A Case Study on Renal Cancer

A Case Study on Renal Cancer

INTRODUCTION

Your kidneys are two bean-shaped organs, each about the size of your fist. They're located behind your abdominal organs. Their main job is to clean your blood, removing waste products and making urine. Like other major organs in the body, the kidneys can sometimes develop cancer.

INTRODUCTION

In adults, the most common type of kidney cancer is renal cell carcinoma, which begins in the cells that line the small tubes within your kidneys.

The good news is that most of these cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully.

INTRODUCTION

The American Cancer Society estimates that almost 51,000 people in the United States are diagnosed with kidney cancer each year.

Of these diagnoses, most occur in people aged 50-70 years, but the disease can occur at any age.

About twice as many men as women develop this cancer, and it occurs in all races and ethnic groups.  

INTRODUCTIONCertain factors appear to increase the risk of getting kidney cancer.

occurs most often in people older than age 40. Smoking obese. Using certain pain medications for a long time having advanced kidney disease having certain genetic conditions, such as von Hippel-Lindau (VHL)

disease or inherited papillary renal cell carcinoma family history of kidney cancer exposure to certain chemicals, such as asbestos, cadmium,

benzene, organic solvents, or certain herbicides having high blood pressure.

GOALS OF THIS RESEARCH • To raise the level of awareness of patient on

health problems that he may encounter.• To facilitate patient in taking necessary actions to

solve and prevent the identified problems on his own and with the assistance from family, relatives or any of the significant others.

• To help patient in motivating him to continue the health care provided by the health workers in Northern Mindanao Medical Center and most especially by the students and Clinical Instructor of Capitol University.

GOALS OF THIS RESEARCH • To render nursing care and information to patient

through the application of the nursing skills. One way of doing this is by having health teachings related to the disease process that the patient is experiencing.

• To add into the current care presentation output that has been collected for how many years in the College of Nursing, Capitol University.

• And of course, to help the RLE 6 more knowledgeable in making or conducting a case presentation in the higher years.

Nursing TheoryThis case presentation is based on

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

CLIENT PROFILE• Patient X is a 76-year-old male, Filipino citizen and was

baptized under Roman Catholic faith. He is currently residing at Macabalan, Cagayan de Oro City. He was married and they were blessed with four siblings.

• Patient X used to work as a porter at Cagayan de Oro City Port. According to him, his job was so tiring and it requires a lot of energy to finish a day’s work.

• Patient X seeks financial support from his children aside from his monthly salary. His family was always supportive of him most specially in problems regarding his health. In times of distress, relaxation, such as walking and sleeping, is his best coping strategy. He personally manages and leads his family aside from the help and support from his wife.

•  

• Vital SignsUpon assessment, the following data was obtained from the Patient X:

Blood pressure=110/60 mm Hg;

Axillary temperature= 35.6oC;

Pulse rate= 86 beats per minute;

Respiratory rate= 28 counts per minute.

• Chief ComplaintsPatient X felt pain upon urination, anorexia and body malaise.

• Family Health- Illness HistoryNo known genetic diseases that run in the family.

History of Present Illness

Two weeks prior to admission, Patient X felt a flank pain at the right retroperitoneal area. He also suffered from dysuria (pain upon urination). A week prior to admission, he noticed blood-tinged / tea-colored urine. Medical assistance was then sought by the patient when pain becomes intolerable. He was admitted at Polymedic Hospital for almost a week.

On August 29, 2009, he was then referred to Northern Mindanao Medical Center for further management. After undergoing several assessments and diagnostic tests, he was diagnosed of having a Left Renal Cancer.

• History of Past Illness This is the first hospitalization of the

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

• Statement of Patient General Appearance.

Patient X looks pale, weak and drowsy. However, he was very responsive and was willing to answer whenever questions were asked to him.

• Nutritional and Metabolic PatternPatient X eats three times a day. He has poor

appetite and usually consumed his food half of share. He seldom drinks water, with an average of 3-4 glasses per day. He also consumes at least 3 cups of coffee every day.

Patient X is a chain-smoker since he was 14 years old and had only stopped smoking lately, about 4 months prior to his hospitalization. He used to smoke ½ packs per day. He was also an occasional alcohol-drinker.

•Elimination PatternPatient X regularly defecates every day with

yellowish to brownish stool and soft in consistency. He doesn’t have any discomforts felt during defecation.

He maturates three times a day in the morning but he also suffered from nocturia, approximately 6-10 episodes every night. The urine color varies from dark yellow to tea-colored urine.

During admission, Patient X was hooked to a foley bag catheter attached to a urobag with cystoclysis, draining with a tea-colored excretions at about 150 cc per shift.

• Activity and Exercise PatternThe patient does not have a regular

exercise activity. He spent his leisure time watching television and playing majong at their neighborhood.

• Cognitive-Perceptual PatternThe patient was well oriented to time,

place and person. He often appears calm upon interaction but sometimes, he appears restless whenever he experienced difficulty of breathing.

He could converse using Cebuano, Filipino and English languages. He was a graduate of BS Commerce.

• Sleep-Rest Pattern Patient X usually sleeps at 10pm

and gets up at 4am. Nevertheless, he has inadequate sleep due to his nocturia. He never has any ways or methods to promote sleep.

Genitourinary System

Right retroperitoneal flank pain w/ pain scale of 9/10Right renal massLeft renal cystHematuriaNocturia- 6-10 episodes (before catheterization)

Pallor skin, nail beds and mucous membranesDelayed capillary refill – 4 sec.senile skin turgorBipedal edema- Grade= +1 Muscle strength= +4

NURSING SYSTEM REVIEW CHART

DOCTOR’S ORDER8/29/09

9:30 AM > please admit at A3F2

>Secure consent

>TPR every 4 hours

>DAT

>IVF D5LR @ 30 gtts per min

>Lab: CBC with BT

: Serum sodium, potassium, crea, BUN

: ECG 12 leads

: CTBT

: PTPA, APTT

>Meds: ciprofloxacin 500 mg BID PO

: Hemostan 1 tab TID PRN for bleeding

: Multivitamins + iron 1 capsule OD

>V/S every 4 hours

>I and O every shift

>Insert FBC three way then start cystoclysis @ 40 gtts per minute

>Refer accordingly

DOCTOR’S ORDER8/29/09

8:30 PM >IVF to follow D5LR 1L @ 30 gtts per min

8/30/09

9:00AM >VF to follow D5LR 1L @ 30 gtts per min

>DAT

>Ambulate

>IVF to follow D5LR 1L @ 30 gtts per min

>Continue cystoclysis

>V/S every 4 hours

>I and O every shift

>Repeat for CT scan on Tuesday

>Secure 6 units of PRBC of patient’s blood type properly secured and cross-matched

>Refer

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

DOCTORS ORDER9:35 PM >IVF to follow D5LR 1L @ 30 gtts per min

8/31/09

7:00 AM >DAT

>Ambulate

>IVF to follow D5LR 1L @ KVO rate

>Continue meds

>V/S every 4 hours

>I and O every shift

>Continue cystoclysis @ 40 gtts per min

>Transfuse 2 units of PRBC of patients blood type properly secured and cross-matched with 6 hour infusion

>BT precaution please

>Still for CT scan

>Refer

DOCTOR’S ORDER9/2/09

>DAT

>Still for Ct scan tomorrow

>Continue meds

>Give celecoxib 200 mg BID for pain>Continue cystoclysis

>Repeat HB, HCT now

>V/S every 4 hours

>I and O every shift

9/4/09

7:30 AM>continue IVF

>Continue cystoclysis

>Continue meds

>Follow-up CT scan result>Refer

LABORATORY AND DIAGNOSTIC

PROCEDURES

HEALTH TEACHINGS / DISCHARGE PLAN

Medications/Management:

• Ciprofloxacin 500 mg 1 capsule BID (twice a day) x 7 days

• Tramadol 50 mg 1 capsule TID (three times a day) for pain

• Multivitamins + FeSO4 1 capsule OD (once a day)

• Watch for adverse reactions and patient’s response to pain management plan as indicated.

• Report any adverse reactions or failure to provide adequate pain relief.

HEALTH TEACHINGS / DISCHARGE PLAN

Economics:• Explain to significant others that the

rehabilitation may be prolonged to be able for the family to prepare financial needs

• Have physical therapist to re-learn function as transferring, walking and other gross motor functions

• Have occupational therapist to help re- learn everyday activities or ADL

HEALTH TEACHINGS / DISCHARGE PLAN

• Treatments:– Primary treatment- involves the removal of the

malignant tumor and a small margin of adjacent normal tissue.

– Adjuvant treatment- involves the removal of tissues to decrease the risk of cancer recurrence.

– Salvage treatment- involves the use of an extensive surgical approach to treat a local recurrence after implementing a less extensive primary approach.

– Palliative treatment- is surgery that attempts to relieve the complications of cancer.

HEALTH TEACHINGS / DISCHARGE PLAN

Health:• Maintain effective deep breathing exercise for lung expansion.• Promote the prevention of infection.• Improve nutritional status.• Importance of proper hygiene for comfort.• Lifestyle modifications for in smoking and drinking hard beverages will

be emphasized to promote healthy lifestyle.• Instruct the patient and family regarding exercises to prevent limited

range of motion and discomfort.• Perform exercises in the morning and evening, initially exercises are

done only once, the number is increased by one and each exercise is done 10 times.

• After each exercise, the patient is instructed to relax.

HEALTH TEACHINGS / DISCHARGE PLAN

Out-patient referral:• OPD follow-up on September 10, 2009.• Emphasize the needs for frequent follow-

up visits and completion of therapy if needed for further evaluation with regards to post-operative complications to ensure complete recovery.

• Keep urethral catheter in place.

HEALTH TEACHINGS / DISCHARGE PLAN

Diet:• Use the food pyramid as guideline and

eat a variety of foods with an emphasis on plant resources.

• Eat five or more servings of vegetables and fruit daily.

• Choose whole grains.• Intake of fluids 8-a0 glasses a day to

avoid constipation and to maintain skin turgor.

HEALTH TEACHINGS / DISCHARGE PLAN

• SpiritualPrayer transcends everything. God

knows thy needs even before we kneel and pray to Him. Health problems are just a matter of challenges which help strengthen one’s faith to God.