163832968 case study-cxca

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Angeles University Foundation
Angeles City
College of Nursing
1

A CASE STUDY ON
CERVICAL CANCER
Submitted by:
BSN II-2 / Group 8 / Subgroup 2
Abeleda, George Smith
Lumba, Chared Joy
Santos, Micoh Ivan
Sarmiento, Nicole Sharina
Submitted to:
Ma. Fe L. Mallari, RN, MAN
2

TABLE OF CONTENTS
Introduction
Current trends about the disease
condition............................................
Reasons for choosing such case for
presentation………………………………
Nursing
Process………………………………………………………………………………..
Assessment…………………………………………………………………………….
Personal
Data……………………………………………………………………
Demographic
data…………………………………………………….
3

Socio-economic and cultural
factors……………………………..
Environmental
factors………………………………………………..
Personal
History………………………………………………………………..
Maternal-obstetric
record………………………………………………
Antepartal
Preparation………………………………………………
Significant Trimestral
changes…………………………………….
Family Health Illness
History………………………………………………
History of Past
Illness………………………………………………………..
History of Present
Illness……………………………………………………
Physical
Examination…………………………………………………………
4

Diagnostic and Laboratory
Procedures…………………………………….
Anatomy and
Physiology………………………………………………………………………
The Patient’s Illness………………………………………………………………………
Synthesis of the disease………………………………………………………….
Definition of the disease…………………………………………………
Predisposing factors……………………………………………………
Signs and symptoms…………………………………………………….
Health Promotion and Preventive Aspects of the Disease……..
The Patient and his care…………………………………………………………………
Medical Management…………………………………………………………
IVFs, BT, NGT feeding, etc.
………………………………………………
Drugs………………………………………………………………………
Diet………………………………………………………………………
Activity and Exercise………………………………………………
Surgical Management……………………………………………………………
Nursing
Management…………………………………………………………………
Nursing Care Plan
5

#1 Chronic pain related to irritation of nerve ending as evidenced by
moaning every secretion of blood from the vagina. …………………………………………
#2 Fluid volume deficient related to cervical bleeding secondary to
cervical cancer as evidenced by HGB of 56g/L………………………………………………
#3 Activity intolerance related to imbalance between oxygen supply
and demand.
……………………………………………………………………………………
#4 Ineffective tissue perfusion related to decreased hemoglobin
concentration as evidenced by low HGB levels 56g/L……………………………………….
#5 Risk for impaired skin integrity related to altered circulation and
pigmentation as evidenced by the pale palpebral conjunctiva, low HGB levels and pale
skin color on palm area.
………………………………………………………………………
Actual SOAPIE
#1 Chronic pain related to irritation of nerve ending as evidenced by
moaning every secretion of blood from the vagina.
………………………………………………
#2 Fluid volume deficient related to cervical bleeding secondary to
cervical cancer as evidenced by HGB of 56g/L………………………………………………
6

#3 Activity intolerance related to imbalance between oxygen supply
and demand. ………………………………………………………………………
#4 Ineffective tissue perfusion related to decreased hemoglobin
concentration as evidenced by low HGB levels 56g/L…………………………………
#5 Risk for impaired skin integrity related to altered circulation and
………………………………………………………………………
Client’s daily progress in the Hospital………………………………………………
Client’s Daily Progress Chart………………………………………………
Conclusion and Recommendations………………………………………………
Bibliography…………………………………………………………………………………
7

I. INTRODUCTION
A. Current trends about the disease condition
In the book “Cervical Cancer Research Trends”, Cervical cancer is a
malignancy of the cervix. Worldwide, it is the second most common cancer of
women. It may be present with vaginal bleeding but symptoms may be absent until
the cancer is in advanced stages, which has made cervical cancer the focus of
intense screening efforts. Most scientific studies point to human papillomavirus
8

(HPV) infection responsible for 90% of the cases of cervical cancer. There are 7
most common types of HPV - 16, 18, 31, 33, 42, 52 and 58. Types 16 and 18 being
the most common cause of the cancer. Treatment is with surgery (including local
exicision) in early stages and chemotherapy and radiotherapy in advanced stages of
the disease.
According to Center for Disease Control and Disease Prevention (CDC),
from 2000 to 2009 in the United States, incidence of cervical cancer has—
• Decreased significantly by 2.0% per year among women.
• Decreased significantly by 1.9% per year among white women.
• Decreased significantly by 3.0% per year among black women.
• Decreased significantly by 3.6% per year among Hispanic women.
• Remained level among American Indian/Alaska Native women.
• Decreased significantly by 3.0% per year among Asian/Pacific Islander women.
From 2000 to 2009 in the United States, deaths from cervical cancer have—
• Decreased significantly by 2.0% per year among women.
• Decreased significantly by 1.9% per year among white women.
• Decreased significantly by 2.6% per year among black women.
• Decreased significantly by 3.2% per year among Hispanic* women.
• Remained level among American Indian/Alaska Native women.
9

• Decreased significantly by 4.4% per year among Asian/Pacific Islander women.
Based on Vanguard, researchers from the Institute of Health Metrics and
Evaluation, IHME, and the University of Queens, discovered from data collected on
mortality and incidence for breast and cervical cancer, while more women are dying
at younger ages of breast or cervical cancer in the developing world, the probability
that women will die from either disease in the developed world has decreased.
Organized screening has contributed to a decline in cervical cancer
incidence and mortality over the past 50 years. However, women in developing
countries are yet to profit extensively from the benefits of screening programs, and
recent trends show a resurgence of the disease in developed countries. The past 2
decades have witnessed substantial progress in our understanding of the natural
history of cervical cancer and in major treatment advances. Human papillomavirus
(HPV) infection is now recognized as the main cause of cervical cancer, the role of
coexisting factors is better understood, a new cytology reporting terminology has
improved diagnosis and management of precursor lesions, and specific treatment
protocols have increased survival among patients with early or advanced disease.
Current research has focused on the determinants of infection with oncogenic HPV
types, the assessment of prophylactic and therapeutic vaccines and the
development of screening strategies incorporating HPV testing and other methods
as adjunct to cytology. These are fundamental stepping stones for the
10

implementation of effective public health programs aimed at the control of cervical
cancer.
An estimated 371 000 new cases of invasive cervical cancer are diagnosed
worldwide each year, representing nearly 10% of all cancers in women. In
frequency, it is the seventh cancer site overall and third among women, after breast
and colorectal cancer.
1
In developing countries, cervical cancer was the most
frequent neoplastic disease among women until the early 1990s, when breast cancer
became the predominant cancer site. (Franco, et.al, 2001)
B. Reasons for Choosing such Case for Presentation
Our group was encouraged by our clinical instructor to get this case. Cervical
cancer is a very curious and interesting topic. Instead of the usual cases of ectopic
pregnancy and uterine bleeding in the ward, we pick this because of the challenge it
presented. Cervical cancer itself is a challenging, intense case we rarely come by. It
is the first time we encountered such case, and a severe one at that. The
medications and procedures provided are a bit different than the average OB patient.
Communication and the nursing care given to them are more sensitive and cautious
than the usual patients we have.
11

Moreover, cervical cancer is now a prevalent disease worldwide. A vaccine
was being commercially advertised on the television few years ago. We don’t know
the disease condition thoroughly since we haven’t studied them yet in the lecture.
We saw this as a chance to understand and have more than the general idea of
cervical cancer.
II. NURSING PROCESS
A. Assessment
1. PERSONAL DATA
a. Demographic Data
Name: “Minnie Mouse”
Age: 62 years old
Civil Status: Single
Role/Postion in the Family: Dependent / Sister
Address: San Matias, Lubao, Pampanga
Date and Place of Birth: May 24, 1950 / Lubao, Pampanga
Nationality: Filipino
Date of Admission: January 3, 2013
12

b. Socio-economic and cultural factors
The patient is single, never been married and never been pregnant
though she had previous sexual contact. She had been living with her older
sister who is the head of the family and is the one working. She has a good
relationship with the rest of her living family. The patient is currently
unemployed. She depends on the income earned by her sister. She
graduated from elementary and there was no further education due to
financial problems.
The patient came originally from Pampanga. She knows how to
fluently speak Filipino and Kapampangan. She belongs to the Roman
Catholic religion and is an active participant at church mass.
She uses herbal medications such as oregano, guava and sambong
leaves. She also believes in quack doctors (albularyos) but she still prefer
medical treatment.
c. Environmental factors
13

The patient lives together with her older sister who has a daughter
working abroad. She lives in a peaceful and clean barangay in Lubao,
Pampanga.
2. PERSONAL HISTORY
a. Maternal – obstetric record
The patient is single but she did have previous sexual contact. She
had never been pregnant (nulligravida). She claimed she had her menarche at age
13 years old and her menopause at 46 years old. She used to have a 28-to-30-day
menstrual cycle and she never had dysmenorrhea then.
b. Antepartal / Prenatal Preparation
n/a
c. Significant Trimestral Changes
n/a
3. FAMILY-HEALTH ILLNESS HISTORY
The patient’s SO claimed that they did not know why or how their
grandparents from both paternal and maternal sides of their family died. The
patient’s uncle from the paternal side died of heart attack on 2002. Her father died
14

of lung cancer on 2007. Her mother, who is the only child of her parents, died of
Pneumonia around 1997. Her mother and youngest sibling also have hypertension.
15

4. HISTORY OF PAST ILLNESS
The patient had some instances of colds, coughs and fever during her
childhood but she did not have any childhood illnesses such as chickenpox, mumps
and measles. Neither the patient nor the SO can remember about the completeness
of the immunizations of the patient. She has no allergies to certain drugs, food or
any other environmental agents. There were also no previous hospitalizations or any
serious surgeries done before.
5. HISTORY OF PRESENT ILLNESS
The patient’s chief complaint when she arrived on 8pm of January 3, 2013 is
vaginal bleeding. She came in Jose B. Lingad – Memorial General Hospital as a
referral from Dr. Ladel for blood transfusion due to Chemo-radiotherapy. Her
admitting diagnosis is Cervical Cancer Stage IIB and Secondary anemia.
According to the SO of the patient, she had a previous Dilatation and
Curettage procedure shortly just after she had her menopause. It is because the
lining of her uterus thickened and needed to be scraped off. Around July 2012, she
had a Papanicolau smear test where a myoma was discovered. The patient
underwent a Biopsy test on December 2012. She should have been admitted before
17

the year ended but she chose not to. She wanted to be confined after the holidays
ended. After the blood transfusion procedures in JBL-MGH, she is expected to be
transferred at Sacred Heart Medical Hospital for radiotherapy.
6. PHYSICAL EXAMINATION
PHYSICAL ASSESSMENT
Date of Physical Assessment: January 8, 2013
General Survey
Assessed/received patient lying on bed, awake, conscious, responsive, and
coherent with an ongoing IVF of 1L Plain NSS at 600cc level running at 15
gtts/min infusing well at right metacarpal vein with the following vital signs:
Temperature: 36.8 °C
Heart rate: 65 bpm
Respiratory rate: 20 bpm
Blood Pressure: 140/80 mmHg
Patient’s GPTPAL: G0 P0 T0 P0 A0 L0 [Nulligravida]
Skin
> Pallor noted.
> Good skin turgor in both upper and lower extremities; the skin returns to its
previous state immediately after being tented.
18

> Dry scaly skin
Hair
> Hair is gray and is evenly distributed.
> Silky and smooth hair.
> No areas of hair loss noted.
> Thick hair strands.
Nails
> Trimmed clean nails.
> Concave shaped; with a nail plate angle of about 160 degrees.
> Smooth in texture.
> Intact epidermal lining around the nails.
> Capillary Refill Test less than 3 seconds.
Skull and Face
> Rounded (normocephalic and symmetrical with frontal, parietal and occipital
prominences).
> Head size is appropriate to body size.
> No nodules or masses upon palpation.
Eyes and Vision
> Eyebrows and eyelashes are evenly distributed.
> Eyelids are intact.
> Sclera appears white.
19

> Pale conjunctiva.
> No discharges and discoloration noted.
> Blink reflex intact.
Ears and Hearing
> Ears are symmetrical in size and in line with the outer canthus of the eyes.
> Color of ears is the same with the facial skin.
> No discharges and foul odor noted upon inspection.
> Pinna and ear canal are clean.
> Auricles are firm and recoil to previous state when folded.
> No nodules or masses noted upon palpation.
Nose and Sinuses
> Symmetric and straight.
> No watery discharges.
> Has a slow uneven breathing pattern.
> Not tenderness, masses and pain noted upon palpation.
> Oxygen inhalation attached.
Oropharynx (Mouth and Throat)
> Dry and pale lips noted upon inspection.
> Tongue is able to move freely and able to swallow foods.
> Good oral hygiene.
Neck
20

> Jugular vein is not visible.
> Muscles are equal in size with the head centered.
> Slow muscle movement.
> Lymph nodes are not palpable.
Cardiovascular and Peripheral System
> Skin color of palm of the hand and feet is pale.
> Pale nail beds upon inspection.
> Symmetric pulse volumes, full pulsations of peripheral pulses.
> Heart rate is 65 beats per minute.
> Blood Pressure is 140/80mmHg.
> (Vital signs taken during the time of assessment on January 8, 2013 @ 7:00
am).
Respiratory System
> Chest is symmetric.
> Skin and chest wall are intact and has uniform temperature.
> No tenderness and masses noted upon palpation.
> Irregular breathing pattern
> No wheezing and crackles sound upon auscultation.
> Full and symmetric chest wall expansion.
Breasts and Axillae
> Breasts are symmetrical in size; color is the same as with the abdomen.
21

> Both nipples are symmetrical in size.
> No discharges noted.
> No tenderness, masses, and nodules noted upon palpation.
Abdomen
> Abdominal skin is intact.
> Distended abdomen noted.
> Presence of striae gravidarum noted.
> Audible bowel sound upon auscultation.
> Abdominal dullness upon percussion.
> Presence of solid rounded mass noted upon palpation (left inguinal region).
> Abdominal pain (pain scale of 8/10) complained.
> Presence of scar at the right hypogastrium.
Musculoskeletal Skeletal
> Posture is good, able to stand straight and can walk alone properly but slowly.
> Movement of muscles has coordination.
> Muscles in the upper extremities are firm.
Neurologic
> Patient has times of looking in the distance and is slow in response when a
question asked.
> Patient was able to answer well when asked of her complete name, birth date
and age.
22

Urinary System
> Patient usually urinates 5 times a day.
Reproductive System
> The patient refused to be assessed with her external reproductive organ but she
verbalized that she has minimal vaginal bleeding and complain of pain when
secretions are expelled.
REVIEW OF SYSTEM
Integumentary System
The patient has no history of bruises in both upper and lower extremities.
Head
The patient had no history of any form of head injuries.
Eyes
Patient had no history of any eye problems.
Ears and Hearing
Patient had no history of smelly discharges on both ears, and no complaints of
hearing impairment.
Breast and Axillae
The patient had no history of breast nodules, no enlargement, no tenderness, no
pain and unusual discharges.
Respiratory System
The patient experienced slow irregular breathing patterns.
23

Cardiovascular System
The patient has a history of hypertension.
Genitourinary System
The patient had no history of any genital problems. Usually urinates 5 times a day.
Gastrointestinal System
The patient had no history of difficulty in defecation.
Musculoskeletal System
Patient has no history of joint pain.
Neurologic System
Patient had no history of any major mental problems but had episodes of mental
absences.
24

7. DIAGNOSTIC AND LABORATORY PROCEDURES
Diagnostic /
Laboratory
Procedures
Date
Ordered
Date
Results in
Indications or
Purposes
Results Normal Values
Analysis and Interpretation
of results
1.
Hematology
test
Date
ordered:
January 3,
2013
Date of
Results:
January 3,
2013
• to see the
hemoglobin
content in the
red blood cells
Blood Typing: O
Rh: (+)
Hemoglobin: 50
g/L
115-155 g/L
The blood type of the patient is
Type O.
The patient is Rh+.
The result indicated that the
haemoglobin (the iron-
containing part of blood that
carries oxygen to cells) level of
the patient is very low, which
25

Hematocrit: 0.15
g/L
WBC count:18.9
0.38 – 0.48 g/L
5-10 x 10^9 /L
leads to her diagnosis of
secondary anemia.
The level of the percentage of
the red blood cells is very low,
almost half of the normal range,
which can account for the
diagnosis of secondary anemia.
The level of white blood cell
count is very high since there
are invading pathogens due to
her condition.
The number of Neutrophils is
26

Neutrophils: 0.77
x 10^9 g/L
Lymphocytes:
0.20 x 10^9 g/L
Monocytes: 0.03
x 10^9 g/L
Platelet count:
357 x 10^9 g/L
0.45-0.65 x 10^9
g/L
0.20-0.35 x 10^9
g/L
0.02-0.06 x 10^9
g/L
150-400 x 10^9
g/L
higher than the normal range.
The number of Lymphocytesis
within the normal level.
The number of monocytes is
within the normal range.
The platelet count is within the
normal range; therefore, there
are no clotting complications
that may occur.
27

2. Complete
Blood Count
Date
ordered:
January 3,
2013
Date of
results:
January 3,
2013
• as a
preoperative
test to ensure
both adequate
oxygen carrying
capacity and
hemostasis
• to identify
persons who
may have an
infection
• to diagnose
Hemoglobin: 56
g/L
Hematocrit: 0.17
g/L
WBC count: 13.8
x 10^9 g/L
123-153 g/L
0.36-0. 45 g/L
4.5-11 x 10^9 g/L
From the first result, the level of
haemoglobin increased but it is
still very low compared to the
normal range. The RBCs are
still having difficulty in
transporting oxygen to cells.
Like haemoglobin, the result
increased from the initial result
but it is still low compared to
the normal range, meaning the
RBCs count is still very low.
The WBC count decreased
from the initial result but it is still
28

anemia
• to identify acute
and chronic
illness, bleeding
tendencies, and
white blood cell
disorders such
as leukemia
• to monitor
treatment for
anemia and
other blood
diseases
Neutrophils: 0.84
x 10^9 g/L
Lymphocytes:
0.14 x 10^9 g/L
Monocytes: 0.02
x 10^9 g/L
0.18-0.70 x 10^9
g/L
0.10-0.48 x 10^9
g/L
0-0.04 x10^9 g/L
higher than the normal range,
meaning it is still fighting the
invading pathogens
The neutrophil count increased
from initial result.
The lymphocyte decreased
from initial result, but within the
normal range.
The monocyte count decreased
from initial result, but within the
normal range.
29

• to determine the
effects of
chemotherapy
and radiation
therapy on
blood cell
production
Eosinophils: 0.00
Basophils: 0.00
Bands: 0.00
Platelet count:
456 x 10^9 g/L
0-0.03 x10^9 g/L
0-0.01 x10^9 g/L
0-0.03 x10^9 g/L
150-400 x10^9 g/
The eosinophils are within the
normal range.
The basophils are within the
normal range.
The bands are within the
normal range.
The platelet count increased
from the initial result and went
out of the normal range. It can
results from the cancer and
anemia condition of the patient.
30

3.Blood
Chemistry
Test
Date
ordered:
January 3,
2013
Date of
results:
January 3,
2013
• Measures the
chemical
components of
blood plasma.
which contains
water, glucose,
proteins, lipids
and minerals
such as calcium
• assess health,
such as the
efficacy of the
blood-calcium
utilization of
bones for growth
Creatinine:
170.4umol/L
SGPT (Glutamate
Pyruvate
Transaminase):
3.4 u/L
Sodium: 136.3
mmol/L
58-120 umol/L
0-39 u/L
135.0-148.0
mmol/L
The creatinine level is elevated,
which may mean that there is
something altering the kidney
function, which might be a
disease.
The result is within the normal
range which indicates normal
liver functioning.
The Sodium level is within the
normal range, which might
indicate normal blood pressure
and volume.
31

and development
Calcium:
2.93mmol/L
BUN (Blood Urea
Nitrogen): 10.4
mmol/L
SGOT (Glutamic
Oxaloacetic
Transaminase):
11.9 u/L
Potassium: 5.34
2.20-2.90mmol/L
1.7-8.3 mmol/L
0.0-40.0 u/L
3.50-5.50 mmol/L
The Calcium level is within the
normal range.
The result is higher than the
normal range, which indicates
altered or impaired renal
functioning.
range which means there is
proper liver functioning.
range which means there is
32

mmol/L fluid equilibrium in the body.
4. HBsAG
(Hepatitis B
Surface
Antigen
test)
Date
ordered:
January 3,
2013
Date of
results:
January 3,
2013
• To detect
acute hepatitis B
infection:
hepatitis B
surface antigen
(HBsAg),
hepatitis B core
antibody (anti-
HBc), IgM and
sometimes
hepatitis B e
antigen (HBeAg)
Non-reactive This indicates that the person is
not infected with Hepatitis B.
33

• To diagnose
chronic HBV
hepatitis:
HBsAg, hepatitis
B virus (HBV)
DNA, and
sometimes
HBeAg
• To detect
previous
exposure to
hepatitis B, in a
person who is
immunocompro
mised (when the
34

virus can
become
reactivated):
hepatitis B core
antibody (anti-
HBc) total and
anti-HBs
5. Cross-
matching
test
Date
ordered:
January 3,
2013
Date of
results:
January 3,
• Most commonly
done to make
certain that a
person who
needs a
transfusion will
receive blood
Compatible
( √ )
No Hemolysis
( √ )
There is no clmping that
occurred, meaning the donor’s
blood is compatible with the
patient.
There is no agglutination that
occurred and this indicated that
there is a compatible cross-
35

2013 that matches (is
compatible with)
his own. People
must receive
blood of the
same blood
type, otherwise,
a serious, even
fatal, transfusion
reaction can
occur.
match.
6. Cervical
Biopsy
--- • to detect cancer
of the cervix or
precancerous
lesions of the
Final Pathological
Diagnosis:
Suspicious for
small cell
undiffentiated
Undifferentiated carcinoma may
indicate malignant cells.
Carcinoma is a malignant
neoplasm whose cells appear
to be derived from epithelium.
36

cervix carcinoma.
Suggest
immunostains for
LCA, CK, NSE
and chromogranin
Gross
Microscopic
description:
Specimen
contains tan brow
tissue fragments
with an aggregate
diameter of 1.5
cm
Neoplasm is a "new growth" of
the body's own cells, a
proliferation of cells no longer
under normal physiologic
control.
37

NURSING RESPONSIBILITIES
 CBC, Cross-matching and Hematology tests:
1. Explain test procedure. Explain that slight discomfort may be felt when the skin is
punctured.
2. Encourage to avoid stress if possible because altered physiologic status influences
and changes normal hematologic values.
3. Explain that fasting is not necessary. However, fatty meals may alter some test
results as a result of lipidemia.
4. Apply manual pressure and dressings over puncture site on removal of dinner.
5. Monitor the puncture site for oozing or hematoma formation.
6. Instruct to resume normal activities and diet.
 Blood Chemistry test
1. Inform the patient this test can assist in evaluating the amount of hemoglobin in the
blood to assist in diagnosis and monitor therapy.
2. Obtain a history of the patient's complaints, including a list of known allergens,
especially allergies or sensitivities to latex.
38

3. Obtain a history of the patient's cardiovascular, gastrointestinal, hematopoietic,
hepatobiliary, immune, and respiratory systems; symptoms; and results of
previously performed laboratory tests and diagnostic and surgical procedures.
4. Note any recent procedures that can interfere with test results.
5. Obtain a list of the patient's current medications, including herbs, nutritional
supplements, and nutraceuticals
6. Review the procedure with the patient. Inform the patient that specimen collection
takes approximately 5 to 10 min. Address concerns about pain and explain that
there may be some discomfort during the venipuncture.
7. Sensitivity to social and cultural issues, as well as concern for modesty, is important
in providing psychological support before, during, and after the procedure.
8. There are no food, fluid, or medication restrictions unless by medical direction.
9. If the patient has a history of allergic reaction to latex, avoid the use of equipment
containing latex.
10.Instruct the patient to cooperate fully and to follow directions. Direct the patient to
breathe normally and to avoid unnecessary movement.
11.Observe standard precautions, and follow the general guidelines. Positively identify
the patient, and label the appropriate tubes with the corresponding patient
demographics, date, and time of collection. Perform a venipuncture; collect the
specimen in a 5-mL lavender-top (EDTA) tube. An EDTA Microtainer sample may
be obtained from infants, children, and adults for whom venipuncture may not be
39

feasible. The specimen should be mixed gently by inverting the tube 10 times. The
specimen should be analyzed within 24 hr when stored at room temperature or
within 48 hr if stored at refrigerated temperature. If it is anticipated the specimen will
not be analyzed within 24 hr, two blood smears should be made immediately after
the venipuncture and submitted with the blood sample. Smears made from
specimens older than 24 hr may contain an unacceptable number of misleading
artifactual abnormalities of the RBCs, such as echinocytes and spherocytes, as well
as necrobiotic white blood cells.
12.Remove the needle and apply direct pressure with dry gauze to stop bleeding.
Observe/assess venipuncture site for bleeding or hematoma formation and secure
gauze with adhesive bandage.
13.Promptly transport the specimen to the laboratory for processing and analysis.
14.A report of the results will be sent to the requesting HCP, who will discuss the
results with the patient.
 Cervical Biopsy
1. Do not eat or drink anything for 8 hours prior to the procedure.
2. After procedure, advice patient to rest and avoid strenuous activity for 24 hours.
40

3. May have some bleeding or discharge from your vagina for several days
postsurgery. A sanitary napkin or pad may be worn. Tampons should not be used
for a month or more after the surgery.
4. Leave packing in place until physician permits removal (usually 12-14 hours).
5. Monitor vaginal bleeding.
6. Sexual intercourse is discouraged for 4-6 weeks.
7. Showers and baths are OK.
8. A postoperative exam takes place at six weeks.
III. ANATOMY AND PHYSIOLOGY (FEMALE REPRODUCTIVE SYSTEM)
The reproductive role of a female is much more complex than that of the male. Not
only must she produce the female gametes (ova), but her body must also nurture and
protect a developing fetus during nine months of pregnancy.
Functions are:
• Produces eggs (ova).
• Secretes sex hormones.
• Receives the male spermatazoa during sexual intercourse.
• Protects and nourishes the fertilized egg until it is fully developed.
• Delivers fetus through birth canal.
41

• Provides
nourishment
to the baby
through milk
secreted by
mammary
glands in the
breast.
Anatomy (External Female Organ)
Physiology (External Female Organ)
 Mons Pubis – a.k.a. Mons Veneris that protects the pubic bone and vulva from the impact
of sexual intercourse. After puberty, it is covered by pubic hair (responsible for not easily
harboring the microorganisms in the vagina.
 Prepuce of Clitoris – protective cover of glans of clitoris.
42

 Glans of Clitoris – a short erectile organ above the vagina that is responsible for sexual
excitation or pleasure.
 Vestibule – the gland at the point where vagina and vulva join that secretes lubricating
substance. It consists of 3 parts:
o Urethral Opening – a.k.a. Meatus that drains urine from the bladder.
o Clitoris – functions sexual pleasures.
o Vestibule of Vagina – a.k.a. Vaginal Introitus that is for the vaginal entrance.
 Openings of Paraurethral – connected to the urethra and lubrication.
 Labium – a fleshy and liplike structure folds that protect the openings from bacterial
invasion. It has:
o Labia Majora – elongated hair covered skin folds that are responsible for
lubrication.
o Labia Minora – smaller folds enclosed by the labia majora and their function is to
protect the vagina and urethra openings. And they also produce lubricant.
 Vagina – receives penis and semen during mating, and passageway of childbirth and
menstrual flow.
 Hymenal Caruncle – a.k.a. Hymen, a membrane which partially covers the vaginal
passage.
 Opening of Greater Vestibular Gland – a.k.a. Bartholin’s Glands, the two glands at
the side of the vagina and between the vulva that secretes a lubricating substance.
 Vestibular Fossa – a.k.a. Navicular Fossa, a small cavity of between the vaginal orifice
and fourchette.
 Frenulum of Labium – the fold connecting the two labia minora posteriorly.
 Posterior Labia Commissure – rear joining of the labia majora above the perineum.
 Perineal Raphe – ridge along the median line that runs forward from the anus.
 Anus – a.k.a. Anal Orifice, in which feces passes through.
Anatomy (Internal Female Organ)
43

Physiology (Internal Female Organ)
 Ovaries – paired shape of almonds. It produces ova (singular, ovum), or eggs. The two
ovaries present in each female are held in place by the following ligaments:
o Broad Ligament – is a section of the peritoneum that drapes over the ovaries,
uterus, ovarian ligament, and suspensory ligament. It includes both the
mesovarium and mesometrium. The mesovarium is a fold of peritoneum that
holds the ovary in place.
o Suspensory Ligament – anchors the upper region of the ovary to the pelvic
wall. Attached to this ligament are blood vessels and nerves, which enter the
ovary at the hilus.
o Ovarian Ligament – anchors the lower end of the ovary to the uterus.
 The following two tissues that cover the outside of the ovary:
o Germinal Epithelium – is an outer layer of simple epithelium.
o Tunica Albuginea – is a fibrous layer inside the germinal epithelium.
 The inside of the ovary, or stroma, is divided into two indistinct regions:
o Outer Cortex and the Inner Medulla – embedded in the cortex are saclike
bodies called ovarian follicles. Each ovarian follicle consists of an immature
oocyte (egg) surrounded by one or more layers of cells that nourish the oocyte
as it matures.
45

o Follicular Cells – the surrounding cells if they make up a single layer, or
granulosa cells, if more than one layer is present.
 Uterine tubes (oviducts) – transport the secondary oocytes away from the ovary
and toward the uterus (the ovaries consist of primary oocytes, which develop into
secondary oocytes). The following regions characterize each of the two uterine tubes
(one for each ovary):
o Infundibulum – is a funnel-shaped region of the uterine tube that bears
fingerlike projections called fimbriae. Pulsating cilia on the fimbriae draw the
secondary oocyte into the uterine tube.
o Ampulla – is the widest and longest region of the uterine tube. Fertilization of
the oocyte by a sperm usually occurs here.
o Isthmus – is a narrow region of the uterine tube whose terminus enters the
uterus.
 Wall of the Uterine Tube – consists of the following three layers:
o Serosa – a serous membrane, lines the outside of the uterine tube.
o Middle Muscularis – consists of two layers of smooth muscle that generate
peristaltic contractions that help propel the oocyte forward.
o Inner Mucosa – consists of ciliated columnar epithelial cells that help propel
the oocyte forward, and secretory cells that lubricate the tube and nourish the
oocyte.
 Uterus – a hollow and pear-shaped organ that is to house, nourish and expel the fetus
during delivery; and for menstrual flow. It composes 3:
o Body or Corpus – the main body part of the uterus.
o Fundus – superior rounded region above the entrance of the uterine tubes.
46

o Isthmus – slightly constricted portion that joins the corpus to the cervix.
 Uterus is held in place by the following ligaments:
o Broad ligaments - fold of peritoneum supporting the uterus, extending from
the uterus to the wall of the pelvis on either side.
o Utero-sacral ligaments - a part of the thickening of the visceral pelvic fascia
beside the cervix and vagina; called also Petit's Ligament.
o Round ligaments - a fibromuscular band attached to the uterus near the
uterine tube, passing through the inguinal ring to the labium majus.
o Cardinal (lateral cervical) ligaments - part of a thickening of the visceral
pelvic fascia beside the cervix and vagina, passing laterally to merge with the
upper fascia of the pelvic diaphragm.
 Wall of the Uterus consists of the following three layers:
o Perimetrium – is a serous membrane that lines the outside of the uterus.
o Myometrium – consists of several layers of smooth muscle and imparts the bulk of
the uterine wall. Contractions of these muscles during childbirth help force the fetus
out of the uterus.
o Endometrium – is the highly vascularized mucosa that lines the inside of the
uterus. If an oocyte has been fertilized by a sperm, the zygote (the fertilized egg)
implants on this tissue.
 Endometrium itself consists of two layers:
 Stratum Functionalis (functional layer) – is the innermost
layer (facing the uterine lumen) and is shed during menstruation.
 Stratum Basalis (basal layer) – is permanent and generates
each new stratum functionalis.
47

 Vagina (birth canal) – serves both as the passageway for a newborn infant and as a
depository for semen during sexual intercourse. It consists of the following layers:
o Outer Adventitia – holds the vagina in position.
o Middle Muscularis – consists of two layers of smooth muscle that permit
expansion of the vagina during childbirth and when the penis is inserted.
o Inner Mucosa – has no glands. But bacterial action on glycogen stored in these
cells produces an acid solution that lubricates the vagina and protects it against
microbial infection. The acidic environment is also inhospitable to sperm. The
mucosa bears transverse ridges called rugae.
Anatomy (Female Internal Cervix)
48

Physiology (Female Internal Cervix)
Cervix is the 3
rd
lower portion of the uterus, neck like part (uteri cervix), narrowed where it
joins of the top end of the vagina. Cylindrical in shape and protrudes through the upper anterior
vaginal wall.
It has cervical mucus that is made of 90% of water, depending on the water content which
varies during the menstrual cycle that functions as barrier. It usually contains electrolytes, mainly
Calcium, Sodium, and Potassium, organic components such as amino acids and soluble proteins.
It is also composed of zinc, copper, iron, manganese, and selenium elements.
After menstrual period, the external os is blocked by mucus that is thick and acidic and it
undergoes a series of changes in position and texture of cervix uteri and wall.
Hormonal Regulation of Oogenesis and Menstrual Cycle
49

Three estrogens circulate in the bloodstream: (1) estradiol, (2) estrone, and (3)
estriol. All have similar effects on their target tissues. Estradiol is the most abundant estrogen,
and its effects on target tissues are most pronounced. It is the dominant hormone prior to
ovulation. In estradiol synthesis, androstenedione is first converted to testosterone, which the
enzyme aromatase converts to estradiol. The synthesis of both estrone and estriol proceeds
directly from androstenedione.
50

Estrogens have multiple functions that affect the activities of many tissues and organs
throughout the body. Among the important general functions of estrogens are (1) stimulating bone
and muscle growth, (2) maintaining female secondary sex characteristics, such as body hair
distribution and the location of adipose tissue deposits, (3) affecting central nervous system (CNS)
activity (especially in the hypothalamus, where estrogens increase the sexual drive), (4)
maintaining functional accessory reproductive glands and organs, and (5) initiating the repair and
growth of the endometrium.
51

The purpose of these cycles is to produce an egg and to prepare the uterus for the implantation
of the egg, should it become fertilized. The ovarian cycle consists of three phases:
1. Follicular Phase – describes the development of the follicle, the meiotic stages of
division leading to the formation of the secondary oocytes, and the secretion of estrogen
from the follicle.
52

2. Ovulation, Occurring at midcycle – is the ejection of the egg from the ovary.
3. Luteal Phase – describes the secretion of estrogen and progesterone from the corps
luteum (previously the follicle) after ovulation.
The menstrual (uterine) cycle consists of three phases:
1. Proliferative phase – describes the thickening of the endometrium of the uterus,
replacing tissues that were lost during the previous menstrual cycle.
2. Secretory phase - follows ovulation and describes further thickening and vascularization
of the endometrium in preparation for the implantation of a fertilized egg.
3. Menstrual phase (menstruation, menses) – describes the shedding of the
endometrium when implantation does not occur.
The activities of the ovary and the uterus are coordinated by negative- and positive-feedback
responses involving gonadotropin releasing hormone (GnRH) from the hypothalamus, follicle
stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary, and the
hormones estrogen and progesterone from the follicle and corpus luteum. A description of the
events follows):
1. Hypothalamus and anterior pituitary initiate the reproductive cycle: The
hypothalamus monitors the levels of estrogen and progesterone in the blood. In a negative-
feedback fashion, low levels of these hormones stimulate the hypothalamus to secrete
GnRH, which in turn stimulates the anterior pituitary to secrete FSH and LH.
2. Follicle develops: FSH stimulates the development of the follicle from primary through
mature stages.
3. Follicle secretes estrogen: LH stimulates the cells of the theca interna and the
granulosa cells of the follicle to secrete estrogen. Inhibin is also secreted by the granulosa
cells.
53

4. Ovulation occurs: Positive feedback from rising levels of estrogen stimulate the anterior
pituitary (through GnRH from the hypothalamus) to produce a sudden midcycle surge of
LH. This high level of LH stimulates meiosis in the primary oocyte to progress toward
prophase II and triggers ovulation.
5. Corpus luteum secretes estrogen and progesterone: After ovulation, the follicle,
now transformed into the corpus luteum, continues to develop under the influence of LH
and secretes both estrogen and progesterone.
6. Endometrium thickens: Estrogen and progesterone stimulate the development of the
endometrium, the inside lining of the uterus. It thickens with nutrient-rich tissue and blood
vessels in preparation for the implantation of a fertilized egg.
7. Hypothalamus and anterior pituitary terminate the reproductive cycle: Negative
feedback from the high levels of estrogen and progesterone cause the anterior pituitary
(through the hypothalamus) to abate the production of FSH and LH. Inhibin also
suppresses production of FSH and LH.
8. Endometrium either disintegrates or is maintained, depending on whether
implantation of the fertilized egg occurs, as follows:
o Implantation does not occur: In the absence of FSH and LH, the corpus luteum
deteriorates. As a result, estrogen and progesterone production stops. Without
estrogen and progesterone, growth of the endometrium is no longer supported, and
it disintegrates, sloughing off during menstruation.
o Implantation occurs: The implanted embryo secretes human chorionic gonadotropin
(hCG) to sustain the corpus luteum. The corpus luteum continues to produce
estrogen and progesterone, maintaining the endometrium. (Pregnancy tests check
for the presence of hCG in the urine).
 Menopause – is the cessation of menstruation. This usually occurs in women between the
ages of 45 and 50. Some women may reach menopause before the age of 45 and some
54

after the age of 50. In common use, menopause generally means cessation of regular
menstruation. Ovulation may occur sporadically or may cease abruptly. Periods may end
suddenly, may become scanty or irregular, or may be intermittently heavy before ceasing
altogether. Markedly diminished ovarian activity, that is, significantly decreased estrogen
production and cessation of ovulation, causes menopause.
PATHOPHYSIOLOGY
(NARRATIVE FORM)
Cancer of the cervix typically originates from a dysplastic or premalignant lesion previously
present at the active squamous columnar junction. The transformation from mild dysplastic to
invasive carcinoma generally occurs slowly within several years, although the rate of this process
varies widely.
Carcinoma in situ is particularly known to precede invasive cervical cancer in most cases.
In different reported series of patients with untreated carcinoma in situ who were followed up for
many years, invasive carcinoma developed in about 30% of patients at 10 years and in about 80%
of patients at 30 years. However, the carcinoma-in-situ lesion may regress after the initial
diagnosis; such an occurrence was reported in 17 (25%) of 67 patients who were followed up for at
least 3 years. Progression to invasive carcinoma becomes established and is considered
irreversible once the malignant process extends through the basement membrane and invasion of
the cervical stroma occurs.
Multiple local growth patterns of invasive cervical cancer have been described, with
combination growth patterns being common. The patterns include the following: exophytic, nodular,
infiltrative, and ulcerative.
55

The exophytic variety is the most common growth pattern. It usually arises from the
exocervix and is often polypoid or papillary in form. Exophytic cervical cancer may result in a large,
friable, bulky mass that involves only the superficial aspect of the cervix and has the tendency for
excessive bleeding.
The nodular variety typically arises in the endocervix and grows through the cervical stroma
into confluent, firm masses that cause the cervix and isthmus to expand. Large, nodular-type
tumors that circumferentially involve the endocervical region and large, exophytic-type tumors that
originate from the endocervix and extend into the endocervical canal result in what has been
referred to as a barrel-shaped cervix.
The infiltrative growth pattern leads to a stone-hard cervix that may be predicated to have
minimal visible ulcerations or an exophytic mass. Infiltrative exocervical lesions tend to invade the
vaginal fornices and the upper part of the vagina. On the other hand, infiltrative endocervical
lesions tend to extend into the corpus and the lateral parametrium.
56

IV. THE PATIENT’S ILLNESS
Synthesis of the Disease
1. DEFINITION OF THE DISEASE
The third most common cancer of the female reproductive system,
cervical cancer is classified as either preinvasive or invasive. Preinvasive
cancer is curable 75% to 90% of the time with early detection and proper
treatment. If untreated (and depending on the form in which it appears), it
may progress to invasive cervical cancer.
With invasive cancer, cancer cells penetrate the basement membrane
and can spread directly to contiguous pelvic structures or disseminate to
distant sites by lymphatic routes. In 95% of cases, the histologic type is
squamous cell carcinoma, which varies from well-differentiated cells to highly
anaplastic spindle cells; only 5% are adenocarcinomas. Invasive cancer
57

usually occurs in patients between ages 30 to 50, although in rare cases it
can occur in those younger than age 20.
One of the most important advances in the early diagnosis and
treatment of cancer of the cervix was made possible by the observation that
this cancer arises from precursor lesions, which begin with the development
of atypical cervical cells. These atypical cells gradually progress to
carcinoma in situ and to invasive cancer of the cervix. Atypical cells differ
from the normal cervical squamous epithelium. There are changes in the
nuclear and cytoplasmic parts of the cell and more variation in cell size and
shape (i.e., dysplasia). Carcinoma in situ is localized to the epithelial layer,
whereas invasive cancer of the cervix spreads to deeper layers.
Stages of Gynecologic Cancer
Stage Description
0
Rarely used; refers to preinvasive
lesions
I
Cancer is confined to organ in which
it originated
II Cancer involves some of the
structures surrounding the organ of
58

origin
III
Regional spread of cancer with lymph
node involvement
IV
Distant spread of cancer with
metastasis
Source: Porth, Carol Mattson. Pathophysiology: Concepts of Altered Health States, 6
th
Ed,
p.1004
2. PREDISPOSING FACTORS
Risk factors include early age at intercourse, multiple sexual partners,
a promiscuous partner, smoking and a history of STDs. Previous Herpesvirus
2 and other bacterial or viral venereal infections may also be a factor.
3. SIGNS AND SYMPTOMS
In the early stages, the patient may possibly manifest abnormal
vaginal bleeding, persistent vaginal discharge and post-coital pain and
bleeding. The vaginal discharge may be foul smelling, watery, thick, or
contain mucus. It varies from woman to woman.
In the advanced stages, there might be already pelvic pain, vaginal
leakage of urine and stool from a fistula, anorexia, weight loss and anemia.
59

Many women describe the pelvic pain ranging from a dull ache to sharp
pains that can last hours. It can be mild or severe.
4. HEALTH PROMOTION AND PREVENTIVE ASPECTS OF THE
DISEASE
• Get a regular Pap smear. The Pap smear can be the greatest defenses
for cervical cancer. The Pap smear can detect cervical changes early
before they turn into cancer.
• Limit the amount of sexual partners you have.Studies have shown women
who have many sexual partners increase their risk for cervical cancer.
They also are increasing their risk of developing HPV, a known cause for
cervical cancer.
• Quit smoking or avoid secondhand smoke. Smoking cigarettes increases
your risk of developing many cancers, including cervical cancer. Smoking
combined with an HPV infection can actually accelerate cervical
dysplasia. Your best bet is to kick the habit.
• If you are sexually active, use a condom. Having unprotected sex puts
you at risk for HIV and other STD's which can increase your risk factor for
developing cervical cancer.
60

• Follow up on abnormal Pap smears. If you have had an abnormal Pap
smear, it is important to follow up with regular Pap smears or
colposcopies, whatever your doctor has decided for you. If you have been
treated for cervical dysplasia, you still need to follow up with Pap smears
or colposcopies. Dysplasia can return and when undetected, can turn into
cervical cancer.
• Get the HPV vaccine. If you are under 27, you may be eligible to receive
the HPV vaccine, which prevents high risk strains of HPV in women. The
HPV vaccine, Gardasil, was approved by the FDA to give to young girls
as young as 9. The vaccine is most effective when given to young women
before they become sexually active.
61

V. THE PATIENT AND HER CARE
A. MEDICAL MANAGEMENT
a. IVFs, BT, Oxygen Therapy, etc.
MEDICAL
MANAGEMEN
T /
TREATMENT
DATE
ORDERED/
DATE
PERFORMED/
DATE
CHANGED
GENERAL
DESCRIPTION
INDICATION(S)/
PURPOSES
CLIENT’S RESPONSE
TO TREATMENT
IVF No. 1
Plain NSS 1L
regulated @
15gtts/min
Date ordered:
January 3, 2013
Date performed:
January 3, 2013
Plain NSS contains 9 g/L
Sodium Chloride with an
osmolarity of 308 mOsmol/L.
It contains 154 mEq/L
Sodium and Chloride. It is
To give intravenous fluids to the
patients suffering from salt and
water deprivation.
Used to replace fluids
Patient was able to avoid
episodes of hypovolemic
shock and doesn’t feel
dehydrated.
62

isotonic, which is same with
the osmolarity of our body
fluids. For isotonic volume
expander and electrolyte
replacement.
in dehydration
Used because it has little to no
effect on the tissues and make
the person feel hydrated
preventing hypovolemic shock
or hypotension.
BT No. 1
4U PRBC
properly typed
and
crossmatched
Date ordered:
January 3, 2013
Date performed:
January 3, 2013
One unit of packed red
blood cells has the same
amount of oxygen carrying
red blood cells as a unit of
whole blood. For each unit
of RBCs transfused, the
average 70 kg adult’s
hemoglobin will usually
increase by 1 g/dL the and
their hematocrit by 2-3
63

percent. Packed red blood
cells have a hematocrit
between 70% and 80%, so
they are among the most
viscous of the blood
products to transfuse.
IVF No. 2
Plain NSS 1L
regulated @
15gtts/min
Date ordered:
January 4, 2013
Date changed:
January 4, 2013
replacement.
To give
intravenous
fluids to the
patients
suffering from
salt and water
deprivation.
Used to
replace fluids
Patient was able to avoid episodes of
hypovolemic shock and doesn’t feel
dehydrated.
64

in dehydration
and go
with blood
transfusions.
Used
because it
has little to no
effect on the
tissues and
make the
person feel
hydrated
preventing
hypovolemic
shock or
hypotension.
65

BT No. 2
3U PRBC
properly typed
and
crossmatched
Date ordered:
January 4, 2013
Date changed:
January 4, 2013
To increase
the oxygen-
carrying
capacity in
anemic
patients.
Patient’s hemoglobin increased by 6g/L. Her
pulse rate has reached within normal limits.
66

IVF No. 3
Plain NSS 1L
regulated @
15gtts/min
Date ordered:
January 5, 2013
Date changed:
January 5, 2013
replacement.
To give
intravenous
fluids to the
patients
suffering from
salt and water
deprivation.
Used to
replace fluids
in dehydration
and go
with blood
transfusions.
Used
because it
dehydrated.
67

has little to no
effect on the
tissues and
make the
person feel
hydrated
preventing
hypovolemic
shock or
hypotension.
BT No. 3
1U PRBC
properly typed
and
crossmatched
Date ordered:
January 5, 2013
Date changed:
January 5, 2013
To increase
the oxygen-
carrying
capacity in
anemic
patients.
68

IVF No. 4
Plain NSS 1L
regulated @
15gtts/min
Date ordered:
January 6, 2013
Date changed:
January 6, 2013
To give
intravenous
fluids to the
patients
suffering from
salt and water
deprivation.
dehydrated.
69

replacement.
Used to
replace fluids
in dehydration
and go
with blood
transfusions.
Used
because it
has little to no
effect on the
tissues and
make the
person feel
hydrated
preventing
70

hypovolemic
shock or
hypotension.
BT No. 4
4U PRBC
properly typed
and
crossmatched
Date ordered:
January 6, 2013
Date changed:
January 6, 2013
To increase
the oxygen-
carrying
capacity in
anemic
patients.
71

BT No. 5
4U PRBC Type
O properly
typed and
crossmatched
Date ordered:
January 6, 2013
Date changed:
January 7, 2013
To increase
the oxygen-
carrying
capacity in
anemic
patients.
72

IVF No. 5
Plain NSS 1L
regulated @
15gtts/min
Date ordered:
January 8, 2013
Date changed:
January 8, 2013
replacement.
To give
intravenous
fluids to the
patients
suffering from
salt and water
deprivation.
Used to
replace fluids
in dehydration
and go
with blood
dehydrated.
73

transfusions.
Used
because it
has little to no
effect on the
tissues and
make the
person feel
hydrated
preventing
hypovolemic
shock or
hypotension.
74

NURSING RESPONSIBILITIES:
 Plain NSS (IVF)
1. Verify the doctor’s order.
2. Know the type, amount and indication of IV therapy.
3. Practice strict asepsis.
4. Inform client and explain purpose of therapy.
5. PRIME IV tubing to expel air. This will prevent air embolism.
6. Clean the insertion site of IV needle from center to the periphery with alcoholized cotton
swab.
7. Monitor patient frequently for:
a. Signs of infiltration / sluggish flow
b. Signs of phlebitis / infection
c. Dwell time of catheter and need to be replaced
d. Condition of catheter dressing
8. Check the level of the IVF.
9. Correct solution, medication and volume.
10. Check and regulate the drop rate to ensure administration of proper volume of IV fluid
as ordered.
11. Change the IVF solution if needed.
 Packed RBC (Blood Transfusion)
75

1. Verify the physician’s written order and make a treatment card according to hospital
policy.
2. Observe the 10 Rs when preparing and administering any blood or blood components.
3. Explain the procedure/rationale for giving blood transfusion to reassure patient and
significant others and secure consent. Get patient histories regarding previous
transfusion.
4. Explain the importance of the benefits on Voluntary Blood Donation (RA 7719- National
Blood Service Act of 1994).
5. Request prescribed blood/blood components from blood bank to include blood typing
and cross matching and blood result of transmissible Disease.
6. Using a clean lined tray, get compatible blood from hospital blood bank.
7. Wrap blood bag with clean towel and keep it at room temperature.
8. Have a doctor and a nurse assess patient’s condition. Countercheck the compatible
blood to be transfused against the crossmatching sheet noting the ABO grouping and
RH, serial number of each blood unit, and expiry date with the blood bag label and other
laboratory blood exams as required before transfusion.
9. Get the baseline vital signs- BP, RR, and Temperature before transfusion. Refer to MD
accordingly.
10. Give pre-meds 30 minutes before transfusion as prescribed.
11. Do hand hygiene before and after the procedure.
12. Prepare equipment needed for BT (IV injection tray, compatible BT set, IV catheter/
needle G 19/19, plaster, torniquet, blood, blood components to be transfused, Plain
76

NSS 500cc, IV set, needle gauge 18 (only if needed), IV hook, gloves, sterile 2×2 gauze
or transplant dressing, etc.
13. If main IVf is with dextrose 5% initiate an IV line with appropriate IV catheter with Plain
NSS on another site, anchor catheter properly and regulate IV drops.
14. Open compatible blood set aseptically and close the roller clamp. Spike blood bag
carefully; fill the drip chamber at least half full; prime tubing and remove air bubbles (if
any). Use needle g.18 or 19 for side drip (for adults) or g.22 for pedia (if blood is given
to the Y-injection port, the gauge of the needle is disregarded).
15. Disinfect the Y-injection port of IV tubing (Plain NSS) and insert the needle, from BT
administration ser and secure with adhesive tape.
16. Close the roller clamp of IV fluid of Plain NSS and regulate to KVO while transfusion is
going on.
17. Transfuse the blood via the injection port and regulate at 10-15gtts/min initially for the
first 15 minutes of transfusion and refer immediately to the MD for any adverse reaction.
18. Observe/Assess patient on an on-going basis for any untoward signs and symptoms
such as flushed skin, chills, elevated temperature, itchiness, urticaria, and dyspnea. If
any of these symptoms occur, stop the transfusion, open the IV line with Plain NSS and
regulate accordingly, and report to the doctor immediately.
19. Swirl the bag gently from time to time to mix the solid with the plasma N.B one B.T set
should be used for 1-2 units of blood.
20. When blood is consumed, close the roller clamp, of BT, and disconnect from IV lines
then regulate the IVF of plain NSS as prescribed.
77

21. Continue to observe and monitor patient post transfusion, for delayed reaction could still
occur.
22. Re-check Hgb and Hct, bleeding time, serial platelet count within specified hours as
prescribed and/or per institution’s policy.
23. Discard blood bag and BT set and sharps according to Health Care Waste
Management (DOH/DENR).
24. Fill-out adverse reaction sheet as per institutional policy.
25. Remind the doctor about the administration of Calcium Gluconate if patient has several
units of blood transfusion (3-5 more units of blood).
78

b. Drugs
Name of
drugs; Generic
name, Brand
name
Date ordered
Date
performed
Date
changed
Route od
administratio
n
Dosage &
freq of admin
General Action
Indication or
Purposes
Client’s response
to the meds w/
actual S/E
Tranexamic
acid
(Cyklokapron,
Lysteda)
Date Ordered:
January 4,
2013
Date Taken:
January 4,
2013
500mg 1cap OD Anti-fibrinolytic drug It was ordered
because it is
thought to treat
heavy bleeding.
Bleeding was reduced.
calcium
gluconate
Date Ordered:
January 4,
1 amp IV
injection
Treating conditions
arising from calcium
Aids in
antagonizing the
Lab tests shown that
the patient's calcium
80

2013
Date Taken:
January 4,5,7,
2013
deficiencies such as
hypocalcemic
tetany,
hypocalcemia r/t
hypoparathyroidism.
cardiac toxicity. level became normal.
furosemide
(Lasix)
Date Ordered:
January 4,
2012
Date Taken:
January
4,5,6,7, 2012
1 vial IV
injection OD
T>38c
Inhibits sodium and
chloride
reabsorption.
It is for excretion
of potassium and
ammonia is
increased while
uric acid excretion
is reduced.
Potassium is excreted
and ammonia level is
increased and uric acid
of patient become
more stable.
clonidine
(Catapres)
Date Ordered:
January 8,
2013
75mg 1 tab SL
oral
Anti-hypertensive
drug
Thought to
stimulate alpha2
receptors and
inhibit the central
Decreased in blood
pressure (120/80).
81

Date Taken:
January 8,
2013
vasomotor
centers,
decreasing
sympathetic
outflow to the
heart, kidneys.
amlodipine
besylate
(Norvasc)
Date Ordered:
January 8,
2012
Date Taken:
January 8,
2012
5mg 1 tab BID
oral
Calcium antagonist
Anti-hypertensive
drug
Inhibits
transmembrane
influx of calcium
ions into vascular
smooth muscle
and cardiac
muscle.
Decreased in blood
pressure of the patient
from 160/100 to
130/80.
metoprolol
succinate
(Lopressor)
Date Ordered:
January 8,
2013
50mg 1 tab BID
oral
Treatment in heart
failure.
Selectivity
blocking the
beta1 receptors in
The patient didn't show
any signs of anxiety
82

Date Taken:
January 8,
2013
the heart, and use
in performance
anxiety, social
anxiety disorder
and other anxiety
disorders.
paracetamol/
Acetaminophe
n
Date Ordered:
January 8,
2012 Date
Taken: January
8, 2012
300mg IV
injection q4°
Analgesic Used for relief of
headache and
other minor aches
and pain. Also
used in
management of
severe pain and
providing
palliative care.
Decreased
temperature to 36.8℃
from 39℃
83

 Tranexamic acid (Cyklokapron)
1. Unusual change in bleeding pattern should be immediately reported to the
physician.
2. For women who are taking Tranexamic acid to control heavy bleeding, the
medication should only be taken during the menstrual period.
3. Tranexamic Acid should be used with extreme caution in CHILDREN younger
than 18 years old; safety and effectiveness in these children have not been
confirmed.
4. The medication can be taken with or without meals.
5. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or
chew before swallowing.
6. If you miss a dose of Tranexamic Acid, take it when you remember, then take
your next dose at least 6 hours later. Do not take 2 doses at once.
7. Inform the client that he/she should inform the physician immediately if the
following severe side effects occur:
8. Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the
chest, swelling of the mouth, face, lips or tongue
o Calf pain, swelling or tenderness
o Chest pain
o Confusion
o Coughing up blood
o Decreased urination
o Severe or persistent headache
o Severe or persistent body malaise
o Shortness of breath
o Slurred speech
o Slurred speech
o Vision changes
85

 Calcium gluconate
1. Give 1 to 1.5 hours after meals if GI upset occurs.
2. Warm solution to body temperature before giving it.
3. After injection, keep patient recumbent for 15 minutes.
4. Monitor calcium levels frequently.
5. Tell patient to report anorexia, nausea, vomiting, constipation, abdominal pain,
dry mouth, thirst or polyuria.
 furosemide (Lasix)
1. To prevent nocturia, give in the morning. Give second dose if ordered early in
the afternoon, 6 to 8 hours after morning dose.
2. Monitor fluid intake and output and electrolyte, BUN, and carbon dioxide levels.
3. Watch for signs of hypokalemia, such as muscle weakness and cramps.
4. Advise patient to immediately report ringing in the ears, severe abdominal pain,
or sore throat and fever; these symptoms may indicate toxicity.
 clonidine (Catapres)
1. Don’t crush, break, or allow patient to chew extended release tablets.
2. Give last dose immediately before bedtime.
3. Monitor blood pressure and pulse rate frequently. Dosage is usually adjusted to
patient’s blood pressure and tolerance.
4. Stop drug gradually by reducing dosage over 2 to 4 days to avoid rapid rise in
blood pressure, agitation, headache and tremor.
86

5. Inform patient that dizziness upon standing can be minimized by rising slowly
from a sitting or lying position and avoiding sudden position changes
 amlodipine besylate(Norvasc)
1. Monitor blood pressure frequently during initiation of therapy. Because drug-
induced vasodilation has a gradual onset, acute hypotension is rare.
2. Give drug without regard for food.
 metropolol succinate(Lopressor)
1. Give drug with or immediately after meal.
2. Always check patient’s apical pulse before giving the drug. If it’s slower than 60
beats/minute, withhold the drug and call prescriber immediately.
3. Monitor blood pressure frequently; drug masks common signs and symptoms of
shock.
 paracetamol/acetaminophen
1. Give drug without regard for food.
2. Many OTC and prescription products contain acetaminophen; be aware of this
when calculating total daily dose.
87

c. Diet
Type of diet
Date Ordered/
Date
Performed/
Date Changed
General
description
Indications or
purpose
Specific foods
taken
Client
response to
the diet
Diet as tolerated
Date Ordered:
January 3, 2012 -
january 7, 2013
Date Taken:
January 3 2012 -
january 7, 2013
Client can now
tolerate any food
he/she desires
that is nutritious, if
this will not lead
to any
complication and
if the client needs
further monitoring
tests. Diet as
To stay healthy
and just
moderation
Rice, Lutong
kamatis, Lugaw
(Any food as long
as the pt can eat)
The patient was
able to eat in his
regular eating
pattern consisting
of healthy foods
and fruits.
88

tolerated is a term
that indicates that
the
gastrointestinal
tracts is tolerating
food and is ready
for advancement
to the next stage.
Nothing Per
Orem
Date ordered:
January 8, 2013
Date taken:
Jauary 8, 2013
Nothing by mouth;
dont take in any
type of food or
liquid by mouth.
To avoid vomiting
while being
sedated and
aspirates the
vomitus into
lungs.
Nothing by mouth Patient did not
vomit.
89

 Diet as Tolerated
1. Check the Doctor’s Order
2. Explain the Indication and purpose of the diet to the patient.
3. Explain the Impostance of Right Nutrition to the Patient / SO.
4. Check the Client’s choice of food.
5. Encourage the Patient to eat Nutritious foods and Fruits.
6. Recommend the Patient to avoid eating Junk Foods and drinking Sodt Drinks.
7. Recommend the Patient to perform Oral Hygiene every after meal.
 Nothing Per Orem
1. Checkdoctor’sorder.
2. AssureIVfluidtherapyifpatientisNPO>
3. InstructSOnottogiveanythingthroughthemouth.
4. Assessclient’scondition.
5. Assurethatnothingistakenthroughthemouth(eitherliquidorsolid.
6. Place³NPO´signonbedwherethepatientorSOcanalwaysseeit.
7. Removefoodsordrinksonpatient’sbedside.
8. Observepatient’sresponseonthediet.
9. Monitorclient’scondition
91

D. Activity/Exercise (Not available)
B. SURGICAL MANAGEMENT (Not available)
C. NURSING MANAGEMENT
1. Nursing Care Plan
92

Assessment
Nursing
Diagnosis
Scientific
Explanation
Objectives Intervention Rationale
Expected
Outcome
S: “sakit ang tiyan ko”,
as verbalized by the
patient.
>Pain scale – 8/10.
O>Guarding/protecting
the affected site
>Facial grimace noted
>Reduced interaction
>Moaning during
excretion of blood from
the vagina
>Acitis (excessive fluid
in peritoneum)
Chronic pain
related to
irritation of
nerve ending
as evidenced
by moaning
every
secretion of
blood from the
vagina.
Almostallpartsof
thebodyare
coveredwithnerve
endingsthatare
eachprogrammed
torespondto
aspecifickindof
unpleasant
sensation. They
require acertain
intensityof
stimulationbefore
they
reactandwilllie
silentuntilthislevel
isreached.some
peripheral
receptorsmay
respondtoseveral
differenttypesof
stimulus,including
strongmechanical
andthermal
Short term:
After 1 hour of
nursing
interventions
the patient will
be able to
verbalize and
demonstrate
proper
techniques to
relieve pain.
Long term:
After 1 week of
nursing
intervention the
patient will be
able to
demonstrate
and initiate
behavioral
modifications of
lifestyle and
1. Established
rapport
2. Monitored
V/S.
3. Assessed for
referred pain as
appropriate.
4. Provided
cutaneous
stimulation;
e.g.,
heat/cold,
massage.
5. Provided
non-
pharmacologic
comfort
To gain trust of
patient.
To obtain
baseline data
To help
determine
possibility of
underlying
condition.
To promote
circulation and
help lessen the
pain.
Promotes
relaxation and
helps refocus
attention.
After 1 hour of
nursing
interventions
the patient shall
be able to
verbalize and
demonstrate
proper
techniques to
relieve pain.
After 1 week of
nursing
intervention the
patient shall be
able to
demonstrate
and initiate
behavioral
modifications of
lifestyle and
appropriate use
of therapeutic
93

stimuli,andare
oftensensitized
intimebyrepeated
applicationof
stimuli. Theseso-
calledpolymodal
nociceptorsmay
alsobe
sensitiveto
chemicalstimuli,
suchaslowpH. It
isbelievedthat
someofthese
typesofreceptor
are
alsolocatedin
deepertissues.
Sinceweknow
thatsome
receptorscanbe
mademorelikely
tobe
activatedbya
numberof
mechanisms
appropriate use
of therapeutic
interventions as
evidenced by
patient being
able to
verbalize the
divisionary
therapy.
measures and
diversional
activities.
6. Instructed
and encouraged
used of
relaxation
technique such
as focus
breathing.
7. Provided
cutaneous
stimulation;
e.g.,
heat/cold,
massage.
8. Provided
comfort
measures and
quiet
Environment
9. Evaluate pain
To destruct
attention and
reduce tension.
May decrease
inflammation,
muscle spasms,
reducing
associated pain.
To promote non-
pharmacological
pain
management.
Goal is
maximum pain
interventions as
evidenced by
patient being
able to
verbalize the
divisionary
therapy.
94

includingthe
chemical
environmentitis
theorizedthat
some
typesofchronic
painmayarise
fromthissocalled
peripheral
sensitization.
Source:
Pathophysiology
ofchronicpainby
JamesL.Henry
Ph.D.
relief/ control at
regular
intervals. Adjust
medication
regimen as
necessary.
10.
Administered
analgesic as
indicated by the
physician.
control with
minimum
interference with
ADL’s.
A wide range of
analgesics and
associated
agents may be
employed
around the clock
to manage the
pain.
Assessment
Nursing
Diagnosis
Scientific
Explanation
Expected
Outcome
95

S: “dumudugo
habang umiihi
ako”, as
verbalized by the
patient.
O: >Pallor noted
>Feeling of
dizziness noted
>Irritability when
asked a question
>Dry skin mucus
membrane noted
>Hematology:
HGB – (low)
56g/L normal
range: 123-153;
HCT – (low)
0.17%
Fluid volume
deficient related
to cervical
bleeding
secondary to
cervical cancer
as evidenced by
HGB of 56g/L
Alowhemoglobin
measurement
usuallymeansthat
thepersonhas
anemia.Common
causesinclude
excessivebleeding,
deficiencyofiron,
Vit.B12,folicacid,
destructionofred
cellsbyantibodies
ormechanical
trauma.
Hemoglobinlevels
arealsodecreased
duetocancer.Fluid
volumeintheblood
affectsthe
hemoglobinvalues.
Ifthereisdecreased
hemoglobin,thereis
alsodecreased
bloodvolume.This
isfurtherevidenced
bypalloranddry
Short term: After
1hr of nursing
interventions the
patient will be
able to verbalize
understanding of
causative factors
and purpose of
individual
therapeutic
interventions.
Long term: After
1 week of
nursing
intervention the
patient will be
able to
demonstrate
behaviors to
monitor and
correct deficit
such as
monitoring input
and outtake and
1. Established
rapport to the
patient.
2. Monitored
V/S.
3. Discussed
factors in related
to occurrence of
deficit
4. Encouraged
fluid intake to
3000 ml a day,
unless
contraindicated.
5. Encouraged
and demonstrate
accurate
To gain trust and
cooperation.
To obtain
baseline data.
To inform the
patient of her
condition.
It flushes
kidneys/bladder
of bacteria and
debris but may
result in water
intoxication/fluid
overload if not
monitored
closely.
To monitor the
amount of fluid
taken and
After 1hr of
nursing
interventions the
patient shall be
able to verbalize
understanding of
causative factors
and purpose of
individual
therapeutic
interventions.
After 1 week of
nursing
intervention the
patient shall be
able to
demonstrate
behaviors to
monitor and
correct deficit
such as
monitoring input
and outtake and
agreeing to
96

skinmucus. agreeing to
blood
transfusion
monitoring of
I&O.
6. Monitor daily
weight of patient
7. Regulated
IVF level (D5LR)
accurately.
8. Instructed
S&S indicating in
need for
immediate or
further
evaluation.
9. Evaluated
CFAC (Color,
Frequency,
removed do as
to detect any
abnormalities.
To detect any
change brought
about by the
excessive
release of fluid in
the body.
Necessary for
fluid volume
replacement
For immediate
referral of any
S&S that may be
a sign of
hypovolemic
shock.
Usually indicates
arterial bleeding
that required
blood transfusion
97

Amount,
and
Consistency) of
vaginal bleeding
e.g.
bright red with
red clots.
10. Infused
PRBC with IVF
as ordered by
the
physician.
aggressive
therapy.
Useful in
evaluating blood
losses/
replacement
needs.
Assessment
Nursing
Diagnosis
Scientific
Explanation
Expected
Outcome
98

S: none
O: >Pallor
>Abnormal
heart rate:
49bpm
>Slow
movements
>Hematology:
HGB – (low)
56g/L
>V/S noted –
HR: 49 bpm;
RR: 16 cpm
Activity
intolerance
related to
imbalance
between oxygen
supply and
demand.
Because there
is decreased
haemoglobin,
the oxygen
being delivered
to the cells is
also decreased
resulting to
decreased cell
nourishment.
There will be
reduced ATP
production,
thus, less
energy. And
because the
patient is
generally feeling
weak, there will
be activity
intolerance.
Short term: After
1 hour of
nursing
interventions the
patient will be
able to
verbaliaze
understanding
of techniques in
evaluating
activities.
Long Term:
After 1 week of
nursing
intervention
patient will be
able to
demonstrate a
decrease in
physiological
signs of
intolerance such
as pulse and
hemoglobin
1. Established
rapport to the
patient.
2. Monitored V/S.
3. Assessed
cardio pulmonary
response to
physical activity.
4. Identify activity
needs versus
desires to
evaluate
appropriateness
5. Plan care to
carefully balance
rest periods with
activity.
6. Demonstrate
simple exercises
and routines to
patient.
To gain trust and
cooperation.
To obtain
baseline data.
To provide
adequate
knowledge on the
patient.
To enhance
patient’s ability to
participate in
activity.
To give an
appropriate
schedules of rest
and activity.
To give
knowledge to the
patient on easy
ways to have
After 1 hour of
nursing
interventions the
patient shall be
able to verbalize
understanding
of techniques in
evaluating
activities.
After 1 week of
nursing
interventions the
patient shall be
able to
demonstrate a
decrease in
physical
intolerance such
as pulse and
hemoglobin
levels within
normal range.
99

levels within
normal range.
7. Increase
exercise level
gradually.
8. Note client
reports of
weakness.
9. Assist client in
learning and
demonstrating
appropriate safety
measures.
10. Evaluate level
of understanding
exercise and
motivate patient
to do exercises.
To gradually
condition the
body and prevent
stagnation of
circulation of
blood.
To assess if when
to tone down
activities given.
To guide patient
in the
demonstration.
To assess if the
patient has
understood the
teachings being
implemented.
100

11. Transfuse
blood as ordered.
2. Provide oxygen
as ordered To
prevent over
exertion.
To aid in the
distribution of
oxygen to the
body by replacing
the blood loss in
the vaginal
secretions.
Assessment
Nursing
Diagnosis
Scientific
Explanation
Expected
Outcome
S: none
O:
>HGB level
(low) 56g/L
Ineffective
tissue perfusion
related to
decreased
Due to
decreased
haemoglobin
that will lead to
Short term: after
1 hour of
nursing
intervention the
1. Establish
rapport
2. Monitor V/S
To gain trust of
patient.
To record
After 1 hour of
nursing
intervention the
patient shall be
101

>Pail nail beds
>Pale palpebral
conjunctiva
>Low pulse rate
46 bpm
>Dry scaly skin
hemoglobin
concentration
as evidenced by
low HGB levels
56g/L
decreased
intravascular
volume, there
will be decrease
in cardiac
output. Anti-
diuretic
hormones will
be secreted
which will lead
to increased
heart rate and
increased
volume,
therefore
increasing
cardiac output.
But there is
continued loss
of volume which
will decrease
cardiac output
and thus,
decreasing
tissue perfusion.
patient will be
able to verbalize
understanding
of condition
therapy given.
Long term: after
1 week of
nursing
intervention the
patient will be
able to increase
tissue perfusion
such as HGB
level within
normal range
and pulse rate
returns to
normal levels.
3. Identify
changes related
to systemic or
peripheral
situations in
circulation (e.g.
altered
mentation).
4. Monitor I&O
5. Provide
psychological
support for
patient such as
staying at the
bedside of
the patient.
baseline data.
To identify the
causes of tissue
perfusion
To identify if
there is a
decrease in the
fluid retention of
the body of the
patient.
To prevent any
signs of anxiety.
able to verbalize
understanding
of condition
therapy given.
After 1 week of
nursing
intervention the
patient Shall be
able to increase
tissue perfusion
such as HGB
level within
normal range
and pulse rate
returns to
normal levels.
102

6. Encouraged
Quiet restful
atmosphere.
7. Caution client
to avoid
activities that
increase cardiac
workload.
8. Elevate HOB
To prevent any
agitation of the
patient that may
cause an
increase in the
vital signs.
To prevent
further
complications
that might occur
with the
activities.
To promote
circulation for
the patient.
103

Assessment
Nursing
Diagnosis
Scientific
Explanation
Expected
Outcome
S: none
O:
>Dry scaly skin
>HGB level low
56g/L
>Dry lips
Risk for
impaired skin
integrity related
to altered
circulation and
pigmentation as
Skin is the
primary
defense of the
body that
protects us
from invading
Short term:
After 1 hour of
nursing
intervention the
patient will be
able to identify
1. Establish
rapport
2. Monitor V/S
To gain trust of
patient.
To record
baseline data.
After 1 hour of
nursing
intervention the
patient shall be
able to identify
individual risk
104

>Pale palpebral
conjunctiva
>Pale colored
skin on the
palm area.
>Pail nail beds
evidenced by
the pale
palpebral
conjunctiva, low
HGB levels and
pale skin color
on palm area.
pathogens. A
healthy skin is
moist and
intact. The
patient has dry,
scaly skin, thus,
making her
more prone to
friction which
may result to
impairment of
skin integrity.
individual risk
factors.
Long term:
After 3 days of
nursing
intervention the
patient will be
able to
demonstrate
behaviors and
techniques to
prevent skin
breakdown.
3. Inspect skin
surfaces
4. Observed for
reddened/blanche
d
areas and institute
treatment
immediately.
5. Massage bony
prominences
gently
and avoid friction
when moving
client.
6. Provide
To inspect the
integrity and
hydration of the
skin of the
patient and to
note any
underlying
lesions that are
present.
Reduces
likelihood of
progression of
skin
breakdown.
To prevent
patient for
getting any pain
upon moving
the patient.
To protect
patient from
any drafts and
factors.
After 3 days of
nursing
intervention the
patient shall be
able to
demonstrate
behaviors and
techniques to
prevent skin
breakdown.
105

adequate covers.
7. Keep
bedclothes dry and
keep bed
free from wrinkles,
crumbs.
to promote
further
circulation.
To provide
comfort for the
patient.
106

Actual SOAPIEs
SOAPIE 1
Subjective Cue: “sakit ang tiyan ko”, as verbalized by the patient. Pain scale – 8/10.
Objective Cues:
* Guarding/protecting the affected site
* Facial grimace noted
* Reduced interaction
* Moaning during excretion of blood from the vagina
* Acitis (excessive fluid in peritoneum)
ASSESSMENT: Chronic pain related to irritation of nerve ending as evidenced by moaning
every secretion of blood from the vagina.
PLANNING:
Short term: After 1 hour of nursing interventions the patient was able to verbalize and
demonstrate proper techniques to relieve pain.
Long term: After 1 week of nursing intervention the patient was able to demonstrate and
initiate behavioral modifications of lifestyle and appropriate use of therapeutic interventions
as evidenced by patient being able to verbalize the divisionary therapy.
107

INTERVENTIONS:
• Established rapport
• Monitored V/S
• Assessed for referred pain
as appropriate.
• Provided cutaneous
stimulation; e.g.,
• heat/cold, massage.
• Provided non-pharmacologic
comfort
• measures and diversional
activities.
• Instructed and encouraged
used of relaxation
• technique such as focus
breathing.
• Provided cutaneous
stimulation; e.g.,
• heat/cold, massage.
• Provided comfort measures
and quiet
• environment.
• Evaluate pain relief/ control
at regular
• intervals.
• Adjust medication regimen
as
• necessary
• Administered analgesic as
indicated by the
physician.
EVALUATION:
108

After 1 hour of nursing interventions the patient shall be able to verbalize and demonstrate
proper techniques to relieve pain.
After 1 week of nursing intervention the patient shall be able to demonstrate and initiate
behavioral modifications of lifestyle and appropriate use of therapeutic interventions as
evidenced by patient being able to verbalize the divisionary therapy.
SOAPIE 2
Subjective Cue: “dumudugo habang umiihi ako”, as verbalized by the patient.
Objective Cues:
* Pallor noted
* Feeling of dizziness noted
* Irritability when asked a question
* Dry skin mucus membrane noted
* Hematology: HGB – (low) 56g/L normal range: 123-153; HCT – (low) 0.17%
ASSESSMENT: Fluid volume deficient related to cervical bleeding secondary to cervical
cancer as evidenced by HGB of 56g/L
PLANNING:
109

Short term: After 1hr of nursing interventions the patient will be able to verbalize
understanding of causative factors and purpose of individual therapeutic interventions.
Long term: After 1 week of nursing intervention the patient will be able to demonstrate
behaviors to monitor and correct deficit such as monitoring input and outtake and agreeing
to blood transfusion
INTERVENTIONS:
• Established rapport to the patient.
• Monitored V/S.
• Discussed factors in related to occurrence of deficit
• Encouraged fluid intake to 3000 ml a day,
• Encouraged and demonstrate accurate monitoring of I&O.
• Monitored daily weight of patient
• Regulated IVF level (D5LR) accurately.
• Instructed S&S indicating in need for
• immediate or further evaluation.
• Evaluated CFAC (Color, Frequency, Amount, and Consistency) of vaginal
bleeding.
• Infused PRBC with IVF as ordered by thephysician.
•
110

EVALUATION:
After 1hr of nursing interventions the patient was able to verbalize understanding of
causative factors and purpose of individual therapeutic interventions.
After 1 week of nursing intervention the patient was able to demonstrate behaviors to
monitor and correct deficit such as monitoring input and outtake and agreeing to blood
transfusion
SOAPIE 3
Subjective Cue: none
Objective Cues:
* Pallor
* Abnormal heart rate: 49bpm
* Slow movements
* Hematology: HGB – (low) 56g/L
* V/S noted – HR: 49 bpm; RR: 16 cpm
ASSESSMENT: Activity intolerance related to imbalance between oxygen supply and
demand.
111

PLANNING:
Short term: After 1 hour of nursing interventions the patient will be able to verbaliaze
understanding of techniques in evaluating activities.
Long Term: After 1 week of nursing intervention patient will be able to demonstrate a
decrease in physiological signs of intolerance such as pulse and hemoglobin levels within
normal range.
INTERVENTIONS:
• Established rapport to the patient.
• Monitored V/S.
• Assessed cardio pulmonary response to physical activity.
• Identify activity needs versus desires to evaluate appropriateness.
• Plan care to carefully balance rest periods with activity.
• Demonstrate simple exercises and routines to patient.
• Increased exercise level gradually.
• Noted client reports of weakness.
• Assisted client in learning and demonstrating appropriate safety measures.
• Evaluated level of understanding
• Transfused blood as ordered.
• Provided oxygen as ordered
112

•
EVALUATION:
After 1 hour of nursing interventions the patient was able to verbalize understanding of
techniques in evaluating activities.
After 1 week of nursing interventions the patient was able to demonstrate a decrease in
physical intolerance such as pulse and hemoglobin levels within normal range.
SOAPIE 4
Objective Cues:
* HGB level (low) 56g/L
* Pail nail beds
* Pale palpebral conjunctiva
* Low pulse rate 46 bpm
* Dry scaly skin
ASSESSMENT: ineffective tissue perfusion related to decreased hemoglobin
concentration as evidenced by low HGB levels 56g/L
PLANNING:
113

Short term: after 1 hour of nursing intervention the patient will be able to verbalize
understanding of condition therapy given.
Long term: after 1 week of nursing intervention the patient will be able to increase tissue
perfusion such as HGB level within normal range and pulse rate returns to normal levels.
INTERVENTIONS:
• Monitored V/S
• Identified changes related to systemic or peripheral situations in circulation
(e.g. altered mentation).
• Monitored I&O
• Provided psychological support for patient such as staying at the bedside of
the patient.
• Encouraged Quiet restful atmosphere.
• Cautioned client to avoid activities that increase cardiac workload.
• Elevated HOB To promote circulation for the patient.
•
EVALUTATION:
114

After 1 hour of nursing intervention the patient was able to verbalize understanding of
condition therapy given.
After 1 week of nursing intervention the patient was able to increase tissue perfusion such
as HGB level within normal range and pulse rate returns to normal levels.
SOAPIE 5
Objective Cues:
* Dry scaly skin
* HGB level low 56g/L
* Dry lips
* Pale palpebral conjunctiva
* Pale colored skin on the palm area.
* Pail nail beds
ASSESSMENT: Risk for impaired skin integrity related to altered circulation and
PLANNING:
115

Short term: After 1 hour of nursing intervention the patient will be able to identify individual
risk factors.
Long term: After 3 days of nursing intervention the patient will be able to demonstrate
behaviors and techniques to prevent skin breakdown.
INTERVENTIONS:
• Monitored V/S
• Inspected skin surfaces
• Observed for reddened/blanched areas and institute treatment immediately.
• Massaged bony prominences gently and avoided friction when moving client.
• Provided adequate covers. To protect patient from any drafts and to promote
further circulation.
• Kept bedclothes dry and keep bed free from wrinkles, crumbs.
EVALUTATION:
After 1 hour of nursing intervention the patient was able to identify individual risk factors.
After 3 days of nursing intervention the patient was able to demonstrate behaviors and
techniques to prevent skin breakdown.
116

VI. CLIENT’S DAILY PROGRESS IN THE HOSPITAL
1. Client’s Daily Progress Chart
DAYS
ADMISSION
01-03-2013
01-04-2013 01-05-2013 01-06-2013 01-07-2013 01-08-2013
Nursing
Problems
> Chronic pain
related to
irritation of
nerve ending
as
evidenced by
moaning every
secretion of
blood from the
vagina
>Fluid volume
deficient
***

related to
cervical
bleeding
secondary to
cervical cancer
as
evidenced by
HGB of 56g/L
>Activity
intolerance
related to
imbalance
between
oxygen
supply and
demand
>Ineffective
tissue
perfusion
related to
decreased
***
***
***

hemoglobin
concentration
as evidenced
by low HGB
levels 56g/L
>Risk for
impaired skin
integrity related
to altered
circulation and
pigmentation
as evidenced
by the pale
palpebral
conjunctiva,
low HGB levels
and pale skin
color on palm
area
*** ***
Vital Signs T=11-7am: T=11-7am: T=11-7am: T=11-7am: T=11-7am: T=11-7am:

Temperature
Pulse rate
Respiratory
rate
Blood
pressure
37℃ =7-3pm:
37℃ =3-11pm:
37.2℃
PR=11-7am:
80bpm =7-
3pm: 80bpm
=3-11pm:
82bpm
RR=11-7am:
18bpm =7-
3pm: 20bpm
=3-11pm:
22bpm
BP=11-7am:
130/70mmHg
=7-3pm:
120/60mmHg
=3-11pm:
130/70mmHg
37.2℃ =7-
3pm: 36.2℃
=3-11pm: 37℃
PR=11-7am:
84bpm =7-
3pm: 76bpm
=3-11pm:
82bpm
RR=11-7am:
22bpm =7-
3pm: 26bpm
=3-11pm:
28bpm
BP=11-7am:
130/80mmHg
=7-3pm:
120/60mmHg
=3-11pm:
140/70mmHg
37℃ =7-3pm:
37℃ =3-11pm:
37.2℃
PR=11-7am:
74bpm =7-
3pm: 80bpm
=3-11pm:
88bpm
RR=11-7am:
30bpm =7-
3pm: 30bpm
=3-11pm:
26bpm
BP=11-7am:
160/100mmHg
=7-3pm:
150/80mmHg
=3-11pm:
130/60mmHg
37.2℃ =7-
3pm: 36.2℃
=3-11pm:
36.4℃
PR=11-7am:
76bpm =7-
3pm: 76bpm
=3-11pm:
84bpm
RR=11-7am:
36bpm =7-
3pm: 32bpm
=3-11pm:
30bpm
BP=11-7am:
130/90mmHg
=7-3pm:
120/60mmHg
=3-11pm:
120/70mmHg
36.2℃ =7-3pm:
36.4℃ =3-
11pm: 36.4℃
PR=11-7am:
60bpm =7-
3pm: 62bpm
=3-11pm:
70bpm
RR=11-7am:
18bpm =7-
3pm: 20bpm
=3-11pm:
24bpm
BP=11-7am:
120/60mmHg
=7-3pm:
120/60mmHg
=3-11pm:
150/70mmHg
36.8℃ =7-3pm:
37℃ =3-11pm:
37.2℃
PR=11-7am:
65bpm =7-
3pm: 76bpm
=3-11pm:
82bpm
RR=11-7am:
20bpm =7-
3pm: 20bpm
=3-11pm:
22bpm
BP=11-7am:
140/80mmHg
=7-3pm:
180/100mmHg
=3-11pm:
150/70mmHg

Diagnostic /
Laboratory
Procedures
Hematology
Test
Blood Typing:
O
Rh: (+)
Hemoglobin:
50 g/L
Hematocrit:
0.15 g/L
WBC
count:18.9
Neutrophils:
0.77 x 10^9 g/L
Lymphocytes:
0.20 x 10^9 g/L

Complete
Blood Count
Monocytes:
0.03 x 10^9 g/L
Platelet count:
357 x 10^9 g/L
Hemoglobin:
56 g/L
Hematocrit:
0.17 g/L
WBC count:
13.8 x 10^9 g/L
Neutrophils:
0.84 x 10^9 g/L
Lymphocytes:
0.14 x 10^9 g/L
Monocytes:

Blood
Chemistry
Test
0.02 x 10^9 g/L
Eosinophils:
0.00
Basophils: 0.00
Bands: 0.00
Platelet count:
456 x 10^9 g/L
Creatinine:
170. 4umol/L
SGPT
(Glutamate
Pyruvate
Transaminase)
: 3.4 u/L
Sodium: 136.3

mmol/L
Calcium:
2.93mmol/L
BUN (Blood
Urea Nitrogen):
10.4 mmol/L
SGOT
(Glutamic
Oxaloacetic
Transaminase)
: 11.9 u/L
Potassium:
5.34 mmol/L
Non-reactive
Compatible

HBsAG test
Cross-
matching
Test
Cervical
Biopsy
( √ )
No Hemolysis
( √ )
Final
Pathological
Diagnosis:
Suspicious for
small cell
undiffentiated
carcinoma.
Suggest
immunostains
for LCA, CK,
NSE and
chromogranin
Gross
Microscopic
description:
Specimen
contains tan
brow tissue

fragments with
an aggregate
diameter of 1.5
cm
Medical
Management
IVFs
BTs
Plain NSS 1L
4U PRBC
Plain NSS 1L
3U PRBC
Plain NSS 1L
1U PRBC
Plain NSS 1L
4U PRBC
----
4U PRBC Type
O
Plain NSS 1L
---
Diet
Diet as
Tolerated
Nothing Per
Orem
*** *** *** *** ***
**

VII. CONCLUSION AND RECOMMENDATION
Tremendous strides have been made in reducing the rate of cervical cancer.
However, women continue to be afflicted by a disease that is potentially preventable and
curable. The women who remain most susceptible to the development of cervical cancer
are those who are lost to screening or who do not receive screening at all. Therefore,
family physicians must remain vigilant by screening all appropriate women with routine
Pap smears. The key to preventing invasive cervical cancer is to detect any cell changes
early, before they become cancerous. Regular pelvic examinations and Pap smears are
the best way to do this. How often a woman should have a pelvic exam and Pap smear
depends on her individual situation. Because of the rarity of the condition, each case must
be managed on its merits with the use of multidisciplinary team. As is known, it is much
easier to prevent than to cure a disease. Many lives can be saved if a few simple things
are taken care of: carrying a healthy life, making periodic tests to detect disease, and
beginning of sexual life at an age appropriate and finding a stable sexual partner. Also,
self-treatment is not appropriate for cancer under most circumstances. Without medical
treatment, the cancer will continue to grow and spread. Eventually vital body organs will
not be able to function properly because the cancer will take their oxygen and nutrients,
crowd them out, or injure them. The result is very often death. Although self-treatment is
inappropriate, there are things a woman can do to reduce the physical and mental stresses

of cancer and its treatment. Maintaining good nutrition is one of the best things a woman
can do.
We recommend this case study to all students in the health profession, especially to
those whose studies are related to the obstetric-gynecological topic that is cervical cancer.
We also recommend this to the physicians, nurses and all other members of the health
care team who are taking care of patients who have cancer of the cervix. This cases tudy
contains information regarding a certain case of a woman who had just been diagnosed of
cervical cancer and was given the initial treatment of blood transfusion.
VIII. BIBLIOGRAPHY
A. Textbook References/Primary References:
 Porth, Carol Mattson. Pathophysiology: Concepts of Altered Health States, 6
th
Ed.
Lippincott- Raven Publishers. P. 1002-1005; 2002
 Nursing: Understanding Diseases. Lippincott Williams & Wilkins. p. 112-114; 2008
 Lippincott Manual of Nursing Practice Series: Pathophysiology. Lippincott Williams
& Wilkins. p.426-427; 2007
 Nursing 2013 Drug Handbook. Lippincott Williams and Wilkins. 2013

B. Electronic Research/Secondary References:
 https://www.novapublishers.com/catalog/product_info.php?products_id=5620
 http://www.cdc.gov/cancer/cervical/statistics/trends.htm
 http://www.vanguardngr.com/2011/09/more-women-are-dying-of-breast-cervical-
cancers-in-developing-countries-research/
 http://www.ecmaj.ca/content/164/7/1017.full
 http://www.medicalhealthtests.com/articles/376/blood-tests/mch-hematology-
test.html
 http://www.surgeryencyclopedia.com/Ce-Fi/Complete-Blood-Count.html#b
 http://www.ehow.com/how_5771668_interpret-blood-chemistry-test-results.html
 http://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test
 http://www.nurseslearning.com/courses/nrp/labtest/course/section4/index.htm
 http://medical-dictionary.thefreedictionary.com/Blood+Typing+and+Crossmatching
 http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/cervical_
biopsy_92,P07767/
 http://www.glowm.com/?p=glowm.cml/section_view&articleid=230#26011
 http://www.oralcancerfoundation.org/facts/detailed_biopsy.htm

 http://nursingcrib.com/medical-laboratory-diagnostic-test/complete-blood-count-cbc-
normal-values-and-nursing-considerations/
 http://wiki.answers.com/Q/Nursing_responsibilities_for_patient_before_and_after_Co
mplete_blood_count
 http://www.thirdage.com/hc/p/101091/cervical-cone-biopsy-what-to-expect
 http://elizarivera.com/Chapter30%20-%20Female%20Reproductive.pdf
 http://cancer.about.com/od/cervicalcancer/a/preventcervical.htm
 http://cancer.about.com/od/cervicalcancer/a/cervcancrsympt.htm
 http://nursingcrib.com/drug-study/tranexamic-acid/
 http://www.livestrong.com/article/205546-what-is-the-meaning-of-diet-as-
tolerated/#ixzz2HrjFpShR

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