Professional Documents
Culture Documents
Mr.P.Yonatan sir
Associate professer
Jgcollege of nursing
Ahmedabad Submitted
MrsHeena Mehta
S.Y.M.sc nursing
Jg nursing college
Ahmedabad
Sr no Content Page no
1 identification
2 history
3 Physical examination
4 investigation
5 Disease condition
6 defination
7 pathophysiology
8 management
9 Nursing diagnosis
10 Health teaching
11 Bibliography
IDENTIFICATION DATA
PATIENT’S NAME: ChetangiriDevgiriGoswami
AGE:40 years
SEX:Male
RELIGIO: Hindu
EDUCATION: 5thstd .
OCCUPATION:Labour work
ADDRESS:Bavaji no delo,nearsanatanashram,S.G.highway,Ahmedabad.
DIAGNOSIS:Oesophagus carcinoma
HEIGHT: 152Cm
WEIGHT: 54Kg
PRESENTING COMPLAINS:
Patient having complained of following:
-Swallowing difficulti
-Nausea
-Vomiting
-Discomfort in chest
-Body ache
-Mild fever
-Constipation
PRESENT HISTORY:
PAST HISTORY:
Upto 40 years chetangiribhai had not any need for stay in hospitalition for any major illness, he
need symptomatic treatment as per symptoms and relieve the symptoms
DIET HISTORY:
Chetangiri’s family is vegetarian so hisfamily eats vegetarian diet. His wife cooked
all type of vegetarian diet and sometimes he eat raw vegetables with fruit.He drink
very hot tea in the day three to four times.
PERSONAL HISTORY:
Diet : vegetarian & taking all type of small amount diet
Appetite : Decreased
Sleep :disturb
Micturation : No burning micturation
Bowel habit: Abnormal habits
Smoking : 1 pack bidi in day
Alcohol : Some times
Drugs : No
Tobacco : Sometimes
No any other habits
FAMILY HISTORY:
In his family no any family members have history of any Hypertension, Diabetes mellitus,
Ischemic heart disease, Epilepsy, Asthma, Storks, Arthritis, Cancer or any other disease.
Labour work
SOCIOECONOMIC HISTORY :
In his family all family member are labour worker so his family’s income is not good they earn
and eat daily and not store adequet stock for diet .they eat routine diet such as roti,rice ,some
times green vegetables, potetoes more used, once in week they cooked dal. There is no any
adequatefacallity in his house also.
PHYSICAL EXAMINATION
VITAL SIGN
GENERAL APPERANCE:
MENTAL STATUS:
Consciousness: conscious
Posture
SKIN CONDITION:
Color: pallor
Texture: Rough skin
Temperature: warm
Lesions: no lesions present
Scalp: clean
Face: pale, fatigue, fear, anxiety
EYES
Eyebrow: normal
Eye lashes: no infection, not open by patient
Eyelids: no any injury or oedema is present
Eye balls: not sunken
Conjunctiva: pale
Sclera: no jaundiced
Pupils: constricted
Vision: react to light
EAR:
NOSE:
NECK:
CHEST:
Thorax: expansion
Breath sound: Crab herd with stethoscope
Heart: normal
ABDOMEN:
EXTREMITIES:
Upper extremities: can move both hands but mild oedema is present
Genital and rectum:
INVESTIGATION
Serum Biochemistry test:
Investigation In patient Normal value
Hemoglobin 14 % gm% 14 – 17 gm %.
RBC 98 mg/dl 153mg/ml
UREA 18.34 mg/dl 15-45mg/dl
WBC 8000/cumm 4000-11000/cumm
S.creat. 0.85mg/dl 0.7-1.5mg/dl
SGPT 48U/L 0-55U/L
S. Alkpo4 68U/L <50-150U/L
S.Billirubin 0.7mg/dl 0.2-1.2mg/dl
BLOOD CHEMISTERY
FASTING 96.0mg/ dl 70-110mg/dl
X-RAY CHEST:
ECG: wnl
Biopsy-Finding
MEDICATION
DISEASE CONDITION
ANATOMY AND PHYSIOLOGY OF OESOPHAGUS-
- The adult esophagus is a 25 cm-long tube and is fixed superiorly at the cricopharyngeus
muscle, which is considered as the upper esophageal sphincter.
- Esophagus courses inferiorly through the posterior mediastinum behind the trachea and the
heart and exits the thorax through the hiatus of the diaphragm.
- The so-called lower esophageal sphincter (LES) is not a true anatomic sphincter, but rather a
functional one.
- Tonic muscular contraction at the lower end of the esophagus creates an action similar to
that of a one-way flutter valve.
- The transition from the normal squamous mucosa of the esophagus to the gastric mucosa at
the esophago-gastric junction occurs abruptly at the level of the diaphragm.
- The venous drainage of the esophagus is important in portal hypertension because it forms
esophageal varices.
- The functions of the esophagus include:
i) Esophagus conducts food and fluids from the pharynx to the stomach and
ii) Prevents reflux of gastric contents into the esophagus.
- These functions require coordinated motor activity including both extrinsic and intrinsic
innervation, myogenic properties and humoral substances.
DEFINITION-
Esophageal cancer (or oesophageal cancer) is malignancy of the esophagus. There are various
subtypes, primarily squamous cell cancer andadenocarcinoma , Squamous cell cancer arises
from the cells that line the upper part of the esophagus. Adenocarcinoma arises from
glandular cells that are present at the junction of the esophagus and stomach
CAUSES:
In Book In Patient
No
Barrett's esophagus
Heredity No
Age is another critical factor No
A man with a personal history of cancer No
Lifestyle and Dietary Causes due to obesity No
Tobacco smoking Yes
Human papillomavirus (HPV) Yes
PATHOPHYSIOLOGY:
The progression of Barrett metaplasia to adenocarcinoma is associated with several changes in
gene structure, gene expression, and protein structure.
The oncosuppressor gene TP53 and various oncogenes, particularly erb -b2, have been studied
as potential markers.
Casson and colleagues identified mutations in the TP53 gene in patients with Barrett
epithelium associated with adenocarcinoma.
alterations in p16 genes and cell cycle abnormalities or aneuploidy appear to be some of the
most important and well-characterized molecular changes.
o Allelic losses at chromosomes 4q, 5q, 9p, 9q, and 18q and abnormalities of p53, Rb, cyclin
D1, and c-myc have been implicated.
CLINICAL MENIFESTATION:
In Book In Patient
Dysphagia (difficulty swallowing) Present
odynophagia (painful swallowing) Present
Pain behind the sternum or in the Present
epigastrium
coughing and an increased risk of aspiration Not Present
pneumonia.
IN BOOK IN PATIENT
- Taking a thorough history - Done
including family history
- Physical examination - Done
- microscopic analysis of the - Done
biopsy
- Laboratory work (cholesterol - Done
levels, glucose )
Biopsies - Done
Computed tomography (CT) - Not Done
Positron emission tomography - Not Done
Esophageal endoscopic ultrasound - Not done
MANAGEMENT:
Esophageal cancer affecting the lower esophageus. Insets show the tumor in more
detail both before and after placement of a stent.
SURGICAL MANAGEMENT:
The thoracoabdominal approach opens the abdominal and thoracic cavities together.
The two-stage Ivor Lewis (also called Lewis-Tanner) approach involves an initial
laparotomy and construction of a gastric tube, followed by a right thoracotomy to excise
the tumor and create an esophagogastric anastomosis.
The three-stage McKeown approach adds a third incision in the neck to complete the
cervical anastomosis
A fourth method of EMR employs the use of a clear cap and prelooped snare inside the
cap. After insertion, the cap is placed on the lesion and the mucosa containing the lesion
is drawn up inside the cap by aspiration. The mucosa is caught by the snare and
strangulated, and finally resected by electrocautery. This is called the "band and snare"
or "suck and cut" technique.
Although most lesions treated in the esophagus have been early squamous cell cancers,
EMR can also be used to debulk or completely treat polypoid dysplastic or malignant
lesions in Barrett’s esophagus.
Laser therapy is the use of high-intensity light to destroy tumor cells; it affects only the
treated area. This is typically done if the cancer cannot be removed by surgery. The
relief of a blockage can help to reduce dysphagia and pain.
Photodynamic therapy, a type of laser therapy, involves the use of drugs that are
absorbed by cancer cells; when exposed to a special light, the drugs become active and
destroy the cancer cells.
MEDICALMANAGEMENT
NURSING MANAGEMENT:
- Identify at risk patients, & teach lifestyle modifications to prevent development any
complication.
- Teach patient to control cholesterol levels through dietary reduction of cholesterol intake,
exercise, smoking cessation.
- Note & report findings from history, physical examination, & laboratory results that
indicate hypertension or diabetes, &teach to control blood pressure by taking treatment
in the nearest hospital.
NURSING DIAGNOSIS:
HEALTH TEACHING:
Arrange specific services for patient(e.g. respiratory therapy education, physical therapy
for exercise & breathing)
Explain patient’s reletives about discharge planning.
Give advice about regular medication as per timing.
Explain and demonstrate about chest physiotherapy by doing deep breathing exercise .
Explain and demonstrate about coughing and how to remove cough.
Advice given about good nutritive .
Advide given for prevention of infection management.