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 INTRODUCTION
Your kidneys are two bean-shaped
organs, each about the size of your fist.
They're located behind your abdominal
organs. Their main job is to clean your
blood, removing waste products and
making urine. Like other major organs in
the body, the kidneys can sometimes
develop cancer.
 INTRODUCTION
þ In adults, the most common type of
kidney cancer is renal cell carcinoma,
which begins in the cells that line the
small tubes within your kidneys.
þ The good news is that most of
these cancers are found before they
spread (metastasize) to distant organs.
And cancers caught early are easier to
treat successfully.
 INTRODUCTION
þ The American Cancer Society
estimates that almost 51,000 people in
the United States are diagnosed with
kidney cancer each year.
þ Of these diagnoses, most occur in
people aged 50-70 years, but the
disease can occur at any age.
þ About twice as many men as
women develop this cancer, and it
occurs in all races and ethnic groups.
 INTRODUCTION
Certain factors appear to increase the risk of getting kidney
cancer.
ã occurs most often in people older than age 40.
ã Smoking
ã obese.
ã Using certain pain medications for a long time
ã having advanced kidney disease
ã having certain genetic conditions, such as von Hippel-Lindau
(VHL) disease or inherited papillary renal cell carcinoma
ã family history of kidney cancer
ã exposure to certain chemicals, such as asbestos, cadmium,
benzene, organic solvents, or certain herbicides
ã having high blood pressure.
 sOALS OF THIS RESEARCH
‡ To raise the level of awareness of patient on
health problems that he may encounter.
‡ To facilitate patient in taking necessary actions to
solve and prevent the identified problems on his
own and with the assistance from family, relatives
or any of the significant others.
‡ To help patient in motivating him to continue the
health care provided by the health workers in
Northern Mindanao Medical Center and most
especially by the students and Clinical Instructor
of Capitol University.
 sOALS OF THIS RESEARCH
‡ To render nursing care and information to patient
through the application of the nursing skills. One
way of doing this is by having health teachings
related to the disease process that the patient is
experiencing.
‡ To add into the current care presentation output
that has been collected for how many years in the
College of Nursing, Capitol University.
‡ And of course, to help the RLE 6 more
knowledgeable in making or conducting a case
presentation in the higher years.
 u



This case presentation is based on the
analysis and critique of a published nursing
philosophy and theory by the nurse theorist
Jean Watson. Nursing: Human Science and
Human Care: A Theory of Nursing. We
applied the 10 carative factors. We had
chosen this theory because it focuses on
the human component of caring and the
moment-to-moment encounters between
the one giving care and the one cared for.
 


‡ Patient X is a 76-year-old male, Filipino citizen and was
baptized under Roman Catholic faith. He is currently
residing at Macabalan, Cagayan de Oro City. He was
married and they were blessed with four siblings.
‡ Patient X used to work as a porter at Cagayan de Oro
City Port. According to him, his job was so tiring and it
requires a lot of energy to finish a day¶s work.
‡ Patient X seeks financial support from his children aside
from his monthly salary. His family was always
supportive of him most specially in problems regarding
his health. In times of distress, relaxation, such as
walking and sleeping, is his best coping strategy. He
personally manages and leads his family aside from the
help and support from his wife.
‡
‡ Ö  

Upon assessment, the following data was obtained
from the Patient X:


 =110/60 mm Hg;
c   35.6oC;
  = 86 beats per minute;
 
 = 28 counts per minute.
‡
 

  
Patient X felt pain upon urination, anorexia and body
malaise.
‡       

No known genetic diseases that run in the family.
  

   
Two weeks prior to admission, Patient X felt a
flank pain at the right retroperitoneal area. He also
suffered from dysuria (pain upon urination). A week
prior to admission, he noticed blood-tinged / tea-
colored urine. Medical assistance was then sought
by the patient when pain becomes intolerable. He
was admitted at Polymedic Hospital for almost a
week.
On August 29, 2009, he was then referred to
Northern Mindanao Medical Center for further
management. After undergoing several
assessments and diagnostic tests, he was
diagnosed of having a  

‡  

   
This is the first hospitalization of the patient.
He has no identified illnesses in the past
because he never visited their health center nor
consulted a physician for health check-ups.

‡ 
    c.
Patient X looks pale, weak and drowsy.
However, he was very responsive and was
willing to answer whenever questions were
asked to him.
‡ u 
  
 
Patient X eats three times a day. He has
poor appetite and usually consumed his food
half of share. He seldom drinks water, with an
average of 3-4 glasses per day. He also
consumes at least 3 cups of coffee every day.
Patient X is a chain-smoker since he was 14
years old and had only stopped smoking lately,
about 4 months prior to his hospitalization. He
used to smoke ½ packs per day. He was also an
occasional alcohol-drinker.
‡:  
 
Patient X regularly defecates every day with
yellowish to brownish stool and soft in consistency. He
doesn¶t have any discomforts felt during defecation.
He maturates three times a day in the morning but
he also suffered from nocturia, approximately 6-10
episodes every night. The urine color varies from dark
yellow to tea-colored urine.
During admission, Patient X was hooked to a foley
bag catheter attached to a urobag with cystoclysis,
draining with a tea-colored excretions at about 150 cc
per shift.
‡ c    :  
The patient does not have a regular exercise
activity. He spent his leisure time watching
television and playing majong at their
neighborhood.
‡


   
The patient was well oriented to time, place
and person. He often appears calm upon
interaction but sometimes, he appears restless
whenever he experienced difficulty of breathing.
He could converse using Cebuano, Filipino
and English languages. He was a graduate of
BS Commerce.
‡   
Patient X usually sleeps at 10pm and
gets up at 4am. Nevertheless, he has
inadequate sleep due to his nocturia.
He never has any ways or methods to
promote sleep.
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8/29/09
9:30 AM > please admit at A3F2
>Secure consent
>TPR every 4 hours
>DAT
>IVF D5LR @ 30 gtts per min
>Lab: CBC with BT
: Serum sodium, potassium, crea, BUN
: ECs 12 leads
: CTBT
: PTPA, APTT
>Meds: ciprofloxacin 500 mg BID PO
: Hemostan 1 tab TID PRN for bleeding
: Multivitamins + iron 1 capsule OD
>V/S every 4 hours
>I and O every shift
>Insert FBC three way then start cystoclysis @ 40 gtts per
minute
>Refer accordingly
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8/29/09
8:30 PM >IVF to follow D5LR 1L @ 30 gtts per min

8/30/09
9:00AM >VF to follow D5LR 1L @ 30 gtts per min
>DAT
>Ambulate
>IVF to follow D5LR 1L @ 30 gtts per min
>Continue cystoclysis
>V/S every 4 hours
>I and O every shift
>Repeat for CT scan on Tuesday
>Secure 6 units of PRBC of patient¶s blood type properly
secured and cross-matched
>Refer

9:25 PM >please give celecoxib 200 mg 1 capsule BID

 `
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9:35 PM >IVF to follow D5LR 1L @ 30 gtts per min
8/31/09
7:00 AM >DAT
>Ambulate
>IVF to follow D5LR 1L @ KVO rate
>Continue meds
>V/S every 4 hours
>I and O every shift
>Continue cystoclysis @ 40 gtts per min
>Transfuse 2 units of PRBC of patients blood type
properly secured and cross-matched with 6 hour
infusion
>BT precaution please
>Still for CT scan
>Refer
 `
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9/2/09
>DAT
>Still for Ct scan tomorrow
>Continue meds
>sive celecoxib 200 mg BID for pain
>Continue cystoclysis
>Repeat HB, HCT now
>V/S every 4 hours
>I and O every shift
9/4/09
7:30 AM>continue IVF
>Continue cystoclysis
>Continue meds
>Follow-up CT scan result
>Refer
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‡ Ciprofloxacin 500 mg 1 capsule BID (twice a day) x
7 days
‡ Tramadol 50 mg 1 capsule TID (three times a day)
for pain
‡ Multivitamins + FeSO4 1 capsule OD (once a day)
‡ Watch for adverse reactions and patient¶s response
to pain management plan as indicated.
‡ Report any adverse reactions or failure to provide
adequate pain relief.
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‡ Explain to significant others that the
rehabilitation may be prolonged to be able for
the family to prepare financial needs
‡ Have physical therapist to re-learn function as
transferring, walking and other gross motor
functions
‡ Have occupational therapist to help re- learn
everyday activities or ADL
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± Primary treatment- involves the removal of the
malignant tumor and a small margin of adjacent
normal tissue.
± Adjuvant treatment- involves the removal of tissues
to decrease the risk of cancer recurrence.
± Salvage treatment- involves the use of an extensive
surgical approach to treat a local recurrence after
implementing a less extensive primary approach.
± Palliative treatment- is surgery that attempts to
relieve the complications of cancer.
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‡ Maintain effective deep breathing exercise for lung expansion.
‡ Promote the prevention of infection.
‡ Improve nutritional status.
‡ Importance of proper hygiene for comfort.
‡ Lifestyle modifications for in smoking and drinking hard beverages will
be emphasized to promote healthy lifestyle.
‡ Instruct the patient and family regarding exercises to prevent limited
range of motion and discomfort.
‡ Perform exercises in the morning and evening, initially exercises are
done only once, the number is increased by one and each exercise is
done 10 times.
‡ After each exercise, the patient is instructed to relax.
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‡ OPD follow-up on September 10, 2009.
‡ Emphasize the needs for frequent follow-
up visits and completion of therapy if
needed for further evaluation with
regards to post-operative complications
to ensure complete recovery.
‡ Keep urethral catheter in place.
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‡ Use the food pyramid as guideline and
eat a variety of foods with an emphasis
on plant resources.
‡ Eat five or more servings of vegetables
and fruit daily.
‡ Choose whole grains.
‡ Intake of fluids 8-a0 glasses a day to
avoid constipation and to maintain skin
turgor.
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‡ Spiritual
Prayer transcends everything. sod
knows thy needs even before we kneel
and pray to Him. Health problems are
just a matter of challenges which help
strengthen one¶s faith to sod.