General Objective

The purpose of this study is to analyze and improve understanding of, to develop
necessary nursing skills and to apply the appropriate nursing care while maintaining
confidentiality of patient having Osteosarcoma.

Specific Objective

 To present a case of osteosarcoma in a 16 year old patient.

 To understand condition about Osteosarcoma.
 To improve our physical assessment skill in patient with Osteosarcoma.
 To correlate laboratory results to its normal value.
 To illustrate the anatomy and physiology of the affected part or organ
 To know the pathophysiology of the chosen case.
 To be aware of the causes, clinical manifestations and complications.
 To formulate a drug study with regards to the patient’s condition.
 To develop effective nursing skill on how to manage proper care to a patient with
this kind of disease
 To provide client a nursing care plan and discharged plan to assure total wellness
during hospitalization, up to the time of discharge.

I. Introduction

a. Background of the study

i. Incidence, rate, gender, age, ratio

Incidence: Osteosarcoma is the eighth most common form of childhood cancer,

comprising 2.4% of all malignancies in pediatric patients, and approximately 20% of all
bone cancers.

Incidence rates for osteosarcoma in U.S. patients under 20 years of age are estimated at
5.0 per million per year in the general population, with a slight variation between
individuals of black, Hispanic, and white ethnicities (6.8, 6.5, and 4.6 per million per
year, respectively. It is slightly more common in males (5.4 per million per year) than in
females (4.0 per million per year).

There is a preference for origination in the metaphyseal region of tubular long bones,
with 42% occurring in the femur, 19% in the tibia, and 10% in the humerus. About 8% of
all cases occur in the skull and jaw, and another 8% in the pelvis

Rate and Age: Osteogenic sarcoma is the sixth leading cancer in children under age 15.
Osteogenic sarcoma affects 400 children under age 20 and 500 adults (most between the
ages of 15-30) every year in the USA. Approximately 1/3 of the 900 will die each year,
or about 300 a year. A second peak in incidence occurs in the elderly, usually associated
with an underlying bone pathology such as Paget's disease, medullary infarct, or prior
irradiation.

Ratio: 1/3 over 900

Gender: Many osteosarcoma are diagnosed among 1is 25years old Filipino women.
 ii. Rationale for choosing the case

Our group had chosen the case of Osteosarcoma for the specific patient,
for us to be more knowledgeable on how important it is to take good care of
ourselves from the tremendous attack of cancer cells. Another reason is that
Osteosarcoma is the tsixth leading cause of mortality rate in the children under 15
years old and we as a group would like to have awareness on how it is being
developed and what are the chances that one could survive from this.

iii. Significance of the study

As a student nurse, this study will be able to expand the knowledge and
skills on nursing management to and of course this will be more effective through
using health education especially during the attack of pain. This study will
motivate the student to the effect of osteosarcoma. This study serves as a
reference on how osteosarcoma affects the activity of daily living. Doing a case
study in nursing practice will improve the nursing knowledge and enhance the
nursing’s scientific base.

iv. Scope of limitation of study

The study would only focus in Osteosarcoma which is indicative to the

client’s health condition and its underlying nursing care and management relevant
for the client. The study will confine at Philippine Orthopedic Center for two
weeks of exposure.

v. Conceptual/theoretical theory

Myra Levine’s defined her theory with four major concepts in Conservation
Model Theory Conservation of energy meaning that all human being reserve her/his
energy by taking rest period after all the activities they have done to re-energize their
body for the next day. By utilizing the proper technique on how to conserve the energy
the body will maintain the homeostasis to prevent some diseases. 2. Conservation of
structural integrity as nurse we need to provide proper care for the patient to prevent
other complications that patient may acquire. We need to provide comfort for the patient
not only by giving medicines but preserving the cleanliness of environment, giving oral
care, perineal and wound care etc. 3. Conservation of personal integrity the goal of this
concept is to help the patient to regain his higher degree of harmony within the mind and
body and soul offer our self to the patient giving them the encouraging words to the
patients give them spiritual advice and listening to their emotional conditions, insights of
their life and opinions to be able to express their feelings. 4. Conservation of Social
integrity as a nurse we should gradually help the patient to enter again in the community
provide and encourage an atmosphere of realistic hope, provide gradual implementation
and continuation of necessary behavior and lifestyle create plans managing interaction
within the community itself between the community and the larger society to meet
collective needs.

vi. Related Literature

Osteosarcoma is also called osteogenic sarcoma, a malignant (cancerous)

tumor that arises from bone itself, and is thus called a primary bone cancer.
 Primary bone cancers are relatively rare overall. Approximately 2,400 new cases
of osteosarcoma occur in the United States every year.

Osteosarcoma occurs most frequently during childhood or adolescence.

About 60% of cases of this disease develop during the second decade of life. The
incidence of osteosarcoma rises again among people in their 40s and 50s.

Osteosarcoma may occur in any bone, but develops most commonly in

long bones, particularly near the knee or in the upper arm. The cancer starts
growing within a bone and forms an expanding, ball-like mass. The tumor
eventually breaks through the surface of the bone and begins to invade adjoining
structures such as muscles. If untreated, the disease usually appears elsewhere in
the same limb and metastasizes to distant parts of the body, such as the lungs.

Causes
►unknown
►DNA mutation – either inherited or acquired after birth
►familial susceptibility
►injury
►infection
►metabolic or hormonal disturbance

Risk Factors: (children)

►repeated trauma
►tall for the age
►genetics
►hereditary abnormalities including exostoses (bony growths), retinoblastoma,
Ollier's disease, osteogenesis imperfecta, polyostotic fibrous dysplasia, and
Paget's disease
►also been linked to exposure to ionizing irradiation associated with radiation
therapy for other types of cancer
►family history of certain types of cancer
►exposure to significant amounts of radiation

Risk Factors: (adult)

►high fat diet
►lack of exercise
► smoking
►drinking alcohol

Clinical Manifestation

►pain (sharp or dull) at the site of the tumor

► increased pain with activity or lifting

►limited motion/decreased movement of affected limb

►limping

►weight loss
►the bony mass may be palpable, tender and fixed with an increased in skin
temperature over the mass and venous destention

►shiny and stretched skin with prominent superficial veins

 ►muscular weakness

►malaise

►anorexia

►toxaemia

►acidosis

►fever

Diagnostic Procedure

► multiple imaging studies of the tumor and sites of possible metastasis, such as:

► x-rays - a diagnostic test that uses invisible electromagnetic energy beams to

produce images of internal tissues, bones, and organs onto film

► bone scans - a nuclear imaging method to evaluate any degenerative and/or

arthritic changes in the joints; to detect bone diseases and tumors; to
determine the cause of bone pain or inflammation. This test is to rule
out any infection or fractures.

►magnetic resonance imaging (MRI) - a diagnostic procedure that uses a

combination of large magnets, radiofrequencies, and a computer to
produce detailed images of organs and structures within the body. This
test is done to rule out any associated abnormalities of the spinal cord
and nerves.

►computed tomography scan (Also called a CT or CAT scan) - a diagnostic

imaging procedure that uses a combination of x-rays and computer
technology to produce cross-sectional images (often called slices), both
horizontally and vertically, of the body. A CT scan shows detailed
images of any part of the body, including the bones, muscles, fat, and
organs. CT scans are more detailed than general x-rays.

►complete blood count (CBC) - a measurement of size, number, and maturity of

different blood cells in a specific volume of blood.

►blood tests (including blood chemistries)

►biopsy of the tumor

Treatment

►antibiotics – to prevent and treat infections

► surgery

► resections - partial excision of a bone or other structure

►bone graft - a piece of bone taken from the patient that is used to take
the place of remove bone or a bony defect at another site
 ►skin graft - using the skin from other part of the body to repair a defect
or trauma of the skin

►limb-sparing (limb salvage) – used to remove the tumor and adjacent

tissue

►reconstruction

►amputation

► chemotherapy

► radiation therapy

► resections of metastasis – spreading of the tumor to other locations

►rehabilitation including physical and occupational therapy and psychosocial

adapting

►prosthesis fitting and training

► sterna marrow puncture

Prognosis

►Stage I – rare and includes poresteal osteosarcoma or low-grade osteosarcoma

- It has an excellent prognosis (>90%) with wide resection

►Stage II – depends on the site of the tumor (proximal tibia, femur, pelvis,etc.),
size of the tumor mass (in cm) and the degree of necrosis from
neoadjuvant chemotherapy (prior to surgery)

- The prognosis for patients with metastatic oateosarcoma improves

with longer times to metastasize (more than 12-24 months), a smaller
number of metastasis and their resectability. Those with a longer
length of time (>24 months) and few nodules (2 or fewer) have the
best prognosis with a 2-year survival after the metastasis of 50%, 5
year of 40% and 10 year 20%.
- If metastasis are both local and regional, the prognosis is worse.

►Initial presentation of Stage III osteosarcoma with lung metastasis depends on

the respectability of the primary tumor and lung nodules, degree of
necrosis of the primary tumor and maybe the number of metastasis.
Overall prognosis is 30% or greater depending.

II. CLINICAL SUMMARY

A. GENERAL DATA PROFILE

Name : Patient MR
Address : # Arona’s Extension Sta. Mesa Manila
Age : 16 years old
Birthday : December 16, 1993
 Nationality : Filipino
Religion : Roman Catholic
Occupation : Student
Father : Melchor Turalba
Mother : Sheryl Turalba
Date of Admission : April 06, 2010
Admitting Diagnosis : pathologic fracture secondary to first bone tumor,
probably malignant to consider osteosarcoma
Admitting Physician : Dr. Sanidad

B. CHIEF COMPLAINT

Prior to admission patient complaint of bone mass at lateral part of the

right thigh associated with pain and swelling.

C. NURSING HISTORY

HISTORY OF PRESENT ILLNESS

One month prior to admission, the patient has palpable mass with redness
at the lateral part of the right thigh and had undergone manipulation “hilot” thrice.
The patient verbalized that “dati sumasakit na talaga kapag naglalaro ako ng
basketball pero nawawala din tapos nung na aksidente ako sa pagbibisikleta di na
nawala ‘yung sakit...”

a. Childhood illness

Fever
Cough and cold
Mumps
Chicken fox
Measles

b. Immunizations

Complete immunization

c. Allergies

No known allergies to foods and allergies.

d. Accidents

With previous bicycle accident

e. Hospitalizations
 Once hospitalized due to a minor accident before being referred
at the Philippine Orthopedic Center

f. Medications used or currently taking

Dolcet i cap TID

Cefalexin 500mg/cap i cap TID

D. FAMILY HISTORY

LEGEND:

Father
Mother

Decesead

MOTHER FATHER
 RENAL
Alive FAILURE
Alive and and
Decese
well well
ad

Alive Alive and Decesea Alive

and well d
Alive and Alive and and
well ASTHMA (HYPER Ovarian
well well well
TENSION) cancer

Patient
Alive and Alive
and ASTH
(OSTEO well MA
SARCOMA well
)

HISTORY- THEORIES OF GROWTH AND DEVELOPMENT

Psychosocial Theory according to Erik Erikson

Stage Age Central Task Indication of Indication of

positive negative
resolution resolution

Adolescents 12-18 years Identity vs. Role Patient should Identity crisis is
old confusion act accordingly one negative
to his sexuality, aspect of this
dress behave, stage people
fitted to his who do have
gender. He this situational
 should engage crisis engage in
to heterosexual homosexual
relationship. relationship
Self they act on un
consistency appropriate to
indicates the their gender,
positive wear dress
resolution at unproperly. As
this stage. The nurse we should
significant engage the
others surround client in
him helps the activities it
patient to helps in
organize acts as identifying self
so that the as an individual
patient will
want to be free
for more
productive
social activities
& relationships.

Psychosexual Theory according to Sigmund Freud

Stage Age Characteristics Indication

Genitals 13-20 years old According to the

patient he solve his
own problem, h
decides want he
wants to do his own
life. He ask help if
he think he cant do
by his own. He said
that he listen to his
parents,
brothers,sisters, &
friends. He also said
that after he finish
the study he will
find job in order to
help financially his
family. And after
that he told to us
that he wanted to
start and create a
new family to live
away from his
parents. It means
that he is in the
stage of independent
life.

E. ENVIRONMENT/LIVING CONDITION
 The environment where he lives can be found near main road. This place has
many motor vehicles that can be seen either in the street or road. The place is
slightly congested.

F. PHYSICAL ASSESSMENT

PARAMETERS NORMAL ACTUAL INTERPRETATION

FINDINGS FINDINGS

General -clean in With balance Due to the disease

Appearance appearance and skeletal traction process
well groomed
- cooperative Slightly thin Client decreased in
weight due to loss of
Conscious and appetite
coherent

Skin - with good skin Good skin turgor With normal

turgor findings

Hair -evenly distributed > evenly  With normal

hair distributed hair findings
-thick hair -thick hair

Nails - with good >With good With normal

capillary refill of 1- capillary refill of 2- findings
2 seconds 3 sec.
-with pinkish nail
beds
-with clean and >With clean and
short nails short nails

Skull and face -mouth uniform -mouth uniform With normal

consistency; consistency; findings
absence of nodules absence of nodules
and masses and masses
-rounded smooth -rounded smooth
skull contour skull contour
-symmetrical facial -symmetrical facial
movement movement

Eyes -no eye discharge >With slightly pale - Due to poor sleeping
-with anecteric conjunctiva habits and anemia
sclera brought about by
-eyebrows hair Osteosarcoma
evenly
distributed/skin
intact
 - (+) blink reflex
-with pinkish
conjunctiva

Ears -auricle color same >Without With normal

as facial skin discharges findings
-auricle are mobile
firm and not tender
-able to hear on -able to hear on
both ears both ears
-no edema and
discharge

Mouth -pinkish lips >With dry lips Due to poor intake

-without missing of foods
teeth
-with pink gums
-no foul odor
-with symmetrical
contour

Musculoskeletal -symmetrical With scar on right - scar is due to

(upper and lower -no atrophy wrist previous vehicular
extremities) -with full range of accident
motion With steinman’s
pin at tiba and
fibula Due to insertion of
steinman’s pin
With palpable mass
on the right knee at
with increase in
temperature

(+ ) 12 x 10 cms
mass @ right knee

No wounds

With limited
extension @ 45
degree

Distal thigh warm

to touch
Abdomen -no abdominal With soft and non- Due to limited
distention tender abdomen motion
-flat rounded upon palpation
abdomen
-symmetrical with complaint of
contour difficulty to
-no surgical defecate
incision
abdominal muscle
weakness

G. PATTERNS OF FUNCTIONING

FUNCTIONAL BEFORE DURING INTERPRETATION

HEALTH PATTERN HOSPITALIZATION HOSPITALIZATION

•Health management > medicated by the > it was her second >He is seeking
patter Doctor time to be medical attention in
hospitalized severe cases that
needed immediate
attention then
>fake healer consulted to fake
healer

•Nutritional/metabolic
a. number of meals >3x a day >3x a day >The number of
per day meals he is taking is
b. appetite >with good appetite >with slightly poor the same but the
appetite appetite is poor, the
intake of water he is
c. glass of water >12 glasses of water >8 glasses of water taking per day
per day decrease since the
d. body built >with normal body >with slightly thin day he was
built body built hospitalized. His
body built became
e. weight >50 kg. >46 kg. slightly thin and his
weight was
decreased

•Elimination
a. frequency of >4-5x per day >4x per day >The frequency of
urination his urination is still
b. amount of urine >Moderate >Scanty the same.
per day
c. frequency of >Once a day >Once a day >The frequency of
bowel movement his bowel
d. consistency of >Formed >Slightly soft elimination was the
the feces same as before but it
e. amount >Moderate >Scanty become slightly soft
defecated per and scanty in amount
day due to limited
mobility and the
 amount of water she
drink

•Activity and exercise

a. exercise Active exercise He cannot do
b. fatigability >Not easily get tired >Easily get tired anything alone
c. ADL >Independent >Slightly dependent without the help of
other

•Cognitive/ >Oriented to time, >Oriented to time, The cognitive and

perceptual place and person place and person perception status of
a. orientation >Respond >Respond the patient is still
b. responsiveness approximately to approximately to normal and active.
verbal and physical verbal and physical
stimuli stimuli

•Roles/ relationship >With good >With good >He still has good
a. as a daughter relationship with his relationship with his relationship with his
parents and he parents and he family
provided financial aid provided financial aid
to the family to the family

b. as a sister >With good >With good

relationship with his relationship with his
brother and sister brother and sister

c. as a boyfriend >With good >With good

relationship with his relationship with his
girlfriend girlfriend

•Self perception/self >Have a high self >Have a low self >He has a low self
concept worth/importance worth/importance worth

•Coping/stress >He seeks for some >He is not always >He has no good
advice to his friends talking with his coping mechanism
and relatives when he family to lessen her
has problems, stress
burdens and stresses

•Value/ beliefs >He has awareness >His awareness to >Even if he suffered

that God exist God become more from osteosarcoma,
strong than before the patient never
blame God instead
his awareness
became more
stronger than before

H. COURSE IN THE WARD

April 05, 2010 Monday 2:00 AM

The patient was submitted in Philippine Orthopedic Center with

the diagnosis of pathologic fracture; secondary to 1st degree bone tumor
DNB malignant tumor to consider osteosarcoma he was admitted at Male
 Traction Ward via wheelchair accompanied by father with deformity at
Right extremity. Sought consults ion under Dr. Santidad. The patient was
conscious, 50 kl. In weight. His initial vital signs are BP 110/70 mmhg, 81
bpm, 22 cpm, and 37.0 degree Celsius. The Doctor’s order laboratory
examinations such as: CBC, CT, BT, PT, PTI, Bld typing, ESR, and CRP
to determine any malfunctions in the pt. He was taken chest x-ray and
pelvis @ right thigh APL to detect any deformity in his bone structure. In
the afternoon he had undergone an operation for Steinman pin insertion
done by dra. Santila under local anesthesia. The Steinman pin was inserted
at right leg with 10x5lbs wt with temporary traction and was accompanied
by nurse helper and helper to the ward. The doctor ordered dolcet 1 tab for
the management of severe pain, the patient is for TP, ALP, LDH, and CA.

April 06, 2010 Tuesday

At the second day at POC, the patient has balanced skeletal

traction to maintain the anatomical position of the fractured bone with
weights applied at right leg 10 lbs traction weight and 5 lbs suspension
weight. Still with dolcet 1 tab to manage pain. The patient was afebrile
with body temperature of 36.5 ‘c.

April 07, 2010 Wednesday

At the third day the patient was still conscious, afebrile and has
BST at the right leg. He was for xray of right knee APL with awaits result.
Still with dolacet 1 tab for severe pain.

April 10, 2010 Saturday

The doctor ordered cefalexin 50 mg 1 cap TID for infection and

the patient was for blood transfusion. In the afternoon the patient has
normal vital signs of 120/90 mmhg, 80 bpm, 18cpm, and 36 ‘c. The
patient was blood transfused of 3 ‘’u’’ of FWB with consent informed and
signed by the father.

I. LABORATORY DIAGNOSTIC EXAM

HEMATOLOGY

April 5, 2010

COMPONENT RESULT NORMAL INTERPRE IMPLICATION NURSING

RANGE TATION RESPONSIBILITIES

Hemoglobin 130 127-185g/l Normal Instruct the client to

maintain an adequate
fluid intake.
Hematocrit .36 0.37-.54g/l Below If the microhematocrit
Normal High: Iron method is used, explain
deficiency anemia that the finger will be
cleansed with an alcohol
sponge and pricked with
a needle to obtain
capillary blood

Leukocyte Count 11.60 4.5- High A rise in the WBC is Instruct the client to
10x10g/l usually caused by check the side effects of
conditions that patent medicines, such
stimulate the bone as cold medications,
marrow to produce which could cause
white blood cells to agranulocytosis, severe
fight off invading leukopenia.
organisms.

Components (Indices)
MCV 83 82-92 fl Normal Instruct the client to eat
MCH 30 28-32 % Normal foods rich in iron.
MCHC 36 32-38 pg Normal Explain to the client
who is taking iron
supplements that the
stool usually appear
dark in color (tarry
appearance)
DIFFERENTIAL COUNT
Segmenters 0.72 0.50-0.70 Slightly high Infection

Lymphocytes 0.19 .20-0.40 Below Low: sepsis, Instruct the client to

normal report any signs and
Monocytes 0.08 0.00-0.07 symptoms of infection,
Eosinophils 0.01 0.00-0.05 such as a presence of a
fever. Encourage the
client to rest,\. take
medications such as
antibiotics as prescribed.
Increase fluid intake as
appropriate, and monitor
temperature.
Riticulocytes 0.5-2.0%
Platelet count 204 150- Normal Instruct the client to
400x10 avoid injury if possible.
^g/l Mild injury could cause
bleeding.

April 6, 2010

TEST RESULT NORMAL Interpretation Implication Nursing

NAME VALUE Responsibility

Alkaline phos 334 0-664 u/l Normal Inform the client that
other enzyme tests may
be ordered to verify
 diagnosis
Total protein 87.8 66.0-87.0 Normal
g/l
Albumin 54.2 38.0- High Teach the client the
51.0g/l importance of
maintaining adequate
amount of protein in
the diet with health
care provider’s
approval. Protein
should increase the
serum albumin level
and decrease peripheral
edema unless the client
has cirrhosis of the
liver.
Calcium 2.15 2.02- Normal
2.60mmol/l
LDH 785.9 225.0- Instruct the client to
450.0u/l notify the nurse of any
recurrence of chest
discomfort or to seek
medical care for
indigestion of several
days
Glob 33.63 32-48g/l Normal
A/G Ratio 1.61 1.50-3.10 Normal Teach the client the
ratio importance of
maintaining adequate
amount of protein in
the diet with health
care provider’s
approval. Protein
should increase the
serum albumin level
and decrease peripheral
edema unless the client
has cirrhosis of the
liver.

III. CLINICAL DISCUSSION OF THE DISEASE

1. ANATOMY AND PHYSIOLOGY

The skeletal system provides support and protection, allows body movements,
stores minerals and fats, and is the site of blood cell production.

Four types of bone tissue:

Long bones - are longer than they are wide, most of the bones of the upper and lower
limbs are long bones. Examples: femur, tibia, and fibula of the leg, the humerus,
radius, and ulna of the arm, and the phalanges of the fingers and toes.
  Short bones- -are approximately are broad as they are long, such as the bones of
the wrist and ankles.

 Flat bones - -have a relatively thin and flattened shape.

 Irregular bones - include the vertebrae and facial bones, with shapes that do not
readily fit into three other categories.

There are two kinds of bone tissue:

 Compact bone - is the hard material that makes up the shaft of long bones and
the outside surfaces of other bones.

 Spongy bone - consists of thin, irregularly shaped plates called trabeculae,

arranged in a latticework network.

Parts of the long bones:

 Diaphysis

-a long tubular portion of long bones, it is composed of compact bone tissue. It

has the medullary cavity or marrow cavity, an open area within the diaphysis, the
adipose tissue inside the cavity stores lipids and forms the yellow marrow.

 Epiphysis

-the expanded end of a long bone

 Metaphysis

-is the area where the diaphysis meets the epiphysis. It includes the epiphyseal
line, a remnant of cartilage from growing bones.

Layers of bone tissue:

 Periosteum

-is the membrane covering the outside of the diaphysis (and epiphyses
where articular cartilage is absent). It contains osteoblasts (bone-forming cells),
osteoclasts (bone-destroying cells), nerve fibers, and blood and lymphatic vessels.
Ligaments and tendons attach to the periosteum.

 Endosteum

-is the membrane that lines the marrow cavity.

 2. PATHOPHYSIOLOGY (BOOK BASED/ CLIENT BASED)

BOOK BASED

Risk Factors
repeated trauma
tall for the age
hereditary abnormalities including
Paget's disease
exposure to ionizing irradiation
associated with radiation therapy
family history of certain types of cancer

Causes
DNA mutation
injury
infection
metabolic or hormonal disturbance

Osteoblast

High grade mecenchymal tumor

Malignant Osteoblast
(abnormal)

Distal femur
Proximal tibia
Proliferation of abnormal
Proximal humerus
osteoblast

Formation of osteoid or immature bone

(thin, wispy and purposeless fragment of bone)

Pain, swelling, tenderness Bulky tumor that destroys

trabeculae of disease area
 Lungs, bones, visceral organs Metastasize through
bloodstream

PATHOPHYSIOLOGY (CLIENT BASED)

> genetics
>gender
>age
>activity

>basketball
>bicycle accident

Fake healer

Malignant neoplasm/tumor arising in the tissue

of mesoderm
90
80
70
60
50 East
40 West
30 North
20
10
0
1st Qtr 2ndQtr 3rdQtr 4thQtr

Dilatation of al
vessels Elevation of
periosteum
 Bone mass

pathologic
fracture

> pain
> swelling
> limited motion

Balanced Skeletal surgical biopsy

Traction

malignant

Lungs, bones, Metastasize through OSTEOSARCOMA

visceral organs bloodstream s

3. DRUG STUDY

NAME OF ACTION INDICATI- DOSAGE ADVERSE NURSING

THE DRUG ON AND REACTION CONSIDERATION
PREPARA-
TION

Cephalexin Inhibit Upper, i tab TID CNS: Assess patient for

bacterial wall lower Headache, previous sensitivity
synthesis respirartory dizziness, reaction to
Antibiotic rendering tract, weakness, penicillin or other
cell urinary tract paresthesia cephalosporinis
wallosmotica skin, bone Respiratory: common
 lly unstable infections, Dyspnea
leading to otitis media GI: Nausea, Assess for sign and
cell deathby vomiting, symptoms of
binding to diarrhea, infection including
the cell wall anorexia, characteristics of
membrane pain,. wounds sputum,
Glossitis urine stool and wbc
HEMA > 10,000/mm3
Leukopenia,
thrombocytop Identify urine
enia, output ,if deceasing
agranulocytis, notify the
anemia ,. prescriber, also
Neutropenia, checked for
lympocytosis, increased BUN
eusinophilia
INTEG: Monitor
Rash, electrolytes:
urticaria, potassium, sodium,
dermatitis chloride..

Dolcet Binds to Mild to 500mg/cap i CNS: Observed 10 rights

opiod moderate cap TID sedation, in giving
receptors& pain dizziness, medication
inhibits the headache,
reuptake of confusion Assess for history of
noreipinephri CV:hypotensi hypersensitivity to
ne& on, drug, intoxication
serotonin; tachycardia, with alcohol, past or
causes many bradycardia present history of
effects GI: nausea, opiod addiction
similar to the vomiting, dry
opiods mouth, Instruct pt. to report
constipation severe nausea
,dizziness and
severe constipation

IV. NURSING PROCESS

A. LONG TERM OBJECTIVES

The study aims to know more about the case and reduce complications of the
client through the collaborative management with physician, nurses, physical
therapist together with the nutritionist.

B. PRIORITIZED LIST NURSING PROBLEM

PROBLEM RANKING JUSTIFICATION

Acute pain related to 1 Many alterations happen

physical injuring agents under acute pain & we
ranked this as a first to be
 prioritizes since our patient
experienced this to prevent
or reduce pain.

Risk for infection related to 2 We rank this as second,

presence of steinman’s pin because we know insertion
inserted at left knee of anything in the body may
cause an infection. This can
be prevented through the
proper care.

Imbalanced 3 Nutrition is important in our

nutrition less than body body, since our patient has a
requirements r/t decreased slightly poor appetite we
appetite secondary to include this in the
treatments prioritized problem.

Risk for constipation r/t 4 Since our patient has a

immobilization as limited movement and
evidenced by decrease always lying on bed he can
peristaltic movement experience constipation.

C. NURSING CARE PLAN (BASED ON THE SEQUENCE OF PRIORITZED

PROBLEM)

ASSESSMENT DIAGNOSIS PLANNIN INTERVENTIO RATIONALE EVALUATION

G N

SUBJECTIVE: Acute pain At the end >Note client age/ >To help determine Goal met as
“Masakit gawa related to Of nursing developmental the possibility of evidence by:
ng may bakal, physical intervention level & current underlying conditions
lalo na kapag injuring and condition The patient will
malamig, kagaya agents collaborativ affecting ability reported that the
kagadi sobrang e medical pain was lessen
sakit” managemen >Assess for >To report pain
t, the patient referred pain parameter With PS=4/10
OBJECTIVES: will report
the pain is BP=120/70mmHg
With steinman’s reduce from >Obtain client’s >To rule out
pin at left knee 7 out of 10 assessment of worsening of P- 91 bpm
down to 4 pain to include underlying conditions
Pain Scale-7/10 out of 10 location,
characteristics,
BP- 130/80 duration @
mmHg aggravating
factors
P- 104 bpm
>Accept client >Pain is a subjective
irritable at times description of experience and
pain cannot be felt by
others

>Monitor skin >Usually altered in

color/ temp, V/S acute pain
 >Provide >To promote non
comfort pharmacological pain
measures like management
repositioning

˃Provide/recom ˃Measures that

mend non reduce cerebral
pharmacological vascular pressure and
measures that that slow sympathetic
reliefs of pain response and
e.g. quite dimly effective in relieving
room, relaxation headache and
techniques associated
(guided imagery, complications
destructing and
diversional
activities.

˃Administer ˃To maintain

analgesic as acceptable level of
indicated to pain. Notify
maximum physician if regimen
dosage as is inadequate to pain
needed. control goal.

SUBJECTIVE: Risk for At the end ˃Observe for ˃To assess causative At the end of the
infection of nursing localized signs or contributing nursing
related to intervention of infection at factors that may help interventions, the
presence of s, the patient insertion site for further patient and his
OBJECTIVES: steinman’s will identify observations and care giver gained
pin inserted intervention management to knowledge and
With open at the right s to prevent prevent infection how to prevent
wound distal fmur or reduce infection
risk for ˃Teach proper ˃To reduce existing
With steinman’s infection hand washing risk factors, hand
pin at the right techniques to washing is the first The patient
distal femur Verbalized patient’s and line of defense verbalized his
understandi caregiver against infection understanding and
With dry and ng of asked some
intact dressing individual ˃Cleanse ˃To prevent wound related questions
causative/ris incision site, contamination
k factors change dressing
as needed

˃Encourage deep ˃For mobilization of

breathing respiratory secretions
exercise,
coughing, and
position change
such as turning
side to side

˃Give health
teachings such
as:
 a. increase ˃To maintain proper
fluid hydration
intake

SUBJECTIVE: Imbalanced At the end > Assess weight >daily weighing Goal met as
nutrition less of nursing provides data to evidenced by:
> Hindi ako than body intervention evaluate nitrogen
makakain ng requirements patient will balance  pt seen in
maayos wala ako r/t loss of demonstrate good
ganang kumain. appetite behaviors >Auscultate > certain conditions appetite
,lifestyle bowel sounds and medications and
changes to prolonged immobility  patient
OBJECTIVES: regain or can disturb G.I intake
maintain function food rich
˃slightly thin in appropriate in
appearance weight. >Evaluate total > identify theneed for nutrients
daily food intake medications and
˃with slightly teaching  weight-
poor appetite 46kg
>Minimize > unpleasant odor
˃weight- 50 kg unpleasant odor effect negative
impact to appetite

>Provide oral >poor oral hygiene

care before and leads to bad odor and
after meals taste, which can
diminish appetite

>Promote >these fluid

adequate/ timely restriction help
fluid intake prevent gastric
distention

>Emphasize >during illness, good

importance of nutrition can reduce
well-balanced the risk of
complications and
speed recovery

SUBJECTIVE: Risk for At the end Explained Regular physical  Seen patient
constipation of nursing passive and activity ais eat high in
>Hindi ako r/t intervention active exercise elimination b fiber foods
makadumi immobilizati patient and improving abdimonal  Patient
tatlong araw na on as s.o will muscle tone and stated that
po. evidenced by understand stimulating appetite he normally
decrease the and peristalsis lose his
OBJECTIVES: peristaltic technique of bowel
movement active Auscultated Bowel sounds movement
 with exercise bowel sounds indicate the nature of  Seen patient
slightly peristaltic activity eat high in
pale in fiber foods
conjunctiva Promote exercise To encourage patient  Patient
program help his status stated that
 with dry he normally
lips noted Provide adequate Increase in fluid
 fluid intake intake help to lose his
 Seen lying necessary for softened stool bowel
on bed treatment movement
frequently regimen

 with Advice to eat High fiber content

complaint foods such as stimulates peristalsis
of vegetables and
difficulty fruits
to defecate
Advice patient to
eat food rich in
 abdominal fiber
muscle
weakness Administer stool A sense of normalcy
mild softener as and familiarity can
ordered help reduce
Discuss rationale embarrassment and
to encourage promote relaxation
continuation of which may aid
successful defecation
intervention
Subjective: >Impaired >At the end >Explain the >Aggressive Goal met as
physical of the rationale for pursuit of evidenced by;
>Hindi ko mobility nursing bed ROM
kayang related to intervention exercises & exercises & >Patient
gumalaw decreased patient early early response to
pag hndi muscle maintain ambulation ambulation. interventions
ako strength position of Can decrease as evidenced
inaalalayan secondary function & deep vein by using
to skin thrombosis & safety
pathological integrity as muscle measures
Objective: disease evidence by wasting & such as ( side
absence of increase in rails,overhead
>Weak in contractures strength trapeze)
appearance foot drop, >Encourage
decubitus, use of >Shoulder >Seen patient
>With and so forth trapeze and arm participating
limited muscles need in self care
range of strengthening routine
motion to use
assistive
>Irritable at >Plan device
times diversional
activities for >Diversional
>With pain stress activity can
scale of management help client to
7/10 refocus on
matters other
>Bradypnea than his
condition
>Difficulty associated
in turning >Observe fears
movement
when client >To rate any
is un aware in
of congruencies
observation with reports
of abilities
>Support
affected
body parts >To maintain
using position of
pillows function &
reduce risk of
pressure
ulcers
>Encourage
participation
in self-care >Enhances
self concept
& sence of
>Instruct in independence
use of
siderails >To reduce
overhead the risk of
trapeze, incidental
roller pads injury
Subjective >Situational >At the end >Note non- >Incongruencies Goal met as
low self of four verbal body between non evidenced
Parang wala esteem hours language verbal by;
na akong related to intervention communication
silbi sa aking social role patient will requires Patient
buhay changes demonstrate clarification expressed
behaviours his concerns
to restore >Provide >To allow the patient seem
Objective positive self feedback of client to participate
esteem self negative experienced in treatment
>action are remarks different program
congruent remarks
with Patient share
>Assist to >Enhances his new
>expressed client commitment to positive
feelings & problem plan, optimizing outlook in
thought solving outcomes life
situations
>Lact of eye developing
contact plans of
action &
>Excessively setting goals
seeks to achieved
reassurance desired
outcomes

>Encourage >Facilitate
expression grieving the loss
of feelings

>Encourage >Frequent visits

visitors support person,
can help the
client feel that
he is still a
worthwhile this
should promote
a positive self
concept
>Help the >The nurse must
client to be inforce
identify positive aspects
positive & encourage the
attributes & client to
possible reincorporate
opportunities them into his
new concept
>Provide >Misconceptions
reliable can needlessly
information increase anxiety
& clarify & damage
any concepts concept
 D. DSCHARGE PLAN (M.E.T.H.O.D)

Medication

• Dolcet i cap TID

• Cefalexin 500mg/cap i cap TID

Environment

a. Maintain a quiet, clean and calm environment for easy and good recovery of
the patient.

b.Provide safety measure

c. Place bedside urinals near patient’s bed for easy access when nature calls.

T reatment

Health Teaching

• Provide with normal growth and development activities

• Advise patient to take the medicine continuously at home.
• Advise patient to avoid lifting heavy objects and use of too much force to
prevent more serious injury.

• Avoid strenuous activities.

• Proper personal hygiene.

• The importance of exercise on both extremities.

• Instruct to do deep breathing and coughing exercises.

• Advise to always keep back dry.

OPD

After discharge, advice patient to come back to specific date said by the doctor

Diet

High protein and rich in vitamin C foods to promote healing.

PHILIPPINE ORTHOPEDIC CENTER

OSTEOSARCOMA
Case Presentation
By;

Affiliation BSNIV GROUP 4