ENDOMETRIAL

ADENOCARCINOMA :
A TAHBSO CASE

BY:

MACEDA, MANGA, MARCAIDA, MARQUEZ,

MARTINEZ, MIRANDA, & OBRERO

PROF. RUBY ROSE M. BONTIGAO RN MAN

 Topic Outline
DIAGNOSTIC
INTRODUCTION
SERVICES

NURSING CARE PA & GORDONS

PLAN
Introduction
Introduction
This case study is about Endometrial
Adenocarcinoma. Patient E is a 56-
years-old woman and was admitted last
March 12, 2023 Sunday 5:00 pm at St.
Victoria Hospital, Marikina City due to
finding of endometrial mass . We chose
this case study because Endometrial
Adenocarcinoma is one of the most
common diseases of the female
reproductive organ. Endometrial cancer
is a disease in which malignant (cancer)
cells form in the tissues of the
endometrium.

OBJECTIVES OF THE STUDY

General Objective:

At the end of this case study, the student

nurses will be able to understand the disease
process and the risk factors of the disease
and will be able to perform proper nursing
care.
Specific Objective:

Specific Objectives
Establish rapport to the patient.
Gather the data of the patient including past and present health status.
Assess gathered data.
Analyze the gathered data.
Understand the Pathophysiology of the disease and the purpose of the
prescribed drug to the patient.
Formulate an appropriate nursing care plan based on identified problems
of the patient
Implement the formulated nursing interventions to the patient.
Evaluate the effectiveness of nursing interventions that are performed to
the patient.
Theoretical Framework

KATHERINE KOLCABA'S
THEORY OF COMFORT
 NURSING HISTORY

* SOURCE OF ALL THE INFORMATION: DATA WAS OBTAINED FROM THE

PATIENT WHO SEEMS RELIABLE. THE CLIENT’S CHART WAS ALSO
INCORPORATED AS A SECONDARY SOURCE OF INFORMATION.
 NURSING HISTORY

B. Reason for seeking health care C. Past Health History

The patient stated she is already All questions were asked to the
menopause 6 years ago but she patient regarding health history but
experienced abnormal uterine the patient stated that she did not
bleeding without menstrual pain. remember any serious illnesses, just
had a simple cough and colds. She
also did not experience any injuries
or accidents in the past and this is her
first hospitalization and operation.
 NURSING HISTORY
History of Present Illness

The patient already menopause 6 years ago prior to admission . 2

months prior to admission, the patient started to have episodes of
uterine bleeding , she reported consuming 1 feminine pad
moderately soaked without menstrual pain. The client decided to
consult a doctor and had an ultrasound (trans-v) which showed
endometrial mass. 1 month prior to admission, Biopsy was done
revealing adenocarcinoma. After these discoveries, she was
scheduled for an operation to remove her uterus, fallopian tubes
and her ovaries (TAHBSO)
FAMILY HISTORY
 Immunization/ Exposure

to Communicable Disease

VI. ALLERGIES: THE PATIENT CLAIMS THAT THE ONLY FOOD

ALLERGY SHE HAS IS TO EGGS, AND THIS INCIDENT OCCURRED IN
2020. SHE HAD SKIN RASHES. SHE VISITED THE DOCTOR, BUT SHE
CAN'T REMEMBER WHAT MEDICATION WAS PRESCRIBED TO HER.
OTHER THAN THAT, THE PATIENT SAID SHE HAD NO DRUG
ALLERGIES.

VII. HOME MEDICATION/ALTERNATIVE MEDICINE: PATIENT E.L.

ACKNOWLEDGED THAT SHE USED OVER-THE-COUNTER DRUGS.
SHE TAKES ONLY PARACETAMOL FOR HER FEVER. SHE TAKES
VITAMIN C EVERYDAY. SHE DOES NOT HAVE ANY MAINTENANCE
DRUGS.
VIII. PSYCHOSOCIAL HISTORY:

THE PATIENT VERBALIZED THAT SHE USED TO DRINK COFFEE

TWICE A DAY. SHE USED TO DRINK ALCOHOL BEFORE DURING
HER TEENAGE YEARS BUT STOPPED WHEN SHE GOT MARRIED.
SHE DOESN'T USE CIGARETTES. SHE USED TO TELL HER
PROBLEMS WITH HER HUSBAND. SHE IS VERY OPEN WHENEVER
SHE IS SAD. PATIENT DID NOT FEEL DEPRESSED WHENEVER SHE
GOT BIG PROBLEMS SINCE SHE HAS A HUSBAND AND
SUPPORTIVE CHILDREN.
IX. OBSTETRICAL HISTORY:

THE PATIENT STATED THAT SHE STARTED TO HAVE

MENSTRUATION AT THE AGE OF 12, SHE DESCRIBED IT HAVING
HEAVY FLOW AT FIRST 3 DAYS THAT CONSUMED 4-5 PADS
EVERY DAY, REDDISH IN COLOR AND LASTS UP TO 6 DAYS,
EXPERIENCED ABDOMINAL CRAMPS EVERY TIME AND HAVING IT
REGULARLY. LAST MENSTRUATION PERIOD WAS IN 2016 AT THE
AGE OF 50 YEARS OLD.. PATIENT STATES THAT SHE IS NOT
SEXUALLY ACTIVE ANYMORE AFTER SHE GOT PREGNANT WITH
HER LAST CHILD. SHE ALSO STATED THAT SHE DOESN’T TAKE
LADIES PILLS AS A FORM OF CONTRACEPTIVES ORALLY. ( G-2 T-
2 P- 0 A-0 L-2 )
 PEDIATRIC HISTORY:

( DEVELOPMENTAL MILESTONES)
GENERATIVITY VS. STAGNATION IS THE SEVENTH STAGE OF
ERIK ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT.
THIS STAGE TAKES PLACE DURING MIDDLE ADULTHOOD,
BETWEEN THE APPROXIMATE AGES OF 40 AND 65.

THE PATIENT WAS 56 YEARS OLD AND CURRENTLY MARRIED

FOR 28 YEARS. SHE DESCRIBES THEIR RELATIONSHIP AS HAPPY
AND FULFILLED. SHE STILL FEELS PRODUCTIVE AT THE AGE OF
56 YEARS OLD. SHE STILL GOES OUT AND JOINS HER FRIENDS
AND FAMILY RELATIVES.
ANATOMY & PHYSIOLOGY

PATHOPHYSIOLOGY

GORDONS
 PHYSICAL
ASSESSMENT
Diagnostic/Laboratory examinations:
COMPLETE BLOOD
COUNT (CBC)
A complete blood count (CBC) is a
blood test. It's used to look at overall
health and find a wide range of
conditions
HISTOPATHOLOGY
REPORT
A report produced by a Pathologist describing the
tissue taken at surgery. There are two main types of
report: a biopsy report which helps in the diagnosis of
the medical condition and a surgical resection, where all
the tissue removed during surgical treatment is
examined.
BLOOD CHEMISTRY
A test done on a sample of blood to
measure the amount of certain
substances in the body. These
substances include electrolytes (such
as sodium, potassium, and chloride),
fats, proteins, glucose (sugar), and
enzymes.
Erythrocyte Sedimentation
Rate (ESR)
An erythrocyte sedimentation rate
(ESR) is a blood test that can show if you
have inflammation in your body.
Inflammation is your immune system's
response to injury, infection, and many
types of conditions, including immune
system disorders, certain cancers, and
blood disorders.
 Coagulation Test

A coagulation factor test is used to find out

if you have a problem with any of your
clotting factors that may cause too little or
too much blood clotting.
Medical
Diagnosis
 ENDOMETRIAL ADENOCARCINOMA

Endometrial cancer is a type of cancer that begins in the uterus.

The uterus is the hollow, pear-shaped pelvic organ where fetal
development occurs. Endometrial cancer begins in the layer of cells
that form the lining (endometrium) of the uterus. Endometrial
cancer is sometimes called uterine cancer. Other types of cancer
can form in the uterus, including uterine sarcoma, but they are
much less common than endometrial cancer. Cells in nearly any
part of the body can become cancer, and can spread to other parts
of the body The five-year survival rate for endometrial cancer is
81%. That means 81% of people diagnosed with the disease are
alive five years later. The rate is even higher when cancer hasn't
spread outside your uterus. Then, the survival rate reaches as high
as 95%.
DRUG STUDY
OMEPRAZOLE KETOROLAC

PARACETAMOL CEFUROXIME
Medical/Surgical
Management:
 Patient E.L.was admitted to the hospital and stayed for 5 days. Patient
had undergone IV therapy of PLR to run for 8 hours and was given
medication such as Ketorolac, Omeprazole, Paracetamol and Cefuroxime.
During hospitalization, the patient's Input and Output is being monitored
and her incision site. Physician advised a soft diet after she underwent
surgery.

Surgical Management

Total abdominal hysterectomy bilateral salpingo-oophorectomy

(TAHBSO) is the removal of the entire uterus, the ovaries, fallopian tubes,
and the cervix. TAHBSO is usually performed in the case of uterine and
cervical cancer. This is the most common kind of hysterectomy. Removal
of the ovaries eliminates the main source of the hormone estrogen, so
menopause occurs immediately. This is the procedure for Patient E.L.
Nursing Responsibilities after Surgery:

Responsible for all the safekeeping of patient’s personal belongings

endorsed by OR nurses.
Responsible for endorsing such items to patient’s relatives or floor nurses.
Diligently carries out doctor’s orders as soon as possible.
Check and record vital signs-blood pressure, pulse rate, O2 saturation,
respiratory rate, temperature, color and condition of skin, if you can move
extremities every 15 minutes (or as often as possible or as indicated by the
patient’s condition) on the Nurse’s Post Anesthesia Record.
Observes and records neuro vital signs for neurological cases on the
Neurological Vital Signs Form provided by the unit.
Observes keenly the patient’s who might undergo post-operative
complications like bleeding, shock, respiratory distress, thyroid storm and
cardiac arrest.
Notifies the anesthesiologist/ AMD immediately for any unusual
symptoms manifested by the patient
NURSING CARE
PLAN
 Acute pain
related to
disruption of
skin as
evidenced by
guarding
behavior in
incision site.
 Impaired Urinary
Elimination related
to mechanical
trauma as
manifested by
bladder distension
and Small, frequent
voiding/ absence of
the urinary output

 Risk for
infection
related to
postoperative
incision.
 REFERENCES
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 DISCHARGE PLAN

M- edication:
Paracetamol - to treat mild to moderate pain
Cefuroxime - It works by stopping the growth of bacteria
Describe the importance of regularly taking prescribed
medications including the potential unpleasant effects of
non compliance.
Instruct the client to continue with follow up medical care
Advise the client not to miss the intake of medications given
by her physician upon discharge.
 DISCHARGE PLAN

E- xercises/Environment
Maintain a quiet, pleasant, environment to promote
relaxation.
Provide a clean and comfortable environment.
Encourage patients to exercise such as walking and
aerobic exercise if possible or any other activities which
help to improve large muscles. Low-level
strengthening exercise may also be beneficial as part
of the program.
 DISCHARGE PLAN

T- reatment
Continue home medications.
For the follow-up check-up repeat.
Nonsteroidal Anti-inflammatory Drugs (NSAIDS) work
well to treat both pain and fever associated with
endometrial adenocarcinoma
Drink 8-12 glasses of fluid every day. Clear fluids such
as water are best.
 DISCHARGE PLAN

H- ealth teachings
Encourage patients to drink fluids.
Administer/take antibiotics as ordered.
Encourage the patient to avoid it frequently.
Teach patients on proper wiping (from front to back).
 DISCHARGE PLAN

O – pd, follow up
Patient is advised to have a follow-up check up on
March 20, 2023.
Consult a doctor for any problems or complications
encountered.

D- iet
Diet as tolerated (DAT)
 DISCHARGE PLAN
S- piritual/sex

Nursing actions to help clients meet their spiritual needs include:

Providing presence supporting religious practices
Assisting clients with Prayer
Referring clients for spiritual counseling.
Patient is recommended to join spiritual groups or be
surrounded by religious people for her to be religious too.
Having the opportunities to serve God and to connect with the
word of God will help her cope with extreme challenges of life
and be able to have a positive outlook towards life amid illness.
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