OVARIAN CANCER CASE

STUDY
Amriati Mutmainna,S.Kep.,Ns.,MSN
 CHAPTER I
 Introduction
 Talk about one case in the world.
 Talk about one case in Indonesia.

 Talk about one case in your region (Ex:

Makassar, Jeneponto, Pare-Pare or whatever do

you want) (If available).
 Talk about one case why do you choose this

case.
 Statement of the Problem
 General Statement of the Problem
 Specific Statement of the Problem
INTRODUCTION
 Cancer is one of the leading causes of morbidity and
mortality worldwide, with approximately 14 million new
cases in 2012. Globally, nearly 1 in 6 deaths is due to
cancer (WHO, 2017).
 In Asian countries, the five countries with the highest
standardized death rate of ovarian cancer were as
follows: Indonesia 1.6 per 100,000, Brunei with 6 per
100,000, Kazakhstan with 6 per 100,000, Armenia with
5.1 per 100,000, and Israel with 5.1 per 100,000. We
can see as a result especially in Indonesia was the
highest standardized death rate of ovarian cancer
(Razi, et al., 2016).
 Ovarian cancer is the eighth most common cancer
among women, and it includes about 4% of all
women’s cancers (Razi, et al., 2016).
STATEMENT OF THE PROBLEM
 General Statement of the Problem
 Thisstudy will serve as a review to fully understand the
causes of this disease, how it affects the person and
how this disease is treated.
 Specific Statement of the Problem
 To understand how to assessment ovarian cancer
patient
 To understand how to nursing diagnose ovarian cancer
patient
 To understand how to intervention ovarian cancer
patient
 To understand how to implementation ovarian cancer
patient
 To understand how to evaluation ovarian cancer
patient
 CHAPTER II
 Related Literatures
 Definition
 Risk Factors

 Signs and Symptoms

 Diagnosed

 For example: Screening test, laboratory

examination, etc.
 Treatment Options

 For example: Surgery, chemotherapy, etc.

RELATED LITERATURES
 Definition
 Ovarian cancer is a disease in which, depending
on the type and stage of the disease, malignant
(cancerous) cells are found inside, near, or on
the outer layer of the ovaries.
 Risk Factors
 Allwomen are at risk
 Genetic predisposition
 Personal or family history of breast, ovarian, or
colon cancer
 Increasing age
 Infertility
RELATED LITERATURES
 Signs and Symptoms
 Bloating
 Pelvicor abdominal pain
 Trouble eating or feeling full quickly
 Feeling the need to urinate urgently or often
 Fatigue
 Upset stomach or heartburn
 Back pain
 Pain during sex
 Constipation or menstrual changes
RELATED LITERATURES
 Diagnosed with Ovarian Cancer
 Screening Tests
 Pelvic Exam
 Physician inserts fingers in the rectum and vagina simultaneously

to feel for abnormal swelling and to detect tenderness

 Transvaginal Sonography

 This ultrasound, performed with a small instrument placed in the

vagina, is appropriate, especially for women at high risk for ovarian

cancer, or for those with an abnormal pelvic exam.
 CA-125 Test

 This blood test determines if the level of CA-125, a protein produced

by ovarian cancer cells, has increased in the blood of a woman at

high risk for ovarian cancer, or a woman with an abnormal pelvic
examination.
 Positive Tests
 Biopsy

 The only way to more accurately confirm an ovarian cancer

diagnosis is with a biopsy, a procedure in which the doctor takes a

sample of the tumor and examines it under a microscope.
RELATED LITERATURES
 Ovarian Cancer Treatment Options
 Surgery
 Surgery to remove the cancerous growth is the most
common method of diagnosis and therapy for ovarian
cancer.
 Chemotherapy
 Chemotherapy is the treatment of cancer using
chemicals designed to destroy cancer cells or stop them
from growing.
 Radiation
 Radiation therapy uses high-­energy X­-rays to kill cancer
cells and shrink tumors.
 Complementary Therapies
 Complementary therapies are diverse practices and
products that are used along with conventional medicine.
 CHAPTER III

 Case Study
 Patient’s Profile
 History of Past and Present Illness of the Patient

 11 Gordon’s Functional Pattern

 Before Hospitalization

 After Hospitalization

 Physical Examination

 Diagnostic Examination

 Pathophysiology

 Nursing Care Plan

 Drug Study
CASE STUDY
 Patient’s Profile
 Name : Mrs. “PRP”
 Age : 71 years old
 Sex : Female
 Civil status : Married
 Address : Biliran, Cebu City, Cebu
 Birth place : Naval, Biliran
 Birth date : March 20, 1946
 Nationality : Filipino
 Whom to notify in case of emergency : Mr. “P”
 Relationship : Husband
 Responsible for hospital account : Mr. “P”
 Responsible for hospital account position: Teacher
 Admission date : July 14, 2017
 Informant : Mr. “P”
CASE STUDY
 History of Past and Present Illness of
the Patient
 History of Past the Patient
 Patient said she has appendicitis before, on November
last year. When she has to get appendectomy, she
must to take surgical. While doctor did surgical, doctor
found her ovarian cancer at the same time. After that,
the doctor recommended her to get her chemotherapy
next month after this surgical to treat her ovarian
cancer. She had menarche on 17 years old, and then
menopause on 52 years old. Patient never uses oral
contraception and patient has 3 children. She doesn’t
have family who has ovarian cancer.
CASE STUDY
 History of Past and Present Illness of the Patient
 Present Illness of the Patient
 The patient was admitted to hospital on 15th December 2016 and the
patient was conducted chemotherapy. Time by time, patient
undergoing her chemotherapy for got her health. When I am on my
duty, I found the patient conducted her chemotherapy 5th circle
already. She had her chemotherapy did every weekly on 1st, 8th, and
15th days. The nurse will be the one who will tell the patient when
patient will get her next chemotherapy. In addition, she can answer
the nurse’s questions properly.
 She could ambulatory herself, but she needed a little assistance from

her husband. Her husband always accompany patient to get her

chemotherapy. The patient looked very calm when she is during her
chemotherapy. Even though, patient felt sometimes anxiety about
her disease. She verbalized she sometimes shy with her
neighborhood because of her changed body part, especially her hair
which always fall in down. Furthermore, she inquired her illness also
to the nurse. She said also she inability to cope. On my duty also, I
found patient looked anxiety, shy, and always asked about her
illness.
CASE STUDY
 11 Gordon’s Functional Pattern
 Health Perception and Health Management
 Before Hospitalization
 The patient already knows about her illness such as ovarian cancer because

she had chemotherapy last years. She had menarche on 17 years old, and
then menopause on 52 years old. She just notified that she got ovarian
cancer while she is undergoing appendectomy because she has
appendicitis. After that, the doctor recommended her to get her
chemotherapy next month after this surgical to treat her ovarian cancer.
 During Hospitalization

 When I am on my duty, I found the patient conducted her chemotherapy 5 th

circle already. The patient looked calm for the treatment he was undergoing
and the patient hopes to recover from her illness. Patient’s husband always
accompany patient when the patient undergoing treatment of
chemotherapy in the hospital. So, patient feels safe, restful and comfort.
Even though, patient felt sometimes anxiety about her disease. She
verbalized she sometimes shy with her neighborhood because of her
changed body part, especially her hair which always fall in down.
Furthermore, she inquired her illness also to the nurse. She said also she
inability to cope. On my duty also, I found patient looked anxiety, shy, and
always asked about her illness. Moreover, patient appeared restless and
anxious. But, now patient is under taken medication.
CASE STUDY
 11 Gordon’s Functional Pattern
 Nutrition and Metabolic Pattern
 Before Hospitalization
 Patient ate 3 meals a day, no food abstinence before

illness. Patient likes to eat meat and doesn’t like to

eat vegetables. Before ill, patient was especially
very fond of roasted meat and curry meat.
 During Hospitalization

 During her hospitalization, the doctor advised her to

take in foods that fit the diet of patient with ovarian

cancer that is milk diet and porridge. Appetite
patient look good and the patient's weight is 51 Kg
right now.
CASE STUDY
 11 Gordon’s Functional Pattern
 Elimination Pattern
 Before Hospitalization
 Patient said her urination 4 – 5 times per day because

patient always drinks much mineral water every day. About

her defecation, she had 1 times per day and she said the
stool looked soft light brown. She can walked alone to
comfort room, but sometimes together with her son or her
husband.
 During Hospitalization

 Patient said her urination 4 – 5 times per day,

approximately 1500 ml per day. The nurse counted with

verbalized patient and patient’s family were 3 glasses of
water. Because of that, patient was always drinks mineral
water every day. About her defecation, she had 1 times per
day and she said her stool looked soft and the color was
light brown. Her husband or her son always help her to
urinate and went to comfort room or CR.
CASE STUDY
 11 Gordon’s Functional Pattern
 Activity and Exercise
 Before Hospitalization
 Patient can move all of her extremities freely but the

patient need a little assistant from her husband. She

can ambulate around her home and walks to the
field to refresh and enjoy the environment. She said
always walked with her son or her husband to her
neighborhoods also who near with her home.
 During Hospitalization

 Patients can move all of her extremities freely but

the patient quickly feel tired. She can ambulate

around her bed and walks to the rest room with a
little assistance. Because of the patient quickly feel
tired that is why she inquired about her illness.
CASE STUDY
 11 Gordon’s Functional Pattern
 Cognition and Perception
 Before Hospitalization
 The patient was conversant and was slightly oriented to

date, time, place, and people and to her condition. There

were no mood swings and emotional changes. Her positive
attitude was consistent all throughout. She is very kind to
her husband, her family and other people.
 During Hospitalization

 The patient was conversant and was slightly oriented to

date, time, place, and people and to her condition. During

the duty, there were no observed mood swings and
emotional changes. Her positive attitude was consistent all
throughout. She answers questions and follow instructions
appropriately although the patient responded very slowly
and weakly. However, she still felt shy with her condition
because of chemotherapy make her hair fall in down easily.
CASE STUDY
 11 Gordon’s Functional Pattern
 Sleep and Rest
 Before Hospitalization
 The patient feels comfortable to sleep in the night

around 5 - 7 hours and in the noon after lunch he

sleeps for a while 1 – 2 hours. In her home very
quite because far from traffic road.
 During Hospitalization

 During hospitalization, the patient was comfortable

in sleeping but there are episodes where she cannot

sleep due to ward setting. She also verbalized that
he has anxiety for remind her disease. She sleeps
when she feels sleepy and she can sleep very easy.
She also sleeps around 4 – 6 hours in the night and
sometimes in the afternoon 1 – 2 hours. She looks
adequate sleep and rest.
CASE STUDY
 11 Gordon’s Functional Pattern
 Self-Perception and Self-Concept
 Before Hospitalization
 Patient’s perception of the disease before is felt

healthy and well-being. The patient’s health condition

is everything well. The patient believed the power of
God. The patient also has adequate esteem and her
husband always support her everything what she does.
 During Hospitalization

 Patient’s perception of the disease is felt anxious and

worried about her disease. During this time, the

patient’s health condition is very easy to feel at all
disturbed. But, patient said to continue to wait and
hope that the power of God. Patient believed only God
is able to help him in order to remain strong and
experienced complete healing.
CASE STUDY
 11 Gordon’s Functional Pattern
 Role and Relationships Pattern
 Before Hospitalization
 Before sick, patient is very active in social activities

available in the environment. Patient often pray for

others who have had problems, and also to follow
the activities of tribal gathering and neighborhoods.
 During Hospitalization

 During sick, patient reduced social activities and

focused on the handling of her disease and then

often anxious to say is very disturbing because
house work and his role as wife and mother at
home.
CASE STUDY
 11 Gordon’s Functional Pattern
 Sexuality and Reproductive Pattern
 Before Hospitalization
 Before ill, patient said there is no problem with

sexual patterns. She said also no more need sexual

pattern. She said again she just needs kissing and
hugging from her husband and her children.
 During Hospitalization

 There is no problem with sexual patterns. In

addition, patient said she is already old and then she

said no need any more for sexual pattern. She just
wanted to consent about his disease. And then, she
needs support from her husband with hugging or
kissing.
CASE STUDY
 11 Gordon’s Functional Pattern
 Coping and Stress Tolerance Pattern
 Before Hospitalization
 Before hospitalization, patient felt comfort and never

think about anything. She just faced her condition

will be not be sick. She has good stress tolerance.
 During Hospitalization

 During sick, patient said she believed the power of

God will heal her disease which is she is undergoing

suffering right now. She looked has effective coping
to faced her disease although patient sometimes felt
shy.
CASE STUDY
 11 Gordon’s Functional Pattern
 Values and Belief System
 Before Hospitalization
 Before ill, patient is diligent in church activities. She

believes also about the power of God which God will

heal her and make her better than now. She always
prays to the church with her husband and her
children, and then she prays also in her own home.
 During Hospitalization

 However, patient said that the disease made her

experienced more completely to God. Patient

believed that with her prayer, she will be growing in
faith and she believed God is able to heal.
CASE STUDY
 Physical Examination

GO TO THE MICROSOFT WORD

CASE STUDY
 Diagnostic Examination
 Clinical Laboratory
 Date: 07/13/2017

Test Name Result Reference Range Interpretation

SGPT/ALT 17 U/L 12 - 78 Normal

Creatinine 0.77 0.55 - 1.02 Normal

mg/dl
CASE STUDY
 Diagnostic Examination
 Complete Blood Account
 Date: 07/13/2017

Test Name Result Reference Interpretation

Range

White blood cell 5.11 x 10^9/L 4.10 - 10.9 Normal

o Neutrophils 47 % 47 - 80

o Lymphocyte 39 % 13 - 40

s 11 % 2 - 11

o Monocytes 1% 0-5

o Eosinophils 1% 0-2

o Basophils

Hemoglobin 11.8 g/dL 12 - 16 Decreased due to chemotherapy

CASE STUDY
 Diagnostic Examination
 Complete Blood Account
 Date: 07/13/2017

Test Name Result Reference Interpretation

Range

Hematocrit 34.4 % 36 - 46 Decreased due to hemo-concentration

caused by the amount of plasma leaking

from the intravascular space

Red blood cell 3.9 x 10^12/L 4.5 - 5.9 Decreased due to stunted formation and

blockage of blood flow

Mean 89.3 fL 80 - 100 Normal

corpuscular vol

Mean 30.7 pg 26 - 34 Normal

corpuscular hgb
CASE STUDY
 Diagnostic Examination
 Complete Blood Account
 Date: 07/13/2017

Test Name Result Reference Interpretation

Range

Mean corps hgb 34 g/L 31 - 36 Normal

conc.

Red cell dist. 13.9 % 11.6 - 14.8 Normal

Width

Platelet count 102 x 10^9/L 140 - 440 Decreased due to production of

thrombocytopenia decreased also

because of chemotherapy consequences

Mean platelet 5.60 fL 0 - 100 Normal

CASE STUDY
 Diagnostic Examination
 Chemotherapy Medication
 Chemotherapy orders – Paclitaxel (Weekly) #5
 Admit c/o Hemo Onco Unit Consent for Chemotherapy Labs

 DAY 1 – 06/02/2017

 PRE MEDS:

 Dexamethasone 4 mg/tab – 5 tabs (total 20 mg) – PO (per orem)

 Start PNSS 500 ml x KVO as mainline

 Give the following 30 minutes before start of chemotherapy:

• Dexamethasone 20 mg IVTT
• Ranitidine 50 mg IVTT
• Diphenhydramine 50 mg IVTT
• 5HT3 antagonist: Zofran 8 mg IVTT c/o phic.
 START CHEMO as follows (piggyback to mainline IVF):
 Incorporate Paclitaxel (80 mg/m2) 100 mg to 250 ml of plain NSS (Glass bottle) and give
solution for 3 hours. Do test dose. Use IV filtered set.
 Incorporate Carboplatin (AUC 6 – 7.5) 450 mg to 250 ml of D5W and gibe solution for 30

minutes. 450 mg – c/o sulay, 150 mg – c/o phic

 VS q 1 hour while on chemotherapy

 DAY 8 – July 14, 2017 (Friday)

 Follow orders as stated in day 1 (No carboplatin)
 DAY 15 –
 Follow orders as stated in day 1 (No carboplatin)
CASE STUDY
 Diagnostic Examination
 Blood Transfusion
 Date: 5/25/17
 Name: Mrs. “PRP”

 Admit c/o Hema Onco Unit Secure Consent

 Full Diet

 IVF : PNSS 500 ml x KVO

 Side drip : PRBC 1 unit, properly typed and x-
matched, each unit to run for 4 hours.
 Pre-meds : Diphenhydramine 50 mg tab before

blood transfusion
 Refer for transfusion reactions VS q hourly.
CASE STUDY
 Pathophysiology

GO TO THE MICROSOFT WORD

CASE STUDY
 Nursing Care Plan (NCP)

GO TO THE MICROSOFT WORD

CASE STUDY
 Drug study
 DEXAMETHASONE
 Classification
 Long-acting corticosteroid

 Action

 Dexamethasone suppresses inflammation and the

normal immune response. It prevents the release of

substances in the body that causes inflammation.
 Indications

 Dexamethasone is used to treat many different

conditions such as allergic disorders, skin conditions,

ulcerative colitis, arthritis, lupus, psoriasis, or
breathing disorders.
CASE STUDY
 Drug study
 DEXAMETHASONE
 Side Effects
 Acne

 Decreased wound healing

 Depression

 Vomiting

 Easy bruising

 Headache, etc

 Nursing Consideration

 Monitor intake and output of patient.

 Observe the patient for peripheral edema, steady

weight gain, rales or crackles or dyspnea. Notify the

physician immediately if these clinical
manifestations are noted.
CASE STUDY
 Drug study
 RANITIDINE
 Classification
 Histamine2 (H2) antagonist

 Pregnancy Category B

 Action

 Ranitidine blocks histamine H2-receptors in the stomach

and prevents histamine-mediated gastric acid secretion.

It does not affect pepsin secretion, pentagastrin-
stimulated factor secretion or serum gastrin.
 Indications

 Short-term treatment of active duodenal ulcer

 Maintenance therapy for duodenal ulcer at reduced

dosage
 Short-term treatment of active, benign gastric ulcer, etc
CASE STUDY
 Drug study
 RANITIDINE
 Side Effects
 Headache, dizziness.

 Rarely hepatitis, thrombocytopaenia,

leucopaenia, hypersensitivity, confusion,

gynecomastia, impotence, somnolence, vertigo,
hallucinations, etc
 Nursing Consideration

 Administer oral drug with meals and at

bedtime.
 Decrease doses in renal and liver failure.

 Provide concurrent antacid therapy to relieve

pain, etc
CASE STUDY
 Drug study
 DIPHENHYDRAMINE
 Classification
 Antihistamine, second generation, ethanolamine

 Action

 Has high sedative, anticholinergic and antiemetic

effects
 Blocks the action of acetylcholine

 Blocks H-1 receptors on effector cells of the GI tract,

blood vessels, and respiratory tract

 Indications

 Treatment of hypersensitivity reactions

 Treatment of motion sickness

 Treatment of Parkinsonism, etc

CASE STUDY
 Drug study
DIPHENHYDRAMINE
 Side Effects
 Drowsiness
 Constipation

 Diarrhea

 Dizziness, etc

 Nursing Consideration
 Give full prophylactic dose 30 min. prior to
travel if used as a prophylaxis for motion
sickness
 Take similar doses with meals and at bedtime

 Do not use more than 2 weeks to treat

insomnia, etc
CASE STUDY
 Drug study
 ZOFRAN
 Classification
 Serotonin 5-HT3 antagonists

 Action

 Zofran (ondansetron) blocks the actions of

chemicals in the body that can trigger nausea and

vomiting.
 Zofran is used to prevent nausea and vomiting that

may be caused by surgery, cancer chemotherapy, or

radiation treatment.
 Indications

 Cancer treatment

 Postoperative

 Pregnancy
CASE STUDY
 Drug study
ZOFRAN
 Side Effects
 Severe constipation, stomach pain, or bloating;
 Headache with chest pain and severe dizziness,

fainting, fast or pounding heartbeats;

 Fast or pounding heartbeats; etc

 Nursing Consideration
 High-risk (for nausea and vomiting) chemotherapy:
The dose of ondansetron for high-risk chemotherapy
is 24 mg 30 minutes before chemotherapy.
 Medium-risk (for nausea and

vomiting) chemotherapy: The dose of ondansetron

for medium-risk chemotherapy is ondansetron 8 mg
twice daily; etc
CASE STUDY
 Drug study
 PACLITAXEL
 Classification
 Paclitaxel is an anti-cancer ("antineoplastic" or

"cytotoxic") chemotherapy drug.

 Action

 Cancerous tumors are characterized by cell division,

which is no longer controlled as it is in normal tissue.

"Normal" cells stop dividing when they come into
contact with like cells, a mechanism known as contact
inhibition.
 Indications

 Treatment of breast, ovarian, lung, bladder, prostate,

melanoma, esophageal, as well as other types of solid

tumor cancers. It has also been used in Kaposi's
sarcoma.
CASE STUDY
 Drug study
PACLITAXEL
 Side Effects
 Feeling tired or weak.
 Upset stomach or throwing up.

 Loose stools (diarrhea); etc.

 Nursing Consideration
 Monitor vital signs frequently, especially during first
hr of the infusion.
 Monitor cardiovascular status especially during first

3 hr of infusion.
 Hypotension and bradycardia are common but

usually do not require treatment.

CASE STUDY
 Drug study
 CARBOPLATIN
 Classification
 Carboplatin is an anticancer drug ("antineoplastic" or

"cytotoxic") chemotherapy drug.  Carboplatin is classified

as an "alkylating agent."
 Action

 Carboplatin is an analog of cisplatin. Like cisplatin, it

contains a platinum atom surrounded in a plane by two

ammonia groups and two other ligands in the cis position.
 Indications

 Carboplatin is used to treat ovarian cancer.

 Carboplatin is also used for other types of cancer, including

lung, head and neck, endometrial, esophageal, bladder,

breast, and cervical; central nervous system or germ cell
tumors; osteogenic sarcoma; and as preparation for a stem
cell or bone marrow transplant.
CASE STUDY
 Drug study
CARBOPLATIN
 Side Effects
 Most people do not experience all of the side effects
listed.
 Side effects are often predictable in terms of their

onset and duration.

 Side effects are almost always reversible and will go

away after treatment is complete.; etc.

 Nursing Consideration
 Monitor results of peripheral blood counts.
 Monitor for peripheral neuropathy (e.g., paresthesias), ototoxicity,
and visual disturbances.
 Monitor serum electrolyte studies, because carboplatin has been
associated with decreases in sodium, potassium, calcium, and
magnesium. Special precautions may be warranted for patients on
diuretic therapy.
THANK YOU…..
ANY QUESTIONS???