Osteosarcoma Case

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<p>TARLAC STATE UNIVERSITY COLLEGE OF NURSING Lucinda Campus,Brgy. Ungot, Tarlac City Philippines 2300 Tel No.: (045) 982-6062 Fax: (045) 982-0110 website: www.tsu.edu.ph</p> <p>A Case Study on Osteosarcoma</p> <p>In Partial Fulfillment of the Requirements of the Subject Nursing Care Management 103 RLE</p> <p>Presented to the Faculty Of the Tarlac State University College of Nursing Presented by: BSN III - C Group C4 Querido, Richen T. Raiz, Jayscent F. Rodriguez II, Rolando D. Sabat, Aprillyn A. Santos, Marivic C. Santos, Willa Milafrosa M. Sotelo, Jeffrey R. Suarez, Christine Karen A. Sumang, Jerico B. Sumaoang, Maria Luisa S. Date Submitted: June 03, 2010</p> <p>Introduction</p> <p>Primary malignant musculoskeletal tumors are relatively rare and arise from connective tissue and supportive tissue cells (sarcomas) or bone marrow elements (multiple myeloma). Malignant primary musculoskeletal tumors include osteosarcoma, chondosarcoma, Ewings sarcoma, and fibrosarcoma. Osteogenic sarcoma</p> <p>(osteosarcoma) is the most common and most often fatal primary malignant bone tumor. Prognosis depends on whether the tumor has metastasized to the lungs at the time the patient seeks health care. Osteogenic sarcoma appears most frequently in males between the ages of 10 and 25 years (in bones that grow rapidly), in older people with Pagets disease and as a result of radiation exposure and accounts 5% of all childhood illness. Clinical manifestations include pain, edema, limited motion, and weight loss (which are considered ominous findings). The bony mass may be palpable, tender, and fixed, with an increased skin temperature over the mass and venous distention. The primary lesion may involve any bone, but the most common sites are the distal femur, proximal tibia, and the proximal humerus. According to the U.S. Surveillance, Epidemiology and End Results Program(2), osteosarcomas contribute 36% of all types of bone cancer, followed by chondrosarcomas and Ewing's sarcomas with around 30% and 16% respectively. The incidence of osteosarcoma appears to be more frequent in two periods of life, during adolescence and old age.In Asia, the Philippines (Manila) has the highest rate of males while Thailand (Khon Kaen) has the highest frequency in females. It is interesting that Singapore Indians</p> <p>have the lowest male/female ratio of bone cancer in the world (0.5), while Israeli on-Jews show the second highest worldwide male/female ratio (4.0).</p> <p>Objectives Nurse centered General: The objective of our case study is to gain more knowledge and skills with regards to the disease chosen and to be able to do effective and appropriate nursing interventions to the patient based on the knowledge gained. Specific: Gather the patients data, personal data, past and present health history and family health history To familiarize the disease process, definition and etiology of the disease and Signs and symptoms and treatment and prevention To gain knowledge about the medical management and procedure concerning the disease and nursing management to be rendered To render nursing intervention and to apply the formulated nursing care plan</p> <p>Patient Centered General: To be able to know his/her existing condition and to be able to participate well with procedures and things he/she needs to comply for the success of his/her disease treatment. Specific: To increase the patients level of awareness about the existence of the disease. To gain cooperation with the health care provider in implementing the nursing intervention as well as compliance to medical management. To apply knowledge gained from the health care provider. To know what other complications may arise, if left untreated</p> <p>Reasons in choosing the Case Study Our group chose this case study to gain more additional knowledge about the disease. The group wants to know more about the disease, its treatment, and the proper nursing management for patients with this kind of disease. The case will help the group in dealing with patient with this condition. Promotion of health, prevention of diseases and illnesses, rehabilitation and restoration of good health are important in doing the case. In the accomplishment of this case study, the group will be able to know and develop more fully our skills in assessment, planning, nursing care plans, implementation/interventions and evaluation for this particular chosen condition.</p> <p>Importance of the Study The case study is primarily important because it enhances the students skills, knowledge and attitude on the practice of the nursing process. It provides broader comprehension about the condition chosen through research and actual observation as it serves as a training ground and practice in developing learned skills in the assessment and management of Osteosarcoma. Through this case study, a holistic approach in assessing patients health will be delivered, where it can be immediately attended to and given proper interventions. It serves as a way to familiarize the students with the different medical approaches toward the ongoing curative phase. This study serves as a tool for future upcoming nursing students of the school. To share to other student nursing colleagues to understand the dynamics of Osteosarcoma as to the book based management and actual clinical interventions. Furthermore, this study may be used as a spring board for a more advanced and in-depth study that is in accordance to changing and developing society.</p> <p>II) NURSING PROCESSA) ASSESSMENT</p> <p>Date: June 1 ,</p> <p>2010 1) Personal Data a) Demographic Data Name: Age: Sex: Civil Status: Occupation: Religious Affiliation: Position in the family: Address: Date of Birth: Place of Birth: Nationality: Health Care Financing: Usual Source of medical Care: Date of Admission: Child OS 6 years old Female Single N/A Roman Catholic Daughter Xevera, Mabalacat, Pampanga February 4, 2004 Tarlac City Filipino Phil health Rural Health Unit May 17, 2010</p> <p>Admitting diagnosis:</p> <p>T/C Septic Knee left, Osteosarcoma on the right femur S/P Hip Disarticulation</p> <p>Final diagnosis: hip</p> <p>Osteosarcoma right distal femur, S/P</p> <p>Disarticulation</p> <p>b) Environmental Status Child OS and her family are currently residing at Mabalacat Pampanga. According to her grandmother, their house is a mixed of concrete and wood with two bed rooms, a small living room and kitchen. Their water source for drinking, laundry, bath, and dishwashing is from a water pump around 5 meters away from their house. They have their own bathroom located at the back of their house with a water sealed latrine. The mother described their place as a congested one. Their major source of lighting facility is electricity. Their place is near the elementary school and barangay hall. Pedicab, tricycle and jeep are their primary mode of transportation.</p> <p>c) Lifestyle Her grandmother stated that upon child OSs admission she usually sleeps at around 7-8 in the evening and wakes up at around 6-7 in the morning. She usually takes a nap for about half an hour to an hour or so every day. In the middle of the day shes fond of watching television, playing with her toys, writing and drawing. She eats more on meat and chicken and less on vegetables.</p> <p>3. History of Past Illness According to the patients grandmother, patient experienced an illness (grandmother dont remember the specific disease/illness that patient experienced) that threatened the patients life when she was 8 months old. Interventions were done to cure patients illness. According to the patient, side effect or complications of the disease will manifest as she grows up. Early 2010, she met an accident. She was hit by a bicycle and strokes her knee. She had bruises at different parts of the body. After two weeks, her grandmother noticed that patient has difficulty in walking but patient stated that she was just tired. After a week her grandmother again noticed that there is atrophy on patients right leg that caused them to seek for medical attention. The physician ordered for x-ray, bone biopsy and bone scan which revealed malignant tumor on the femur. Because the cancer already metastasized to the rest of her right leg, patient had undergone disarticulation of her right hip. Management continued as well as chemotherapy and the like. According to the patients grandmother, patient had not completed immunization. She also denies any allergies to food, medications and other environmental factors. She experienced cough, fever and colds and managed it with over the counter medications like paracetamol.</p> <p>4. History of Present Illness Three weeks prior to admission, April 19, 2010, patient hit her left knee with mother knee. Patient noted pain and swelling. No interventions were done that time. One week prior to admission, May 10, 2010, patient noted persistence and increase severity of pain and swelling. Prolonged consult to our institution work-up was done and was sent home.</p> <p>Day of admission, May 17, 2010, results came in, patient is subsequently with chest pain, dysphagia, vomiting episodes, mild swelling and tenderness of the left knee. Admitting diagnosis was primary bone tumor probably malignant osteosarcoma recurrence r/o septic. Antibiotics are given via IV.</p> <p>5. Physical Assessment 01, 2010 13 Areas of Assessment a. Social Status</p> <p>Date: June</p> <p>Child OS is the eldest among the two siblings and she currently lives with her family. She grows up with her grandmother. She usually plays with other children. She maintains good relationship with her classmates as well as other family members. Norms: The ability to interact successfully with people and within the environment of which each person is a part, to develop and maintain intimacy with significant others and to develop respect and tolerance for those with different opinion and beliefs are necessary determinant for a persons social state. (Kozier,2004) Families consist of persons and their responsibilities within the family. A family structure of parents and their offspring is known as the nuclear family (Kozier, 2004) The ability to achieve balance between work and leisure time is also a needed factor. A persons belief about education, employment and home influence personal satisfaction and relationships with others (Kozier, 2004) Analysis: The patient does not have abnormality with regards to her social status. She established good relationship with others.</p> <p>b. Mental Status Upon assessment the patient was awake. She was wearing a t-shirt and short during the assessment. She cried a little during the interview because of pain but started to tell stories afterwards. She responds to the questions correctly and maintains eye</p> <p>contact upon conversing. She possesses appropriate facial expression with frequent frowning due to pain felt at the Right leg which is again swelling and has tenderness. Norms: Physical Appearance and Behavior Posture and movements: The patient should appear relaxed with the appropriate amount of concern for the assessment. The patient should exhibit erect posture, and symmetrical body movements. (Estes, 2006) Dress, Grooming and Personal Hygiene: The patient should be clean and wellgroomed, and should wear appropriate clothing for age, weather, and socioeconomic status. (Estes, 2006) Facial Expression: Facial expressions should be appropriate to the content of the conversation and should be symmetrical. (Estes, 2006) Affect: The appropriateness and degree of affect should vary with the topics and the patients cultural norms, and be reasonable, or eurorhythmic (normal). (Estes, 2006) Communication: The patient should be able to produce spontaneous, coherent speech. The speech should have an effortless flow with normal inflections, volume, pitch, articulation, rate, and rhythm. Content of the message should make sense. (Estes, 2006) Cognitive Abilities and Mentation Attention: The patient should be able to correctly repeat the series of 5 numbers. (Estes, 2006) Memory: The patient should be able to correctly respond to questions and to identify all the objects requested. (Estes, 2006)</p> <p>Analysis: Patients mental status is normal, since she can answer the questions ask but stop for a while and cry when shes in pain. c. Emotional Status The patients grandmother stated that whenever she has problem she tells it to her grandmother or her mother. She cried during the interview but it was managed by her grandmother. Afterwards she exhibits happiness and actively joins the conversation. He was able to convey emotions appropriate to her feeling according to her mother. Norms: A person expresses himself as an optimistic and a positive thinker in life. There should no presence of fear, anxiety, grieving etc. The patient should have the ability to manage stress and to express emotions appropriately. It also involves the ability to recognize, accept, and express feelings and to accept ones imitations. (Kozier, 2004) Analysis: There is no abnormality noted on the patients emotional status. She was able to display the emotions that she needs to display from what she feels. d. Sensory Perception Sense of Sight From a distance her eyes appeared to be symmetrical and round, the sclera is white in color and the iris appeared to be colored black. There are no lesions, redness. Nodules and tenderness noted in her eyes including in the lacrimal glands.</p> <p>Norms: Eyes symmetrically aligned, equal movement, eye bilaterally blinking, sclera appears white, skinny smooth conjunctiva, no edema and tenderness on lacrimal gland. Pupillary constriction should occur when struck by light. (Estes, 2004) Analysis: Patients eyesight is normal based from the assessment done.</p> <p>Sense of Taste According to the patients grandmother, she was able to distinguish different taste of food like salty, sour sweet and the like. Upon inspecting the mouth, the lips are reddish in color and are moist. The tongue is also moist with the absence of lesion and redness. Norms: Tongue is reddish/pink in color, central in position, no lesions, raised papillae (taste buds), moves freely, no tenderness no palpable nodules. (Estes, 2006) Analysis: Patients tongue color is normal but she is choosy and refuse to eat the hospital food delivered that time we assess her. Sense of Hearing The grandmother stated that she does not experience any difficulties in hearing. The group also observed that she responds accordingly to any questions that are asked to her without the need to repeat it.</p> <p>Norms: Normal voice tones are audible. (Kozier, etal, 2004) For the auditory accuracy, the patient should be able to repeat the words whispered from the distance of 2 feet. (Health Assessment and Physical Examination, Estes 2006) Analysis: The patients hearing has no abnormality. Sense of Smell The patient nose is symmetrical and is located at the midline of the face with no nodules, lesion and tenderness noted. The patient was able to identified different smells by verbalizing the odor of objects used like a...</p>