npgordons.ovarian cancer

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Pres. Diosdado Macapagal Blvd. Metropolitan Park, Pasay City

A Nursing Process

on

Ovarian Cancer

In Partial Fulfillment of the Requirements

In Related Learning Experience, NCM 104

Manila Doctors, College of Nursing

Submitted by:

SCN IV

RLE Group 7

Albovias, JuanchoCo, Kyle Robertson

Elivera, Gwyn Alda

Guerrero, IvanJose, Ronald Michael

Mamisay, Ralston Peter

Menor, AnaOlayres, Jan Raphael

Pascasio, Leah Lhynn

Qui o, Quennie

Solano, ChristitaVicencio, Claire

Date Submitted:

March 6, 2010


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NURSING PROCESS

I. ASSESMENT

A. General Data

Patients Initials: P.A.S.P. Sex: Female

Address: Paraaque City Civil Status: Married

Age: 74 yrs. old Occupation: retired employee

# of Days in Hosp.: 2 days Place of Birth: Manila

Date of Birth: May 14, 1936 Order of Admission: Ambulatory

Date of Admission: January 14, 2010 Date of History: January 14 and 15, 2010

Informant: P.A.S.P. (client)

B.Chief Complaints

Stomach fullness and being bloated frequently for the past month.

C. History of Present Illness

16 years, prior to confinement, the client has already been diagnosed and under operation (Right

Total Mastectomy) for breast cancer, but have remained clean from it the following years.

1 month prior to confinement, the client has been feeling stomach fullness and passing pain

frequently. Her stomach was bloated and she experienced hyperacidity. Her friend sent her an e-

mail regarding the diagnosis of ovarian cancer, and she began to worry. She sought the help of a

Gynecologist in Singapore and she was asked to undergo CT scan, thoracic, pelvic and chest X-

ray. She underwent Trans-Vaginal Ultrasound and fluid was extracted from her stomach. She

also sought the help of an Oncologist in Singapore, who confirmed that she was positive for

ovarian cancer after undergoing PET scan and CA 125.

3 days prior to confinement, the client arrived from Singapore to have her check up under the

service of Dr. V. They got to discuss about the clients present state of health only 2 days prior to

confinement. Dr. V suggested for the client to undergo Chemotherapy and be observed in the

hospital.

D.Past History

1. Childhood Illness

Patient was unable to recall

2. Adult Illness

Breast cancer (1994), Appendicitis (1989),

3. Immunization


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Patient was unable to recall

4. Previous Hospitalization

Capitol Medical Center (March 1994) due to Breast Cancer, and undergone Right

Total Mastectomy in the same year. Makati Medical Center (September 1989) due

to appendicitis and undergone appendectomy and Caesarean Section operation

(April 1977). East Avenue Medical Center (August 1950) due to Chronic Tonsilitis

and undergone Tonsillectomy.

5. Operation/s

Tonsillectomy (East Avenue Medical Center; August 1950)

Caesarean Section (Makati Medical Center; April 1977)

Appendectomy (Makati Medical Center; September 1989)

Mastectomy (Capitol Medical Center; March 1994)

6. Injuries

First degree burn on Right arm (1995)

Vehicular accident (1992)

7. Medications taken prior to confinement

Centrum 500mg PO 1tab daily.

8. Allergies

The client has allergy on Seafoods. (specifically Crab and Shrimp)

E. Systems Reviews

1. Health Perception Health Management

The client stated that her general health has been well, except for the time when she

started to feel stomach fullness, being bloated, passing stomach pains and hyperacidity.

Aside from symptoms felt stated, she does not feel anything more. She says shes been well

with no occurrence of cough, colds and fever. She rarely gets sick. She does not take drugs,

smokes nor drink alcohol. She says to be living a healthy life. She had been in a vehicular

accident in 1992 but never experienced any more accidents in the years that came. She does

not know specifically why she had this cancer, but her thoughts point to the fact that she went

through her menopausal stage, late in life. She had been diagnosed with breast cancer in 1994

and had been through Mastectomy on the same year. When she began to feel the symptomsof her new disease, she immediately consulted the doctors, and every opinion she got

affirmed that she had ovarian cancer.

During her stay in the hospital, no significant changes occurred according to her. She

stated that she still considers her health to be good, even after chemotherapy. Generally she is

very tired and would like to take more rest periods. After chemotherapy, she states to have a

different reaction than other patients who have also undergone the same procedure. She looks

strong and composed, regardless of the known fact of her condition. She has an IV of PNSS


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with vital signs of: temp. 36.7 C, bp: 120/70 mm Hg, pulse rate: 78 bpm and respiratory

rate: 19 cpm.

2. Nutritional Metabolic Pattern

Before hospitalization, the client said that she has lost her appetite. She eats 1-2

square meals a day. She stated that back in Singapore, during breakfast, she loves to eat any

kind of cheese and grilled products. For lunch, and dinner, she would usually have grilled

meat or fish and vegetable. The client verbalized that she does not experience any discomfort

in eating or swallowing, other than not being able to digest meat properly and fully, so she

avoids eating a lot of meat. She drinks more than 10 glasses of water a day. Since the day she

was diagnosed with ovarian cancer in Singapore, she has been losing weight. When she

arrived in the Philippines, from 43kg, she got down to 38kg. Her wounds heal well.

During hospitalization, she stated that she does not like the food of the hospital.

hindi ako masyadong nakakakain dito kasi ayoko ng lasa ng ulam nila, matabang din kasi

kaya konti lang nakakain ko as verbalized by the patient. She knows that her weight is

continually decreasing, but she says that she will continue to eat a lot still, since her illness

did not affect her taste buds, or appetite for eating. The client stated that she only had a few

true teeth. Most are false teeth and dentures. There are no observed bony prominences in the

lower and upper extremities. Integrity of oral mucous membrane is still intact. Buccal

mucosa is pinkish with no lesions.

3. Elimination Pattern

Before hospitalization, the client had no difficulties in bowel elimination. Her bowel

elimination pattern is daily (1-2 times a day with the characteristics of brownish and semi-

solid stool and she does not use any aid to eliminate bowel. In urination, there are times when

she lacks control. Once she feels the urge to urinate, she has to rush to do so, because she

cannot control it that much. She urinates on an average, 7 times a day. She does not

experience excessive perspiration and she does not have odor problems. The color of her

urine is yellowish.

During hospitalization, she found it hard to eliminate bowel. Her bowel size is

smaller than her usual bowel size. She does not have any drainage system.

4. Activity Exercise Pattern

Before hospitalization, the client stated that she has sufficient energy to perform

desired activities. She tries to walk at least every morning, plays with her grandchildren most

of the time. In Singapore she also allots her free time playing with her grandchildren, she

reads novels or autobiographies for long hours. She stated that she can eat, bathe, dress,


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groom and do toileting on her own. She can also do chores and cooking alone but it usually

done by the maids.

During hospitalization, the patient verbalized that she easily get tired, mabilis akong

mapagod ngayon, tingin ko kailangan ko pa ng sapat na lakas para magawa ko yung mga

karaniwang ginagawa ko as verbalized by the client. But she can still do some range of

motions, her muscles are firm and she is able to grip things.

5. Cognitive Perceptual Pattern

In general, she verbalized that she does not experience any major sensory deficit. The

patient is not having any hearing difficulty but wears eye glasses. According to her, she has

not observed any changes in her memory lately. She is able to make important decisions but

she consults her family, relatives or friends first. The easiest way for her to learn things is

through demonstration. She feels happy and contented that among women at her age can

perform in the cyber world efficiently since she can chat; send messages via email and so on.

Upon hospitalization, there were no significant changes experienced by her. She is

aware of the date, time, place and the things she do. The patient is not having any hearing

difficulties and her eyeglass is on the bedside table. She is able to respond appropriately

when she is being asked with questions. She is attentive, participative, and responsive during

the interview. She is able to speak Filipino and English language. Vocabulary level and

attention span is good.

6. Sleep/Rest Pattern

Before hospitalization, the client verbalized that she is well rested and able to perform

her daily desired activity after sleeping. She usually sleeps for 6-7 hours a day not including

the afternoon naps which lasts for at least 1 hour. She usually starts to sleep at 9 10 pm then

wakes up at around 5 am. She has not used any sleeping aid and has not experienced any

nightmares or sleep onset problems.

During hospitalization, the patient was able to sleep for 4-5 hours. The client cannot

sleep well due to occasional visits of nurses on duty. She is not experiencing any nightmares

and does not use any sleeping aids.

7. Self Perception Self Concept Pattern

She feels good about her self. She stated that when given a chance to change anything

in her body she would change nothing. She also verbalized that she is happy and satisfied

with herself, even if she lacks her right breast. She verbalized that she is not encountering

any low self esteem issues.


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No significant changes upon hospitalization were reported. She is not easily

distracted. She still feels good about herself and has not shown any signs of low self esteem

issues even when someone asked on how she feels about the future.

8. Role Relationship Pattern

The client verbalized that she lives with her only daughters family, including her

husband and two children. She said that she is not having any family problems. She loves her

daughter and her daughters family so much. She lost her husband 22 years ago and has

never had anybody else in her life thereafter. Her relationship with her daughters family is

good.

During hospitalization, there were no significant and observed changes as verbalized

by the client. Her daughter could not join her in the Philippines, but still asks how she is and

her relatives stayed with her.

9. Sexual Reproductive Pattern

The client lost her husband 22 years ago and she had no other partner after that. She is

also very satisfied with her social relationship with her friends and relatives. She has not

encountered any serious problem with other people.

During hospitalization, there were no significant or observed changes as verbalized

by the client.

10. Coping/Stress Tolerance

During the stressful times of knowing of her illness, to chemotherapy, she stood on

her own and was strong. Her relatives never left her side. She is rarely neither tensed nor

anxious. Whenever there is big problem she just tries to speak it out with her family, relatives

or friends.

During hospitalization, no significant changes were noted. She does not even express

pain after undergoing chemotherapy. She is very independent, and strong. She never

complained of anything at all.

11. Values and Beliefs

Generally, she is able to get the basic needs in life. She plans to provide a better

future for herself. She is not afraid of what is to come, even death. She stated that if it is


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Gods will, she cannot do anything but prepare herself. She goes to mass every chance she

gets. She verbalized that any medical care will not be interfered by any religious practices.

F. Family Assessment

Name Relation Age Sex Occupation Educational

Attainment

P.A.S.P. Client 74 y/o F Retired

employee

College

Undergraduate

(2nd year college)

M.T.S.P.L. Daughter 32 y/o F Sales person College graduate

E.S.L. Son-in-law 33 y/o M I.T. specialist College graduate

S.S.P.L. Granddaughter 5 y/o F N/A Kinder IIB.G.S.P.L. Grandson 2 y/o M N/A N/A

J.G. House help 29 y/o F House help Elementary

Undergraduate

(Grade 6)

G. Heredo Familial Illness

Maternal: Breast Cancer

Paternal: none

H. Development History

Theorist Age Task Patient

DescriptionPsychosexual

theory bySigmund Freud

74y/o Genital stage The patient ismore on despair.

Though, the factthat she was

able to supporther family, sendher child tocollege andprovide themwith all theirbasic needswhich is for hergreatest dream.

There was also apart of the

patient thatsuggests her tohave achievedintegrity which isher verbalizationof contentmentand satisfactionto life and waseven ready(according toher) to facedeath itself.


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She has a verygoodrelationship withher neighborsand relatives.She believes

that she hasbeen a goodmother to herchildren but nota perfect wife toher husband.

The patient wasable to adapt tochanges inlifestyle as sheages and still

was independentin performingher ADLs such aseating, toileting,bathing andambulating.

Psychosocialtheory by

Eric Erikson

74y/o Integrity VS. Despair The patient hasmothered 1

child. She wasable to build herown family andraise them onher own whileproviding all

their basic needsand sending

them to schoolat the same

time.

Although there isalready no

sexual activitybetween herhusband for along time now,their intimacyshows their

strong tie witheach other andlove seems toendure afteryears. Even if

both of them arenot expressive

with theirfeelings with

each other, thepatient said thatshe appreciates

how herhusband takescare of her. Forher, thats oneway of showinghow they love

each other.


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Cognitivetheory by

Jean Piaget

74y/o Formal Operational

Phase

The patientexperiences

gradual declinein her cognitive

function.

She has hearingdifficulties andvision problemswhich were thenvalidated during

the interview.She used to

wear readingglasses before

but she stoppedwhen shenoticed it

doesnt help hervision even a bit.She doesnt use

any hearingaids. According

to her, sheexperiences

memorychanges; she is

sometimeshaving a hardtime recalling

things.

The patientrespects thedecision andopinions of

others becauseshe believes thateach is entitled

to her ownopinion

Moral theoryLawrence by

Kohlberg

74y/o Level III:Post- ConventionalStage 6: Universal

Ethical Principle

According to thepatient, beforemaking a majordecision she first

outweighs thebenefits and

disadvantages ofher decision. She

based herdecision on herown evaluationand standard of

what is right.

The patientbelieves what

you do to otherpeople is what

other people willdo to you.

Furthermore,she is not thetype of person

who simplycomplies with


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the rules ofmajority, if she

thinks it isunnecessary.

Spiritualtheory

James Fowler

74 years old Universalizing The patient is areligious person.

She nevermissed a singlechurch activityevery Sundays

(that is beforeher

confinement).

They used toattend the mass

every Sundaywhich then

serves as theirfamily bonding

moments.

Despite of thethings she

experiencedwith her life, thepatient said thatshe knows that

God wantseverything to

happen and thatshe had a

purpose fordoing so. She

said that she is awoman of

integrity andhonesty. She

works hard andthe values of

fair-play,perseveranceand dedicationare the things

she holds on intoher character

and the thingsshe wants herchild to learn

from her.

I. PHYSICAL EXAMINATION (January 15, 2010; 1000H)

A. GENERAL SURVEY

Date: January 15, 2010


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Time: 1000H

Height : 146 cm

Actual Weight: 38 kg

Body Mass Index: 17.8 kg/m2

Abdominal Girth: 37.5 cm

Vital Signs

Temp: 36.7 C

PR: 78 beats per minute

RR: 22 breaths per minute

BP: 120/70 mmHg

B. REGIONAL EXAMINATION

Skin

I:

Fair complexion

No visible lumps and masses

Striae on the abdomen

Presence of 1st degree burn on right arm

P:

Good skin turgor

Warm to touch

dry skin

Hair and Scalp

I:

Hair is brownish to reddish

Thin Hair

Wavy to curly hair

Evenly distributed in the scalp

No observable flakes or dandruff

P:

Minimal oiliness hair

No masses

No tenderness

Nails

I:

Transparent, well-rounded and convex


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Fingernails are clean and short

Cuticles of the fingernails are intact without inflammation

Fingernail beds are pale

P:

Smooth fingernails

Rough toenails

Firmly attached to nail bed

Capillary refill returns after 3 seconds

Head and Face

I:

Normocephalic and positioned on the midline

Proportion to gross body structure

Facial expressions are symmetrical

No excessive hair around face

P:

Absence of deformities, lumps or masses

Absence of tenderness

Eyes

I:

Eyes are parallel to each other

Eyebrows are grayish and symmetrical

Eyelids color same as skin

Eyelashes are evenly distributed and curved outward

Pinkish conjunctiva

Anicteric sclera

Corneas are shiny and smooth

Pupils are equally round and reactive to light and accommodation

Blinking in response to bright light

Blinking in response to quick movement of an object toward eyes

Able to blink when wisped with cotton

Blinking is symmetrical

Normal convergence and extraocular movements

Able to see things in the periphery

Near visual acuity: can hardly read printed materials with or without

eyeglasses

P:

Absence of tenderness and drainage from lacrimal apparatus

Ears


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I:

Bean shaped

At the level of outer canthus of the eyes

Absence of discharges and lesions

P:

Firm and smooth

Absence of tenderness

Tests:

Rinnes Test: air conducted sound was heard twice as long as bone

conducted sound

Webers Test: able to hear sounds on both ears; louder on right ear Patient can easily hear whispers on right ear

Patient has difficulty hearing whispers on left ear

Nose and Sinuses

I:

Nose is same color as skin

Nasal mucosa is pinkish and moist

P:

Patent nares

Absence of masses and tenderness

Mouth and Pharynx

I:

Lips are light pink to light brown

Lips are smooth

Absence of lesions on the gums, tongue, or buccal mucosa

Pinkish buccal mucosa

Tongue is in midline position, dull red & moist

Neck

I:

Proportional to her body

Light scar on xiphoid process

No neck vein engorgement seen

Able to move neck without difficulty

Symmetrical to the body

Same color as the body

P:

No palpable lymph nodes


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No tenderness

No masses

Thorax and Lungs

Posterior, Lateral, Anterior:

I:

Rib slopes across and down

Thorax is symmetrical

With shoulders on same level

Straight spine

P:

No lumps

No masses

No Tenderness

P:

Resonant over all the lung field

A:

Bilaterally normal breath sounds

Breast

I:

Right breast removed through Mastectomy

Keloid scar visible from just below right armpit, until below where the right breast is.

Nipples and areola are round and brown in color on left breast.

P:

No lumps

No masses

No tenderness

Heart

I:

Absence of visible pulsations

P:

Absence of jugular vein distention

Absence of heaves, lifts, or thrill

A:

PMI is located at the 5th intercostals space left midaxillary line

Presence of S1 and S2

Absence of murmurs

Abdomen


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I:

Incision seen from below the umbilicus down towards the mons pubis

Bloated

No protruding masses

Abdomen is round and symmetric

The color is the same as neighboring skin

Umbilicus is concave positioned and at midline

A:

Soft

Absence of masses

P:

With no tenderness

No masses

Fullness felt upon palpation

Per:

Dullness

Musculoskeletal System

Upper, Lower Extremities:

I:

No gross deformities

No enlarged bony structure

IVF on left metacarpal vein, sight is free from signs of infection or inflammation

P:

Negative edema, and swelling

No masses and tenderness on all joints

Range of Motion:

Able to perform passive and active range of motions in all extremities

Genitalia

Not examined

Anus and Rectum

Not examined

Neurological System

Appearance and Behavior:

Awake and alert

Understand questions and responds appropriately


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Able to walk around

Looks relaxed

Kyphotic posture

Dressed appropriately, has good hygiene

Has appropriate facial expression

Speech and Language:

Able to express feelings well

Speech was in moderate rate

Talks in a moderate tone voice

Able to speak clearly and distinctly

Mood:

Has appropriate mood depending on the situation

Thought and Perception:

Able to converse coherently with relevant and organized information

Cognitive Functions:

Oriented to time, place, self and other people

Has good attention span

Able to recall remote memory as evidenced by ability to remember past

events in his life

Able to recall recent memory

Cranial Nerve Assessment:

Cranial Nerve I (Olfactory) - Able to detect smell of perfume

Cranial Nerve II (Optic) - Unable to read printed materials

Cranial Nerve III, IV, VI (Oculomotor, Trchlear, and Abducens) - Pupils

are reactive to light and accommodation. Able to follow six directions of gaze.

Cranial Nerve V (Trigeminal) - Able to clench jaw; Able to detect painful

stimuli applied to his face; Eyes blinked when wisped with cotton.

Cranial Nerve VII (Facial) - Able to show different facial expressions

Cranial Nerve VIII (Acoustic) - Positive for lateralization of sounds. Air

conduction lasted longer than bone conduction on both ears.

Cranial Nerve IX and X (Glossopharyngeal and Vagus)- Presence of gag

reflex

Cranial Nerve XI (Spinal Accessory) - Able to shrug shoulders

Cranial Nerve XII (Hypoglossal) - Has good articulation. Tongue is

symmetrical, located on the midline, and able to move freely

Sensory System:

Able to determine painful stimuli


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Able to detect light touch

Has difficulty detecting sensation of vibration

Two -point discrimination: 45 mm

Reflexes:

Biceps Reflex- 2+ average, normal

Triceps Refles- 2+ average, normal

Abdominal reflex- 2+ average, normal

Knee Reflex- 2+ average, normal

Plantar Response- plantar flexion of toes

II. PERSONAL / SOCIAL HISTORY

Habits: The client loves nothing else but plays with her grandchildren and read numerous

amounts of books.

Vices: none

1. Lifestyle: Sedentary. The patient used to have an active lifestyle until he

started to experience a gradual decline in his health. Presently, he gets easily

fatigued after walking several steps, that is why he usually limits his activity

to sitting and walking a few steps.

Social Affiliation: none

Rank in the Family: 8th of 9 siblings

Travel: Singapore

Educational Attainment: College Undergraduate2nd Year College

Clients usual day: Client usually starts her day by waking up between 5 7 am. Upon

waking up, she takes a bath, goes to church and get back before 8 am,

for breakfast. When she has nothing to do, she just reads books for

long hours or at least get an hour of sleep. She oftentimes goes to

malls to window shop, either by herself or with relatives.

III. ENVIRONMENTAL HISTORY

The client resides in Singapore and only came back to have her ovarian cancer be

treated since it is expensive there. Singapore is known to be one of the cleanest places in the

world. The client lives by the highway, but there are no belches and smog. In the Philippines,

she lives in a private subdivision where there are guards, and the church is at a close distance.

Public establishments though are quite distant. One needs to rife a public vehicle to reach

such destinations. In their subdivision, the water is NAWASA. There are trees and garbage is

collected, every week.

IV. OB GYNE HISTORY


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Menarche (age): 14 When: Dec. 1950 .

Amount and Characteristic: none

Duration: 6 days / irregular

Associated Symptoms: none.

Deliveries:G____P____ Operations:____

OB Score :T_____P____A_____L_____

V. PATHOPHYSIOLOGY

Pathophysiology

Theoretically Based

Ovarian Cancer

`

1 0 3 1

4 1 1

Predisposing Factors:

Hereditary

Previous history of Cancer

Age > 55 y/o

Gender (Female > Male)

Infertility

Precipitating Factors:

OB Score (nulliparity)

Lifestyle

Hygiene

Egg cellsConnective tissue cells that produce

hormones (estrogen-progesterone)Outer surface of

the ovary

Germ cell

tumors

Stromal cell

tumors

Epithelial

tumors

Error in tissue-repair process

New cells form when the body does

not need them

Old cells do not die when they

should

Formation of a mass of tissue from

the extra cell

Growth or tumor formation

Benign tumor Malignant tumor

Most Common Symptoms

Abdominal pressure,

fullness, swelling or bloating

Urinary urgency

Pelvic discomfort or pain

Additional Symptoms

Persistent indigestion, gas

or nausea

Unexplained changes in

bowel habits, such asconstipation

Changes in bladder habits,

including a frequent need tourinate

Loss of appetite or quickly

feeling full

Increased abdominal girth

or clothes fitting tighter around

your waist

Pain during intercourse

(dyspareunia)

A persistent lack of energy

Low back pain

Changes in menstruation


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* Textbook of Medical-Surgical NursingSmeltzer; Bare; Hinkle; Cheever11th ed; vol 2; pp1689-1690

Pathophysiology

Client Based

Ovarian Cancer

`

Predisposing Factors:

Hereditary

Previous history of Cancer Age > 55 y/o

Female

Precipitating Factors:

OB Score (nulliparity)

Lifestyle

Hygiene

Outer surface of the ovary

Epithelial

tumors

Error in tissue-repair process

New cells form when the body does

not need them

Old cells do not die when they

should

Formation of a mass of tissue from

the extra cell

Growth or tumor formation


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X. ONGOING APPRAISAL

Client P.A.S.P a 74 year old female was admitted last January 14, 2010 at around 1:59

pm. Client was ambulatory when she arrived her informant was M.A.D.G (niece). P.A.S.P wasborn on April 14, 1936 at Manila. Civil status is widowed, currently living at Paranque City.

P.A.S.P is on DAT diet P.A.S.P is scheduled for a Chemotheraphy course 1 procedure, consent

for chemo secured last Jan. 14. IVF # 1 D5 NM 1L x 8 hours regulated to 31 gtts/min and SD # 1D5 W 500cc x 3 + 230mg Faclitatel regulated to 41 gtts/mi was administered. 1 st IVF consumed

and was replaced by IVF # 2 D5 NSS 1L x 10 regulated at 25 gtts/min. P.A.S.P was given the

following medications Megestrol Acetate 400mg 1 tab TID, Decilone Forte 4mg 1 tab BID andCarmocain 400mg. P.A.S.P was diagnosed of Breast Cancer

XI. DISCHARGE PLAN

MEDICATIONS:

Encourage the client to comply with all the prescribed medications.

Emphasize to the client and her family of the importance of taking the medications at the

prescribed schedule, dosage and frequency.

Educate the client about the purpose of the drugs. Advice the significant others not to leave the client during medication to secure that the

client has taken the medicines.

Explain to the client the side effects and adverse effects of the drug she takes bydescribing its manifestations. Client and significant others should be aware so that

prompt medical intervention can be given if in case such reaction occur.

Megestrol Acetate 400mg 1 tab TID

Decilone Forte 4mg 1 tab BID

Carmocain 400mg

EXERCISE: Encourage to ambulate and assume her normal activities as long as there will be no

problems.

Instruct client to have frequent arms and leg exercises.

Educate the client on proper body mechanics to enable her to relax, be comfortable and

prevent strains.

Instruct the client to balance activities with adequate rest periods.

TREATMENT:

Educate the client on the importance of drug and money compliance.

Discuss to the client the complication of the condition because knowledge about thecondition supports learning that will decrease anxiety.


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Instruct the client to report or ask medical assistance when abnormalities occur.

Educate the family on how to demonstrate a correct performance of the treatment.

HYGIENE:

Instruct the client to do proper personal hygiene such as taking a bath daily, brushing her

teeth after eating and proper grooming. Stress out to the client the importance of hand washing before and after using the comfort

room and eating to deter the spread of microorganisms.

Encourage the client as well as the significant others to follow physicians instructionsregarding personal hygiene and self care.

OUT-PATIENT REFERRALS:

Instruct the patient to comply with the scheduled follow up check up to enable the

physician to have continuous record on the clients condition.

Advice the client to report any abnormalities observed to provide immediate medicalintervention.

Review signs and symptoms with the client. These symptoms may include pressure onthe bladder with difficulty voiding or urinary frequency and urgency, pressure on the

rectum with constipation, lower back and abdominal pain, as well as heavy bleeding.

DIET:

Instruct the client to follow physicians order regarding proper food intake and tell her its

importance.

Encourage the client to avoid fatty foods and increase intake of vegetables and fruits.

Advice client to increase oral fluid intake to facilitate proper circulation or blood and toprovide needed nutrients and electrolytes.

SEXUALITY:

Inform the client that there is a breath and depth of sexual expression possible and that

she is a person of value.

Recognize the feeling of warmth, approval, and friendship, as well as sharing andtouching, are important.

Inform the patient of the availability of the following services: sex education or

counseling services (individual, couples and family); sex therapy; group discussion;

audiovisual materials and regarding materials.

SPIRITUALITY:

Encourage client to strengthen her faith with Almighty Father to provide spiritual growthand promote healing.

Advice client never to forget God, to ask for Jesus help and to believe in the healing

power of the Holy Spirit to promote peace of mind and relaxation, thus promotingcomfort and healing not just to the mind but also to avoid harm and promote a soothing

and pleasant atmosphere with everyone.

npgordons.ovarian cancer

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