REMEDIOS TRINIDAD ROMUALDEZ MEDICAL FOUNDATION

COLLEGE OF NURSING
Tacloban City
Name: JOHN CARLOS C. LLEVER
Section: BSN 2-B
Date: 6/08/2021

1. Case introduction

DEFINITION

Serous surface papillary carcinoma of the ovary is a rare peritoneal neoplasm found in postmenopausal women that is histologically characterized by an exophytic papillary tumor originating from
the surface epithelium of the ovary.

DIAGNOSIS

Screening the general population is currently neither cost-effective nor practical. However, certain sub-populations of patients (primarily those defined by the genetic risk factors described above)
may be candidates for ovarian cancer screening. Three screening tests are currently employed: bimanual pelvic examination, cancer antigen (CA) 125, and transvaginal ultrasound. The pelvic
examination does not add additional cost for women who are already undergoing regular gynecologic evaluation and is reliable when done by an experienced examiner, but it lacks adequate
sensitivity and specificity as a screening test.

TREATMENT

Women with papillary serous carcinoma of the peritoneum are treated similarly to those with EOC. Optimal surgical cytoreduction may be more difficult to achieve in the setting of widespread
peritoneal disease without a predominant ovarian or pelvic mass. Chemotherapy regimens and response rates are similar to EOC.

2. Health History

2:56 pm, June 5, 2021. Patient A was admitted to the OB – High Risk ward, with a diagnosis of serous papillary carcinoma ovary stage IIC. Patient is ambulatory, alert and coherent.
For chemotherapy and carboplatin – paclitaxel VI once with lab results;

• CBC, BTC, RH
• Na, K, Cl
• SGPT, SGOT, BUN, Creatine

Vital signs were taken ( BP = 110/70 mmHg, RR = 19 cpm, Temp = 36. 5 HR = 75 bpm ), no abnormal findings. Abdominal exam ( soft, no mass, flat, no tenderness). Pelvic
examination ( + intact vaginal stump, smooth reginal wall, no palpable mass, good sphinteric tune, no intra/extraluminal mass)

June 7, 2021. No subjective Complaints. Vital signs were checked. No abnormal findings were found. Conducted a thorough health history taking, reveals she underwent THBSO,
omentectomy, appendectomy (11/03/18), tumor recurrence and paracentesis ( 12/10/19) and Carboplatin – Paclitaxel VI ( 4/14/21). And during the health interview she
expressed her feelings of anxiety/fear and confusion of fer illness, treatment and care
PATIENT’S PROFILE:

This is the case of patient A , a 53-year-old female, Roman Catholic, and a resident of Delores, Eastern Samar. She was born on 5/11/1968 . For chemotherapy and
carboplatin – paclitaxel VI.

PRESENT HEALTH HISTORY:

Patient A a 53-year-old, admitted on June 5, 2021, for chemotherapy and carboplatin-paclitaxel VI, with a diagnosis of serous papillary carcinoma ovary stage IIC. Her
initial vital signs; RR: 19 cpm PR: 70 bpm SpO2: 98%TEMP: 36.0 °C BP: 100/70 mmhg. No subjective Complaints of pain or any discomforts.

PAST HEALTH HISTORY:

Patient experienced childhood diseases such as mumps, measles, and chickenpox. She a previous history of abdominal surgery (THBSO, omentectomy, appendectomy) and urinary
tract infections, but she did not specify when or cause. No other illnesses and diseases were mentioned. She received all necessary vaccinations in the past. Don’t have any known
allergy to food or drug.

FAMILY HEALTH HISTORY:

Her family composition is nuclear family, but her 2 children are no longer living with them, her living is comfortable but sometimes it could be stressful, she said “okay manla haam
balay danay stressful kay tungod hit waray kawrta ngan ito na danay diri kami mag iintindihay nak asawa, pero ha kabugosan okay manla”. The maternal side of the patient claims
to have a history of hypertension. And in the paternal side claims to have no known diseases or illnesses.

GORDON’S TYPOLOGY OF FUNCTIONAL HEALTH PATTERNS

1. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN

 Patient have describe her health as something important to take care of because it’s the only thing that matters in order to survive, as verbalized by the patient.
She always see her doctor everytime when theres already a problem. She takes her daily multivitamins and she frqeuntly exercises.

2. NUTRITION AND METABOLISM

Patient A drinks adaqute amount of water everyday. She eats three times a day with am and pm snacks. Her diet is mostly fish and vegetables, and he try to prevents
oily and fatty food.

3. ELIMINATION PATTERN
In the terms of urination, patient urinates independently and frequently due to her habit of drinking water “feeling ko suki na ako hit cr kay permi ako na ihi, tungod hit
tak habit pag ininom hin tubig”. Patient defecates two times a day. And she is not expericning any pain upod defecating and urinating.

4. ACTIVITY AND EXERCISE PATTERN

Client stated she freuquntly exercise such as jogging and walking. “ permi talaga ako nag eexcercise kay nag jojogging ako permi ngan nag wawalking, tas it akon
mga trabahoun ha balay exercise ko na iton”. And for leisure time “ it akon leisure time kay nangangaon kami ito ha gawas ngan nag fafamily bonding haak mga anak,
kabugtuan ngan mga nephews and niece” as stated by the client.

5. COGNITIVE-PERCEPTUAL PATTERN
The client can express herself clearly and has no problems with her memory. “waray man ako ito nga mga memory loss ngan maupay pa tak pag hinomdum hit
mga bagay”, as stated by the client. she is not having difficulty in making decisions. And has not noticed any change in her ability to smell, hear, or touch over the years.

6. SLEEP-REST PATTERN
The client’s sleeping patter is normal and does not have any trouble sleeping. She usually sleeps at 10pm and wakes up at 10am. She is able to get enough hours
of sleep. She is able to provide herself with ample rest and recuperation from her daily activities.

7. SELF-PERCEPTION PATTERN

The client loves to watch spend time with her family and cook. “Danay kun hin nakakaabat ako hin masuka suka o masakit ha tyan, nalakat lakat ako ha balay o
ginaaliw nala tak sarili para mawara it sakit”, as stated by the client. She states that she is reasonably satisfied with her current status in life and what she has achieved
for herself and her family.

8. ROLE-RELATIONSHIP PATTERN
Client is a mother, aunt, wife, sister, and friend. She views her primary roles at this stage of her life as being an essential component in her family. “it akon pamilya kay
important talga haak kinabuhi ngan ig hihimo ko talaga para la hira maging malipay ngan safe.” As stated by the client.

9. SEXUAL REPRODUCTIVE PATTERN

 Client use contraceptions, family planning, and her pregnancies were not planned. But in the current years she is no longer experience any sexual activity. “ han
una han bura bata paak, nag sesex kami nak asawa pero yana nga mga lagas na kami diri na pero okay la”as stated by the client.

10. COPING AND TOLERANCE PATTERN

Client states that she copes up with stress by sleeping, talking with family and friends, exercising and singing. Client does not show signs of depression or anxiety.
She has a strong support system which is her family.

11. VALUES AND BELIEF PATTERN

She is a Roman Catholic and attends the holy mass (virtual) every Sunday.

3. Interpret the laboratory and diagnostics results with clinical significance.

Physical exam result Clinical findings

Abdominal exam Soft, no mass, flat, no tenderness Normal

Serum Electrolytes

Electrolytes Result Normal range Clinical significance

Na (sodium) 137.4 mmol/L 135 – 148 mmol/L Normal
K ( Potassium) 3.58 mmol/L 3.5 – 5.3 mmol/L Normal
Cl (chloride) 102.1 mmol/L 96 -107 mmol/L Normal

Complete Blood Count

Laboratory and diagnostic test Result Normal range Clinical significance

Hematocrit 0.33 L/L 0.37 – 0.47 Low, An insufficient supply of healthy red blood cells (anemia) A large number of white blood cells due to long-
term illness, infection or a white blood cell disorder such as leukemia or lymphoma.
Hemoglobin 114 g/L 120-150 Low, A low hemoglobin count can be associated with a disease or condition that causes your body to have too few
red blood cells.
RBC 3.84 x10^12/L 4.2-5.4 Low, A low RBC count could also indicate a vitamin B6, B12 or folate deficiency. It may also signify internal
bleeding, kidney disease or malnutrition (where a person's diet doesn't contain enough nutrients to meet their
body's needs).
Eosinophils 0.16 0.01 – 0.03 High, indicates a parasitic infection, an allergic reaction or cancer.

Chemistry result

Result Normal range Clinical significance

Creatine 137.4 mmol/L 53 – 97 Normal
SGOT 3.58 mmol/L 15 – 41 Normal
SGPT 102.1 mmol/L 14 – 54 Normal
Blood Urea 6.4 mmol/L 2.9 – 9.3 Normal
Nitrogen

4. Drug study
Name of the General action Mechanism of action Indication Contraindication and caution Side effects/adverse effects Nursing responsibilities
drug
Generic Interferes with Paclitaxel interferes Ovarian cancer, Contraindications • . CV: Ventricular Assessment & Drug Effects
name: growth of rapidly with the normal breast cancer, tachycardia, ventricular
PACLITAXEL dividing cells function of Kaposi's Pregnancy (category X) and ectopy, transient • Monitor for hypersensitivity
including cancer microtubule growth. sarcoma, non- lactation. For Taxol and Onxol: bradycardia, chest pain. reactions, especially during first
cells, and Whereas drugs like small cell lung hypersensitivity to paclitaxel, • CNS: Fatigue, headaches, and second administrations of the
Brand name: eventually colchicine cause the cancer. baseline neutrophil count peripheral neuropathy, paclitaxel. S&S requiring treatment,
Taxol causes cell depolymerization of <1500 cells/mm3; with AIDS- weakness, seizures. but not necessarily discontinuation
death. May be microtubules in vivo, related Kaposi sarcoma • GI: Nausea, vomiting, of the drug, include dyspnea,
Dosage: 247 used alone or paclitaxel arrests their baseline neutrophil count diarrhea, taste changes, hypotension, and chest pain.
mg Paclitaxel with other function by having the <1000 cells/mm3. For mucositis, elevations in Discontinue immediately and
via special chemotherapy opposite effect; it Abraxane: baseline neutrophil serum triglycerides. manage symptoms aggressively if
venous fitter agents or hyper-stabilizes their count <1500 cells/mm3. • Hematologic: angioedema and generalized
to run for 3 radiation structure. This urticaria develop.
Neutropenia, anemia,
hours therapy. destroys the cell's
Cautious Use thrombocytopenia. • Monitor vital signs frequently,
ability to use its
cytoskeleton in a • Body as a Whole: especially during the first hour of
Cardiac arrhythmias; impaired Hypersensitivity reactions infusion. Bradycardia occurs in
flexible manner.
liver function; Safety and (Hypotension, dyspnea approximately 12% of patients,
Specifically, paclitaxel
efficacy in children are not with bronchospasm, usually during infusion. It does not
binds to the β subunit
established. urticaria, abdominal and normally require treatment.
of tubulin. Tubulin is
extremity pain, Cardiac monitoring is indicated for
the "building block" of
diaphoresis, angioedema), those with severe conduction
mictotubules, and the
myalgias, arthralgias, abnormalities.
binding of paclitaxel
locks these building alopecia. • Lab tests: Monitor hematologic
blocks in place. The • Skin: Alopecia, tissue status throughout course of
resulting necrosis with treatment. Severe neutropenia is
microtubule/paclitaxel extravasation. common but usually of short
complex does not • Urogenital: Minor duration (less than 500/mm3 for
have the ability to elevations in kidney and less than 7 d) with the nadir
disassemble. This liver occurring about day 11.
adversely affects cell Thrombocytopenia occurs less
function because the often and is less severe with the
shortening and nadir around day 8 or 9. The
lengthening of incidence and severity of anemia
microtubules (termed increase with exposure to
dynamic instability) is paclitaxel.
necessary for their • Monitor for peripheral neuropathy,
function as a the severity of which is dose
transportation dependent. Severe symptoms
highway for the cell. occur primarily with higher than
Chromosomes, for recommended doses.
example, rely upon
this property of Patient & Family Education
microtubules during
mitosis. Further
• Immediately report to physician
research has indicated
S&S of paclitaxel hypersensitivity:
that paclitaxel induces
 programmed cell difficulty breathing, chest pain,
death (apoptosis) in palpitations, angioedema
cancer cells by binding (subcutaneous swelling usually
to an apoptosis around face and neck), and skin
stopping protein rashes or itching.
called Bcl-2 (B-cell • Be sure to have periodic blood
leukemia 2) and thus work as prescribed.
arresting its function • Avoid aspirin, NSAIDs, and alcohol
to minimize GI distress.
• Be aware of high probability of
developing hair loss (>80%).
• Do not breast feed while taking this
drug.

Name of the General action Mechanism or Indication Contraindication and caution Side effects/adverse effects Nursing responsibilities
drug action
Generic name: Full or partial Carboplatin Carboplatin is Contraindications • Body as a Whole: Assessment & Drug Effects
CARBOPLATIN activity against a predominantly indicated in Hypersensitivity reactions.
variety of acts by attaching combination with an History of severe reactions to • GI: Mild to moderate • Monitor closely during first 15 min
Brand name: cancers alkyl groups to established carboplatin or other nausea and vomiting, of infusion, since allergic reactions
Paraplatin resulting in the nucleotides, combination of platinum compounds, severe anorexia, hypogeusia, have occurred within minutes of
reduction or leading to the chemotherapeutic bone marrow depression; dysgeusia, mucositis, carboplatin administration.
Dosage: stabilization of formation of agents for the initial significant bleeding; impaired diarrhea, constipation, • Lab tests: Baseline and periodic
450 mg tumor size and monoadducts, treatment of renal function; pregnancy elevated liver enzymes. CBC with differential, platelet
carboplatin to useful in and DNA advanced ovarian (category D), and lactation. • Hematologic: count, Hgb and Hct. Monitor
run for 2 hours patients with fragmenting carcinoma. Thrombocytopenia, periodically kidney function with
impaired renal when repair Carboplatin is also leukopenia, neutropenia,
Cautious Use creatinine clearance tests and
function, enzymes attempt indicated for the anemia. serum electrolytes.
patients unable to correct the palliative treatment
Use with other nephrotoxic • Metabolic: Mild • Monitor results of peripheral
to error. 2% of of ovarian
drugs. hyponatremia, blood counts. Median nadir occurs
accommodate carboplatin's carcinoma, recurrent
hypomagnesemia, at day 21. Leukopenia,
high-volume activity comes after prior
hypocalcemia, and neutropenia, and
hydration, or from DNA cross- chemotherapy.
hypokalemia. thrombocytopenia are dose
patients at high linking from a
risk for base on one • CNS: Peripheral related and may produce dose-
neurotoxicity strand to a base neuropathy. limiting toxicity.
and/or on another, • Skin: Rash, alopecia. Special • Monitor for peripheral neuropathy
ototoxicity. preventing DNA Senses: Tinnitus. (e.g., paresthesias), ototoxicity,
strands from • Urogenital: Nephrotoxicity. and visual disturbances.
separating for • Monitor serum electrolyte studies,
synthesis or because carboplatin has been
transcription. associated with decreases in
Finally, sodium, potassium, calcium, and
carboplatin can magnesium. Special precautions
induce a number
 of different may be warranted for patients on
mutations. diuretic therapy.

Patient & Family Education

• Learn about the range of potential

adverse effects. Strategies for
nausea prevention should receive
special attention.
• During therapy you are at risk for
infection and hemorrhagic
complications related to bone
marrow suppression. Avoid
unnecessary exposure to crowds
or infected persons during the
nadir period.
• Report paresthesias (numbness,
tingling), visual disturbances, or
symptoms of ototoxicity (hearing
loss and/or tinnitus).
• Do not breast feed while taking
this drug.

Name of the General action Mechanism or action Indication Contraindication and Side effects/adverse effects Nursing responsibilities
drug caution
Generic name: Prevents nausea Ondansetron is a selective Prevention of Contraindications • . CNS: Dizziness and light- Assessment & Drug Effects
ONDANSETRON and vomiting antagonist of the serotonin nausea and headedness, headache,
associated with receptor subtype, 5-HT3 vomiting Hypersensitivity to sedation. • Monitor fluid and
Brand name: cancer Cytotoxic chemotherapy and associated with ondansetron. • GI: Diarrhea, constipation, electrolyte status.
Zofran chemotherapy radiotherapy are associated with initial and dry mouth, transient Diarrhea, which may
and anesthesia. the release of serotonin (5-HT) repeated courses increases in liver cause fluid and electrolyte
Cautious Use
Dosage: from enterochromaffin cells of of cancer aminotransferases and imbalance, is a potential
8 mg IVTT the small intestine, presumably chemotherapy, bilirubin. adverse effect of the drug.
initiating a vomiting reflex including high- Pregnancy (category
B), lactation.
• Body as a Whole: • Monitor cardiovascular
through stimulation of 5-HT3 dose cisplatin; Hypersensitivity reactions. status, especially in
receptors located on vagal postoperative
patients with a history of
afferents Ondansetron may nausea and
coronary artery disease.
block the initiation of this reflex. vomiting.
Rare cases of tachycardia
Activation of vagal afferents may
and angina have been
also cause a central release of
reported.
serotonin from the
chemoreceptor trigger zone of
the area postrema, located on Patient & Family Education
the floor of the fourth
 ventricle Thus, the antiemetic • Be aware that headache
effect of ondansetron is probably requiring an analgesic for
due to the selective antagonism relief is a common
of 5-HT3 receptors on neurons adverse effect.
located in either the peripheral
or central nervous systems, or
.
both .
Although the mechanisms of
action of ondansetron in treating
postoperative nausea and
vomiting and cytotoxic induced
nausea and vomiting may share
similar pathways, the role of
ondansetron in opiate-induced
emesis has not yet been formally
established

Name of the drug General action Mechanism or action Indication Contraindication and Side effects/adverse effects Nursing responsibilities
caution
Generic name: Drug has Long-acting synthetic Adrenal insufficiency Contraindications • . Aerosol therapy: Nasal Assessment & Drug Effects
DEXAMETHASONE antiinflammatory adrenocorticoid with concomitantly with a irritation, dryness,
and intense mineralocorticoid; Systemic fungal epistaxis, rebound • Monitor and report S&S of
Brand name: immunosuppression antiinflammatory inflammatory infection, acute congestion, bronchial Cushing's syndrome (see
Dexameth properties. (glucocorticoid) conditions, allergic infections, active or asthma, anosomia, Appendix F) or other systemic
activity and minimal states, collagen resting tuberculosis, perforation of nasal adverse effects.
Dosage: mineralocorticoid diseases, septum.
vaccinia, varicella, • Monitor neonates born to a
20 mg slow IV activity. hematologic administration of • Systemic Absorption— mother who has been receiving a
push Antiinflammatory disorders, cerebral live virus vaccines (to CNS: Euphoria, corticosteroid during pregnancy
action: Prevents edema, and patient, family insomnia, convulsions, for symptoms of
accumulation of addisonian shock. members), latent or increased ICP, vertigo, hypoadrenocorticism.
inflammatory cells at Also palliative active amebiasis. headache, psychic
sites of infection; treatment of • Monitor for S&S of a
Ophthalmic use: disturbances. hypersensitivity reaction (see
inhibits phagocytosis, neoplastic disease, as Primary open-angle • CV: CHF, hypertension,
lysosomal enzyme adjunctive short- Appendix F). The acetate and
glaucoma, eye edema. sodium phosphate formulations
release, and synthesis term therapy in acute infections, • Endocrine: Menstrual may contain bisulfites, parabens,
of selected chemical rheumatic disorders superficial ocular irregularities, or both; these inactive
mediators of and GI diseases, and herpes simplex, hyperglycemia; ingredients are allergenic to
inflammation; as a diagnostic test keratitis and cushingoid state; some individuals.
reduces capillary for Cushing's tuberculosis of eye. growth suppression in
dilation and syndrome and for Safe use during children; hirsutism.
permeability. differential diagnosis pregnancy (category Patient & Family Education
Immunosuppression: of adrenal • Special Senses:
C), lactation, or in
Not clearly hyperplasia and Posterior subcapsular
children is not cataract, increased IOP, • Take drug exactly as prescribed.
understood, but may adrenal adenoma. established. glaucoma, • Report lack of response to
be due to prevention
exophthalmos. medication or malaise,
or suppression of
orthostatic hypotension,
delayed
hypersensitivity • GI: Peptic ulcer with muscular weakness and pain,
immune reaction. Cautious Use possible perforation, nausea, vomiting, anorexia,
abdominal distension, hypoglycemic reactions (see
nausea, increased Appendix F), or mental
Stromal herpes
appetite, heartburn, depression to physician. These
simplex, keratitis, GI
dyspepsia, pancreatitis, symptoms may signal
ulceration, renal
bowel perforation, oral hypoadrenocorticism.
disease, diabetes
mellitus,
candidiasis. • Report changes in appearance
hypothyroidism, • Musculoskeletal: and easy bruising to physician.
Muscle weakness, loss These symptoms may signal
myasthenia gravis,
of muscle mass, hyperadrenocorticism.
CHF, cirrhosis,
psychic disorders, vertebral compression • Note: Hiccups that occur for
seizures. fracture, pathologic several hours following each
fracture of long bones, dose may be a complication of
tendon rupture. high-dose oral dexamethasone.
• Skin: Acne, impaired • Keep appointments for
wound healing, checkups; make sure electrolytes
petechiae, ecchymoses, and BP are evaluated during
diaphoresis, allergic therapy at regular intervals.
dermatitis, hypo- or • Add potassium-rich foods to
hyperpigmentation, SC diet; report signs of hypokalemia
and cutaneous atrophy, (see Appendix F). Concomitant
burning and tingling in potassium-depleting diuretic can
perineal area (following enhance dexamethasone-
IV injection). induced potassium loss.
• Note: Dexamethasone dose
regimen may need to be altered
during stress (e.g., surgery,
infections, emotional stress,
illness, acute bronchial attacks,
trauma). Consult physician if
change in living or working
environment is anticipated.
• Discontinue drug gradually under
the guidance of the physician.
• Note: It is important to prevent
exposure to infection, trauma,
and sudden changes in
environmental factors, as much
as possible, because drug is an
immunosuppressor.
• Do not breast feed while taking
this drug without consulting
physician.
Name of the General action Mechanism or Indication Contraindication and Side effects/adverse effects Nursing responsibilities
drug action caution
Generic name: Blocks daytime After a meal, the This drug is used Contraindications • CNS: Headache, malaise, Assessment & Drug Effects
RANITIDINE and nocturnal hormone gastrin, alone or with dizziness, somnolence,
basal gastric acid produced by cells concomitant antacids Hypersensitivity to insomnia, vertigo, mental • Potential toxicity results from
Brand name: secretion in the lining of the for the following ranitidine; acute confusion, agitation, decreased clearance (elimination)
Zantac stimulated by stomach, conditions: short- porphyria; OTC depression, hallucinations and therefore prolonged action;
histamine and stimulates the term treatment of administration in in older adults. greatest in the older adult patients
Dosage: reduces gastric release of active duodenal ulcer, children <12 y. • CV: Bradycardia (with or those with hepatic or renal
50 mg IVTT acid release in histamine, which treating gastric acid rapid IV push). dysfunction.
response to food, then binds to hypersecretion due to •
Cautious Use GI: Constipation, nausea, • Lab tests: Periodic liver functions.
pentagastrin, and histamine H2 Zollinger-Ellison abdominal pain, diarrhea. Monitor creatinine clearance if
insulin. Shown to receptors, leading syndrome, systemic Skin: Rash.
Hypersensitivity to H2- renal dysfunction is present or
inhibit 50% of the to the secretion of mastocytosis, and
blockers; hepatic and • Hematologic: Reversible suspected. When clearance is <50
stimulated gastric gastric acid. other conditions that
renal dysfunction; decrease in WBC count, mL/min, manufacturer
acid secretion. Ranitidine reduces may pathologically
renal failure; PKU; thrombocytopenia. recommends reduction of the dose
the secretion of raise gastric acid
gastric acid by levels. It also used in pregnancy (category • Body as a Whole: to 150 mg once q24h with cautious
B), infants <1 mo, Hypersensitivity reactions, and gradual reduction of the
reversible binding the short term
lactation. anaphylaxis (rare). interval to q12h or less, if
to histamine (H2) treatment of active
necessary.
receptors, which benign gastric ulcers
are found on and maintenance • Be alert for early signs of
gastric parietal therapy of gastric hepatotoxicity (though low and
cells. This process ulcers at a reduced thought to be a hypersensitivity
leads to the dose. In addition to reaction): jaundice (dark urine,
inhibition of the above, ranitidine pruritus, yellow sclera and skin),
histamine binding can be used for the elevated transaminases (especially
to this receptor, treatment of GERD ALT) and LDH.
causing the symptoms, treatment • Long-term therapy may lead to
reduction of gastric of erosive esophagitis vitamin B12 deficiency.
acid secretion. The (endoscopically
relief of gastric- diagnosed) and the Patient & Family Education
acid related maintenance of
symptoms can gastric or duodenal
• Note: Long duration of action
occur as soon as 60 ulcer healing.11,12
provides ulcer pain relief that is
minutes after
maintained through the night as
administration of a
well as the day.
single dose, and
the effects can last • Be aware that even if symptomatic
from 4-10 hours, relief is provided by ranitidine, this
providing fast and should not be interpreted as
effective absence of gastric malignancy.
symptomatic Follow-up examinations will be
relief.3,9,11 scheduled after therapy is
discontinued.
• Adhere to scheduled periodic
laboratory checkups during
ranitidine treatment.
 • Do not supplement therapy with
OTC remedies for gastric distress or
pain without physician's advice
(e.g., Mylanta II reduces ranitidine
absorption).
• Do not smoke; research shows
smoking decreases ranitidine
efficacy and adversely affects ulcer
healing.
• Do not breast feed while taking this
drug without consulting physician.

Name of the drug General action Mechanism or action Indication Contraindication and Side effects/adverse effects Nursing responsibilities
caution

Generic name: Competes for Diphenhydramine Temporary Contraindications • CNS: Drowsiness, dizziness, Assessment & Drug Effects
H1-receptor predominantly works symptomatic relief headache, fatigue, disturbed
DIPHENHYDRAMINE sites on via the antagonism of of various allergic Hypersensitivity to coordination, tingling, heaviness • Monitor cardiovascular status
effector cells, H1 (Histamine 1) conditions and to and weakness of hands, tremors,
Brand name: antihistamines of especially with pre-existing
thus blocking receptors Such H1 treat or prevent cardiovascular disease.
similar structure; euphoria, nervousness,
histamine receptors are located
Belix motion sickness, lower respiratory restlessness, insomnia; • Monitor for adverse effects
release. on respiratory
vertigo, and tract symptoms confusion; (especially in especially in children and the
smooth muscles,
reactions to blood (including acute children): excitement, fever. older adult.
vascular endothelial
Dosage: cells, the or plasma in asthma); narrow- • CV: Palpitation, tachycardia, mild • Supervise ambulation and use
gastrointestinal tract susceptible angle glaucoma; hypotension or side-rails as necessary.
50 mg IVTT (GIT), cardiac tissue, patients. Also used prostatic hypertension, cardiovascular Drowsiness is most prominent
immune cells, the in anaphylaxis as hypertrophy, bladder during the first few days of
collapse.
uterus, and the adjunct to therapy and often disappears
neck obstruction; GI • Special Senses: Tinnitus, vertigo, with continued therapy. Older
central nervous epinephrine and obstruction or dry nose, throat, nasal adults are especially likely to
system (CNS) other standard stenosis; pregnancy stuffiness; blurred vision, manifest dizziness, sedation,
neurons When the measures after (category C),
H1 receptor is diplopia, photosensitivity, dry and hypotension.
acute symptoms lactation, premature eyes.
stimulated in these have been neonates, and • GI: Dry mouth, nausea, Patient & Family Education
tissues it produces a
controlled; in neonates; use as
variety of actions epigastric distress, anorexia,
treatment of nighttime sleep aid
including increased vomiting, constipation, or • Do not use alcohol and other
parkinsonism and in children <12 y.
vascular permeability, diarrhea. CNS depressants because of
promotion of drug-induced
extrapyramidal • Urogenital: Urinary frequency or the possible additive CNS
vasodilation causing Cautious Use depressant effects with
reactions; as a retention, dysuria.
flushing, decreased
atrioventricular (AV) nonnarcotic cough • Body as a concurrent use.
History of asthma; Whole: Hypersensitivity (skin • Do not drive or engage in
node conduction suppressant; as a
convulsive disorders; rash, urticaria, other potentially hazardous
time, stimulation of sedative-hypnotic;
increased IOP; activities until the response to
sensory nerves of and for treatment drug is known.
 airways producing of intractable hyperthyroidism; photosensitivity, anaphylactic • Increase fluid intake, if not
coughing, smooth insomnia. hypertension, shock). contraindicated; drug has an
muscle contraction of cardiovascular • Respiratory: Thickened bronchial atropine-like drying effect
bronchi and the GIT, disease; diabetes secretions, wheezing, sensation (thickens bronchial secretions)
and eosinophilic mellitus; older that may make expectoration
of chest tightness.
chemotaxis that adults, infants, and difficult.
promotes the allergic
young children. • Do not breast feed while
immune taking this drug.
response Ultimately,
diphenhydramine
functions as an
inverse agonist at H1
receptors, and
subsequently
reverses effects of
histamine on
capillaries, reducing
allergic reaction
symptoms

2. NCP

Fear and Anxiety

Cues Nursing Scientific rationale Objectives Nursing interventions Rationale Evaluation

diagnosis
Subjective Fear/Anxiety Anxiety is a common After 12 hours of Independent After 12 hours of
• “bagat (mild) related to problem for patients nursing intervention 1. Encourage client to share 1. Provides opportunity to nursing intervention
hadlok ngan situational crisis with a cancer diagnosis. the patient will be thoughts and feelings examine realistic fears the patient:
kin kukulba regarding At different times able to: 2. Provide open and misconceptions • Display
gad ako kun chemotherapy during treatment and • Display environment in which about diagnosis. appropriate
ano it na regimen recovery, cancer appropriate client feels safe to discuss 2. Helps client feel accepted range of
hihitabo patients and their range of feelings or to refrain from in present condition feelings and
haak yana family and caregivers feelings and talking without feeling judged lessened fear.
nga mga may feel fearful and lessened fear. 3. Maintain frequent and promotes sense of • report anxiety
panahon” as anxious. Simply finding • report contact with client. Talk dignity and control. is reduced to a
verbalized a lump or possible anxiety is with and touch client, as 3. Provides assurance that manageable
by the client other sign or reduced to a appropriate the client is not alone or level.
symptom of cancer can manageable 4. Permit expressions of rejected; conveys
Objective cause anxiety and fear, level. anger, fear, and despair respect for and
• Restless along with finding out without confrontation. acceptance of the
• Feelings of that they have cancer Give information that person, fostering trust
anxiety or that the cancer has feelings are normal and 4. Acceptance of feelings
come back. Fear of are to be appropriately allows client to begin to
treatment, doctor visits, expressed deal with situation.
and tests might also
 cause apprehension 5. Explain the
(the feeling that recommended treatment,
something bad is going its purpose, and potential
to happen). side effects. Help client
prepare for treatments.
Source: Cancer.org. 6. Explain procedures,
(2020, February 1). providing opportunity for
Anxiety. Retrieved from questions and honest
American Cancer answers. Stay with client
Society : during anxiety-producing
https://www.cancer.org procedures and
/treatment/ consultations.
treatments-and-side- 7. Provide reliable and
effects/physica consistent information
l-side- and support for SO.
effects/emotional- 8. Include SO as indicated
mood- and client desires when
changes/anxiety.html major decisions are to be
made.
Collaborative
1. Refer to additional
resources for counseling
and support as needed.
Source: Marilynn Doenges, M. F.
(2014 ). Nursing Care Plans:
Guidlines for Individuaizing client
care across the life span .
Philadelphia, PA 19103: F.A. Davis
Company .
Deficient Knowledge
5. The goal of cancer
treatment is to destroy
malignant cells while
minimizing damage to
normal ones. Treatment
may include curative,
preventive, or palliative
surgery as well as
chemotherapy, internal
or external radiation, or
newer, organ-specific
treatments such as
whole-body
hyperthermia or
biotherapy. Bone marrow
or peripheral progenitor
cell transplant may be
recommended for some
types of cancer.
6. Accurate information
allows client to deal more
effectively with reality of
situation, thereby
reducing anxiety and fear
of the unknown
7. Allows for better
interpersonal interaction
and reduction of anxiety
and fear.
8. Provides a support
system for the client and
allows the SO to be
involved appropriately.
Collaborative
1. May be useful from time
to time to assist client
and SO in dealing with
anxiety.
Source: Marilynn Doenges, M. F.
(2014 ). Nursing Care Plans:
Guidlines for Individuaizing client
care across the life span .
Philadelphia, PA 19103: F.A. Davis
Company
 Cues Nursing Scientific rationale Objectives Nursing interventions Rationale Evaluation
diagnosis
Subjective: deficient Serous surface papillary After 12 hours of Independent 1. Validates current level After 12 hours of nursing
• “ diri man gud Knowledge carcinoma of the ovary is a nursing intervention the 1. Review with client and of understanding, intervention the patient:
ak maaram regarding rare peritoneal neoplasm patient will be able to: SO understanding of identifies learning • Verbalize
hito nga mga illness, found in postmenopausal • Verbalize specific diagnosis, needs, and provides accurate
cancer ngan prognosis, women that is histologically accurate treatment knowledge base from information
mga pan treatment, characterized by an information alternatives, and which client can make about
tambal siton, self-care, and exophytic papillary tumor about future expectations. informed decisions treatment at
basta maaram discharge originating from the surface treatment at 2. Determine client’s 2. Aids in identification own level of
ak nga needs related epithelium of the ovary. own level of perception of cancer of ideas, attitudes, readiness.
kailangan to Serous surface papillary readiness. and cancer fears, misconceptions, • Verbalize
talaga iton unfamiliarity carcinoma of the ovary has • Verbalize treatment(s). Ask and gaps in understanding
magpakita hin with a better response to surgical understanding about client’s own or knowledge about of therapeutic
doctor para information reduction followed by of therapeutic previous experience cancer needs
maupay” as resources as chemotherapy than needs or experience with 3. Helps with adjustment
verbalized by evidenced by peritoneal carcinomatosis other people who to the diagnosis of
the client reports the from other diseases. have, or had, cancer cancer by providing
problem Therefore, it is important to 3. Provide clear, needed information
Objective differentiate serous surface accurate information along with time to
• Verbalization papillary carcinoma of the in a factual but absorb it. Note: Rate
of the ovary from other, sensitive manner. and method of giving
problem unresponsive forms of Answer questions information may need
• Seeking peritoneal carcinomatosis specifically, but do not to be altered to
bombard with decrease client’s
information
about illness, Source: Hye Jin Kim, J. K.-S. nonessential details. anxiety and enhance
treatment (2004). CT Features of 4. Provide anticipatory ability to assimilate
and care. Serous Surface Papillary guidance with client information.
Carcinoma of the Ovary. and SO regarding 4. Client has the “right to
Retrieved from American treatment protocol, know” and participate
Journal of Roentgenology: h length of therapy, in decisions. Accurate
ttps:// www expected results, and and concise
.ajronline.org/doi/ possible side effects. information helps to
10.2214/ajr.183.6.01831721 Be honest with client dispel fears and
5. Provide written anxiety, helps clarify
materials about the expected routine,
cancer, treatment, and enables client to
and available support maintain some degree
systems. of control
6. Ask client for verbal 5. Anxiety and
feedback, and correct preoccupation with
misconceptions about thoughts about life
individual’s type of and death often
cancer and treatment interfere with client’s
choices. ability to assimilate
7. Review specific adequate information.
medication regimen Written materials
and use of over-the- provide reinforcement
counter (OTC) drugs. and clarification about
8. Outline normally
expected limitations, if
any, on ADLs, 6.
including difficulty
cooking meals when
nauseated or fatigued
and loss of work time
because of effects of
treatments 7.
9. Review with client and
SO the importance of
maintaining optimal
nutritional status.
10. Recommend
cookbooks that are 8.
designed for cancer
clients.
11. Recommend
increased fluid intake
and fiber in diet, as
well as routine 9.
exercise
12. Instruct client to
assess oral mucous
membranes routinely,
noting erythema or 10.
ulceration
13. Advise client
concerning skin and 11.
hair care: avoid harsh
shampoos, hair dyes,
permanents, salt 12.
water, and chlorinated
water; avoid exposure
to strong wind and
extreme heat or cold;
avoid sun exposure to
target area for 1 year
after end of radiation
treatments; and 13.
regularly apply
sunblock (SPF 15 or
greater).
14. Review signs and
symptoms requiring 14.
medical evaluation,
such as infection,
delayed healing, drug
reactions, and
information as client
needs it
Misconceptions about
cancer may be more
disturbing than facts
and can interfere with
treatments or delay
healing
Enhances ability to
manage self-care and
avoid potential
complications and
drug reactions or
interactions.
Enables client and SO
to begin to put
limitations into
perspective and plan
for, or adapt, as
indicated
Promotes well-being,
facilitates recovery,
and is critical in
enabling the client to
tolerate treatments
Helps provide specific
menu and recipe
ideas.
improves consistency
of stool and
stimulates peristalsis
Early recognition of
problems promotes
early intervention,
minimizing
complications that
may impair oral intake
and provide avenue
for systemic infection.
Prevents additional
hair damage and skin
irritation and may
prevent recall
reactions
Early identification
and treatment may
limit severity of
complications. Note:
The use of central
 increased pain; or
swelling of face or
hands and arms that
may worsen when
lying down, dyspnea,
cough, headache, and
visual disturbances
suggestive of SVCS
15. Stress importance of
continuing medical
follow-up
16. Encourage periodic
review of advance
directives. Promote
inclusion of family and
SO in decision-making
process.
Source: Marilynn Doenges, M. F.
(2014 ). Nursing Care Plans:
Guidlines for Individuaizing client
care across the life span .
Philadelphia, PA 19103: F.A.
Davis Company .
Source: Marilynn Doenges, M. F.
(2014 ). Nursing Care Plans:
Guidlines for Individuaizing
client care across the life span .
venous access devices
for various
therapies—
chemotherapy, TPN,
or antibiotic
administration—may
cause local vein
trauma leading to
SVCS days, months, or
even years after
catheter insertion
15. Provides ongoing
monitoring of
progression or
resolution of disease
process and
opportunity for timely
diagnosis and
treatment of
complications and
early detection of
second malignancies.
Note: Some
complications can
develop long after
therapy is completed,
such as pathological
fractures, radiation
cystitis, or
pneumonitis. Periodic
thyroid function tests
are indicated for
clients with radiation
to the neck and upper
chest because
hypothyroidism may
develop.
16. Client, family, and SO
need to reevaluate
choices as condition
changes and
treatment options
become available or
are exhausted.
 Philadelphia, PA 19103: F.A.
Davis Company .
.