University of the East Ramon Magsaysay

Memorial Medical Center Inc.

#64 Aurora Boulevard, Barangay Dona Imelda, Quezon City, Philippines 1113







In partial fulfillment of
Summer Enhancement 2014






NURSING CARE PROCESS












Submitted to:
Maam Janelle Castro



Submitted by:
Susmiran, Michelle Anne C.
N3-A3







INTRODUCTION

This is a case of a 53 year old female that was diagnosed with Gastric Adenocarcinoma. Gastric
cancer is the one of the most common cancer in the world after lung and is a major cause of mortality and
morbidity. Through a marked reduction has been observed in the incidence of gastric carcinoma in in
North America and Western Europe in the last 50 years, 5-year survival rates are rates are less than 20%,
as most patients present late and are unsuitable for curative, radical surgery.

Gastric cancer can develop in any part of the stomach and may spread throughout the stomach
and to other organs: particularly the esophagus, lungs, lymph nodes, and the liver. Stomach cancer causes
about 800,000 deaths worldwide. Comes from several Hystological types of Gastric Cancer of which
adenocarcinoma is by far the most frequent. Sarcomas and Lymphomas can also occur.


EPIDEMIOLOGY

Gastric cancer is one of the most common cancers worldwide. Approximately 22,220 patients are
diagnosed annually in the United States, of whom 10,990 are expected to die. Global, country-specific
incidence rates are available in the World Health Organization GLOBOCAN database.
Gastric cancer used to be the leading cause of cancer deaths in the world until the 1980s when it
was overtaken by lung cancer. The worldwide incidence of gastric cancer has declined rapidly over the
recent few decades. Part of the decline may be due to the recognition of certain risk factors such as H.
pylori and other dietary and environmental risks. However, the decline clearly began before the discovery
of H. pylori. The decline first took place in countries with low gastric cancer incidence such as the United
States (beginning in the 1930s), while the decline in countries with high incidence like Japan was slower.
In the United Kingdom, there was a consistent decline in incidence of gastric cancer, with a reduction in
RR from 1.14 in 1971 to 1975 to 0.84 in 1996 to 2009 in men, and 1.18 in 1971 to 1975 to 0.81 in 1996 to
2009 in women. In China, the decline was less dramatic than other countries; despite an overall decrease
in gastric cancer incidence, an increase has been observed in the oldest and the youngest group, and a less
remarkable decline has been observed among women than in men. Of note is that the age of onset of
developing gastric cancer in Chinese population is younger than that in the West. In the United States,
risk factors for noncardia gastric cancer include male gender, non-white race, and older age. Between
1977 and 2009, the incidence rate for noncardia gastric cancer in the United States declined among all
race and age groups except for whites aged 29 to 39 years for whom it increased. The rise in incidence of
noncardia gastric cancer among those at 25 to 39 years is noteworthy since this may signal the
introduction of new environmental factors.








Demographic Profile

Patients name: L.F.
Address: 1571 Morales St. Lolomboy, Bucaue Bulacan.
Age/Gender: 53 years old/Female
Nationality: Filipino
Religion: Roman Catholic
Marital Status: Married
Educational Attainment: Elementary graduate
Occupation: House wife

Chief Complaint: 11
th
cycle of chemotherapy
Source of liability: Patient herself of good reliability
Date of admission: May 03, 2014
Admitting Diagnosis: Gastric Adenocarcinoma, Poorly Differentiated Stage III-B
Attending Physician: Dr. Isauro Guiang, MD.

PRESENT HEALTH HISTORY
12 months PTA, patients symptoms of epigastric pain worsened noting a 7/10 and are now
associated with nausea and vomiting, and vomitus is described as the food eaten prior to the episode.
Patient then sought consult after 2 week and had endoscopy with shaved a mass in the intestine. She has
been known to have Gastric Carcinoma, poorly differentiated stage III-B. Patient was then advised to
have surgery and then after that 2 weeks, she was admitted to the UERM hospital and underwent total
gastrectomy roux-en-y esophagojejunostomy. After the operation, patient and significant other noted
weight loss from 55-35kg but no other complications were revealed.

8 months PTA, patient started her chemotherapy treatment and at present is on the 11
th
cycle of
the chemotherapy. Patient noted to have nausea, vomiting, weakness, diarrhea, and polyuria after
treatment but these symptoms reveal spontaneously every time she is about to start her succeeding cycles.
On the day of admission, the patient was admitted to the UERM Hospital for the 11
th
cycle chemotherapy
(5FU).


PAST HEALTH HISTORY

Patient L.F. has vaccinated completely during her childhood times. She had experienced chicken pox as
well as measles with unrecalled date. She had underwent some surgeries such as Hemmorrhoidectomy
(2006); Cholecystectomy (2012); Total Gastrectomy and Roux-en-y Esophagojejunostomy (2013) in
UERM hospital.



Gastric
Adenocarcinoma
Diabetes
Mellitus
Type 2
Lung Cancer
Lung
Cancer


FAMILY HISTORY

Male Female Patient Deceased












SOCIAL HISTORY
Patient L.F. is a non-smoker individual and a non-beverage drinker. She is an elementary
graduate who is a plain housewife who has been living together with her husband but her son lives with
his own family. She is financially supported by her husband and son. The patients family supports her all
throughout the process of this chemotherapy. Their house is made of semi-concrete with 3 occupants as
the patient stated.

DEVELOPMENTAL HISTORY
Care: Generativity vs. Stagnation (Middle adulthood, 25-64, or 40-64 years)
- Aging speeds up during this time, and it is characterized by further vision problems, hearing loss,
and the end of reproductive capability for women, known as menopause.
- During middle age the primary developmental task is one of contributing to society and helping
to guide future generations. When a person makes a contribution during this period, perhaps by
raising a family or working toward the betterment of society, a sense of gene rativity- a sense of
productivity and accomplishment- results. In contrast, a person who is self-centered and unable or
unwilling to help society move forward develops a feeling of stagnation- a dissatisfaction with the
relative lack of productivity.


Unrecalled Unrecalled
- Central tasks of middle adulthood
- Help growing and grown children to be responsible adults.
- Relinquish central role in lives of grown children.
- Create a comfortable home.
- Adjust to physical changes of middle age.
-
ACTIVITIES OF DAILY LIVING

Patient L.F. wakes up early at 4:00 in the morning. Do her all house hold chores accompanied by
her husband sometimes. Cleaning the house is her priority in every morning upon waking up in the
morning. Sometimes she waters the plant as well. After all the morning chores, she prepares their lunch
and does before and after meal chores but sometimes due to weakness, she is unable to accomplish them.
She usually has her afternoon nap but in irregular sleep pattern and then upon wakeing up, shell watch
her favorite TV show on television until dinner time comes. 9:00 pm is her regular time in sleeping.