location. The peak incidence
occurs after the fifth decade of life, most commonly between the sixth and eight decade in men, and rarely
in patients under 40 years of age. Yet, current studies reveal a rise in the incidence in this latter group of
young patients. The main risk factors for the onset of oral carcinoma are: tobacco and alcohol consumption
(both of which a synergistic effect), betel nut, certain dietetic habits, genetic factors, sun exposure, poor oral
hygiene and human papillomavirus (HPV) infection. (Slam P, Gale N, et. al. 2017.)
• Historically, squamous cell carcinoma (SCC) of the oral cavity has been a disease of older men with medical
histories significant for tobacco and alcohol use. Over the past 30 years, the incidence of oral cavity SCC
(OCSSC) has been decreasing while the incidence of oropharyngeal SCC (OPSCC) has been increasing. The
decline in tobacco uses and the association of the carcinogenic strains of human papilloma virus (HPV) with
OPSCC may explain these trends. The incidence of lethal cases due to oral carcinoma remains rather high,
not because it is difficult to detect or diagnose but because this carcinoma is routinely detected in the
advanced stage of the disease.
ETIOLOGY
The two most important independent risk factors for the development of tongue SCCA are
heavy smoking and alcohol use. Cigarette smoke contains known carcinogens, mainly nitrosamines,
and polycyclic hydrocarbons. Alcohol metabolizes into acetaldehyde, which affects DNA
repair. Although less known, other important risk factors for the development of tongue cancer are
betel use, radiation exposure, immunocompromised states, poor oral hygiene, and genetic factors.
Human papillomavirus (HPV) infection is also known to play a role in tongue cancer. More recently,
HPV-related carcinoma of the base of the tongue has been linked to an improved response to therapy
and improved survival when compared to its HPV-negative counterpart. (N Engl J Med. 2010)
DIAGNOSIS
The need for a rapid diagnosis and referral of patients to a skilled physician with
expertise in the management of tumors of the head and neck is very important because early
diagnosis can lead to a reduction in mortality. Any suspicious areas should be biopsied.
Incisional or brush biopsy can be done depending on the surgeon’s preference. Direct
laryngoscopy and esophagoscopy are done in all patients with oral cavity cancer to exclude
a simultaneous second primary cancer. Head and neck CT usually is done and a chest CT or
x-ray is done; however, as in most sites in the head and neck, PETCT has begun to play of
patients with oral cavity cancer.
RISK FACTOR
A risk factor is anything that increases a person’s chance of developing SCC.

Tobacco use. Using tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor
for head and neck cancer.

Alcohol. Frequent and heavy consumption of alcohol increases the risk of head and neck cancer. Using alcohol and tobacco
together increases this risk even more.

Other factors that can raise a person’s risk of developing Oral Squamous Cell Carcinoma include:

Prolonged sun exposure. High exposure to the sun, without sun protection measures, is linked with cancer in the lip area.

Human papillomavirus (HPV). Research shows that infection with the HPV virus is a risk factor for oral cancer. In recent
years, HPV-related oropharyngeal cancer in the tonsils and the base of the tongue has become more common. Sexual
activity, including oral sex, with someone who has HPV is the most common way someone gets HPV. There are different
types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers.
RISK FACTOR

Gender. Men are more likely to develop oral cancers than women.

Fair skin. Fair skin is linked to a higher risk of lip cancer

Age. People older than 45 have an increased risk for oral cancer, although this type of cancer can develop in people of any age.

Poor oral hygiene. Lack of dental care and not following regular oral hygiene practices may cause an increased risk of oral cavity
cancer. Poor dental health or ongoing irritation from poorly fitting dentures, especially in people who use alcohol and tobacco
products, may contribute to an increased risk of oral and oropharyngeal cancers. Regular examinations by a dentist or dental
hygienist can help detect oral cavity cancer at an early stage.

Poor diet/nutrition. A diet low in fruits and vegetables and a vitamin A deficiency may increase the risk of oral cancer.

Weakened immune system. People with a weakened immune system may have a higher risk of developing oral cancer. (Shanta V,
et al. 2003)
SIGN AND SYMPTOMS
A common first sign of this cancer is an ulcer, sore or bump on
Lump in your neck
your tongue that doesn’t heal or fade away, and it may bleed
Sore throat or persistent feeling that something is caught in
easily
the throat
Signs and symptoms of Squamous Cell Carcinoma may
include:




White or red patch on the tongue
Thickened area on tongue
Persistent discomfort or pain in tongue and/or jaw
Burning sensation in tongue

Numbness in tongue

Bleeding from tongue that’s not from an injury

Swallowing or chewing problems

Difficulty moving tongue or jaw

Trouble speaking

Bad breath

Weight loss

Fatigue

Loss of appetite
CLINICAL MANIFESTATION
 Appears as reddish rough, thickened, scaly lesion with bleeding and soreness or may be
asymptomatic, border may be wider, more infiltrated, and more inflammatory than basal
cell carcinoma.
 May be preceded by leukoplakia (premalignant lesion of mucous membrane) of the
mouth or tongue, actinic keratoses, scarred or ulcerated lesions.
 Seen most commonly on lower lip, rims of ears, head, neck, and backs of the hands.
COMPLICATIONS
Squamous cell carcinoma of the tongue is a mouth cancer and its
treatment can cause several complications, including changes to the
appearance of your mouth, difficulty swallowing and speech problem.
Sometimes cause emotional problems and withdrawal from normal life.
Dysphagia can be potentially serious problem. If small pieces of food enter
your airways and become lodged in your lungs, it could trigger a chest
infection, known as aspiration pneumonia. (Rivera C. Essentials of oral
cancer. Int J Clin Exp Pathol. 2015)
TREATMENT
Treatment of Oral Squamous Cell Carcinoma Surgery, with postoperative radiation or chemo radiation as needed.
For most oral cavity cancers, surgery is the initial treatment of choice.

Radiation or chemo radiation is added postoperatively if disease is more advanced or has high-risk histologic features.

Selective neck dissection is indicated if the risk of nodal disease exceeds 15 to 20%. Although there is no firm consensus,
neck dissections are typically done for any lesion with a depth of invasion > about 3.5 mm.

Routine surgical reconstruction is the key to reducing postoperative oral disabilities; procedures range from local tissue
flaps to free tissue transfers. Speech and swallowing therapy may be required after significant resections.

Radiation therapy is an alternative treatment. Chemotherapy is not used routinely as primary therapy but is recommended
as adjuvant therapy along with radiation in patients with advanced nodal disease.
Treatment of squamous cell carcinoma of the lip is surgical excision with reconstruction to maximize postoperative
function. When large areas of the lip exhibit premalignant change, the lip can be surgically shaved, or a laser can remove all
affected mucosa. Mohs surgery can be used. Thereafter, appropriate sunscreen application is recommended.
NURSING ASSESSMENT

Assessment. The nurse assesses the patient’s skin and oropharyngeal mucosa regularly when radiation therapy is directed to these areas, and also the nutritional
status and general well-being should be assessed

Symptoms. If systemic symptoms, such as weakness and fatigue, occur, the nurse explains that these symptoms are a result of the treatment and do not represent
deterioration or progression of the disease.

Monitoring therapeutic and adverse effects. The nurse must be familiar with each agent given and its potential effects, and also, the nurse must be aware of the
impact of these side effects on the patient’s quality of life.

Stomatitis. Assessment of the patient’s subjective experience and an objective assessment of the oropharyngeal tissues and teeth are important and for the
treatment of oral mucositis, Palifermin (Kepivance), a synthetic form of human keratinocyte growth factor, could be administered.

Radiation-associated skin impairment. Nursing care for patients with impaired skin reactions includes maintaining skin integrity, cleansing the skin, promoting
comfort, reducing pain, preventing additional trauma, and preventing and managing infection.

Reducing Anxiety
•
- Allow patient to express feelings about the seriousness of diagnosis.
•
- Answer questions; clarify information and correct misunderstandings.
•
- Emphasize use of positive coping skills and support system.
DIAGNOSTIC TEST
To make a diagnosis, the doctor will take a medical history and ask specific questions about symptoms. A patient's tongue and neck will
be examined and a small, long-handled mirror will be used to look down the throat.
• Several tests are used to aid in the diagnosis. These tests include:

X-rays of the mouth and throat, including CT (computed tomography) scans (X-rays that show images in thin sections).

PET scans (positron emission tomography), which use radioactive materials to identify excessive activity in an organ. This may
indicate the tumor is growing.

Tongue cancer usually requires a biopsy, a small sample of tissue that is removed from a tumor to diagnose cancer. After the
surgeon removes the tissue, a pathologist will examine the cells under a microscope. There are different methods to obtain a
biopsy: - Fine needle aspiration biopsy. A thin needle is inserted into the tumor mass and a sample is drawn out by suction into a
syringe.

Incisional biopsy. A sample is removed with a scalpel (surgical knife).

Punch biopsy. A small circular blade removes a round area of tissue.

Pan endoscopy. Pan endoscopy is a procedure used to obtain a biopsy when the suspected tissue is at the back of throat or inside
nasal cavities.
MEDICAL MANAGEMENT
Surgery
o
For mouth cancer, the aim of surgical treatment is to remove any affected tissue while minimizing damage to the rest of the mouth.
Photodynamic therapy (PDT)
o
If the cancer is in its early stages, it may be possible to remove any tumors using a type of laser surgery known as photodynamic
therapy (PDT). PDT involves taking a medicine that makes your tissue sensitive to the effects of light. A laser is then used to
remove the tumor.
Radiotherapy
o
It uses doses of radiation to kill cancerous cells. It may be possible to remove the cancer using radiotherapy alone, but it is usually
used after surgery to prevent the cancer from reoccurring.
Chemotherapy
o
It is often used in combination with radiotherapy when the cancer is widespread, or if it is thought there is a significant risk of the
cancer returning.
PREVENTION
There's no proven way to prevent mouth cancer. However, you can reduce your risk of mouth cancer if you:

Stop using tobacco or don't start. If you use tobacco, stop. If you don't use tobacco, don't start. Using tobacco, whether
smoked or chewed, exposes the cells in your mouth to dangerous cancer-causing chemicals.

Drink alcohol only in moderation, if at all. Chronic excessive alcohol use can irritate the cells in your mouth, making
them vulnerable to mouth cancer. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up
to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and
younger.

Avoid excessive sun exposure to your lips. Protect the skin on your lips from the sun by staying in the shade when
possible. Wear a broad-brimmed hat that effectively shades your entire face, including your mouth. Apply a sunscreen
lip product as part of your routine sun protection regimen.

See your dentist regularly. As part of a routine dental exam, ask your dentist to inspect your entire mouth for abnormal
areas that may indicate mouth cancer or precancerous changes.
EPIDEMIOLOGY
Tongue carcinoma is a condition of older males with a history of smoking and/or
drinking alcohol. It has a slight male predominance, and the estimated frequency of disease
varies widely with geographic location. In the past, there had been a steady decrease in the
incidence of the disease, perhaps attributable to a worldwide overall decrease in
smoking. However, studies suggest an alarming increasing incidence of both oral and base
of the tongue squamous cell carcinoma during the last decades, specifically in women and
younger patients without the traditional risk factors of alcohol or tobacco use. This is, in
part, believed to be related to the dramatic spike in HPV-associated oropharyngeal
squamous cell carcinoma. (Acta Otorhinolaryngol Ital. 2018 Jun;38(3):175-180).
PROGNOSIS
A recent study using the Surveillance, Epidemiology, and End Results
(SEER) database looked at the incidence and survival of oral tongue
squamous cell carcinoma. They report that although the incidence is
increasing for both oral tongue SCCA and oropharyngeal squamous cell
carcinoma, survival has also significantly improved. The study shows that
from 1976 to 2015, oral tongue SCCA and oropharyngeal squamous cell
carcinoma both showed the highest absolute increase in survival, with
conditional survival of over 90% for both diseases independent of the
treatment. (Sci Rep. 2020 May 12;10(1):7877)
PATIENT HEALTH HISTORY
BIOGRAPHIC DATA
• Name:
Patient C
• Case No:
159272
• Date of Birth:
April 05, 1950
• Age:
73
• Sex:
Male
• Civil Status:
Widowed
• Address:
Kasilak, Poblacion, Tubod, SDN
• Occupation:
None
• Father’s Name:
[Not Stated]
• Mother’s Name:
[Not Stated]
• Date and Time of Clinical Encounter:
May 16, 2023/ 12:05 PM
ADMISSION DATA
Hospital:
Surigao Medical Center
Room Number:
301
Room Type:
Private Room
Date and Time admitted:
May 16, 2023/ 12:05 PM
Mode of Admission:
On Wheelchair May 16, 2023/ 12:05 PM
Admitting Vital Signs:
Blood Pressure: 80/ 60
Temperature: 38 °C
Pulse Rate: 100 bpm
Respiratory Rate: 20 cpm
SPO2: 97
Weight:
46 kg
Chief Complaint:
Body Malaise and Loss Appetite
Admitting Physician:
Catherine C. Jumawan, M.D.
Attending Physician:
Victor B. Dumngas, MD
Impression:
Anorexia and Cachexia
Diagnosis:
Cachexia/Squamous Cell Carcinoma, Tongue
Source of Information:
Primary source
Secondary source
:
Patient C
:
SO and Patient’s Chart
CLIENT HEALTH HISTORY
Clients Profile
• Patient C is a 73-year-old male, Filipino citizen born on April 5, 1950, who is permanently living at Kasilak, Poblacion Tubod, Surigao Del
Norte. The patient was admitted to Surigao Medical Center due to body malaise and loss of appetite.
BRIEF HISTORY OF PRESENT ILLNESS:
•
On February 20, 2023, Patient C noticed a node in his tongue, and it was painful. Patient C, experiencing difficulty swallowing, which
leads to malnutrition, they immediately decided to see a doctor. On March 23, 2023, a patient was admitted to Surigao Doctor Hospital due to
inflammation on the right side of his tongue that had a cyst, and then a biopsy was advised. Then, on March 24, 2023, they underwent a biopsy.
The result was released on April 13, 2023. On May 16, 2023, the patient was then admitted to Surigao Medical Center due to anorexia, tremors,
and cachexia noted for 5 months due to the inability to eat solids due to pain when swallowing. Weight loss with progressive body weakness,
thus this admission.
PAST HEALTH HISTORY
•
Patient C's lifestyle is that he is a heavy drinker and cigarette smoker, but he eventually stops his vices due to his illness. He was
diagnosed with cancer of the tongue upon a biopsy done by an EENT surgeon and was advised to undergo surgery when physically fit for it.
CLIENT HEALTH HISTORY
Immunizations
• Patient C completed immunizations during childhood.
A. Surgical history
• The patient underwent biopsy surgery.
B. Accidents and injury
• Patient C never experienced any accidents or injuries
C. Medications
• During hospitalization, the patient was taking six (3) prescription drugs such as:
o
Omeprazole
o
Cefalixane
o
Arcoxia
o
Ensure milk
o
Amino acid+ multivitamins (moriamin forte)
o
Feso4 + folic acid
o
Sodium chloride
o
Lactulose syrup
Family Health History
•
According to the patient, no one in their family has the disease he has now, but they are susceptible to acquiring high blood pressure.
CLIENT HEALTH HISTORY
PERSONAL AND SOCIAL HISTORY
•
Before hospitalization:
The patient was able to smoke two packs of cigarettes every day, drink alcohol, and still manage to do daily activities in life.
•
During hospitalization:
After the admission, further therapeutic assessment was done, and after taking the prescribed medication, the patient was able to express minor relief and was advised to be physically
fit for surgery.
Nutritional Metabolic Pattern
•
Before hospitalization:
The patient eats three full meals a day. There are no food restrictions except for shrimp because he's allergic. The patient experienced a loss of appetite days before admission. The
patient is experiencing eating discomfort due to difficulty swallowing and malnutrition.
•
During hospitalization:
The patient, who was on a soft diet, still has a loss of appetite. The patient only eats foods that have a soft consistency and are easy to swallow, and he also drinks milk.
Elimination Pattern
•
Before hospitalization:
Patient C shows body weakness and lethargy. The patient does not use any assistive devices.The patient urinates 3–4 times a day in a light yellow color. The client defecates twice a
day, in the morning and evening.The stool is formed, soft, and brown. No discomfort or bleeding when defecating.
•
During hospitalization:
Patient C urinates 3–4 times a day in a light yellow color. There is no discomfort during urination. The patient defecates twice a day with a fluid consistency. The patient still shows
body weakness.
CLIENT HEALTH HISTORY
Activity Exercise Pattern
Before hospitalization:
The patient woke up at 6 a.m. Takes a shower, then eats breakfast. Do chores on his own.In the afternoon, he was able to visit their neighbor. Then take a
nap to rest. Patient C is not limited to daily activities.
During hospitalization:
Patient C wakes up at 5 a.m. and does not have any activity to do.
Sleep-Rest Pattern
Patient C's sleeping patterns are from 8 p.m. to 6 a.m. every day during hospitalization. The patient doesn’t take any sleeping pill or sleeping aid. Patient C
rarely has a sleeping problem.
During hospitalization Patient C's sleeping pattern is to go to sleep at 6 p.m. and wake up at 10 p.m. due to the painful right side of his tongue. He is having
sleep disturbances. He takes sleeping pills sometimes..
Cognitive Perceptual Pattern
Before hospitalization. Patient C's five senses are intact. He is conscious, coherent, and oriented to time, places, events, and people.
During hospitalization. There are no changes in his cognitive perception pattern. Still, he is conscious, coherent, and oriented to time, places, events, and
people..
CLIENT HEALTH HISTORY
Self-Perception Pattern
The patient's greatest concern during admission is to get well and to be physically fit so he can have surgery and go
back to normal.life and into his family.
Role-relationship Pattern
The patient speaks Boholano and Surigaonon; he was able to communicate but had difficulty speaking due to a painful
right side of the tongue. Fortunately, he was able to express himself verbally. Patient C lives with his family in their
own house. He is surrounded with his family, his support system is strong. In terms of needs and assistance, he has
family with him.
Coping-stress management Pattern
Patient C’s coping mechanism with stress is keeping him busy with home chores and bonding with his grandson.
Value-Belief Pattern
The patient is a Catholic; he goes to church and hears the word every Sunday.
PHYSICAL ASSESSMENT
GENERAL PHYSICAL SURVEY
Patient is properly dressed, lying in bed awake and responsive. With an on-going IVF of D5NM 1L@ 20gtts/min hooked at right metacarpal
vein infusing well and regulated. He responds appropriately and shows coordinated movements. He wears Black colored shirt and blue short appropriate for
the temperature of the room. Patient shows expressions relevant to his mood. Patient “C” is conscious, oriented and aware of place, time, and people. He
listens and responds appropriately as asked and examined.
Vital Signs Measurement
Temperature:
36.1 degree Celsius
Heart rate:
100bpm
Respiratory rate:
20cpm
Weight:
46kg
Blood Pressure:
80/60
Skin:
Skin is warm and dry, No edema. Hair has normal integrity
GENERAL PHYSICAL SURVEY
Head and Face:
No scalp lesions or flaking. Head symmetrically rounded upon palpation. No inflammation, lumps and masses noted on the skull. Bilateral corneal reflexes are intact.
Eyes:
Both eyes were symmetrical, conjuctiva is pink, sclerae white, without jaundice. Eyebrows distributed equally. Irises are uniformly dark-brown. Pupils are round and
reactive to light.
Ears and Nose:
External pinnae are symmetrical with no lesions or abnormalities, no discharge noted. External nose is uniform color and size, both nostrils were patent.
Mouth and Throat:
Lips are pale and dry. Complete teeth and has teeth anomalies upon inspection. Inflammed tonsils, tongue is swelling, have ulceration and gums are swollen red in color.
Neck:
Neck is asymmetric have masses in the right digastric anterior belly muscle. Cervical lymph nodes are palpable. Trachea is in mid placement in midline of neck.
GENERAL PHYSICAL SURVEY
Arms, Hands, and Fingers:
Arms are equal in size and symmetry bilaterally: pale, warm and dry to touch without edema. No lesions and bruising on hands and arms. Three flexion
creases present in palm. Fingernails are finely cut, clean and clear. No clubbing.
Chest:
No lesion and rashes were noted. Chest movement is apparent during inhaling and exhaling. Regular breathing, respiratory rate of 20cpm.
Abdomen:
Symmetrical contour and uniform in color. No tenderness and masses noted, normal active bowel sounds.
Legs, Feet and Toes:
Legs have no abrasion and wound. Skins are intact, brown, pale and cold to touch without edema. No edema palpated. Toenails are finely cut, clean and
clear. No clubbing.
Genitalia (female):
No bulging or masses in the inguinal area. No presence of pain during urination and in the genital area.
REVIEW OF SYSTEM
REVIEW OF SYSTEM
Integumentary System
Patient C has thinner, pale, clear skin but had a pigmented spots both on his hands. No history of scalp lesions or flaking, pigmented
lesions, jaundice, cellulitis, or adenopathy.
Head, Eyes, Ears, Nose, and Throat (EENT)
Head: Patient has no scalp, hair is color black and distribution consistent with no dryness or oiliness and no lesions present.
Eyes: The patient has visual problems and wearing reading glasses.
Ears: The patient has no history of ear infection, draining ears, lumps or lesions. No discharged (Otorrhea). No history of ear pain
(otalgia). Ear Ringing (Tinnitus).
Nose: Patient has no history of Nasal Bleeding (Epistaxis), nasal stuffiness. No nasal discharge (Rhinorrhea), laryngitis.
Throat: Patient has a lymph node on his right neck (submandibular).. patient has a history of tonsillitis, sore throats bleeding gums
(Gingival Hemorrhage)
Gastrointestinal System
The patient has a history of abdominal pain.
REVIEW OF SYSTEM
Musculoskeletal system
Poor reflexes. No edema at both lower extremities. No inflammations, or bony deformities. No joint pain. No muscle pain.
Neurological System
Patient is drowsy and not respond easily. Patient has no history of memory loss, seizure.
Urinary System
Patient has no history of any urinary tract infection. No pain in urination. No discharge.
Reproductive System (Male)
No history of bulging or masses in the inguinal area. No discharge.
Hematologic or Lymphatic
Patient has no varicose veins and currently has a lymph node on his neck.
Endocrine
No history of Diaphoresis. No polyuria.
Psychiatric
A patient has a history of depression for losing his wife.
LABORATORY RESULTS
Result
Unit
Normal
Value
Hemoglobin
10.6
g/dL
12.0 – 17.0
Anemia
Hematocrit
31.3 (Low)
%
37 – 54
Anemia
RBC
3.37 (Low)
x10^12/L
4.0 – 6.0
Anemia
MCV
92.9 (High)
fL
87+-5
Macrocytic anemia
MCH
31.6 (High)
pg
29+-2
Macrocytic anemia
MCHC
34.0
g/dL
34+-2
Normal
RDW
12.4
11.6 – 14.6
Normal
Platelet Count
266
x10^9/L
150 – 450
Normal
WBC
6.05
x10^9/L
4.5 – 10.0
Normal
Neu %
71.3 (High)
%
50 – 70
Infection
Lym %
14.0 (Low)
%
20 – 40
Infection
Mon %
9.1 (High)
%
0–7
Infection
Eos %
4.7
%
0–5
Normal
Bas %
0.9
%
0–1
Normal
Test
Significance
HEMATOLOGY
RESULTS
• HEMATOLOGY
• May 16, 2023
• Remarks:
• Decreased Hemoglobin and Hematocrit
indicates anemia, decreased RBC indicates
anemia, increased MCV indicates microcytic
anemia, increased MCH indicates microcytic
anemia, increased Neutrophils and
Monocytes indicates infection and
decreased Lymphocytes indicates Infection.
BLOOD
CHEMISTRY
RESULTS
• Remarks:
• Decreased Sodium
indicates hyponatremia and
decreased Ionized Calcium
indicates
hypoparathyroidism.
Test
SODIUM
POTASSIUM
IONIZED
CALCIUM
MAGNESIUM
Result
Reference/Unit
Significance
124.67 (L)
135.00 – 148.00
mmol/L
Hyponatremia
3.58
3.50 – 5.30
mmol/L
Normal
1.06 (L)
1.10 – 1.35
mmol/L
Hypoparathyroidism
2.44
1.7 – 2.4 mg/dL
Normal
DRUG STUDY
DRUG STUDY NO. 1
Generic Name: Omeprazole
Brand Name: Losec
k-alkali syndrome
Adverse Reaction:
Classification: Therapeutic class: Antiulcer drugs
Prescribed & recommended dosage: 4g
Frequency: q24
CNS: Asthenia, dizziness, headache.
GI: Abdominal pain, constipation, diarrhea, flatulence, nausea,
vomiting, acid regurgitation.
Musculoskeletal: back pain, weakness
Route of administration: PO, IV
Mechanism of action: Inhibits proton pump activity by binding to hydrogenpotassium adenosine triphosphatase, located at secretory surface of gastric
parietal cells, to suppress gastric acid secretion.
Respiratory: cough, URI
Skin: rash
Nursing implications:
Indication: Symptomatic
GERD
without esophageal lesions Erosive

esophagitis, Pathologic hypersecretory conditions, Duodenal ulcer, Helicobacter
pylori infection and duodenal ulcer disease, to eradicate H.pylori with
clarithromycin , H.pylori infection and duodenal ulcer disease, to eradicate
H.pylori with clarithromycin and amoxicillin, Short-term treatment of active

benign gastric ulcer, Frequent heartbur, Dyspepsia
Contraindication:





Hypersensitive to drug
Use cautiously in patients with hypokalemia and respiratory alkalosis and in
patients on a low-sodium diet
Risk of fundic gland polyps
Long-term administration of bicarbonate with calcium or milk can causemil
False positive results in diagnostic investigation for neuroendocrine tumors
may occur due to increased CGA level. Temporarily stop atleast 14 days
Periodically assess patient for osteoporosis
Monitor patient for sign and symptoms of acute interstitial nephritis
Discontinue drug if sign or symptoms of cutaneous lupus erythmatosus or
SLE develop
Gstrin level rises in most patients during the first 2 weeks of therapy.
DRUG STUDY NO. 2
Generic Name: Cephalexin

Brand Name: keflex
Classification:
Therapeutic class: Antibiotics
Prescribed & recommended dosage: 750 g
Frequency: q8
Route of administration: IV
Use cautiously in patients with history of colitis and in those with re
nal insufficiency
Adverse Reaction:
CNS: dizziness, headache, fatigue, agitation, confusion, hallucination
GI: anorexia, diarrhea, gastritis, dyspepsia, abdominal pain, anal pruritus
GU: genital pruritus, candidiasis vaginitis
Musculoskeletal: arthritis, arthralgia, joint pain.
Skin: maculopapular, and erythematous rashes, urticaria
Mechanism of action: Inhibit cell-wall synthesis, promoting osmotic
instability; usually bactericidal
Nursing implications:
Indication: Respiratory tract infection caused by susceptible isolates of
Streptococcus pneumoniae and streptococcus pyogenes

Contraindication:

Hypersensitive to cephalosporins

Use cautiously in patients hypersensitive to penicillin because of
possibility of cross-sensitivity with other beta-lactam antibiotics

Drug may increase risk of seizures. Use cautiously in patients with
history of seizures

If large doses are given monitor patient for superinfection and
diarrhea
Treat group of A beta-hemolytic streptococcal infections for a
minimum of 10 days
If anemia develops during or after cephalexin therapy, obtain a
diagnostic work-up for drug-induced haemolytic anemia, discontinue
drug, and institute appropriate therapy.
DRUG STUDY NO. 3
Generic Name: Etoricoxib

Brand Name: Arcoxia
Adverse Reaction:
Classification:
•
Gastrointestinal effects: Abdominal pain, indigestion, nausea, and potential gastrointestinal ulcers or bleeding.
Therapeutic class: NSAID
•
Cardiovascular effects: Increased risk of heart attack or stroke.
Prescribed & recommended dosage: 90 g
•
Edema and fluid retention: Swelling and exacerbation of heart failure.
Frequency:
•
Hypersensitivity reactions: Rare allergic reactions, including rashes and difficulty breathing.
Route of administration: PO
•
Liver effects: Rare instances of abnormal liver function or liver injury.
Mechanism of action: Like any other COX-2 selective inhibitor Etoricoxib selectively inhibits isoform 2 of cyclo-•
oxigenase enzyme (COX-2), preventing production of prostaglandins (PGs) from arachidonic acid.
•
Pregnancy and breastfeeding
Other effects: Headache, dizziness, high blood pressure, and visual disturbances.
Indication:
Nursing implications:

Ankylosing spondylitis

Assess medical history, allergies, and pre-existing conditions.

Gouty arthritis

Educate patients about the medication and its potential side effects.

Relief of acute pain associated with dental surgery

Adjust dosage for elderly or patients with hepatic/renal impairment.

Symptomatic relief in the treatment of osteoarthritis

Monitor for adverse effects like bleeding, heart events, fluid retention, or liver issues.

Symptomatic relief in the treatment of rheumatoid arthritis

Be cautious of drug interactions and adjust medications if needed.
Contraindication:

Avoid Arcoxia during pregnancy and breastfeeding.

Hypersensitivity

Monitor geriatric patients closely due to higher risk of adverse effects.

Active peptic ulcer or gastrointestinal bleeding

severe liver impairment

Severe heart failure

Inflammatory bowel disease
DRUG STUDY NO. 4
Generic Name: Albuterol Sulfate
Contraindication:
Brand Name: Salbutamol


Classification:
•
Therapeutic class: Bronchodilators
•
Pharmacologic class: Adrenergic beta-2 agonists
Prescribed & recommended dosage:
Contraindicated in patients hypertensive to drug or it’s ingredients.
Use cautiously in patients with CV disorders, hyperthyroidism, or
diabetes mellitus and in those who are unusually responsive to
adrenergics.
Adverse Reaction:
CNS: tremor, nervousness, headache, hyperactivity, insomnia, dizziness,
Adults and children age 12 and older:2.5 mg by nebulizer, given over 5 to 15
weakness,CNS stimulation, malaise.
minutes t.i.d. or q.i.d.
EENT: conjunctivitis, otitis media, dry and irritated nose and throat, nasal
Frequency:
congestion, epistaxis, hoarsness, pharyngitis, rhinitis.
• Every 8 hours
CV: tachycardia, palpitations, HTN, chest pain, lymphadenopathy, edema.
• Given over 5 to 15 minutes t.i.d. or q.i.d.
GI: nausea, vomiting, heartburn, anorexia, altered taste, increased appetite.
Route of administration: Nasal
Mechanism of action:
Nursing implications:
Relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta2
Advise patient not to chew or crush extended-release tablets or mix them with
receptors.
food.
Indication:
To prevent or treat bronchospasm in patients with reversible obstructive
airway disease
DRUG STUDY NO. 5
Generic Name: Calcium Pantothenic
Brand Name: Moriamin Forte
Classification:
• Therapeutic class: Multivitamins & Minerals
• Pharmacologic class: Essential Amino Acids
• Folic acid
Prescribed & recommended dosage: 1 capsule, per orem
Frequency: Twice a day (BID)
Route of administration: Oral
Mechanism of action:
malnutrition, nutrient deficiencies, sarcopenia, pregnancy, lactation;
prevention and auxiliary treatment of diseases such as post-operative
improvement, convalescence, dysfunction of the liver, biliary duct and
pancreas, anemia, auxiliary treatment of tuberculosis, improvement in
burns, bone fractures, eczema, urticaria and nephrosis.
Contraindication:
May color urine yellow
Adverse Reaction:
• CNS: Headache and unpleasant taste buds.
• GI: Diarrhea, GI disorder, nausea, abdominal cramp and vomiting.
Nursing implications:

Regulate the antioxidant enzyme activity and increase the body's
antioxidant capacity by regulating the Keap1-Nrf2/ARE signaling the

pathway.

Indication:
Health maintenance; severe consumption of nutriments such as
Assess patient for vital signs of deficiency before and periodically
throughout therapy.
Assess nutritional status through 24 h diet recall.
Determine frequency of consumption off vitamin-rich foods.
DRUG STUDY NO. 6
Brand Name: Hemarate FA



Classification:
Adverse Reaction:
•
Therapeutic class: Vitamins and Minerals
CNS: Headache, insomnia, unpleasant taste bud
•
Pharmacologic class: Antiemetics
GI: abdominal cramp, diarrhea, GI disorder, nausea, vomiting
Generic Name: Iron + Folic, Acid + Vitamin B Comple
peptic ulcer
regional enteritis
ulcerative colitis.
Prescribed & recommended dosage: 1 capsule, per orem
Nursing implications:
Frequency: Twice a day (BID)




Route of administration: Oral
Mechanism of action:
• Inhibits proton pump activity by binding to hydrogen-potassium adenosine triphosphatase,

located at secretory surface of gastric parietal cells, to suppress gastric acid secreation.
Indication:





Maintenance of healing of erosive esophagitis.
Short-term treatment of erosive esophagitis associated with GERD.
Long-term maintenance of healing erosive esophagitis and reduction in relapse rates of da
ytime and nighttime heartburn symptoms in patients with GERD.
Treatment of pathologic hypersecretion caused by Zollinger-Ellison syndrome.
Dyspepsia
Contraindication:


Hypersensitivity
Hemochromatosis
check the physicians order.
Follow the 14 rights of medication.
Advise patient to take medicine as prescribed.
Caution patient to make position changes slowly to minimize orthostatic
hypotension.
Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and
feet and hypotension.
DRUG STUDY NO. 7
Generic Name: Sodium Chloride
Brand Name:
Classification:
•
Therapeutic class: Antacids
•
Pharmacologic class : Alkalinizers
Prescribed & recommended dosage: 4,000 mg, Per Orem
Frequency: Thrice a day (TID)
Route of administration: Oral
Mechanism of action:

Renal failure
Adverse Reaction:
CNS: mood changes, tiredness, muscle weakness, irregular heartbeat,
flatulence, hypertonicity
CV: hypercalcemia, hypokalemia
GI: stomach cramps
Respiratory: shortness of breath
Nursing implications:


Sodium bicarbonate acts as an alkanizing agent by releasing bicarbonate
ions. Following oral administration of this medication, it releases

bicarbonate which is capable of neutralizing gastric acid.

Indication:

• Used as an electrolyte replenisher to help prevent heat cramps caused by
too much sweating
Contraindication:



Contraindicated in patients metabolic/ respiratory alkalosis
Hypocalcemia
Excessive chloride loss
Assess fluid balance throughout the therapy, intake and output, edema
and lung sounds.
Symptoms of fluid overload should be reported (hypertension, edema,
DOB)
Tablets must be taken with full glass of water
Hypertremia manifestations should be assessed and monitored (edema,
hypertension, tachycardia, fever, flushed skin and mental irritability)
Hypokalemia should also be assessed by monitoring signs and
symptoms (weakness, fatigue, polyuria and polydipsia.
DRUG STUDY NO. 8
Generic Name: Lactulose
Contraindication:
Brand name: Constilac

Classification:
Adverse Reactions:
•
Therapeutic class: Laxatives
GI: flatulence, borborygmi, belching, abdominal cramps, pain, and distention
•
Pharmacologic class: Disaccharides
Initial Dose: diarrhea,
Prescribed and recommended Dosage: 30 ml Per Orem
Frequency: Every hour of sleep (HS)
Route of administration: Oral
Mechanism of action:
Excessive Dose: nausea, vomiting, colon, accumulation of hydrogen gas,
hypernatremia
Nursing Implications:

• Reduce blood ammonia by acidifying colon contents, thus retarding
diffusion of non- ionic ammonia from colon to blood while promoting its
migration from blood to colon. In the acidic colon, NH3 is converted to

nonabsorbable ammonium ions and is then expelled in feces.
Indication:
• Prevention and treatment of portal – systemic encephalopathy (PSE),
including stages of heaptic precoma and coma, and by prescription for relief
of chronic constipation.
Contraindicated in patients with low galactose diet.
Assess patient for abdominal distention, presence of bowel sounds, and
normal pattern of bowel function. Assess color, consistency, and amount
of stool produced.
Assess mental status ( orientation, level of consciousness) before and per
iodically throughout course of therapy.
Promote fluid intake during drug therapy for constipation; older adults o
ften self- limit liquids. Lactulose induced osmotic changes in the bowel
support intestinal water loss and potential hypernatremia.
HUMAN ANATOMY AND
PHYSIOLOGY
INTEGUMENTRY
SYSTEM
Your integumentary system is the body’s
outer layer. It’s made up of skin, nails,
hair and the glands and nerves on the
skin. The system acts as a physical
barrier and protecting the body from
bacteria, infection, injury and sunlight. It
helps regulate the body temperature and
allows to feel skin sensations like hot
and cold.
MOUTH ANATOMY
TONGUE
Tongue is a muscular organ in the mouth that aids in chewing,
speaking and breathing. The tongue is made of muscles. It’s anchored inside
of your mouth by webs of strong tissue and it’s covered by mucosa, a moist,
pink lining that covers certain organs and body cavities. The tongue is
covered with different types of papillae or bumps and taste buds.
The four different types of taste buds, including:
 Filiform. Located on the front two-thirds of your tongue, filiform papillae
are thread-like in appearance. Unlike other types of papillae, filiform don’t
contain taste buds.
 Fungiform. These papillae get their name from their mushroom-like shape.
Located mostly on the sides and tip of the tongue, fingiform papillae consis
t of approximately 1,600 taste buds.
 Circumvallate. The small bumps on the back of the tongue are the circumv
allate papillae. The appear larger than the other types of papillae.
 Foliate. Located on each side of the back portion the tongue, the foliate pap
illae look like rough folds of tissue. Each person has about 20 foliate papill
ae, which contain several hundred taste buds.
PHARYNX
The pharynx, also known as the throat, is a muscular
funnel that extends from the posterior end of the nasal cavity to the
superior end of the esophagus and larynx. The pharynx is divided
into 3 regions: the nasopharynx, oropharynx, and laryngopharynx.
The nasopharynx is the superior region of the pharynx found in the
posterior of the nasal cavity. Inhaled air from the nasal cavity
passes into the nasopharynx and descends through the oropharynx,
located in the posterior of the oral cavity. Air inhaled through the
oral cavity enters the pharynx at the oropharynx. The inhaled air
then descends into the laryngopharynx, where it is diverted into the
opening of the larynx by the epiglottis.
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Narrative:
The predisposing factors that contribute to squamous cell carcinoma are age, sex, family history, ethnicity, occupation, and
exposure to ultraviolet lights. Age 40 above, for males, is much more common to have squamous cell carcinoma. The patient’s age was 73
which still belong to the age group that commonly experiences squamous cell carcinoma. Males are common to have early exposure to SCC
because most of them use cigarette smoking. The patient had no family history of any neoplasm conditions. Squamous cell carcinoma is
common in the western world as well as in the Philippines in which the patient is living.
Smoking is a precipitating factor for the client since patient C smokes 20 sticks per day and this greatly contributes to having oral
squamous cell carcinoma. The patient is also an alcoholic in which also contributed to having SCC. Poor diet is manifested on the client as one
of the factors that contributed to SCC. Patient C had cachexia in which pale to look and lethargic during assessment, and after calculating his
body mass index, he was malnourished. He had been hospitalized twice for having SCC and malnutrition.
Cellular aberration happen at the right lateral border of the tongue after the patient was exposed to different factors that
contribute to squamous cell carcinoma. The toxins from smoking, alcohol intake and exposure to UV lights damaged the epithelial cells causing
hyperproliferative stratified squamous epithelium. Then, the reaction creates pre malignant lesions called leukoplakia and erythroleukoplakia,
these are white and red patches that forms in the mucous membranes of the mouth and tongue. Chronic pain, fatigue, and muscle weakness
was manifested on the patient. The pre malignant lesions, then proliferates excessively due to genetic changes and finally epithelial cells grow
down into underlying connective tissues.
Eventually a tumor forms at the right lateral border of the tongue. Tumor cells continue to divide and destroy the underlying
tissues. Tissues in the mouth and tongue feel hard and not functioning properly. Tumor invades lymphatic vessels and spreads into cervical
lymph nodes in the neck and continues to metastasize. Eventually the tumor turns into oral squamous cell carcinoma, the patient was
diagnosed oral SCC after the result of the lymph node biopsy.
PATHOPHYSIOLOGY
The patient had pale skin, fatigue, body malaise, and alteration of heart rate. Due to chronic inflammation of the mouth and the
submandibular section of the neck the patient had been given ceftriaxone omeprazole and arcoxia. The patient had decreased the blood
pressure of 80/60 in which he is hypotensive. The patient was restless based on his actions. Meanwhile, tremors, headaches, and
apprehensiveness were also present on the client.
The patient condition leads into increased pro-inflammatory cytokins and decreased anabolic hormones. The said hormones will
create an effect on the patient’s body causing cytokine induced malnutrition which results from the actions of pro-inflammatory cytokines. The
tumor necrosis factor and interleukin 1, 6 and 8. Then the patient was anorexic due to poor swallowing with pain and anemia, then cachexia
resulting to being malnutrition, associated with decreased turnover of epithelial cells resulting in delayed recovery which may prolong an
episode of infectious diarrhea by itself as well as by promoting tissue invasion by other enteropathogens.
The diagnosis is now determined, if the illness is left untreated it will cause disrupted signals of the epithelial cells and this will
result mucosal ischemia can lead to bacterial translocation of the gut flora, increasing the risk that the patient will present with bacteremia
and it eventually becomes tissue infarction. Tissue infarction progresses to bowel necrosis, perforation, and later on will become sepsis/septic
shock then organ failure to multiple organ failure then death.
Meanwhile, when the said illness will be treated properly through medications or surgical interventions, there will be a restored
blood flow. Through surgical interventions and radiotherapy, the dying cells will be saved because they can experience restored blood flow and
restored oxygen flow while the dead cells will be removed. Through this, there will be a continuous function of the mucosal membranes and
squamous epithelial part of the HEENT and continuous circulation of blood into the body.
NURSING CARE PLAN
NURSING CARE PLAN NO. 1
Assessment:
NURSING INTERVENTIONS
Subjective: "Mag hinuktok rakan sija unsahay kay siguro naway
an na sija ng pag -asa, kay na feel nija na pabug-at rakan sija sa
amo" as verbalized by the SO.
Objective:
RATIONALE
INDEPENDENT:

Encourage the patient to share thoughts
and feelings.


Provide an open environment in which
tha patient feels safe to discuss feelings or
refrain from talking..


Provide accurate, consistent information
regarding diagnosis and prognosis. Avoid
arguing about the patient perceptions of
the situation.

* Altered Behavioral expression
* Poor social interactions
* decrease in perceptual field
Nursing Diagnoses: Anxiety r/t situational crisis as evidence by
expressed concerns regarding changes of life events.
Planning:
• After 8 hrs of nursing intervention, the patient will be able to
acknowledge the implications of his fear, as well as to know
some relaxation techniques that help alleviate anxiety.
Evaluation:
•
After 8 hrs of nursing intervention the goal has been met.
Provides an opportunity to
examine realistic fears and
misconceptions about the
diagnosis.
Helps patients feel accepted in
their present conditions without
feeling judged, and promotes a
sense of dignity and control.
Can reduce anxiety and enable
patients to make decisions and
choices based on realities.
COLLABORATIVE:

Include SO as indicated or patient desires
when major decisions are to be made.

Provides a support system for the
patient and allows SO to be invol
ved appropriately.
NURSING CARE PLAN NO. 2
Assessment:
Subjective: " Dili na sija karajaw mukaon, ginagmay rakan
kay sakit kuno itulon" as verbalized by the SO.
Objective: abnormal esophageal phase of swallow
difficulty iniatiting swallowing
Painscale: 7
Nursing Diagnoses:
• Impaired swallowing r/t dysphagia secondary to dry oral
mocusa.
Planning:
• After 2 weeks of nursing intervention the patient will be
able to demonstrate improved swallowing ability as
evidenced by the absence of discomfort when swallowing
foods,fluids no evidence of aspirations and ability to ingest
foods and fluid.
Evaluation:
• After 2 weeks of nursing intervention the patient will be able
to demonstrate improved swallowing ability as evidenced by
the absence of discomfort when swallowing foods, fluids no
evidence of aspirations and ability to ingest foods and fluid.
Nursing interventions
Rationale
INDEPENDENT:
Determine the clients potentials for
swallowing problems, noting age and
medical conditions
Review the history of the patient
medication.
Swallowing disorders are specially common
in the elderly due to the coexistence of a
variety of neurological, neuromuscular, or
other conditions.
To determine if any medications are one of
the factors cause impaired swallowing such as
benzodiapines, nsaids, serostomia, etc.
Encourage the patient to have rest period To minimize fatigue and pain
before swallowing food or drink.
COLLABORATIVE:



Provide oral hygiene to the patient at Frequent oral hygiene may help to alleviate th
least 4hrs as needed.
e patient's feeling of dry mouth and improve t
heir ability to swallow
Monitor the patient's feeding and To determine the ability of the patient to swall
swallowing activities.
ow.
Assess what the patient can safety eat To provide the client with a consistency of fo
and drink
od and fluid that is most easily swallowed.
Nursing interventions
Rationale
INDEPENDENT:
NURSING CARE
PLAN NO. 3
Assessment:
Subjective: "Mag hinuktok rakan sija unsahay kay siguro naway an na
sija ng pag -asa, kay na feel nija na pabug-at rakan sija sa amo" as
verbalized by the SO.the patient.
Objective:
poor eye contact
excessive seeking of reassurance
exaggerates negative feedback about self
overly conforming ; dependent on others opinion
hesitant to try new experiences
Nursing Diagnoses:
•
Situational Low Self-Esteem related to social role changes
evidenced by Not taking responsibility for self-care.
Planning:
• The patient will verbalize understanding of body changes, and
acceptance of self in the situation.

The patient will begin to develop coping mechanisms to deal effecti
vely with problems.

The patient will demonstrate adaptation to changes/events that hav
e occurred as evidenced by the setting of realistic goals and active p
articipation in work/play/personal relationships as appropriate.

Express positive self-appraisal.
Evaluation:

After nursing intervention the patient was able to met the goal, ver
balize understanding of body changes and acceptance of self in the
situation, and develop coping mechanisms to deal effectively with p
roblems.
Discuss with the patient and SO how the diagnosis and treatment Aids in defining concerns to begin the problem-solving process.
are affecting the patient’s personal life, home, and work activities.
Encourage discussion of concerns about the effects of cancer and May help reduce problems that interfere with the acceptance of
treatments on the role of homemaker, wage earner, parent, and so treatment or stimulate the progression of the disease.
forth.
Assess negative attitudes and/or self-talk.
An individual who is feeling unimportant, incompetent, and
not in control is often is unconsciously saying negative things.
Assess negative attitudes and/or self-talk.
An individual who is feeling unimportant, incompetent, and
not in control is often is unconsciously saying negative things.
Encourage expression of feelings, anxieties.
Facilitates grieving the loss.
Help client identify own responsibility and control or lack of control
When able to acknowledge what is out of his or her control,
situation.
client can focus attention on area of own responsibility.
Provide emotional support for the patient and SO during diagnostic
Although some patients adapt or adjust to cancer effects or
tests and treatment phases.
side effects of therapy, many need additional support during
this period.
Use touch during interactions, if acceptable to the patient, and
Affirmation of individuality and acceptance is important in
maintain eye contact.
reducing the patient’s feelings of insecurity and self-doubt.
COLLABORATIVE:
Refer for professional counseling as indicated.
May be necessary to regain and maintain a positive psychosocial
structure if the patient and SO support systems are deteriorating.
Involve extended family in treatment plan.
Increases likelihood they will provide appropriate support to
client.
Assist with treatment of underlying condition when possible.
For
example,
cognitive
restructuring
and
improved
concentration in mild brain injury often result restoration of
the positive self-esteem.
NURSING CARE
PLAN NO. 4
Nursing interventions
Assessment:
Perform pain assessment each time pain occurs To demonstrate improvement in status or to
Subjective:
" Sakit ija dila kay hamok luas sanan hubag" as verbalized by the SO.
Objective:
Distraction behavior
Rationale
INDEPENDENT:
Assess for potential types of pain that may be To aid in understanding reason for severity of
affecting client.
pain associated with clients condition..
identify worsening of underlying condition/
Facial expression of pain
change in physiological parameters
sore in the tongue
developing complications.
observe nonverbal cues and pain behaviors.
Pain scale 7
Observations may not be congruent with
verbal reports or may be only indicator present
Nursing Diagnoses:
• Acute Pain related to inflammation and sore of the tongue evidenced by
Alteration in muscle tone
Planning




The patient will report maximal pain relief/control with minimal interference wi
th ADLs.
The patient will follow the prescribed pharmacological regimen.
The patient will demonstrate the use of relaxation skills and diversional activitie
s as indicated for the individual situation.
The patient will verbalize sense of control of response to acute situation and po
sitive outlook for the future.
Evaluation:

After nursing intervention the patient was able to met the goal report maximal
pain relief and demonstrate the use of relaxation skills and diversional activities
.
when client is unable to verbalize.
Monitor skin color and temperature and vital Which are usually altered in acute pain.
signs
encourage patient to maintain oral hygiene
To avoid microbes.
COLLABORATIVE:
Evaluate pain relief and control at regular To monitor the pain level.
intervals.
Adjust
medication
necessary.
Administer analgesics as indicated.
Collaborate
in
treatment
of
regimen
as To maintain acceptable level of pain.

To treat the patient.
underlying Pain medications may include iv dosing,
conditions or disease process causing pain.
tablets.
Nursing interventions
NURSING CARE
PLAN NO. 5
Rationale
INDEPENDENT:
Monitor Vital signs
To avoid any complications.
Encourage the use of relaxation techniques, visualization, May prevent the onset or reduce the severity of nausea,
guided imagery, and moderate exercise before meals.
decrease anorexia, and enable the patient to increase oral
intake.
Encourage open communication regarding anorexia.
Often a source of emotional distress, especially for SO who
wants to feed patients frequently. When the patient
refuses, SO may feel rejected or frustrated.
Assessment:
Subjective:
" Dili na sija karajaw mukaon, ginagmay rakan kay sakit kuno
itulon" as verbalized by the SO.
Objective:
Loss of weight with inadequate food intake
uscl
weakness of muscles required for swallowing or mastication;poor m
e tone
Sore buccal cavity
auscultate bowel sound. Note characteristics of stool
To determine ability and readiness of intestinal tract to
handle digestive processes.
Encourage the patient to eat a high-calorie, nutrient-rich diet, Metabolic tissue needs are increased as well as fluids (to
with adequate fluid intake
eliminate waste products). Supplements can play an
Nursing Diagnoses:
important role in maintaining adequate caloric and protein
• Imbalanced Nutrition: Less Than Body Requirements related to emotional
distress, fatigue, poorly controlled pain evidenced by sore, inflamed buccal cavity
Planning:



The patient will demonstrate stable weight/progressive weight gain toward the
goal with normalization of laboratory values and be free of signs of malnutritio
n.
The patient will verbalize understanding of individual interferences to adequat
e intake.
The patient will participate in specific interventions to stimulate appetite/incre
ase dietary intake.
Evaluation:
• After Nursing Intervention the patient was able to met the goal and able to
participate in specific interventions to stimulate appetite/increase dietary intake.
intake.
COLLABORATIVE:
Monitor daily food intake; have the patient keep a food diary Identifies nutritional strengths and deficiencies.
as indicated.
Administer antiemetic on a regular schedule before or during Nausea and vomiting are frequently the most disabling and
and after administration of antineoplastic agent as
psychologically stressful side effects of chemotherapy.
appropriate.
Refer to a dietitian or nutritional support team.
Provides a specific dietary plan to meet individual needs
and reduce problems associated with protein, calorie
malnutrition, and micronutrient deficiencies.
NURSING CARE PLAN NO. 6
Assessment:
Subjective: "Mag inom sija nag tubig ginagmay ra" as verbalized by the
SO.
Objective:
Vitals signs:
Nursing interventions
INDEPENDENT:
decrease fluid intake
monitor vitals signs
lethargic
monitor laboratory results
BP: 100/80 mmhg
HR=62 bpm
RR=16 cpm
TEMP=35.1°c
Rationale
That may cause or be the effect of dehydration
To evaluate fluid and electrolyte status.
evaluate nutritional status, noting current intake
and type of diet
encourage increase fluid intake
To avoid dehydration
Nursing Diagnoses:
assess skin and oral mucous membranes for sign
•
of dehydrations
Risk for Fluid Volume Deficit due to insufficient fluid intake
Planning:



the patient identify individual risk factors and appropriate intervention
s.
the patient maintain fluid volume at a functional level as evidenced by
individually adequate urinary output with normal specific gravity and
stable vitals sign.
demonstrate behavior or lifestyle changes to prevent development of fl
uid volume deficit.
Evaluation:
• After nursing intervention the patient was able to met the goal maintain
fluid volume at a functional level as evidenced by individually adequate
urinary output with normal specific gravity and stable vitals sign.
That can negatively affect fluid intake.
For signs of dehydration, such as dry skin and
mucous membranes, poor skin turgor
offer a variety of fluids and water-rich foods,
Increase the clients daily fluid intake.
and make them available throughout the day.
Provide encouragement and praise while This approach creates a supportive environment
identifying the patient’s progress.
and sends a message of caring.
COLLABORATIVE:
administer
medications
as
appropriate
as To stop or limit fluid losses.
prescribed
provide nutritionally balanced diet or enteral To provide and gain good nutritions
feedings, when indicated
provide supplemental IV fluids as indicated
To avoid dehydration
Nursing interventions
NURSING CARE
PLAN NO. 7
Rationale
INDEPENDENT:
Assess for conditions that affect speech
Neurological conditions such as stroke, tumors,
cerebral palsy, autism, or other hearing impairments
can affect the patient’s ability to verbally
communicate.
Assess for a language barrier
If a patient does not communicate effectively or
seems to refuse to communicate, ensure they are
being spoken to in their native language.
Assessment:
Subjective:
as verbalized by the SO.
" Dili sija makastorya kay hubag ija dila"
Objective:
difficulty comprehending communication
difficulty expressing thoughts verbally
difficulty speaking verbally
Nursing Diagnoses: Impaired verbal communication related to
physical barriers evidenced by inflamed tongue
Planning:





the patient will verbalize or indicate an understanding of the com
munication difficulty and plans for ways of handling.
establish method of communication in which needs can be expres
sed.
participate in therapeutic communication.
demonstrate congruent verbal and nonverbal communication.
use resources appropriately.
Evaluation:

After nursing intervention the patient was able to met the goal est
ablish method of communication in which needs can be expressed
Continue speaking to the patient even if they can’t Patients with a tracheostomy or physical barrier or
respond
who have dysphagia or dementia should still be
spoken to as a person.
assess the style of speech
To communicate in a sign language or gestures.
establish rapport with client, initiate eye contact, shake To make patient for comfortable.
hands, address by preferred name, and meet the family
member present.
advice other healthcare
communication deficits
providers
of
client To minimize the clients frustration and promote
understanding.
maintain a calm, unhurried manner. Provide sufficient Individuals with expressive aphasia may talk more
time for the client to responds
easily when they are rested and relaxed and when
they are talking to one person at a time.
Maintain eye contact with patient when speaking. Patients may have defect in field of vision or they
Stand close, within patient's line of vision (generally may need to see the nurses' face or lips to enhance
midline).
their understanding of what is being communicated
COLLABORATIVE:
Provide systemic or topical analgesics as prescribed
This will provide comfort and relieve pain.
NURSING INTERVENTIONS
RATIONALE
INDEPENDENT:
NURSING CARE
PLAN NO. 8
Assessment:
Subjective: “Walay gana mokaon kay sakit iyang dila” as
verbalized by the SO.
Objective: Decreased Body Temperature
V/S taken as follows:
Monitor Vital signs
It helps to detect other possible medical condition and
monitor the wellbeing of the patient.
Practice and emphasize constant and proper hand hygiene A first-line
by all caregivers between therapies and clients. Wear gloves infections.
when appropriate to minimize contamination of hands, and
discard after each client. Wash hands after glove removal.
Instruct the client/significant other (SO)/ visitors to wash
hands, as indicated.
defense
against
healthcare-associated
Monitor the client’s visitors and caregivers for respiratory To limit exposures, thus reducing cross-contamination.
illnesses. Ask sick visitors to leave client area or offer masks
and tissues to client or visitors who are coughing or
sneezing.
Perform or instruct daily mouth care. Include use of At high risk for healthcare-associated
antiseptic mouthwash for individuals in acute or long-term especially in client on a ventilator.
care settings.
infections,
T: 35.1
Maintain sterile technique for all invasive problems
procedures.
P: 62
Cleanse incisions and insertion sites per facility protocol To reduce the potential for catheter-related
with appropriate antimicrobial topical or solution.
bloodstream infections, and to prevent the growth of
R: 16
bacteria.
Nursing Diagnoses:
COLLABORATIVE:
• Infection related to Malnutrition as evidenced by
decreased of Body Temperature.
Administer/monitor medication regimen and note the To determine effectiveness of therapy or presence of
client’s response.
side effects.
Planning:
• The patient will remain afebrile and achieve timely
healing as appropriate.
Evaluation:
• After rendering nursing interventions, the goal partially
meet.
Maintain adequate hydration, stand or sit to void, and To avoid bladder distention and urinary stasis
catheterize, if necessary
Provide regular urinary catheter and perineal care.
This reduces the risk of ascending urinary tract infection
Emphasize the necessity of taking antivirals or antibiotics, as Premature discontinuation of treatment when client
directed
begins to feel well may result in return of infection and
potentiation of drug-resistant strains
Discuss the importance of not taking antibiotics or using Inappropriate use can lead to development of drug“leftover” drugs unless specifically instructed by healthcare resistant strains or secondary infections.
provider.
NURSING CARE
PLAN NO. 9
Nursing interventions
Rationale
INDEPENDENT:

Assess vital signs

To evaluate fluid status and cardiopulmonary response
to activity.

Ask the client to rate fatigue (using a 0- 10 or similar
numerical scale) and its effects on the ability to
participate in desired activites..


Interview parent/caregiver regarding specific changes
observed in child or elder client.

Fatigue may vary intensity and its often accompanied
by irritability, lack of concentration, difficulty making
decisions, problems with leisure, and relationship
difficulties that can add to stress level and aggravate
sleep problems.
These individuals may not be able to verbalize
feelings or relate meaningful information.

Encouraged nutritionally dense, easy- to- prepare- and 
consume foods, and avoidance of caffeine and highsugar food and beverages.
Assessment:
Subjective:
Insufficient energy
Tiredness
Rest requirements
Objective: V/s: Temp: 38°C
HR: 100 bpm
RR: 20 cpm
BP: 80/ 60 mmHg
Nursing Diagnoses:
•
Fatigue related to physiological condition (malnutrition).
•
Planning:
• After rendering of nursing intervention the client will report an
improved sense of energy.

Promote overall health measures (e.g. nutrition,
adequate fluid intake and appropriate vitamin and iron
supplementation).
COLLABORATIVE:

Assist with self- care needs, keep the bed in a low
position and keep travel ways clear of furniture, assist
with ambulation as indicated.

Refer to comprehensive rehabilitation program,
physical and occupational therapy for programmed
daily exercises and activities.

To improve stamina, strength, and muscle tone and to
enhances sense of well- being.

Review medication regimen/ use.

Certain medications, including prescription (
especially beta- adrenergic blockers, chemotherapy),
over- the- counter drugs, herbal supplements, and
combinations of drugs and or substances, are known to
cause and/or exacerbate fatigue.
Evaluation:
• After rendering of nursing intervention the client will report an
improved sense of energy.
To promote energy.
DISCHARGE PLAN
DISCHARGE PLAN
Medication: Instruct the patient significant other (S.O) to contibue taking prescribed medications such as Calcium pantothenic BID, Iron+Folic, Acid-Vitamin B Conple BID,
Sodium Chloride TID, Lactulose HS , Omeprazole , Cephalexin, Arcoxia, Ensure milk for feeding
Emphasized to the patients significant other (S.O) that the frequency of taking medications should be followed as prescribed by the physician.
Emphasized to the patients significant other (S.O) about the importance o taking the medications, since it is only to his healing development.
Environmental Consideration:Provide a clean environment.
Maintaining cleanliness inside and outside in the house at all times.
Treatment:
Advised the patients significant other (S.O) to follow to take the medications properly as prescribed by the physician and discussed on the importance of strict adherence
to medications.
Instruct patient significant other (S.O) to follow proper instructions medications prescribed by the physician (dosage).
Instruct the patient significant other (S.O) to understand and follow discharge plan instructions religiously and accurately.
Health Teaching:
Encouraged the patient maintain good personal hygiene.
Advised the patient to stop smoking and drinking alcohols.
Instruct the patient to have a complete bed rest.
Out-patient check-up:`
Instruct the patient significant other (S.O) to have a check-up or to consult physician once a while to monitor patient’s condition and for detection of
recurrences and other complications that may arise on to it.
Remind the patients significant other (S.O) to consult the physician when signs and symptoms is observed.
Diet:
Encouraged nutritious foods.
Instruct the patient significant other (S.O) to have a diet plan for appetite.
Spiritual:
Encouraged the patient significant other (S.O) to pray for fast recovery and for good health of the patient.
Encouraged the patient significant other (S.O) to always believe in God Almighty.
Advised the patient significant other (S.O) to pray every day
APPENDICES
GENOGRAM
APPENDICES
IV CHART
NO. OF
BOTTLE
DATE
SOLUTION
VOLUME
ADDITIVE
RATE OF FLOW
TIME
5/16/23
1
1L
D5LR
200cc/hr
5/17/23
3
1L
D5NM
20gtts/min
4:18 pm
5/18/23
2 SD
Dextrose + Multivitamins
80cc/hr
12:00 mid
VITAL SIGNS MONITORING SHEETS
Date/Time
Blood pressure
Pulse Rate
Respiratory Rate
Temperature
Oxygen Saturation
4:00 PM
90/60
56
20
36.9
97%
8:00 PM
100/60
73
21
36.6
96%
12:00 MN
100/70
74
20
36.4
97%
4:00 AM
100/60
58
20
36.4
97%
8:00 AM
90/60
55
20
36.4
97%
12:00 NN
100/70
64
21
36.1
98%
4:00 PM
90/70
60
21
36
97%
8:00 PM
100/60
74
21
36.1
97%
12:00 MN
100/70
58
22
36.3
96%
4:00 AM
100/60
60
21
36
97%
100/60
53
20
36.4
97%
5/16/23
5/17/23
5/18/23
8:00 AM
APPENDICES
INPUT AND OUTPUT
IVF
Date
Clinical shift
Oral Fluid
Intake
Total
Urine
Credit
Consumed
4PM-12MN
800ml
200ml
200ml
400ml
100ml
12MN-4AM
410ml
390ml
500ml
890ml
100ml
Vomitus
Stool
_
_
_
_
Total
100ml
5/16/23
TOTAL =
5/17/23
TOTAL =
1,290ml
TOTAL =
4AM-8AM
NH
410ml
50ml
460ml
150ml
8AM-12NN
800ml
200ml
420ml
620ml
100ml
12NN-4PM
550ml
330ml
400ml
730ml
150ml
1,810ml
TOTAL =
100ml
200ml
_
_
_
_
150ml
1x
100ml+1x
1x
150ml+1x
400ml+2x
DEFINITION OF TERMS
•
Squamous cell carcinoma: Cancer that begins in cells that form the epidermis (outer layer of the skin).
•
Metastases : the development of secondary malignant growths at a distance from a primary site of cancer.
•
Synergistic effect: the interaction of two or more drugs when their combined effect is greater than the sum of the effects seen when each drug is given
alone.
•
Human papillomavirus: A type of virus that can cause abnormal tissue growth (for example, warts) and other changes to cells.
•
Carcinogen: a substance capable of causing cancer in living tissue
•
Nitrosamines: A type of chemical found in tobacco products and tobacco smoke.
•
Polycyclic hydrocarbons: a class of chemicals that occur naturally in coal, crude oil, and gasoline.
•
Biopsy: procedure to remove a piece of tissue or a sample of cells from your body so that it can be tested in a laboratory.
•
Cachexia: a complicated metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss
•
Anorexia: an eating disorder and serious mental health condition
•
Anemia: a condition in which the body does not have enough healthy red blood cells.
•
Malnutrition: deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization.
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