Case Study
 CASE NO:
 NAME:
 AGE:
 SEX:
 DIAGNOSIS:
116***
Mr. M
46 yrs old
Male
Nasopharyngeal
Carcinoma
 BP- 120/70 mmhg
 RR- 32/min
 PR- 72/min
Temp- 36.8’C
 Skin allergy noted at upper
extremities
 With good skin turgor
 With capillary refill test
(1-2secs)
 No
palpable lesion on the head
 With right side facial numbness
 Always complaining of
headache
 Pale palpebral conjunctiva
 PERRLA (Pupils Equally Round
and Reactive to Light
Accommodation)
 Sometimes experienced blurring
of vision and light sensitivity
 Symmetrical
in shape and
size
 With occasional ear pain
 Diminished hearing
 Tinnitus noted at
times
 with
epistaxis
 with right nasal obstruction
 with mass, reddish in color
seen through rigid endoscope
 cough and cold noted, whitish
secretions
 Hard
and soft palate grayish
in color.
 Difficulty in uttering words
noted
 Mouth breathing
 With
painless, enlarged
lymph nodes in the neck
 Sore throat noted
 Chest
is symmetric
 Use of accessory muscles
when breathing
 Crackles noted both lung
fields
 No
edema found on both
legs
 No lesions noted
 No
major medical problems
 Common colds- treated
with water therapy
 Ignored sneezing


Sedentary lifestyle
Smoking 1 pack in a day


No restrictions for food- Filipino foods
Shoe factory worker store keeper(construction
materials)
store keeper (KSA)
store
keeper(hosp)
▪ - father
▪
mother
▪
aunt
lung cancer
NPC
prostate cancer
▪
cousin
1st
2nd
3rd
Present
Medical History
Dr. H.
 Chief complaint- nose bleeding
 Nasopharyngoscopy done
 Dx- deviated nasal septum
 Advised for CT –scan (rejected by
insurance)
 Dr.
P
 Cc: persistent Rt. Nasal
obstruction with recurrent
epistaxis
 Nasopharynggoscopy done
Examination;
Mass, dark round, fill nasopharynx, seems to
be originating from right side:
Dx- bleeding mass
nasopharynx inverted
papilloma/hemangioma.
 Dr.
P. advised CT scan &
histopathology
 Prescribed Otrivin nasal Spray
 Ct-
scan done with contrast
Explain
the procedure to the client
Assess
allergy to dye.
Secure
consent for the procedure.
Insert
IV cannula aseptically as the
dye will inject in through the vein.
Inform
that the client may feel
hot sensation when dye is
injected.
Encourage
the client to drink
plenty of water after the
procedure.
NORMAL CLIENT
MR. M
Possible dx;
Nasopharyngeal
carcinoma
Granulomatous lesions

Biopsy was done
 Confirmed the dx of nasopharyngeal
cancer
 Explain
the procedure to the
client.
 Informed consent
 Make sure all the equipments
needed are available.
 Send tissue samples at the
laboratory in a sterile container
with formalin.

Chemotherapy

Radiotherapy
 Types
of Tumors
 Benign- non cancerous
 Malignant- cancerous
TNM
System
Number system
Tumor
Nodes
Metastasize
T0- no tumor
N0- no lymph nodes
M0- not spread in other parts of the
body
T1- within the nasopharynx,
oropharynx or nasal cavity
N1- cancer cells in lymph nodes on
one side of the neck, not > 6cm
across
M1- cancer has spread to other parts of
the body.
T2- spread into the areas next to
N2- cancer cells in lymph nodes on
nasopharynx, not spread into the bone both sides of the neck, > 6m across
T3- spread into the sinuses
T4- spread in one or more;
•Cranial nerves
•Hypopharynx
•Eye or surrrounding tissue
•Bony spaces
N3•N3a- cancer cells in one or more
lymph nodes , one node is > 6cm
across
•N3b- there are cancer cells in the
supraclavicular area
No. Stage
Description
Stage 0
Carcinoma in situ
Stage 1
Not spread
Stage 2
Larger cancer, affects more than half
the area of nasopharynx
No. Staging
Stage 3
Description
Stage 4
Advanced stage
4a
4b
4c
-grown within the skull
-nearby tissues and bones
-spread in other parts of the body ex. lungs
Spread ;
Oropharynx
Throat
Nearby b0nes and air cavities
Diets
-
in salt cured fish and
meat
Epstein Barr Virus Infection
Genetic Factors
Male
Age 30- 55 yrs old
Asian
 Painless
and enlarged lymph nodes in the
neck
 Nasal obstructions
 Epistaxis
 Diminished hearing
 Tinnitus
 Recurrent Otitis Media
 Cranial Nerve Dysfunctions
 Sore throat
 Headache
 Medical
History and physical Assessment
 Fiberoptic Endoscopic Examination
 Ct
Scan

MRI (Magnetic Resonance Imaging)

Biopsy

Cisplatin - drug of choice
 Side Effects
Anorexia
Constipation
Bone marrow damage
Hair loss
Increase risk of infection
Mouth sores
Nausea and vomiting
Fatigue
External Beam Radiation/ Brachytherapy
Side Effects
▪
▪
▪
▪
▪
▪
▪
▪
▪
Skin burns
Confusion
Difficulty of swallowing
Fatigue
Hairloss
Headaches
Nausea and vomiting
Rashes and other skin problems
Weight loss
Bleeding
Infection
Difficulty
breathing
Tumor spread to other organs
Cancer Precaution
C
A
U
T
I
O
N
U
S
changes in bowel & bladder habits
a sore that does not heal
unusual bleeding
thickening lump in breast or elsewhere
indigestion or difficulty in swallowing
obvious changes in moles or warts
nagging cough and hoarseness
unexplained anemia
sudden weight loss
Unknown
Predisposing Factors;
Asian
Men; 30-50yrs old
Hereditary
Precipitating Factors;
Cigarette Smoking
Alcohol Abuse
Occupational exposure
Diet; salt preserved foods
Genetic Mutation
Uncontrolled cell division at squamous
cells that line the nasopharynx
Pre- malignant cell
Untreated
Cell continues to divide out of control and all
daughter cells produced with the same ability
Increased in malignant and appearance
Cancer cells confined in the
cells of the throat
(nasopharynx greatly
affected)
Signs and
symptoms occur
Drug Study
Name
Classificatio
ns
Actions
Generic Name:
Xylometazoline
Decongesta
nt
It works by
constricting blood
vessels that leads
to a decrease in
congestions. The
formulation acts
directly on the
blood vessels in the
nose and sinuses
Brand Name:
Otrivin
Indications
Contraindicati
ons
Nasal
High blood
congestions due pressure
to cold,
sinusitis
Heart disease
Respiratory
allergies
Irregular
heartbeat
Thyroid
problems
Diabetes
Pregnant
woman
Glaucoma
Adverse
Reaction
Dizziness
Sweating
Tiredness
Slow heart
rate
Nursing
Considerations
Advice the client
not to use drug >
3-5 days, longer
use could cause
damage to nasal
tissue
Advice client that
this drug should
not be use with
MOA.
strictly follow the
instructions
ordered by the
doctor
Name
Classifications
Generic Name: Antineoplastic
Cisplatin
Brand Name:
Platinol
Actions
Indications
Contraindicati
ons
May cross link
strands of
cellular DNA
and interfere
with RNA
transcription,
causing an
imbalance of
growth that
leads to cell
death
Head and neck Hypersensitivit Renal failure
cancer
y do drug
Liver failure
Others:
Severe renal
Prostate cancer disease
Ocular toxicity
Hearing
impairment
Adverse
Reactions
neuritis
Nursing
Considerations
Monitor intake
and output
Advise pt. to
watch for signs
of infection
Tell pt to
immediately
report ringing
in the ears and
numbness in
hands or feet

Ineffective Airway Clearance related to
nasal blockage as manifested by presence of
mass in nasal cavity as seen through rigid
endoscopy.

Ineffective Breathing Pattern related to
nasal obstruction as manifested by
respiratory irregularities and mouth
breathing.

Activity Intolerance related to weakness

Therapeutic Regimen management; Readiness for
enhance as manifested by frequent asking
questions regarding disease treatments.

Impaired verbal communication related to
inability of air pass through the nose as
manifested by mouth breathing and difficulty of
uttering words

Knowledge deficit, management of therapy and
treatment related to misinterpretation of
information.

Risk for Imbalanced Nutrition less than
body requirements as a result of nausea
and vomiting, side effects of
chemotherapy.

Risk for Impaired skin integrity related to
side effects of chemotherapy and
radiotherapy.

Risk for situational Low self esteem.
Cues
Nsg Dx
Planning
Subjective;
“I cant’ breathe
through my nose’
as verbalized by the
client.
Ineffective Airway
Clearance related to
nasal blockage as
manifested by mass
seen through rigid
endoscopy
At the end of 8 hrs
of duty the client’s
respiratory
irregularities will
improve.
Objective;
•Mouth breathing
•Clogged nose
•Resp irregularities
RR- 34/min
•With right nasal
bleeding
Interventions
Rationale
Proper breathing
technique
demonstrated like
breathing through
mouth in perfect
rhythm
To improve
respiratory
difficulties.
Otrivin 0.1%, 1
nasal spray given
each nostril 3 x a
day as prescribed by
the physician.
Helps to reduce
symptoms of nasal
congestions, works
by narrowing the
blood vessels in the
lining of the nose.
Evaluation
After the 8 hrs of
duty client
respiratory
irregularities
improved as
manifested by:
RR- 26/min
Health teaching
done as follows;
•Client need to
stop smoking
•Use mask when
expose to dust
and chemicals
•Eat foods rich
im CHO, fats.
Smoking triggers
more
complications like
difficulty of
breathing and
possible
infections.
The client is
immunocompromi
sed.
To increase
clients’s stamina
since he is still
Limit intake of
working.
salty, grilled, fried Since this foods
and smoked foods are contributing
factors of having
NPC
 Advised
client to use protective
equipments like mask when
exposed to dust and any
chemicals.
 Encouraged
to strictly follow
treatment regimen.
 Encouraged
to eat small frequent
feedings to reduce nausea, take
anti- nausea medications as
prescribed
 Encouraged
to drink at least 1- 2
liters of fluid every 24 hrs, unless the
client are instructed to limit fluid
intake.
 Drinking
alcohol beverages
should be kept to a minimum or
avoided completely
 Encouraged to stop smoking
completely
 Encouraged to get plenty of rest
and maintain good nutrition.
Presented a case of 46 yrs old
client with chief complaint of right
nasal obstruction, nose bleeding.
Nasopharyngoscopy shows presence of
mass in nasal cavity with CT scan and
histophatology report pertaining to
common diagnosis; nasopharyngeal
carcinoma
 Treatment
for nasopharyngeal
carcinoma involves combination
of radiation and chemotherapy
for this client.
 Early
detection of
nasopharyngeal cancer is vital for
treating the disease to prevent its
development and metastasis.
 The
stage of cancer, size of tumor,
the client’s age, general health
and compliance to treatment
regimen are factors that can
affect prognosis.
 Cisplatin
case.
 Nursing
is the drug of choice in this
management includes
provision of an emotional
supportive environment,
encouragement for strict compliance
of treatments are important.
Gleeson, michael Otorhinolaryngology; Head and
Neck Surgery. (editon 2008)
 Htpp://www.cancer.gov/cancertopics
 Htpp://www.medicenter.com/nasopharyngealcancer/
articles
 Modalities of surveilance in treated nasophayngeal
cancer. Head and Neck Surgery.

Presented by: EENT department