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, Juancho
Co, Kyle Robertson
Elivera, Gwyn Alda
Guerrero, Ivan
Jose, Ronald Michael
Mamisay, Ralston Peter
Menor, Ana
Olayres, Jan Raphael
Pascasio, Leah Lhynn
Quiṅo, Quennie
Solano, Christita
Vicencio, Claire

Date Submitted:
March 6, 2010
 NURSING PROCESS
I. ASSESMENT
A. General Data

Patient’s Initials: P.A.S.P. Sex: Female

Address: Parańaque City
Age: 74 yrs. old
# of Days in Hosp.: 2 days
Date of Birth: May 14, 1936
Date of Admission: January 14, 2010
Informant: P.A.S.P. (client)
Civil Status: Married
Occupation: retired employee
Place of Birth: Manila
Order of Admission: Ambulatory
Date of History: January 14 and 15, 2010

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 client’s 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
  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 she’s 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 symptoms
of 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
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,
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.
 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 daughter’s family, including her
husband and two children. She said that she is not having any family problems. She loves her
daughter and her daughter’s family so much. She lost her husband 22 years ago and has
never had anybody else in her life thereafter. Her relationship with her daughter’s 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
 God’s 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 College
employee 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 II
B.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
Description
Psychosexual 74y/o Genital stage The patient is
theory by more on despair.
Sigmund Freud Though, the fact
that she was
able to support
her family, send
her child to
college and
provide them
with all their
basic needs
which is for her
greatest dream.

There was also a

part of the
patient that
suggests her to
have achieved
integrity which is
her verbalization
of contentment
and satisfaction
to life and was
even ready
(according to
her) to face
death itself.
 She has a very
good
relationship with
her neighbors
and relatives.
She believes
that she has
been a good
mother to her
children but not
a perfect wife to
her husband.

The patient was

able to adapt to
changes in
lifestyle as she
ages and still
was independent
in performing
her ADLs such as
eating, toileting,
bathing and
ambulating.
Psychosocial 74y/o Integrity VS. Despair The patient has
theory by mothered 1
Eric Erikson child. She was
able to build her
own family and
raise them on
her own while
providing all
their basic needs
and sending
them to school
at the same
time.

Although there is
already no
sexual activity
between her
husband for a
long time now,
their intimacy
shows their
strong tie with
each other and
love seems to
endure after
years. Even if
both of them are
not expressive
with their
feelings with
each other, the
patient said that
she appreciates
how her
husband takes
care of her. For
her, that’s one
way of showing
how they love
each other.
 Cognitive 74y/o Formal Operational The patient
theory by Phase experiences
Jean Piaget gradual decline
in her cognitive
function.

She has hearing

difficulties and
vision problems
which were then
validated during
the interview.
She used to
wear reading
glasses before
but she stopped
when she
noticed it
doesn’t help her
vision even a bit.
She doesn’t use
any hearing
aids. According
to her, she
experiences
memory
changes; she is
sometimes
having a hard
time recalling
things.

The patient
respects the
decision and
opinions of
others because
she believes that
each is entitled
to her own
opinion
Moral theory 74y/o Level III: According to the
Lawrence by Post- Conventional patient, before
Kohlberg Stage 6: Universal making a major
Ethical Principle decision she first
outweighs the
benefits and
disadvantages of
her decision. She
based her
decision on her
own evaluation
and standard of
what is right.

The patient
believes what
you do to other
people is what
other people will
do to you.

Furthermore,
she is not the
type of person
who simply
complies with
 the rules of
majority, if she
thinks it is
unnecessary.

Spiritual 74 years old Universalizing The patient is a

theory religious person.
James Fowler She never
missed a single
church activity
every Sundays
(that is before
her
confinement).

They used to
attend the mass
every Sunday
which then
serves as their
family bonding
moments.

Despite of the
things she
experienced
with her life, the
patient said that
she knows that
God wants
everything to
happen and that
she had a
purpose for
doing so. She
said that she is a
woman of
integrity and
honesty. She
works hard and
the values of
fair-play,
perseverance
and dedication
are the things
she holds on into
her character
and the things
she wants her
child to learn
from her.

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

A. GENERAL SURVEY
Date: January 15, 2010
 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 ºC
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
 • 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
• Eyelid’s 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
 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:
• Rinne’s Test: air conducted sound was heard twice as long as bone
conducted sound
• Weber’s 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
  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
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
 • 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
 • 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 Undergraduate 2nd Year College

Client’s 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

 Menarche (age): 14 When: Dec. 1950 .
Amount and Characteristic: none
Duration: 6 days / irregular
Associated Symptoms: none.

4 1 1
Deliveries: G____ P____ Operations: ____
1 0 3 1
OB Score : T_____P____A_____L_____

V. PATHOPHYSIOLOGY
Pathophysiology
Theoretically Based
Ovarian Cancer

`
Predisposing Factors:
Precipitating Factors:
• Hereditary
• OB Score (nulliparity)
• Previous history of Cancer
• Lifestyle
• Age > 55 y/o
• Hygiene
• Gender (Female > Male)
• Infertility

Connective tissue cells that produce Outer surface of

Egg cells hormones (estrogen-progesterone) the ovary

Germ cell Stromal cell Epithelial

tumors tumors tumors

Error in tissue-repair process

New cells form when the body does Old cells do not die when they
not need them should

Additional Symptoms
Formation of a mass of tissue from
• Persistent indigestion, gas
the extra cell or nausea
• Unexplained changes in
Growth or tumor formation
bowel habits, such as
constipation
• Changes in bladder habits,
Benign tumor Malignant
including tumor need to
a frequent
urinate
• Loss of appetite or quickly
Most Common Symptoms feeling full
• Abdominal pressure, • Increased abdominal girth
fullness, swelling or bloating or clothes fitting tighter around
• Urinary urgency your waist
• Pelvic discomfort or pain • Pain during intercourse
(dyspareunia)
• A persistent lack of energy
• Low back pain
• Changes in menstruation
* Textbook of Medical-Surgical Nursing
Smeltzer; Bare; Hinkle; Cheever
11th ed; vol 2; pp1689-1690

Pathophysiology
Client Based

Ovarian Cancer

`
Predisposing Factors:
Precipitating Factors:
• Hereditary
• OB Score (nulliparity)
• Previous history of Cancer
• Lifestyle
• Age > 55 y/o
• Hygiene
• Female

Outer surface of the ovary

Epithelial
tumors

Error in tissue-repair process

New cells form when the body does Old cells do not die when they
not need them should

Formation of a mass of tissue from

the extra cell

Growth or tumor formation

 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 was
born 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 # 1
D5 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 and
Carmocain 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 by
describing 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 the
condition supports learning that will decrease anxiety.
 • 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 physician’s instructions
regarding 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 client’s condition.
• Advice the client to report any abnormalities observed to provide immediate medical
intervention.
• Review signs and symptoms with the client. These symptoms may include pressure on
the 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 to
provide 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 and
touching, 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 growth
and 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 promoting
comfort and healing not just to the mind but also to avoid harm and promote a soothing
and pleasant atmosphere with everyone.