I.

INTRODUCTION

Hepatoma also known as Hepatocellular carcinoma (HCC), is the one of the most common cancer in the world with 1 Million new cases diagnosed every year. Roughly 20,000 new cases are diagnosed every year in United states. It is more frequent in men and OrientalAmericans. The average age at the time of diagnosis if 60 years. Unfortunately, most patients are diagnosed in advanced stages when cure is not possible. http://www.tirgan.com There are a number of risk factors that are associated with liver cancer. In the United States , the most common risk factor for liver cancer is liver cirrhosis . Sixty to eighty percent of patients presenting with liver cancer have some signs of cirrhosis. Cirrhosis results from scar formation within the liver, most commonly due to chronic alcohol use. Chronic infection with hepatitis C virus (HCV) is also a common cause of liver cancer in the United States . Worldwide, other risk factors, such as chronic infection with hepatitis B virus (HBV) is more common. http://www.oncolink.org Hepatitis B is an infectious hepatitis caused by the hepatitis B virus. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely. Approximately 90% to 95% of infected adults are able to fight off the virus so their infection is cured. Only about 5% to 10% of adults infected with HBV go on to develop chronic infection. About two-thirds of people with chronic HBV infection are chronic carriers. These people do not develop symptoms, even though they harbor the virus and can transmit it to other people. The remaining one third develop "active" hepatitis, a disease of the liver that can be very serious. http://www.emedicinehealth.com Bacterial Peritonitis is the inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. These is common in individuals with alcoholic cirrhosis, spontaneous bacterial peritonitis is now known to affect patients with cirrhosis from any cause. http://www.diseasesatoz.com Hospital-acquired pneumonia is an infection of the lungs that occurs during a hospital stay. Hospital-acquired pneumonia tends to be more serious than other lung infections, because patients in the hospital are often sicker and unable to fight off germs and the types of

germs present in a hospital are often more dangerous than those encountered in the community. http://www.nlm.nih.gov Our patient is Mr. ML, 58 years old, diagnosed with Hepatoma secondary to Chronic Hepatitis B/ Alcoholic Liver Cirrhosis; Bacterial Peritonitis; Hospital Acquired Pneumonia. We have chosen him to be the focus of our study because of the uniqueness and rareness of his disease condition. The students believe that through the study of his case, it will broaden their knowledge about his disease condition and improve the quality of nursing care rendered to patients with the same diease condition.

B. Objectives and the Purposes of the Study: NURSING PRACTICE This study aims to contibute to the nursing practice by enhancing the quality of care to patients with the diagnosis of the client. It also aims to : know the health history of the client and the family provide thorough and comprehensive assessment of the health status of the patient describe the symptoms manifested by the client provide appropriate nursing diagnoses for the client s condition plan appropriate nursing interventions for the client provide quality nursing care to the client evaluate progress and redefine goals as appropriate NURSING EDUCATION The study aims to contribute to nursing education by providing a reference for plan of care for the condition of the patient. It aims to give accurate information for the readers of this care study. NURSING RESEARCH This study aims to contribute to the nursing research by providing a reference for the disease condition. The study would provide a tool for researchers to aid their researches with this study. However, this study also is subject for further evaluation of the nursing research body so as to meet its aim of providing basis for evidence-based practice.

C. Scope and Limitation of the Study

The scope of the study are as follows: The scope of the study includes the patient s profile, the family history and the personal history of the patient, the patient s diagnosis, the nursing management, the medical management and the recommendation and the patient s prognosis as evaluated by the students who are conducting this study. The different references are also part of this study, which encompasses the use of the different medical-surgical nursing books, nursing care plan books, internet sources and other sources which served as our guide in conducting the study. The limitations of the study are as follows: Interaction with the client and the significant others was limited to 3 days only. There was an assessment on February 12, 2012 made prior to the two-days duty which was on February 13-14, 2012. The assessment covered questions about the health history of patient, chief complaints and nursing systems review chart. The assessment time lasted for about an hour. There was no follow-up check-up after the duty. Information about the client s history of illness was based only on the interview with the client and client s significant others. There are only limited informations gathered by the students since the patient gets easily annoyed during the interview. The physician was not interviewed. The outcomes of the planned nursing interventions are dependent upon the cooperation and participation of the client and the significant others

II. HEALTH HISTORY A. PATIENT S PROFILE Name: Date of Birth: Age: Patient M.L. June 10, 1953 58 years old

Sex: Civil Status: Height: Weight: Blood Type: Religion: Nationality: Address: Occupation: Income: Educational Attainment:

Male Married

A Roman Catholic Filipino P-5, Salay, Misamis Oriental Unemployed None College level (Second year)

Type of Previous Illness/Pregnancy/Delivery: 1991- History of Hepatitis Heredofamilial disease: (+) HPN father s side CLINICAL/ADMITTING DATA Date Admitted: Time: Physician: Admitting Diagnosis: Final Diagnosis: January 21, 2012 4:30 pm Dr. Miguel Daitia Jr. M.D. T/C Viral Hepatitis Hepatoma secondary to Chronic Hepatitis B/ Alcoholic Liver Cirrhosis Bacterial Peritonitis Hospital Acquired Pneumonia

Family and Personal Past Health History Patient ML has a heredofamilial disease of hypertension at the paternal side and no heredofamilial disease at the maternal side. Patient ML had a history of Hepatitis 20 years ago on year 1992 in Gingoog Hospital. HISTORY OF PRESENT ILLNESS\ This is a case of patient ML, 58 years old, residing in P-5, Salay, Misamis Oriental, male, in due to body malaise, jaundice, and fever. Januray 16, 2012, patient had onset of body malaise, jaundice, abdominal distention, abdominal tenderness. Two days prior to admission, January 18, 2012, chief complaints was associated with fever and abdominal pain. On January 20, 2012, symptoms aggravated thus sought consult to Balingasag Hospital. On January 21, 2012, patient was then transferred to Sabal Generel Hospital.