1. Case Study Nasopharyngeal Carcinoma

2. Demographic Data • CASE NO: 116*** • NAME: Mr. M • AGE: 46 yrs old • SEX: Male • DIAGNOSIS: Nasopharyngeal Carcinoma

3. Physical Assessment

4. Vital Signs; • BP- 120/70 mmhg • RR- 32/min • PR- 72/min • Temp- 36.8’C

5. Integument • Skin allergy noted at upper extremities • With good skin turgor • With capillary refill test (1-2secs)

6. Head • No palpable lesion on the head • With right side facial numbness • Always complaining of headache

7. Eyes • Pale palpebral conjunctiva • PERRLA (Pupils Equally Round and Reactive to Light Accommodation) • Sometimes experienced blurring of vision and light sensitivity

8. Ears • Symmetrical in shape and size • With occasional ear pain • Diminished hearing • Tinnitus noted at times

9. Nose • with epistaxis • with right nasal obstruction • with mass, reddish in color seen through rigid endoscope • cough and cold noted, whitish secretions

10. Mouth • Hard and soft palate grayish in color. • Difficulty in uttering words noted • Mouth breathing

11. Neck and Throat • With painless, enlarged lymph nodes in the neck • Sore throat noted

12. Respiratory/ Chest • Chest is symmetric • Use of accessory muscles when breathing • Crackles noted both lung fields

13. Extremities • No edema found on both legs • No lesions noted

14. Medical History

15. Past Medical History • No major medical problems • Common colds- treated with water therapy • Ignored sneezing

16. Socio-economic Lifestyle • Sedentary lifestyle • Smoking 1 pack in a day • No restrictions for food- Filipino foods • Shoe factory worker store keeper(construction materials) store keeper (KSA) store keeper(hosp)

17. Family History

18. Legend • - father • mother • aunt • cousin lung cancer NPC prostate cancer

19. Father’s side Mother’s side 1st 2nd 3rd

20. Present Medical History

21. 1st visit- (July 24, 2010) Dr. H. • Chief complaint- nose bleeding • Nasopharyngoscopy done • Dx- deviated nasal septum • Advised for CT –scan (rejected by insurance)

22. 2nd visit (April 10, 2012) • Dr. P • Cc: persistent Rt. Nasal obstruction with recurrent epistaxis • Nasopharynggoscopy done

23. Nasopharyngoscopy Examination; Mass, dark round, fill nasopharynx, seems to be originating from right side: Dx- bleeding mass nasopharynx inverted papilloma/hemangioma.

24. Dr. P. advised CT scan & histopathology • Prescribed Otrivin nasal Spray

25. 3rd visit- (August 26, 2012) • Ct- scan done with contrast

26. Nursing Responsibilities • Explain the procedure to the client • Assess allergy to dye. • Secure consent for the procedure. • Insert IV cannula aseptically as the dye will inject in through the vein.

27. Inform that the client may feel hot sensation when dye is injected. • Encourage the client to drink plenty of water after the procedure.

28. CT Image Result (Aug 26, 2012) Normal client Mr. m

29. CT Result • Possible dx; • Nasopharyngeal carcinoma • Granulomatous lesions

30. Sept. 2, 2012 • Biopsy was done • Confirmed the dx of nasopharyngeal cancer

31. Nursing Responsibilities • Explain the procedure to the client. • Informed consent • Make sure all the equipments needed are available. • Send tissue samples at the laboratory in a sterile container with formalin.

32. Advised by Dr. P. • Chemotherapy • Radiotherapy

33. Introduction

34. Nasopharyngeal cancer

35. Anatomy & Physiology

37. Etiology

38. Nasopharyngeal Cancer • Types of Tumors • Benign- non cancerous • Malignant- cancerous

39. Staging of NPC

40. 2 Ways of Staging Cancer • TNM System • Number system

42. Number Staging of Cancer

44. Risk Factors • Diets - in salt cured fish and meat • Epstein Barr Virus Infection • Genetic Factors • Male • Age 30- 55 yrs old • Asian

45. Signs and Symptoms • Painless and enlarged lymph nodes in the neck • Nasal obstructions • Epistaxis • Diminished hearing • Tinnitus • Recurrent Otitis Media • Cranial Nerve Dysfunctions • Sore throat • Headache

46. Diagnostic Test • Medical History and physical Assessment • Fiberoptic Endoscopic Examination • Ct Scan

47. MRI (Magnetic Resonance Imaging) • Biopsy

49. Treatments

50. Chemotherapy • Cisplatin- drug of choice • Side Effects • Anorexia • Constipation • Bone marrow damage • Hair loss • Increase risk of infection • Mouth sores • Nausea and vomiting • Fatigue