CASE PRESENTATION

(Nasopharyngeal
Carcinoma)
RLE GROUP 9
ABIOG, Danah Franz B.
ABLAY, Irvin Phillip G.
AGANAN, Angelica Ann I.
ALCANTARA, Krislyn
ALARCON, Jade
AMANSE, Jotessa Maria Emerlita I.
Area of Exposure: MSH
Our Lady of Miraculous Medal Unit
INTRODUCTION

Nasopharyngeal carcinoma (NPC) is a cancer originating in the nasopharynx,

the uppermost region of the pharynx or "throat", where the nasal passages
and auditory tubes join the remainder of the upper respiratory tract. NPC
differs significantly from other cancers of the head and neck in its
occurrence, causes, clinical behavior, and treatment. It is vastly more
common in certain regions of East Asia and Africa than elsewhere, with viral,
dietary and genetic factors implicated in its causation.

It is classified as a malignant neoplasm, or cancer, arising from the mucosal

epithelium of the nasopharynx, most often within the lateral nasopharyngeal
recess or fossa of Rosenmuller. There are three microscopic subtypes of NPC:
a well-differentiated keratinizing type, a moderately-differentiated
nonkeratinizing type, and an undifferentiated type, which typically contains
large numbers of non-cancerous lymphocytes (chronic inflammatory cells),
thus giving rise to the name lymphoepithelioma. The undifferentiated form is
most common, and is most strongly associated with Epstein-Barr virus
infection of the cancerous cells.

It most often affects people who are between 30 and 50 years of age. Men
are more likely to have nasopharyngeal cancer than women. People are most
likely to get this cancer if their ancestors came from southern China,
particularly Guangzhou or Hong Kong. People are also more likely to get this
cancer if they are from a country in Southeast Asia, like Laos, Vietnam,
Cambodia or Thailand. No one knows for sure what causes nasopharyngeal
cancer. Eating salt-preserved foods (like fish, eggs, leafy vegetables and
roots) during early childhood may increase the risk of getting this form of
cancer.
 PATIENT’S PROFILE

Name: Ms. 209

Age: 33

Sex: Female

Address: Pili, Camarines Sur.

Civil Status: Single

Occupation: Roman Catholic

Birth date: January 5, 1977

Ms. 209 used to be very physically active prior to the diagnosis

of NPC (she usually works for about 16 hours 3x a week)

PATIENT’S HISTORY
Previous illness: NO HISTORY

Health History : Nasal congestion on the left side

TX Medication: Plasil
Past illness/ hospitalization

 Sore throat

 Epistaxis

 Plaza Medica, BMC, Perpetual Help Manila

Allergies: None

DATE OF ADMISSION (V/S, CC WHY ADMITTED)

 BP: 90/70 mmHg

 Pulse rate: 65 bpm

 RR: 20 bpm

 Temperature: 36.4°C

 Date of Admission: Feb, 21 2010 5:00pm

 Room: MSH 209 MEDAL UNIT

 Ms. 209 was admitted to the hospital for continuation of the

CHEMOTHERAPY.

 Attending Physician: Dr. Malanyaon

Gordon’s 11 Functional Health Pattern

A. Health Perception / Health management Pattern

 As stated by Ms. 209, she has no vices such as alcohol, tobacco

or drug. She is quiet conscious of his health lifestyle.

B. Nutritional Metabolic Pattern

 Previously Ms. 209 has no difficulty in chewing and swallowing

certain foods.

 She likes to eat salt-preserved foods especially fish

C. Elimination Pattern

 Ms. 209 has a normal bowel habits

 D. Activity Exercise pattern

 She is a Clinical Instructor in CSPC from Monday to Wednesday

and a nurse on duty from Thursday to Saturday. She loves to
work for a long time for she is a workaholic person and the
breadwinner of their family.

 Ms. 209 is currently not in pain. She has no past history of any
illness she is independent to his grooming and other basic
activities for herself.

E. Self- Rest Pattern

 Ms. 209 has insufficient time for sleeping due to her fully loaded
schedule. She almost stay until 12 midnight for preparation of
her lecture that made her time insufficient to rest.

F. Sensory Perceptual Pattern

 VISION: has a clear vision and is not wearing eye glasses and
contact lenses

 HEARING: Ms. 209 does not wear any hearing aid.

 SMELL: She has difficulty in smelling due to her nasal congestion

 TOUCH: No stated sensory problem

 TASTE: Mrs. 209 has difficulty in tasting foods. She states that
she only has one taste in all kinds of food she take.

G. Cognitive Pattern

 Mrs. 209 actually has no difficulty in speaking but her throat

becomes dry every time she talks for a long time.

. Role Relationship Pattern

• Ms. 209 is single and she is the financer of her family. She has a
good relationship with her family

I. Self Perception- Self Concept Pattern

• Ms. 209 is conscious when it comes to herself especially her body

appearance due to the effects of chemotherapy
 • She is also wary of her hair loss due to the effects of the surgery
but she has a positive outlook when it comes to herself.

J. Coping Stress Tolerance Pattern

• Ms. 209 states that she is regularly scanning her books to relieve
stress and do other recreational activities such as exercise
painting etc. to cope from stress.

K. Value Belief Pattern

• Religious preference is Roman Catholic. She has a strong faith in

God.

Anatomy and Physiology

RESPIRATORY SYSTEM

The respiratory system consists of the nasal cavity, pharynx, larynx, trachea,
bronchi, and lungs.

 Upper respiratory tract refers to:

Nasal cavity, pharynx, and associated structures.

 Lower respiratory tract refers to:

Larynx, trachea, bronchi, and lungs

 In humans, inspiration and expiration usually takes place through the

nose.

 The diaphragm and the muscles of the thoracic wall accomplish

respiratory movements.

 The respiratory system does two very important things: it brings

oxygen into our bodies, which we need for our cells to live and function
properly; and it helps us get rid of carbon dioxide, which is a waste
product of cellular function. The nose, pharynx, larynx, trachea and
bronchi all work like a system of pipes through which the air is
funneled down into our lungs. There, in very small air sacs called
alveoli, oxygen is brought into the bloodstream and carbon dioxide is
pushed from the blood out into the air. When something goes wrong
 with part of the respiratory system, such as an infection like
pneumonia, it makes it harder for us to get the oxygen we need and to
get rid of the waste product carbon dioxide.

Sinuses
The sinuses are small cavities that are lined with mucous membrane within
the bones of the skull.

Pharynx
The pharynx, or throat carries foods and liquids into the digestive tract and
also carries air into the respiratory tract.
Larynx
The larynx or voice box is located between the pharynx and trachea. It is the
location of the Adam's apple, which in reality is the thyroid gland and houses
the vocal cords.

Trachea
The trachea or windpipe is a tube that extends from the lower edge of the
larynx to the upper part of the chest and conducts air between the larynx
and the lungs.

Lungs
The lungs are the organ in which the exchange of gasses takes place. The
lungs are made up of extremely thin and delicate tissues. At the lungs, the
bronchi subdivides, becoming progressively smaller as they branch through
the lung tissue, until they reach the tiny air sacks of the lungs called the
alveoli. It is at the alveoli that gasses enter and leave the blood stream.

Bronchi

The trachea divides into two parts called the bronchi, which enter the lungs.

Bronchioles

The bronchi subdivide creating a network of smaller branches, with the

smallest one being the bronchioles. There are more than one million
bronchioles in each lung.

Alveoli

The alveoli are tiny air sacks that are enveloped in a network of capillaries. It
is here that the air we breathe is diffused into the blood, and waste gasses
are returned for elimination.
The "nasopharynx" is the highest portion of the throat, behind the nose.
When we breathe through our nose, the air then goes into the nasopharynx.
At the top of this area, close to the brain, is a special "sieve" (cribriform
plate) where smells are made into nerve signals and conducted up into the
brain to be recognized. Air breathed through the nose is "filtered" by the
tonsil tissue in the lower nasopharynx; air carried germs are slammed
directly into these tonsils and destroyed by the body's immune system.
Cancer in the nasopharynx, while rare in America, is more common in the
Orient.

Thus, problems in the nasopharynx can damage these nerves (which come
from the brain and are called "cranial nerves") leading to eye or facial
paralysis or blood distribution problems in the brain. The nose is in front of
the nasopharynx and the throat is downward. The most dangerous places for
the cancer to grow are upward and backward, that is into the brain. People
usually go for long periods before the cancer is diagnosed, since many
symptoms are much more often due to non-cancerous causes.

The nasopharynx is located behind the nose and is the upper part of the
throat (also called the pharynx). The pharynx is a muscular tube about 5
inches long. It starts behind the nose and goes down to the neck to become
part of the tube that divides to the esophagus (toward the stomach) and the
trachea (toward the lungs). The upper 2/3 of the pharynx has an inner lining,
or "mucosa" of a special type of cell, called "squamous” cells. 90% of
cancers are "squamous cell carcinomas", while the remaining 5% are
melanomas, lymphomas, and sarcomas. Air and food pass through the
pharynx on the way to the windpipe (trachea) or the esophagus. The nostrils
in the nose lead into the nasopharynx.

PATHOPHYSIOLOGY

DEFINITION

Nasopharyngeal cancer is a disease in which malignant (cancer) cells form in

the tissues of the nasopharynx.

SIGNS AND SYMPTOMS:

-Anorexia -Shortness of breath

-Chest wall pain -Venous stasis

-Chest pain - Weight loss

-Hoarseness of voice -Distended neck veins

-Hyperglycemia -Atelectasis

-Hyperkalemia -Dyspnea

-Hyperetension

-Hypervolemia
-Immunosupression

-Osteoporosis

-Pneumonia
 Nasop
Cancer/ L

Squamous Cell Small Cell

Carcinoma Carcinoma

Irritation of Compression
the laryngeal
Chronic Sputum of esophagus
Irritati
cough nerveproduction obstru
MEDICATIONS airw
Brand name: Plasil
Difficulty in
Shortness
Irritation of Wheezingswallowing
Generic name: Metoclopramide

of breath
the laryngeal
nerve
Classification: (Therapeutic) Antiemetic

Action

 Physiologic mechanism

 Decrease nausea and vomiting

 Decrease symptoms of gastric stasis

 Pharmacologic mechanism

 Blocks Dopamine receptors in chemoreceptor trigger zone of the CNS

 Stimulates motility of the upper Gastrointestinal tract and accelerates gastric

emptying.

Indication

 Management of esophageal reflux

 Treatment and prevention of postoperative nausea and vomiting

Contraindication

 Gastrointestinal hemorrhage, mechanical obstruction or perforation,

pheochromocytoma, epileptics.

Nursing considerations

 Assess patient for nausea, vomiting, abdominal distention, and bowel sounds
before and after administration

 May cause drowsiness

 Advise patient to avoid concurrent use of alcohol and other CNS depressant
while taking this medication.

 Advise patient to notify health care professional immediately if involuntary

movement of eyes, face or limbs occurs.

Adverse Reactions

 Restlessness, drowsiness, fatigue and lassitude. Extrapyramidal symptoms,

insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, rash
including urticaria, bowel disturbances, increased prolactin level, and
gastroparesis.
 LABORATORY AND

Results Refe
WBC 3.60 4.8-10.8

PLATELET 11.2 M 14.0-1

F12.0-16

NURSING CARE PLANS

HEMOGLOBIN 130-400
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REFERENCES

 Nurses Pocket Guide 11th Edition

 Nurses Handbook of Health Assessment 6th Edition

 MIMS 115th Edition 2008

 Internet

• www.wikipedia.com

• www.medscape.com

• www.google.com