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INTRODUCTION

“The more severe the pain or illness, the more severe
will be the necessary changes. These may involve
breaking bad habits or acquiring some new and better
ones”.
-Peter McWilliams

Endometrial cancer is the growth of abnormal
cells in the lining of the uterus. The lining is called the
endometrium. Endometrial cancer is also called cancer
of the uterus, or uterine cancer. Endometrial cancer
usually occurs in women older than 50. The good news
is that it is usually cured when it is found early. And
most of the time, the cancer is found in its earliest
stage, before it has spread outside the uterus.

The most common cause of endometrial
cancer is having too much of the hormone
estrogen compared to the hormone
progesterone in the body. This hormone
imbalance causes the lining of the uterus to get
thicker and thicker. If the lining builds up and
stays that way, then cancer cells can start to
grow. Women who have this hormone
imbalance over time may be more likely to get
endometrial cancer after age 50.Most
endometrial cancers develop over a period of
years and may arise from less serious problems
such as endometrial hyperplasia. Although the
majority of endometrial cancers occur in
postmenopausal women, up to 25% may occur
before menopause. The survival rate for all

In the Philippines, cancer of the cervix is
still the most frequent gynecological
malignancy; it far exceeds cancer of the ovary
and cancer of the endometrium. If we consider
all cancers affecting our women, it runs second
exceeded only by cancer of the breast. If we
consider all cancers affecting both sexes, it
ranks fourth exceeded by cancer of the lungs,
cancer of the breast, and cancer of the liver. In
the 1998 Philippine Cancer Facts and Estimates,
it was predicted that about 4,536 new cases of
cancer of the cervix would be seen and about
2,204 deaths from this malignancy would occur.
At the Philippine General Hospital, the
country’s leading referral center for cancer,
about 600 new cases are seen every year. The

We have targeted perhaps less than 10% of
our susceptible women.Sociocultural factors,
economic factors, and other government
priorities have been blamed for this and health
resources limited as they are have been
directed to control of communicable diseases,
safe motherhood, and promotion of children’s
health.
We chose this case because we know
this case would help us a lot in rendering
quality and efficient nursing care and services
to the client needs, to help client alleviate
sufferings and to serve as a tool to increase

nursing students will be able to gain knowledge about endometrial caner.OBJECTIVES General Objectives As part of our course competency. we aim to gain more knowledge regarding Endometrial Cancer to provide us understanding its pathophysiology. . Through this case study. and how to deal with patients who are suffering from this disease. They will be able to impart their knowledge and develop skills and attitude in terms of providing proper nursing management.

4. 9. 2. To analyze patient's profile and his past and present health status.Specific Objectives: 1. To evaluate patient's physical appearance and recognize clinical manifestation of the disease. 3. 8. To enumerate and analyze the drugs that have been prescribed to the patient. 6. 5. To analyze the anatomical part and function of the organ affected specifically the uterus. . To utilize and prioritize client's immediate needs to create effective nursing care plan. To interpret diagnostic and laboratory examinations to relate it to the disease process. To explore the predisposing factors that lead to the development of the Endometrial cancer. To have an overview regarding Endometrial cancer. To discuss how the disease progressed and advanced in the body. 7.

Patient’s Profile Name: Patient X Age: 60 years old Address: San Roque Rosario. Batangas Civil status: Widow Nationality: Filipino Sex: Female Religion: Roman Catholic Date of Admission: January 27. 2009 Time: 1:50 pm Chief complaint: Vaginal bleeding Admitting Diagnosis: T/C Endometrial Carcinoma G4P4 Attending Physician: Dr. Jun Berberabe .

Family History Patient X is 60 years old. The eldest is happily married with one daughter. She is healthy enough to do all the household chores. diabetes mellitus etc. Personal History Patient X loves to cook delicious foods for the family and washes their clothes everyday. the two are working and the youngest is still studying. Her husband died last December 13. 2008 because of heart attack. Her family doesn’t have any history of diseases such as hypertension. She has 4 children. Past Health History Patient X is fully-immunized and has no allergies in any drugs or animals. After finishing all the tasks. She has no serious illness and it was her first time to be hospitalized. B.A. she’s having bonding with her . patient X is using self-medication by over-the-counter drugs whenever she is having fever or in pain. C.

Psychological History The patient doesn’t have any problems except for financial but her children are earning but . Patient X doesn’t finished her studies because of financial problem but she graduated at elementary. Community services are available at their community but it’s quite far at their house. Every Sunday they go to church together and after they eat out. She just stays at home and take good care of her grand daughter. E. go to some places to relax or sometimes they just decided to stay at home watching television or sharing different stories. Social History The patient said that her family has a closed family ties. Her 3 children works for the family and supports her. Since she is already 60yrs old she is not working anymore.D.

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nail beds) in dark skinned clients No lesions Normal Palpation Normal body temperature Normal When pinched. lips. areas of lighter pigmentation (palms. skin goes Normal.Body Part Method Findings Diagnosis Skin Inspection Generally uniform in color Normal except in areas exposed to the sun. Due to back slowly aging skin .

absence of nodules and masses Scalp Inspection No lesions Normal Absence of seborrhea Normal Hair Inspection Evenly distributed hair Normal Thick hair Normal Silky.Head Skull Inspection Rounded (normocephalic Normal & symmetrical. parietal. with frontal. resilient hair Normal Flaking Abnormal. uniform Normal consistency. smooth skull contour Palpation Smooth. due to poor hygiene . and occipital prominences).

yellowish evident. sclera appears sclera is normal in yellow dark-skinned clients Pupils Inspection Illuminated pupil constricts Normal (direct response) . no discharge.Face Inspection Symmetric facial features Normal Symmetric facial Normal movements No lesions Normal Eyes Eyebrows Inspection Hair evenly distributed Normal Symmetrically aligned Normal Eyelids Inspection Skin intact. noNormal discoloration Conjunctiva Inspection Transparent. capillaries Normal.

no Normal tenderness. generally symmetric Uniform in color Normal Palpation No tenderness.Chest and Inspection Anteroposterior to transverse Normal Lungs diameter in ratio of 1:2 Chest symmetric Normal Palpation Skin intact. uniform in Normal temperature Chest wall intact. slightly Normal unequal in size. no masses Normal . no masses Auscultation Vesicular & bronchovesicular Normal breath sounds Breast Inspection Rounded shape.

Ears Inspection Auricle’s color is the same as Normal facial skin Symmetrical Normal Auricle is aligned with outer Normal canthus of eye Palpation Mobile. firm & not tender. pinna Normal recoils after it is folded Nose Inspection Symmetric & straight Normal No discharge or flaring Normal Uniform in color Normal Palpation Not tender. no lesions Normal .

dark colored lips is normal in dark skinned clients Teeth Inspection Missing teeth Abnormal.Mouth Lips Inspection Uniform dark color Normal. due to poor enamel (may indicate hygiene staining or the presence of caries) Gums Inspection Dark patches in gums Normal. dark patches in gums is normal in dark skinned clients Tongue Inspection Central position Normal Brown pigmentation Normal in tongue on tongue borders in dark- skinned clients . due to maybe poor hygiene or ageing Brown discoloration of Abnormal.

Hard palate Inspection Pinkish in color Normal No sores Normal Soft Palate Inspection Pinkish in color Normal No inflammation Normal Symmetrically aligned Normal Neck Inspection Muscles equal in size. due to generalized weakness and ageing Palpation Lymph nodes not palpable Normal Central placement of trachea in Normal midline of neck . head Normal centered Muscle stiffness Abnormal.

rounded abdomen Normal Soft to touch/ no tenderness Normal Lower Inspection Uniform in color Normal Extremities No lesions Normal Uniform in temperature Normal Genitalia R E F U S E D .Abdomen Inspection Unblemished skin Normal Uniform in color Normal Palpation Flat.

Anatomy and Physiology .

fertilizing it. where it begins the . and the ovaries. which includes the labia. The fertilization usually occurs in the oviducts. clitoris and urethra. but can happen in the uterus itself. The vagina is attached to the uterus through the cervix. in this transit. while the uterus is attached to the ovaries via the Fallopian tubes. the sperm penetrate and merge with the egg. the vagina meets the external organs at the vulva. If. which produce the female's egg cells. which act as the receptacle for the male's sperm.Female reproductive system (human) The female reproductive system contains two main parts: the uterus. These parts are internal. The zygote then implants itself in the wall of the uterus. the ovaries release an ovum. which passes through the Fallopian tube into the uterus. At certain intervals. it meets with sperm.

The ova are larger than sperm and are generally all created by birth. Female insects and other invertebrates also have a vagina. a process of oogenesis matures one ovum to be sent down the Fallopian tube attached to its ovary in anticipation of fertilization. Approximately every month. Vagina The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female mammals. this egg is flushed out of the system through menstruation. If not fertilized. which is the terminal part of the oviduct. or to the cloaca in female birds and some reptiles. The vagina is the place where semen from the male is deposited into the female's body at the climax .

Cervix The cervix is the lower. opens into the vagina. The uterus is a pear-shaped muscular organ. Uterus The uterus or womb is the major female reproductive organ of humans. Its major function is to accept a fertilized ovum which becomes implanted into the endometrium. the remainder lies above the vagina beyond view. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. the cervix. Approximately half its length is visible. narrow portion of the uterus where it joins with the top end of the vagina. and derives nourishment from blood vessels which . the other is connected on both sides to the fallopian tubes . One end.

. There it travels toward the uterus. If the ovum is fertilized while in the Fallopian tube. the follicle and the ovary's wall rupture. allowing the ovum to escape and enter the Fallopian tube.Oviducts The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of female mammals into the uterus. This trip takes hours or days. then it normally implants in the endometrium when it reaches the uterus. which signals the beginning of pregnancy. pushed along by movements of cilia on the inner lining of the tubes. On maturity of an ovum.

The speed of ovulation is periodic and impacts directly to the length of a menstrual cycle. the ovum is captured by the oviduct. after traveling down the oviduct to the uterus. The process by which the ovum is released is called ovulation. After ovulation. The Fallopian tubes are often called the . leading to pregnancy and the eventual birth of a new human being.Ovaries The ovaries are the place inside the female body where ova or eggs are produced. occasionally being fertilized on its way by an incoming sperm.

PATHOPHYSIOLOGY Exogenous Estrogen taken by post menopausal women Excessive Estrogen Stimulation Excessive proliferation of cells in the endometrium (endometrial hyperplasia) Infiltration in the inner lining of the uterus (endometrium) Thickening of endometrial wall Tumor fills the anterior uterus and extends to surrounding structures .

Anemia Palpable mass ain/ discomfort in lower abdomen Weight lossPainless vaginal bleedin .

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from the from 6 to 1 pain scale destruction of rating scale. After 30 minutes “ Masakit pa ang related to break inmultidimensional of nursing pinag. Post intervention.operahan the skin integrity experience. . the ko. ASSESSMENT NURSING SCIENTIFIC PLANNING DIAGNOSIS EXPLANATION Subjective: Acute pain Pain is a complex.” secondary to post operative surgical patient will be Objective: operation in the site pain results reduced the pain 6 pain rating endometrium. Paleness nerves and tissue Restless during the surgery Facial grimace because the skin Guarding has nerve endings behavior and special Decreased ability receptors which to provides sensory concentrate and perception for any stimuli.

environment. •Accepted client’s description of pain. surgical incision site when coughing •Pain is a subjective experience and •Positioned patient in comfortable cannot be felt by others. . •To know the affected body part that •Instructed patient to splint her needs immediate manage-ment. •Facilitates comfort and decrease •Encouraged to limit movement. •To facilitate comfort and reduces •Diverted patient’s attention to a embarrass-ment and anxiety for more lighter topic using therapeutic effective coping. thus prevents infection. thus. •To reduce pressure in the incision •Provided patient a clean and safe site. reduce pain. . hazards and prevents harbor of microorga-nisms. INTERVENTION RATIONALE •Determined possible causes of pain. communi-cation. position and provide privacy. •Reduces anxiety and perceptions of pain. •To decrese metabolic demand and prevent fatigue.

the patient’s pain is reduced from 6 to 4 pain rating scale. . EVALUATION After 30 minutes of nursing interventions.

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As a vomiting. diarrhea. formation of pregnancy anorexia hemoglobin Other: temporarily stained teeth from liquid forms . elemental iron. Sulfate Provides Deficiency epigastric pain. Name of Classification / Indication Side Effect Drug Action Ferrous Hematinics Iron GI: nausea. black component in the during stool. an essential supplement constipation.

transfusions. . ulcerative or water. primary take tablets positive guaiac hemocromatosis hemolytic with juice test results. but 99m and colitis. . or regional enteritis not with milk or interfere skeletal and in those receiving blood antcids imaging. Contraindication Nursing Monitoring Responsibilities Parameters Contraindicated with patients Tell patients to May yield false- with hemosiderosis. crashed or chew extentded- release forms. May anemia (unless patient also (preferably decrease uptake has iron deficiency anemia) orange juice) of technetium- peptic ulceration. Instruct Use cautiously on long-term patients not to basis.

bone or joint. promoting tract. Name of Drug Classification / Action Indication Ceftriaxone Cephalosporins Uncomplicated Sodium 3rd generation gonoccocal cephalosporin that vulvocaginitis inhibits cell-wall UTI. gynecologic. intra- usually bactericidal abdominal. skin. osmotic instability. lower respiratory synthesis. septicemia Meningitis Perioperative prevention Acute bacterial otitis media . skin structure infection.

headache. breastfeeding women and in serum sickness patientds with history of colitis and renal insufficiency . induration. diarrhea Use cautiously in patients GU: genital pruritus. pruritus Use cautiously in Other: hypersentivity reactions. rash. beta-lactam antibiotics tenderness at injection site. Side Effect Contraindication CNS: fever.candidiasis hypersensitive to penicillin Hematologic: because of possibility of eosinophilialeukopenia cross-sensitivity with other Skin: pain. Contraindicated in patients dizziness hypersensitive to drug or CV: phlebitis other cephlorporins GI: pseudomembranous colitis.

Nursing Responsibilities Monitoring Parameters Tell patient to report May increase alkaline adverse reaction promptly phosphatase. Instruct patient to report bilirubin. and LDH discomfort at IV insertion levels site May increase eosinophil and platelet counts. ALT. May decrease WBC count . AST. BUN.

particularly those of the bronchial tubes. but doesn’t reverse. motion histamine for h1. receptor sites. Name of Drug Classification / Action Indication Diphenhydramine Antihistamines Rhinitis. uterus and blood vessels . Parkinson disease Prevents. allergy Hydrochloride Competes with symptoms. GI tract. sickness. histamine mediated responses.

seizures hypersensitive to drug. tinnitus women. CV: hypotension. breastfeeding nasal congestion. stenosing distress peptic ulcer GU: dysuria. Contraindicated in patients sleepiness. nausea. dizziness. urine retention Avoid use in patients taking MAO inhibitors Children younger than age 12 should use drug only as directed by prescriber . neonates. premature EENT: diplopia. tachycardia newborns. epigastric closure glaucoma. sedation. patients with angle- GI: dry mouth. Side Effect Contraindication CNS: drowsiness. blurred vision.

Nursing Responsibilities Monitoring Parameters Instruct patient to take May decrease hemoglobin level drugs 30mins before travel and hematocrit to prevent motion sickness May decrease granulocyte and platelet counts Inform patient that sugarless gum. reduce. or mask candy or ice chips may positive result in diagnostic skin relieve dry mouth test . hard May prevent.

prostaglandin in urticaria the CNS. analgesia by leucopenia. blocking pain neutropenia. impulses by pancytopenia inhibiting Hepatic: jaundice sysnthesis of Skin: rash.Name of Drug Classification / Indication Side Effect Action Paracetamol NSAID Mild pain or Hematologic: Thought to reduce fever hemolytic anemia. .

urge them to because therapeutic doses consult prescriber if giving to cause hepatotoxicity in children for longer than 5days or these patients adults longer than 10 days . Contraindication Nursing Responsibilities Contraindicated in patients Tell patients to consult prescriber hypersensitive to drug before giving drug to children younger than age 2 Use cautiously in patients Advise parents that drug is only with long-term alcohol use for short-term use.

Monitoring Parameters May decrease glucose and hemoglobin levels and hematocrit May decrease neutrophil. RBC. WBC. and platelet counts .

PROGNOSIS The patient is still confined in the hospital for continues treatment. Patient X is under observation after undergoing an operation called extrafascial hysterectomy of removal right pelvic lymph node. .

– Instruct to maintain a clean and safe . non-stressful with normal room and body temperature environment. its time. The family is advised to continue regular intake of home meds that were prescribed by the physician. dosage and route.DISCHARGE PLANNING M – Provide the family with assistance in planning and providing aspects of care. E – Instruct the patient’s watcher to provide calm. frequency. – Reinforce importance of medical compliance to patient and its relatives. – Advise to report unusual manifestations and adverse reactions of drugs to physician. duration.

– Advise the relatives to assist patient in maintaining personal hygiene and emphasized the importance of daily hygiene. – Discuss possible complications of the disease and its signs and symptoms. . – Discuss with the family the home treatment for cancer to help manage the side effects that may accompany endometrial cancer or cancer treatment such as chemotherapy. H – Explain to the patient’s relatives regarding patient’s disease and its manifestations. such as perineal care and sponge bath.T – Instruct the relatives of the patient the modification of home environment to facilitate the challenge of living with an illness.

– Instruct the patient and relatives to have a follow-up check-up for monitoring her condition. .O – Inform relatives regarding importance of compliance on follow-up check-up. D – Advise the patient to eat variety of nutritious foods that can help her to regain his strength – Encourage the patient to have healthy habits such as eating a balanced diet and getting enough sleep and exercise to help control symptoms S – Encourage the patient’s relatives to seek spiritual support – Encourage the patient to hold her faith to God.

for the kindness and selflessness she showed us in imparting her ideas. First. to our family for always being there to guide us and support us all the way. . who shared the journey with us in making this case study. ACKNOWLEDGEMENT We want to extend our deepest gratitude and appreciation to the people who helped us in the pursuit of this case study. for always opening their hearts and doors whenever we need them. Zaraspe. Mrs. To our clinical instructor. To the patient and his relatives. To our fellow group mates.

1998. Pathophysiology (A Self-Instructional Program). and Smeltzer. Essentials of Pathophysiology. Nursing 2008 Drug Handbook. Textbook of Medical – Surgical Nursing. pp. Carol M. Lynn M. and Murr.. 174-175 Doenges. Mary F. Mary V. 2005. 2008. Nursing Care Plans (7th edition). pp. Lippincott Williams and Wilkins. pp. BIBLIOGRAPHY Books: Abel. Appleton and Lange. Moorhouse. Lippincott Williams and Wilkins. and Antonawich. Lippincott Williams and Wilkins. 2008. Alice C. 475-477 . Suzanne C.. Marilyn E.. pp. FA Davis Company: Philedelphia Porth. Brenda G. Steven R.. et al. 567 and 756 Burns. 63-70 Bare.

Thank You! .