INTRODUCTION

In the Philippines, cervical cancer is the second leading cancer site among
women. On march 6, 2011, according to statistics, cervical cancer
claims lives of 12 Filipino women everyday. International statistics on cervical
cancer are also high; with approximately 500,000 women diagnosed and 250,000
dying every year. Moreover, about 50% of patients with cervical cancer have never
had a Pap smear for about 10 years.

Out of the estimated 6,000 new cases diagnosed with the disease each year, only
44 percent will survive.

Cervical cancer is a growth on the cervix or tumor. It begins in cells on the surface
of the cervix. Over time, the cervical cancer can invade more deeply into the cervix
and nearby tissues. The cancer cells can spread by breaking away from the original
(primary) tumor. They enter blood vessels or lymph vessels, which branch into all
the tissues of the body. The cancer cells may attach to other tissues and grow to
form new tumors that may damage those tissues.

CAUSES

HPV infection
Lack of regular Pap tests
Smoking
Weakened immune system
Sexual history
Using birth control pills for a long time
Having many children
DES (diethylstilbestrol)

SYMPTOMS
Early cervical cancers usually are asymptomatic. When the cancer grows larger,
women may notice one or more of these symptoms:
Abnormal vaginal bleeding
Bleeding that occurs between regular menstrual periods
Bleeding after sexual intercourse, douching, or a pelvic exam
Menstrual periods that last longer and are heavier than before
Bleeding after going through menopause
Increased vaginal discharge
Pelvic pain
Pain during sex
NURSING HEALTH HISTORY

A. PATIENT’S PROFILE

Name: Mrs. ABC

Address: Brgy. Monbon, Sierra Catbalogan, Samar
Age: 32 y/o
Birthday: April 5, 1978
Birthplace: Brgy. Monbon, Sierra Catbalogan, Samar
Date of Admission: March 2, 2011
Admitting Physician: Dr. Catalan
Chief Complaint: Gradual enlargement of abdomen and enlargement of
both extremities
Treatment Dx: Stage IV Cervical cancer

B. HISTORY OF PRESENT ILLNESS:

According to Mrs ABC, she experienced irregular menstrual flow but

have metrorrhagia once she has her period. Her last menstrual period was
on last September 2010 and up to present she have a cessation of
menstruation. Due to this symptoms she seek medical assistance in PGH and
was diagnosed to have Stage II cervical cancer through biopsy. She
undergone chemotherapy for two times and because of financial constraints
he was not able to pursue the therapy. This March 2, 2011 she was admitted
at Samar Provincial Hospital and was diagnosed for Stage IV cervical cancer
with a chief complaint of enlargement of abdomen and enlargement of both
extremities.

C. PAST HISTORY:

Stage II cervical cancer was the only serious illness she verbalized.
Other illness reported are measles and asthma.

D. PATTERN OF HEALTH CARE:

The client seeks the help of tambalan but when she recognizes that
the condition gets worse, she already seeks medical help from the hospital.
E. PHYSICAL ASSESSMENT

BODY PARTS NORMAL ACTUAL METHOD OF INTERPRETATION

FINDINGS FINDINGS ASSESSMENT

HEAD

Skull Rounded, Rounded Palpation, Normal

smooth skull Inspection
contour

Hair Smooth, Dry and Palpation, Deviation from

absence of brittle Inspection normal
nodules evenly
distributed,
thick hair, silky

EYES

Eyebrows Evenly Evenly Inspection Normal

distributed, skin distributed,
intact, skin intact
symmetrically
aligned, equal
movement

Eyelashes Equally Equally Inspection Normal

distributed, distributed,
curled, slightly curled, slightly
toward toward

Eyelids Skin intact, no No Inspection Normal

discharge, no discoloration,
discoloration no discharge,
skin intact

Lids close Close Inspection Normal

symmetrically symmetrically

Conjunctiva Shiny, smooth, Pale Inspection Deviation from

pink/red normal

Cornea Transparent, Transparent, Inspection Normal

shiny, smooth shiny, smooth

Pupil Black, equal in Black, equal in Inspection Normal

size, 3-7 mm, size, 3-7 mm,
 round, iris flat & round, iris flat
round & round

EARS

Auricle Color same as Color same as Inspection Normal

facial skin, facial skin
symmetrical

Aligned w/ outer Aligned Inspection Normal

cantus of eye

Mobile, firm, & Firm and not Palpation Normal

not tender, tender, pinna
pinna recoils recoils
after is folded

Tympanic Gray, semi- Gray, semi- Inspection Normal

membrane transparent transparent

NOSE

External nose Straight, no No discharge, Inspection Normal

discharge/ uniform in color
flaring uniform
color

Not tender, no Not tender, no Inspection Normal

lesions lesions

Nasal cavities Air moves freely Air moves Inspection Normal

as the client freely
breaths through
the nose

Clear watery Watery Inspection Normal

discharge, no discharge, no
lesions lesions

Sinuses (maxillary No tender No tender Inspection Normal

& frontal) palpation

MOUTH
Outer lips Uniform pink pale, dry, Inspection Deviation from
color, soft, rough texture normal
moist, smooth
texture

Ability to pursue Able to pursue Inspection Normal

lips lips

Inner lips Uniform pink in Pink, smooth Inspection Normal

color, soft, soft, elastic
moist, elastic texture
texture

Teeth Smooth, shiny Some teeth Inspection Deviation from

tooth enamel missing normal

Gums Pink, moist, firm Pale, moist, Inspection Deviation from

texture, no firm texture, normal
retraction no retraction

Tongue Central position Central Inspection Normal

Pink, moist, Pink, moist, Inspection Normal

slightly rough, slightly rough,
thin, whitish thin, whitish
coating, smooth coating,
lateral margins, smooth lateral
no lesions margins, no
lesions

Move freely, no Move freely, no Inspection Normal

tenderness tenderness

Smooth w/ no Smooth, no Inspection Normal

palpable nodules
nodules

NECK

Coordinated Coordinated Inspection Normal

movements w/ movements w/
no discomfort no discomfort

Lymph nodes Not palpable Palpation Normal

not palpable lymph nodes

TRACHEA Central Central Inspection Normal

placement in placement,
midline of neck, spaces are
 spaces are equal
equal on both
sides

THYROID GLAND Not visible on Not visible Inspection Normal

inspection

Glands ascend Glands ascend Inspection Normal

during but not visible
swallowing but
not is visible

Lobes may not Lobes palpable Palpation Normal

palpated but is painless,
smooth & small

THORAX AND
LUNGS

Anteroposterior Anteroposterior Inspection Normal

to transverse in to transverse in
ratio 1:2 ratio 1:2

Chest Chest Inspection Normal

symmetric symmetric

Spine vertically Spine vertically Inspection Normal

aligned aligned

Spine column Spine column Inspection Normal

straight, right & straight, right &
left shoulders & left shoulders &
hips are at same hips are at
height same height

Chest wall Intact no Inspection Normal

intact, no tenderness, no
tenderness/ masses
masses

Full chest Full chest Inspection Normal

expansion expansion

Bilateral Bilateral Inspection Normal

symmetry of symmetry of VF
vocal fremitus

Excursion is 5-6 Excursion is 5-6 Inspection Normal

 cm (2-3 inch) cm

Diaphragm is Lower right Inspection Normal

slightly lower on side of
right side diaphragm

Vesicular and Vesicular Auscultation Normal

bronchovesicula breathsound
r breath sound s

Quiet, rhythmic, Increased Auscultation Deviation from

and effortless effort on normal
respirations respirations,
uses
accessory
muscles in
breathing

HEART AND No pulsations in No pulsations Inspection Normal

CENTRAL VESSELS aortic &
pulmonary
areas

No pulsations in No pulsation Inspection Normal

tricuspid area

Symmetric pulse Symmetric Inspection Normal

volume pulse volume

Carotid artery Full pulsations Full pulsations Auscultation Normal

in carotid artery, & elastic
elastic arterial
walls

Jugular veins Veins not visible Not visible Inspection Normal

BREAST AND
AXILLAE

Breast Breast are even Breast are even Inspection Normal

at the chest wall at the chest
wall

Skin uniform in Darkened Inspection Normal

color

Akin smooth & Smooth & Inspection Normal

intact intact
 No tenderness, No tenderness, Palpation, Normal
nodules, or & discharge inspection
nipple discharge

Axillae No tenderness No tenderness Palpation, Normal

masses or masses or inspection
nodules nodules

ABDOMEN

Uniform color, Uniform color, Inspection Normal

unblemished unblemished
skin skin

Symmetric tender, Inspection Deviation from

contour distended, normal
edematous

No visible No visible Inspection Normal

vascular pattern

Audible sounds altered bowel Auscultation Deviation from

sounds normal

Absence of Absence of Inspection Normal

friction rub friction rub

6-12 cm 10 cm Inspection Normal

midclavicular midclavicular, 6
line, 4-8 cm at cm midsternal
midsternal line

No tenderness, No tenderness Inspection Normal

smooth,
consistent
tension

Liver may not Not palpable Palpation Normal

be palpable

Bladder not Not palpable Palpation Normal

palpable

MUSCULO-
SKELETAL SYSTEM
MUSCLES

Equal size on Equal size Inspection Normal

both sides of
 body

No contractures None Inspection Normal

and tremors

Firm Firm Inspection Normal

Smooth, smooth, Inspection Normal

coordinated coordinated

Extremities No edema No Edema Inspection Normal

NEUROLOGIC
SYSTEM

Walking gait Has upright Unable Inspection Deviation from

posture and normal
steady gait
w/opposing
arms swing;
walks unaided,
maintaining
balance

Heel-toe walking Maintains heel- Unable Inspection Deviation from

toe walking normal
along a straight
line

Toe or heel Able to walk Unable Inspection Deviation from

walking several steps on normal
toes or heels

Alternating Can alternately Unable Inspection Deviation from

supination and supinate and normal
pronation of promote hands
hands on knees at rapid pace

Pain sensation Able to Able Inspection Normal

discriminate
“sharp & dull”
sensations

Temperature Able to Able Inspection Normal

sensation discriminate
between hot &
 cold sensations

Position or kinetic Can readily Able Inspection Normal

sensation determine the
position of
fingers & toes

Stereognosis Recognizes Able Inspection Normal

common objects

Extinction Both points of Able Inspection Normal

phenomenon stimulus are felt

One & two point Able to sense Able Inspection Normal

discrimination whether one or
two areas of the
skin are being
stimulated by
pressure

INTEGUMENTARY
SYSTEM

Skin

Varies from light Pale, poor Inspection Deviation from

to deep brown; skin turgor normal
Skin uniform in and dry
color except in
areas exposed
to the sun;
areas of lighted
pigmentation in
dark skinned
people.

No edema Edematous Inspection Deviation from

normal

Skin Skin Inspection Normal

temperature is
normal in range.

Activity/Rest
Subject: “Dire ako nakakabuhat kay magbuag-at akon lawas.”
Occupation: Housewife
Usual activities/ hobbies: watching tv, sitting, lying
“permi la ako nagliliningkod pati naghihinigdaon”
Limitations imposed by illness: “ makuri ako makabuhat kay mabug-at akon mga
tiil”
Sleep: 3-5 hrs/night Naps: NO
Insomnia: Danay kinukurian ako pagkaturog kay mangutngut ngan masakit dapit ha
akon my tiyan”

Objectives:
HR: 80 bpm
BP: 100/90 mmhg
RR: 30 cpm

Respiration
Subjective: “nakukurian ako pagginhawa labi na kon nahigda ako”
Dyspnea: Yes
Cough: productive, clear sputum
Emphysema: O Bronchitis: O Asthma: Yes TB: O
Use of respiratory aids: with supplemental O2

Objective
Respiratory rate: 30 cpm
Auscultation: few wheezes
Cyanosis : O Clubbing of fingers: O
Sputum characteristic: none to observe
Mentation: Active
Medication: Salbutamol/ Nebulization

Elimination
Subjective: “Haros usa ka semina ako san-o maka-uro”
Usual bowel pattern: Almost every morning
Last bowel movement: Last week
Bleeding: O Hemorrhoids: O
Constipation: Acute/ occasional
Characteristic of stool:
Frequency: 1 -2 x/week
Consistency: solid
Color: brown with mucus
Odor: faint aromatic/ foul smelling
Characteristic of urine:
Frequency: FBC
Color: Tea-color urine (with blood)
Odor: Aromatic

Objective
Abdomen: tender, distended, swelling
Tenderness/pain (quadrant location) : all sides
Abdomen (auscultation): attend bowel sounds
Presence/ use of catheter/ continence device: with FBC
Medication: bisacodyl

Circulation
Subject: “Mabanhod ngan makuri makiwa an akon mga paa kay nahubag”
Cough: productive cough

Objective
Color
Skin: pale
Mucus membrane: pale
Lips: pale
Nail beds: pale
Conjunctiva: pale
Skin Rate: Radial_80bpm
Extremities: Temperature_37.30oc
Color: brown
Capillary refill: slow
Edema: Lower extremities and abdomen Severity: +3

Pain/Discomfort
Subjective: “Mangut-ngut dapit hit akon tiyan.”
Primary focus: abdominal area
Location: hypogastric area
Intensity: 7 out of 10
Quality: chronic pain
Precipitating factors: movement
Medication: Ketorolac

Objective:
Facial grimece
Guarding abdomenal area
BP: 100/90 mmHg
pulse: 80 bpm
RR: 30 cpm

FEMALE REPRODUCTIVE SYSTEM

EXTENAL STRUCTURES
• Labia majora: The labia majora enclose and protect
the other external reproductive organs. Literally
translated as "large lips," the labia majora are
relatively large and fleshy, and are comparable to
the scrotum in males. The labia majora contain sweat
and oil-secreting glands
• Labia minora: Literally translated as "small lips,"
the labia minora can be very small or up to 2 inches
wide. They lie just inside the labia majora, and
surround the openings to the vagina and urethra
• Bartholin’s glands: These glands are located next
to the vaginal opening and produce a fluid (mucus)
secretion.
• Clitoris: The two labia minora meet at the clitoris, a
small, sensitive protrusion that is comparable to the
penis in males. The clitoris is covered by a fold of
skin, called the prepuce, which is similar to the
foreskin at the end of the penis. Like the penis, the
 clitoris is very sensitive to stimulation and can
become erect.
INTERNAL STRUCTURES
• Vagina: The vagina is a canal that joins the cervix to
the outside of the body. It also is known as the birth
canal.
• Uterus (womb): The uterus is a hollow, pear-
shaped organ that is the home to a developing fetus.
The uterus is divided into two parts: the cervix, which
is the lower part that opens into the vagina, and the
main body of the uterus, called the corpus. The
corpus can easily expand to hold a developing baby.
• Ovaries: The ovaries are small, oval-shaped glands
that are located on either side of the uterus. The
ovaries produce eggs and hormones.
• Fallopian tubes: These are narrow tubes that are
attached to the upper part of the uterus and serve as
tunnels for the ova (egg cells) to travel from the
ovaries to the uterus. Conception, the fertilization of
an egg by a sperm, normally occurs in the fallopian
tubes.

CERVIX
 The cervix is the lower, narrow portion of the uterus
where it joins with the top end of the vagina. It is
cylindrical or conical in shape and protrudes through the
upper anterior vaginal wall. Approximately half its length
is visible with appropriate medical equipment; the
remainder lies above the vagina beyond view. The
narrow opening of the cervix is called the os. The opening
of the cervical canal is normally very narrow. However
under the influence of the body hormones and the
pressure from the fetal head, this opening widens to
about 4 inches (10 cm.) during labor, to allow the birth of
a baby. The function of the cervix is to allow flow of
menstrual blood from the uterus into the vagina, and
direct the sperms into the uterus during intercourse.
Cervix means neck in Latin.
PARTS OF THE CERVIX
Ectocervix
The portion projecting into the vagina is referred to as the
ectocervix. On average, the ectocervix is 3 cm long and
2.5 cm wide. It has a convex, elliptical surface and is
divided into anterior and posterior lips. . The ectocervix
(more distal, by the vagina) is composed of
nonkeratinized stratified squamous epithelium
External os
The ectocervix's opening is called the external os. The
size and shape of the external os and the ectocervix
varies widely with age, hormonal state, and whether the
woman has had a vaginal birth. In women who have not
had a vaginal birth the external os appears as a small,
circular opening. In women who have had a vaginal birth,
the ectocervix appears bulkier and the external os
appears wider, more slit-like and gaping. The endocervix
(more proximal, within the uterus) is composed of simple
columnar epithelium.

Endocervical canal
The passageway between the external os and the uterine
cavity is referred to as the endocervical canal. It varies
widely in length and width, along with the cervix overall.
Flattened anterior to posterior, the endocervical canal
measures 7 to 8 mm at its widest in reproductive- aged
women
Internal os
The endocervical canal terminates at the internal os
which is the opening of the cervix inside the uterine
cavity.
.
 Indication
Laboratory Result Normal Findings
s

Decreased
(120- Deviation to
Hemoglobin 101.4 due to
160gms/L) normal
bleeding
 Decreased
Deviation to
Hematocrit 0.26 (0.36-0.46) due to
normal
bleeding

Increased
White Cell Deviation to
18.8 (5-10x10/L) indicates
Count normal
infection

Increased
which
Deviation to
Segmenter 0.99 (0.40-0.60) indicates
normal
bacterial
infection
Decreased
Deviation to which
Lymphocytes 0.06 (0.20-0.35)
normal indicates
infection

Prognosis:
Our patient Mrs. ABC was diagnosed
with cervical cancer has a bad prognosis
due to the fact that her illness was in late
stage or in stage 4 of its development.
Thus, the patient’s chance of being cured
decreases because the cancer cells had
been metastasized or spread into other
organs or parts of the body that may lead
into more severe complications. In
addition, Mrs. ABC can’t afford to sustain
continues medication and other medical
or surgical treatment that would stop the
progression of cancer cells.