MARIANO MARCOS STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF NURSING

NCM 106

UTERINE CANCER
Submitted by:

Andres, Louette Geneve

Calingasan, Karla Janille
Fernandez, John Lester M.
Jerez, Cecille Odette
Ranjo, Laurice Faye A.

Sagun, Juliet G.
Santos, Milcca Hanyl A.

BSN IV-B

Submitted to:
Prof. Gileen I. Lagadon
I. Description
The uterus is a hollow organ in females located in the pelvis, commonly called the womb.
The uterus functions to support fetal development until birth. The uterus is shaped like an
upside-down pear; the top is the fundus, the middle is the corpus, and bottom is the cervix;
the inner layer of the uterus is the endometrium, and the outer layer is muscle (myometrium).
Uterine cancer is the abnormal (malignant) growth of any cells that comprise uterine
tissue. The build-up of cancer cells may form a mass (malignant tumor).

Two Primary Types of Uterine Cancer

Endometrial cancer develops in the lining of the uterus, called the endometrium. This is
the most common type of uterine cancer, accounting for more than 95 percent of cases.
Uterine sarcoma is a more rare type of uterine cancer, and forms in the muscles or other
tissues of the uterus.

Incidence
The number of new cases of endometrial cancer was 25.7 per 100,000 women per year.
The number of deaths was 4.6 per 100,000 women per year. These rates are age-adjusted
and based on 2010-2014 cases and deaths.
According to American Society of Clinical Oncology, this year, an estimated 61,380
women in the United States will be diagnosed with uterine endometrial cancer. Uterine cancer
is the fourth most common cancer for women in the United States. The incidence of
endometrial cancer is rising, mostly because of a rise in obesity, which is an important risk
factor for this disease.
It is estimated that 10,920 deaths from this disease will occur this year. It is the sixth most
common cause of cancer death among women in the United States.
In the Philippines, the annual mortality rate per 100,000 people from uterine cancer in
Philippines has increased by 83.0% since 1990, an average of 3.6% a year.

Etiology
The exact cause of uterine cancer is unknown. What's known is that something occurs to
create a genetic mutation within cells in the endometrium the lining of the uterus.
 The genetic mutation turns normal, healthy cells into abnormal cells. Healthy cells grow and
multiply at a set rate, eventually dying at a set time. Abnormal cells grow and multiply out of
control, and they don't die at a set time. The accumulating abnormal cells form a mass (tumor).
Stages of Uterine Cancer:
o Stage 0: The abnormal cells are found only on the surface of the inner lining of the
uterus. The doctor may call this carcinoma in situ.
o Stage I: The tumor has grown through the inner lining of the uterus to the endometrium.
It may have invaded the myometrium.
o Stage
o Stage III: The tumor has grown through the uterus to reach nearby tissues, such as the
vagina or a lymph node.
o Stage IV: The tumor has invaded the bladder or intestine. Or, cancer cells have spread
to parts of the body far away from the uterus, such as the liver, lungs, or bones.

II. Risk Factors

There are 5 factors that increases the risk for uterine cancer;
Age- The risk of developing uterine cancer increases with age. The majority of
cases occur in women aged 40 to 74, with only 1% of cases being diagnosed in women
under 40.
Changes in the balance of female hormones in the body - Estrogen is one of the
hormones that regulate the reproductive system in women. The risk of developing uterine
cancer is linked to the body's exposure to estrogen. Usually the level of oestrogen and
progesterone are balanced with each other. If happens that the oestrogen is not kept in
balance by progesterone, the level in the body increases. This is called unopposed
estrogen. After menopause, the body stops producing progesterone. This unopposed
estrogen causes the cells of the endometrium to divide thus it increases the risk for uterine
cancer.
A disease or condition that increases the amount of estrogen, but not the level of
progesterone, in the body can increase the risk of endometrial cancer. Examples include
irregular ovulation patterns, such as those that can occur in women with polycystic ovary
syndrome, obesity and diabetes. Taking hormones after menopause that contain estrogen
but not progesterone increases the risk of endometrial cancer.
Obesity. As estrogen can be produced in fatty tissue, being overweight or
obese increases the level of oestrogen and this significantly increases the risk for uterine
 cancer. According to the cancer research in United Kingdom women who are overweight
are three times more likely to develop womb cancer compared with women who are a
healthy weight. Very obese women are six times more likely to develop endometrial
cancer compared with women who are a healthy weight.
Tamoxifen- tamoxifen is a hormone treatment for breast cancer and it works by blocking
the effects of estrogen. However, this risk is outweighed by the benefits that tamoxifen
provides in preventing breast cancer.
Diabetes- causes an increase in the amount of insulin in the body which in turn can raise
the estrogen level in the body thus causing cell to divide in the endometrium.

III. SIGNS AND SYMPTOMS

o Vaginal bleeding or spotting: This includes vaginal bleeding between periods, prolonged
periods, or bleeding after intercourse or after menopause.
o Abnormal vaginal discharge: Some women experience a watery or bloody discharge as
a symptom of their disease, though this is often a sign of infection or other non-cancerous
conditions.
o Pelvic pain or pressure: Pain during intercourse or at other times may be a uterine
cancer symptom, or the sign of a less serious condition

IV. Medical Management

Diagnostic Procedure & Laboratory Examinations
If a patient has symptoms that suggest uterine cancer, the doctor will try to find out whats
causing the problems. She may have physical exam and blood tests.
Also, a patient who is suspected to have uterine cancer may undergo one or more of the
following tests:
Ultrasound
Ultrasound is often one of the first tests used to look at the uterus, ovaries, and
fallopian tubes in women with a possible gynecologic problem. Ultrasound tests use
sound waves to take pictures of parts of the body. A small instrument called a
transducer or probe gives off sound waves and picks up the echoes as they bounce
off the organs. A computer translates the echoes into pictures.
o For a pelvic ultrasound, the transducer is placed on the skin of the lower part of
the abdomen. Often, to get good pictures of the uterus, ovaries, fallopian tubes,
nearby tissues for any lumps or changes in shape or size. Women getting a pelvic
 ultrasound are asked to drink lots of water before the exam. A full bladder helps
move the uterus up and moves the bowel away for better imaging.
o A transvaginal ultrasound (TVUS) is often preferred for looking at the uterus. For
this test, the TVUS probe (that works the same way as the ultrasound transducer)
is put into the vagina. Images from the TVUS can be used to see if the uterus
contains a mass (tumor), or if the endometrium is thicker than usual, which can be
a sign of endometrial cancer. It may also help see if a cancer is growing into the
myometrium.
o Salt water (saline) may be put through a small tube into the uterus before the
ultrasound so the doctor can see the uterine lining more clearly. This procedure is
called a saline infusion sonogram or hysterosonogram. Sonography may help
doctors pinpoint the area they want to biopsy if other procedures didn't detect a
tumor.

Endometrial tissue sampling

To find out whether endometrial hyperplasia or endometrial cancer is present, the
doctor must remove some tissue so that it can be looked at with a microscope.
Endometrial tissue can be obtained by endometrial biopsy or by dilation and curettage
(D&C) with or without a hysteroscopy.
o Endometrial biopsy- An endometrial biopsy is the most commonly performed test
for endometrial cancer and is very accurate in postmenopausal women. In this
procedure, a very thin flexible tube is inserted into the uterus through the cervix.
Then, using suction, a small amount of endometrium is removed through the tube.
The suctioning takes about a minute or less. The discomfort is similar to menstrual
cramps and can be helped by taking a nonsteroidal anti-inflammatory drug such
as ibuprofen before the procedure. Sometimes numbing medicine (local
anesthetic) is injected into the cervix just before the procedure to help reduce the
pain.
o Hysteroscopy- For this technique doctors insert a tiny telescope (about 1/6 inch in
diameter) into the uterus through the cervix. To get a better view of the inside of
the uterus, the uterus is filled with salt water (saline). This lets the doctor see and
biopsy anything abnormal, such as a cancer or a polyp. This is usually done using
a local anesthesia with the patient awake.
 o Dilation and curettage (D&C)- If the endometrial biopsy sample doesn't provide
enough tissue, or if the biopsy suggests cancer but the results are uncertain, a
D&C must be done. In this outpatient procedure, the opening of the cervix is
enlarged (dilated) and a special instrument is used to scrape tissue from inside the
uterus. This may be done with or without a hysteroscopy. This procedure takes
about an hour and may require general anesthesia or conscious sedation either
with local anesthesia injected into the cervix or a spinal (or epidural).

Testing endometrial tissue samples

Endometrial tissue samples removed by biopsy or D&C are looked at with a
microscope to see whether cancer is present. If cancer is found, the lab report will
state what type of endometrial cancer it is (like endometrioid or clear cell) and what
grade it is.
Endometrial cancer is graded on a scale of 1 to 3 based on how much it looks like
normal endometrium. Women with lower grade cancers are less likely to have
advanced disease or recurrences.
If the doctor suspects hereditary non-polyposis colon cancer (HNPCC) as an
underlying cause of the endometrial cancer, the tumor tissue can be tested for protein
changes (such as having fewer mismatch repair proteins) or DNA changes (called
microsatellite instability, or MSI) that can happen when one of the genes that causes
HNPCC is faulty. If these protein or DNA changes are present, the doctor may
recommend that you consider genetic testing for the genes that cause HNPCC.
Testing for low mismatch repair protein levels or for MSI is most often ordered in
women diagnosed with endometrial cancer at a younger than usual age or who have
a family history of endometrial or colon cancer.

To learn whether uterine cancer has spread, the doctor may order one or more of the following
tests:
Computed tomography (CT)
The CT scan is an x-ray procedure that creates detailed, cross-sectional images
of the body. CT scans are not used to diagnose endometrial cancer. However, they
may be helpful to see whether the cancer has spread to other organs and to see if the
cancer has come back after treatment.
Magnetic resonance imaging (MRI)
 MRI scans use radio waves and strong magnets instead of x-rays. The energy
from the radio waves is absorbed and then released in a pattern formed by the type of
tissue and by certain diseases. A computer translates the pattern of radio waves given
off by the tissues into a very detailed image of parts of the body. This creates cross
sectional slices of the body like a CT scanner and it also produces slices that are
parallel with the length of the body.
Some doctors also think MRI is a good way to tell whether, and how far, the
endometrial cancer has grown into the body of the uterus. MRI scans may also help
find enlarged lymph nodes with a special technique that uses very tiny particles of iron
oxide. These are given into a vein and settle into lymph nodes where they can be
spotted by MRI.
Positron emission tomography (PET)
In this test, radioactive glucose is given to look for cancer cells. Because cancers
use glucose at a higher rate than normal tissues, the radioactivity will tend to
concentrate in the cancer. A scanner can spot the radioactive deposits. This test can
be helpful for spotting small collections of cancer cells. Special scanners combine
a PET scan with a CT to more precisely locate areas of cancer spread. PET scans are
not a routine part of the work-up of early endometrial cancer, but may be used for more
advanced cases.

Cystoscopy and proctoscopy

If a woman has problems that suggest the cancer has spread to the bladder or
rectum, the inside of these organs will probably be looked at through a lighted tube.
In cystoscopy, the tube is placed into the bladder through the urethra. In
proctoscopy, the tube is placed in the rectum. These exams allow the doctor to look
for possible cancers. Small tissue samples can also be removed during these
procedures for pathologic (microscopic) testing. They can be done using a local
anesthetic but some patients may require general anesthesia. These procedures were
used more often in the past, but now are rarely part of the work up for endometrial
cancer.

Blood tests
o Complete blood count
 The complete blood count (CBC) is a test that measures the different cells in
the blood, such as the red blood cells, the white blood cells, and the platelets.
Blood tests can also show how well the liver and kidneys are working. Endometrial
cancer can cause bleeding, which can lead to low red blood cell counts (anemia).
o CA-125 blood test
CA-125 is a substance released into the bloodstream by many, but not all,
endometrial and ovarian cancers. If a woman has endometrial cancer, a very high
blood CA-125 level suggests that the cancer has probably spread beyond the
uterus. Some doctors check CA-125 levels before surgery or other treatment. If
they are elevated, they can be checked again to find out how well the treatment is
working (for example, levels will drop after surgery if all the cancer is removed).
CA-125 levels are not needed to diagnose endometrial cancer, and so this test
isnt ordered on all patients.
Papanicolaou Smear This test involves gathering a sample of cells from the cervix
which may indicate if the cancer cells have spread to the cervix.

Treatment
Treatment options for people with uterine cancer are surgery, radiation therapy,
chemotherapy, and hormone therapy. The patient may receive more than one type of
treatment. The treatment depends mainly on the following:
Whether the tumor has invaded the muscle layer of the uterus
Whether the tumor has invaded tissues outside the uterus
Whether the tumor has spread to other parts of the body
The grade of the tumor
The age and general health

Surgical Procedures
Surgery is the most common treatment for women with uterine cancer.
o Hysterectomy: During a hysterectomy, the uterus and cervix are removed.
o Radical hysterectomy: Although several uterine cancer surgery options exist, for
all but a very small percentage of women with uterine cancer, a radical
hysterectomy will be necessary. This type of uterine cancer surgery involves
removing the uterus, cervix and ovaries, as well as all of the surrounding tissue
(the parametria) and the upper part of the vagina.
 o Lymphadenectomy: The lymph nodes in the pelvis may also be removed. Your
doctor may remove lymph nodes as part of a hysterectomy to stage the cancer
and develop a more targeted uterine cancer treatment plan.
o Pelvic extenteration: For women with recurrent or advanced uterine cancer,
pelvic extenteration may be an option. During this type of cancer surgery, the
uterus, cervix, vagina, ovaries, bladder, rectum and nearby lymph nodes are
removed. Tissue from elsewhere in the body is used to reconstruct the vagina, and
urine and stool are passed into external bags.
o Abdominal hysterectomy: The uterus, ovaries, and fallopian tubes are removed
through an incision (laparotomy) in the lower abdomen. An abdominal incision
provides a large opening into the abdomen for the surgeon to easily see the organs
and to find out the extent of the cancer. An abdominal hysterectomy will leave a scar
(usually 5 inches) on the abdomen.
o Laparoscopic hysterectomy: Laparoscopic surgery is done with a tiny camera and
special instruments. The surgeon puts these tools through several small incisions
(cuts) in the belly. In a laparoscopic hysterectomy, the surgeon usually is able to see
the organs well enough to find out the extent of the cancer.
o Total Abdominal Hysterectomy and Bilateral Salphingo-Oophorectomy
(TAHBSO) is the removal of the uterus including the cervix, tubes and ovaries.
This is often performed on cancer patients or to relieve severe pelvic pain and
heavy menstrual cycles from patients suffering from endometriosis or
adenomyosis.
o Hysterectomy is the surgical removal of the uterus. This may be total (removing
the body and cervix of uterus) or partial which is also called supra-cervical.
o Oophorectomy is the removal of a single or both ovaries via surgery.

Radiation Therapy
Radiation therapy is an option for women with all stages of uterine cancer. It may be
used before or after surgery. For women who cant have surgery for other medical
reasons, radiation therapy may be used instead to destroy cancer cells in the uterus.
Women with cancer that invades tissue beyond the uterus may have radiation therapy
and chemotherapy.
 Radiation therapy uses high-energy rays to kill cancer cells. It affects cells in the
treated area only. Doctors use two types of radiation therapy to treat uterine cancer.
Some women receive both types:
o External radiation therapy: A large machine directs radiation at your pelvis or
other areas with cancer. The treatment is usually given in a hospital or clinic. You
may receive external radiation 5 days a week for several weeks. Each session
takes only a few minutes.
o Internal radiation therapy (also called brachytherapy): A narrow cylinder is placed
inside the vagina, and a radioactive substance is loaded into the cylinder. This
common method of brachytherapy may be repeated two or more times over
several weeks. Once the radioactive substance is removed, no radioactivity is
left in the body.
Side effects depend mainly on which type of radiation therapy is used, how
much radiation is given, and which part of the body is treated. External radiation
to the abdomen and pelvis may cause nausea, vomiting, diarrhea, or urinary
problems. There may be hair loss in the genital area. Also, skin in the treated
area may become red, dry, and tender.
The patient may likely to become tired during external radiation therapy,
especially in the later weeks of treatment. Resting is important, but doctors
usually advise patients to try to stay as active as they can. For women who have
not had surgery to remove the ovaries, external radiation aimed at the pelvic area
can harm the ovaries. Menstrual periods usually stop, and women may have hot
flashes and other symptoms of menopause. Menstrual periods are more likely to
return for younger women.

Chemotherapy
Chemotherapy uses drugs to kill cancer cells. It may be used after surgery to treat
uterine cancer that has an increased risk of returning after treatment. Also,
chemotherapy may be given to women whose uterine cancer cant be completely
removed by surgery. For advanced cancer, it may be used alone or with radiation
therapy. Chemotherapy for uterine cancer is usually given by intravenously. Its usually
given in cycles. Each cycle has a treatment period followed by a rest period. The side
effects depend mainly on which drugs are given and how much.
 Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells
that divide rapidly:
Blood cells: When drugs lower the levels of healthy blood cells, youre more
likely to get infections, bruise or bleed easily, and feel very weak and tired.
Your health care team will check for low levels of blood cells. If your levels
are low, your health care team may stop the chemotherapy for a while or
reduce the dose of the drug. There are also medicines that can help your
body make new blood cells.
Cells in hair roots: Chemotherapy may cause hair loss but it will grow back
after treatment. The color and texture may be changed.
Cells that line the digestive system: Chemotherapy can cause poor
appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

Other possible side effects include skin rash, tingling or numbness in the hands
and feet, hearing problems, loss of balance, joint pain, or swollen legs and feet.

Hormone Therapy
Some uterine tumors need hormones to grow. These tumors have hormone receptors
for the hormones estrogen, progesterone, or both. If lab tests show that the tumor in
the uterus has these receptors, then hormone therapy may be an option. Hormone
therapy may be used for women with advanced uterine cancer. Also, some women
with Stage I uterine cancer who want to get pregnant and have children choose
hormone therapy instead of surgery. The most common drug used for hormone
therapy is progesterone tablets.
Other hormone therapies include hormone-expressing intrauterine devices (IUDs) and
the aromatase inhibitors (AIs), such as anastrozole (Arimidex), letrozole (Femara), and
exemestane (Aromasin), which are often used for the treatment of women with breast
cancer. An AI is a drug that reduces the amount of the hormone estrogen in a woman's
body by stopping tissues and organs other than the ovaries from producing it.
Hormone therapy may be used for women who cannot have surgery or radiation
therapy or it can be used in combination with other types of treatment.
Side effects of hormone therapy may include fluid retention, increase in appetite,
insomnia, muscle aches, swelling, breast tenderness and weight gain.
 NURSING CARE PLAN

NURSING DIAGNOSIS 1.

Acute pain related to nerve compression/irritation, secondary to tumor growth as

manifested by guarding behaviour, restlessness, grimacing face and report of pain with a pain
scale of 7/10.

NURSING INFERENCE

Increase predisposition of a person to different risk factors and precipitating factors that
play in the development of uterine cancer can disrupt the estrogen and progesterone balance,
wherein there will be excessive level of estrogen compares to progesterone, this will lead to the
increased in reformation of endometrial lining, normal cells continuously growing and old cells do
not die, therefore extra cell will form and eventually tumor formation. The uncontrollable
proliferation of the endometrial cell in the uterus can compress the nerves that innervates the
uterine muscle as a result pain will be felt by the patient. In addition to the tumor growth, it also
impedes the blood flow that supply the area, in order to generate energy, the cells will utilizes
anaerobic metabolism consequently, this kind of metabolism produces lactic acid as by product.
Lactic acid irritates nerve endings.

NURSING GOAL

After an hour of rendering nursing intervention, the patient will demonstrate relieved of pain as
would be manifested by absence of guarding behaviour, restlessness, grimacing face and a pain
scale of 3/10.

NURSING INTERVENTIONS

Intervention Rationale
1. Provide cutaneous stimulation (cold Basically, temperature do affect the ability
compress). of the nerve to conduct impulses. Cold
temperature prolongs the opening time of
the voltage gated sodium channel,
therefore, it generates a longer action
potential thus it reduces the nerve
conduction velocity and increase the
latency. In short it numbs the area, hence
it reduces pain sensation.
Cold compress also promotes
vasoconstriction in which it reduces the
occurrence of bleeding which can also
aggravate pain due to accumulation of
blood in the area causing now irritation and
compression to the nerves.
But take note that cold compress promotes
vasoconstriction, and as a result it
compromises blood flow to the area,
prompting now the use of anaerobic
metabolism which yield lactic acid as by
product which can irritates nerve endings.
Therefore limit the time for the application
of cold compress (not more than 1 hour)
 2. Encourage patient to do deep
breathing exercises.
3. Encourage patient to do diversional
activities such as listening to soft
music, watching TV and others.
4. Provide quite environment
5. Provide gentle massage in the
affected area when suitable only
6. Administer pain medication like
opioids, acetaminophen
corticosteroids as prescribed
7. Provide placebo as prescribed
NURSING EVALUATION
After an hour of rendering effective nursing intervention, the pain felt by the patient was
reduced or relieved as manifested by absence of guarding behaviour, restlessness, grimacing
face and a pain scale of 3/10.
NURSING DIAGNOSIS 2
DBE promotes oxygenation as a result, it
stimulates the brain to release endorphins,
a neurotransmitter that helps to reduce
stress and decreases the level of pain by
interacting to the opiate receptors in the
brain to reduce perception of pain.
To drive patient attention from pain felt.
To not intensify the pain because
excessive stimulation to the patient can
cause stress response and consequently it
causes muscle to tense and contract which
can aggravate the pain felt by the patient.
A massage traps pain transmission and it
stimulate the body to release endorphins
that is said to believe that it produces
analgesic effect.
These drugs blocks the transmission of
pain impulses thus if relieves pain
(analgesic effect. For corticosteroid it
reduces inflammation, thus, it is also
effective for pain control.
Placebo offers psychological effect in
which the patient may feel anxious and
decreased level of stress, therefore it
promotes relation.
 Deficit volume related to blood loss secondary to uterine bleeding as manifested by
presence of severe to moderate bleeding for more than a week, decresed urine output, decreased
BP, increased pulse rate (more than 100 Beats per min) dry skin and mucous membrane report
of having body weakness and easy fatigability and elevated Hct and decreased Hgb level.

NURSING INFERENCE

The formation and growth of tumor in the lining of the uterus can erode the underlying
tissues which include also the blood vessels the supplies the uterus, this causes ulceration and
bleeding due to the ruptures of blood vessels in the uterus in which it is evidence by discharge of
blood in the vagina. Excessive bleeding will result to the decreased intravascular volume and
possible haemorrhagic shock. The manifestation would be, there will be decreased urine output
due to decrease in blood going to the kidney, decreased blood pressure, increased in pulse rate
as compensatory mechanism of the body in response to the decreased blood volume, dry skin
and mucous membrane due to decreased blood supply to the skin and mucosal layer of the body,
weakness is also noted due to the decrease level RBC and Hgb level therefore oxygen level is
depleted which is important in ATP production. The elevation of haematocrit is brought about by
the stimulation of the kidney to produce erythropoietin that is responsible for RBC formation in
response to the decrease oxygenation.

NURSING GOAL

After 1-2 days of effective nursing interventions, patient normal fluid volume will be
restored at th fuctional level as evidenced by normal volume of urine output (<30ml/hour), stable
vital signs, moist mucous membranes and good skin turgor, increased energy necessary for ADL
and Hgb and Hct levels become normal.

NURSING INTERVENTIONS

Intervention
1. Application of cold compress in the
area.
2. Encourage the patient to increase
fluid intake (up to 3L/day) as
individual appropriate or tolerated
Rationale
To control bleeding as a result of
vasoconstriction in which it decreases the
blood flood to the area thus it prevent
excessive bleeding.
To increase the blood volume and to
prevent haemorrhagic shock
 and keeps fluids within the clients
reach.
3. Administer IV fluids (isotonic solution)
4. BT therapy as prescribe
5. Provide oral hygiene
NURSING EVALUATION
To increase the fluid volume within the
intravascular compartment.
To replace the loss blood/ to correct fluid
loss from active uterine bleeding.
When there is bleeding, there will be a
decreased blood volume, thus it affect the
distribution of blood in the peripheral area
including mucosal membrane, in which it
becomes dry. Dry mucous membrane
especially on the mouth produces
discomfort and decreases the interest to
drink fluid, hence providing good oral care
will promote good oral hydration.

After 1-2 days of effective nursing interventions, patient normal fluid volume was restored
to the fuctional level as evidenced by adequate Urine output (<30ml/hour) stable vital signs, moist
mucous membranes and good skin turgor, increased energy necessary for ADL and Hgb and Hct
levels become normal.

NURSING DIAGNOSIS 3.

Moderate Anxiety related to diagnosis of cancer as manifested by apprehension,

preoccupation, increase muscle tension, palpitation, increased respiratory rate and verbalization
of fears and sleep pattern disturbance.

NURSING INFERENCE

Cancer is a deadly disease if not treated and one of the most common cause of fatality
globally. In most cases, people develops fear and anxiety, the condition renders the cancer patient
into a state of perpetual panic that may affect their day to day functioning and activities. Negative
thoughts stimulates the amygdala. The amygdala in the brain reacts by preparing the body to fight
or run (activation of the SNS). Activation of the SNS involves the release of adrenal hormone
epinephrine into the bloodstream, therefor it produces physical symptoms such as increased HR,
muscle tension, hyperventilation, palpitation. Recognition of the bodily sensation as catastrophic
produces uncontrollable fear which lead to development of moderate to severe anxiety.

NURSING GOAL

After 2-3 hours of rendering appropriate nursing interventions the patient will be able to
appear relaxed as manifested by absence of muscle tension, normal cardiac rate and respiratory
rate and report that anxiety is reduced to a manageable level.

NURSING INTERVENTIONS

Nursing Intervention Rationale

Establish a therapeutic relationship, To avoid the contagious effect or
conveying empathy and unconditional positive transmission of anxiety.
regard.
Be available to client for listening and talking. To reduce patients anxiety.
Encourage patient to share thoughts and Provides opportunity to examine realistic
feelings. fears and misconceptions about diagnosis.
Provide open environment in which patient Helps patient feel accepted in present
feels safe to discuss feelings or to refrain from condition without feeling judged, and
talking. promotes sense of dignity and control.
Maintain frequent contact with patient. Talk Provides assurance that patient is not
with and touch patient as appropriate. alone or rejected; conveys respect for and
acceptance of the person, fostering trust.
Assist patient and significant others in Coping skills are often stressed after
recognizing and clarifying fears to begin diagnosis and during different phases of
developing coping strategies for dealing with treatment. Support and counseling are
fears. often necessary to enable individual to
recognize and deal with fear and to realize
that control and coping strategies are
available.
Provide accurate, consistent information Can reduce anxiety and enable patient to
regarding diagnosis and prognosis. Avoid make decisions and choices based on
arguing about patients perceptions of realities.
situation.
 Permit expressions of anger, fear, despair Acceptance of feelings allows patient to
without confrontation. Give information that begin to deal with situation.
feelings are normal and are to be appropriately
expressed.
Explain procedures, providing opportunity for Accurate information allows patient to deal
questions and honest answers stay with more effectively with reality of situation,
patient during anxiety- producing procedures thereby reducing anxiety and fear of the
and consultations. unknown.
Provide primary and consistent caregivers May help reduce anxiety by fostering
whenever possible. therapeutic relationship and facilitating
continuity of care.
Promote calm, quiet environment. Facilitates rest, conserves energy, and
may enhance coping abilities.
Encourage and foster patient interaction with Reduces feelings of isolation. If family
support system. support systems are unavailable, outside
sources may be needed immediately.
Provide reliable and consistent information Allows better interpersonal interaction and
and support for significant others. allows significant others to be involved
appropriately.

NURSING EVALUATION

After 2-3 hours of rendering appropriate nursing interventions the patient was able to
appear relaxed as manifested by absence of muscle tension, normal cardiac rate and respiratory
rate and report that anxiety is reduced to a manageable level.

References

http://www.cancer.net/cancer-types/uterine-cancer/statistics
https://www.cancer.gov/publications/patient-education/uterus.pdf
https://www.drugs.com/tamoxifen.html
http://www.medicinenet.com/uterine_cancer/article.htm
http://www.nhs.uk/Conditions/Cancer-of-the-uterus/Pages/Causes.aspx