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Case Study of Osteosarcoma and Pathologic Fracture
of the Humerus
Submitted By: BSN – III. Group I
Arago, Alvin
Banaag, Glady Maicel
Cordero, Marissa
Dimayacyac, Lyka
Formaran, Jheny
Hilario, Joeven
Submitted To:
Dr. Ma. Purisima B. Macatangay
Dean of College of Nursing, RN, MAN, Ph.D
OBJECTIVES:
General Objectives:
To learn important information about bone tumors specifically
osteosarcoma, enabling the group gain deeper knowledge and understanding,
towards giving a safe and quality nursing care for patients with said condition.
Specific Objectives:
>Nurse-centered objectives
To focus on bone tumors and give a brief discussion of fracture of
the humerus.
To review the anatomy and physiology of the affected area and to
discuss the pathophysiology osteosarcoma including its predisposing
factors.
To outline and analyze the drug used by the patient in the course of
treatment.
To plan and carry out nursing interventions appropriate in the
management of the disease.
>Patient-centered objectives
To have an idea and be familiar about the risk bone tumors and bone
fractures.
To be able to gain insights about the condition enable to render an
appropriate actions/management so that the patient will prevent
further complications.
I. INTRODUCTION
Bone Tumor is neoplasm in the skeletal system. They maybe primary or
metastatic tumor from primary cancer elsewhere in the body. Metastatic Tumor are more
common than primary bone tumor. There are two types of bone tumor the Benign Tumor
and Malignant Bone Tumor. Benign bone tumor
includes: Osteoma, Chondroma, Csteochondroma
and Giant Cell Tumor. This tumor tends to grow
slowly and usually do not destroy the supporting or
surrounding tissue or spread to other part of the
body. Malignant bone tumor is an ill defined, lack
sharp border and extend beyond the confines of the
bone. There are several types of malignant bone
tumor which includes Osteosarcoma, Ewing/s
Sarcoma and Chondroma.
Osteosarcoma is an ancient disease that is still incompletely understood. The term
sarcoma was introduced by the English surgeon Jhon Abernalty in 1804 and was derived
from Greek roots meaning fleshy excrescene. In 1805, the French surgeon Alexis Boyer
first used the term osteochondroma. It gross appearance was described 1847 by Baron
Guillaume Dupuytren as a whitish or reddish mass, lardaceous and firm at an early stage
of the disease; but presenting at a later period, points of softening, cerebriform matter,
extravasting blood and white or straw colored fluid of a viscid consistence in its interior.
The incidence of osteosarcoma is slightly higher in males than females with males
( 5.2 per million per year) and females (4.5 per million per year). It is very rare in young
children (0.5 cases per million per year in children <5 years.). Incidence increases
steadily with age, increasing more dramatically in adolescence, corresponding with the
growth spurt. Osteosarcoma is deadly form of musculoskeletal cancer that most
commonly causes patients to die from pulmonary metastatis disease and which has 5 year
survival rate of 15-20%.
Fracture of the humerus represents 3-5% of all
fractures it is related to bimodal age distribution. It
may occur in children due to accident resulting to
injury or trauma to the bones and in elderly due to
weakened bones which are prone to fracture when
accidentally fall. Fracture of the humerus can be
described according to its location, it can be either,
proximal, middle or distal third and its pattern spiral,
transverse and comminuted.
A pathologic fracture is a broken bone caused by disease leading to weakness of
the bone. This process is most commonly due to osteoporosis, but may also be due to
other pathologies such as: cancer, infection, inherited bone disorders,or a bone cyst. Only
a small number of conditions are commonly responsible for pathological fractures,
including osteoporosis, osteomalacia, paget's disease, osteitis, osteogenesis imperfecta,
benign bone tumors and cysts, secondary malignant bone tumours and primary malignant
bone tumours.
Fragility fracture is a type of pathologic fracture that occurs as result of normal
activities, such as a fall from standing height or less.This definition arises because a
normal human being ought to be able to fall from standing height without breaking any
bones, and a fracture therefore suggests weakness of the skeleton.
II. PATIENT’ PROFILE
Name: Patient X
Permanent Address: # 0522 Bulihan, Bulacan
Birthdate : Oct. 11 1945
Age: 67 yrs. Old
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: March 14, 2013
Admitting Diagnosis: Primary Bone Tumor L2 vertebra, No neurologic deficit,
pathologic fracture humerus @ right arm
A. Past History
Patient X is a mother of three siblings. She is a vendor, selling “kakanin” such as
suman, puto, bibingka etc. According to her in terms of nutrition she loves to eat
vegetables, fruits, and meat however, she is not fond of drinking milk which might
precipitate the occurrence of disruption in continuity of bone. At the age of 66 she notices
a palpable mass on her back specifically lumbar 2 vertebra. Then last December 2012 she
started to experience the signs and symptoms of bone tumor primary night time
awakening due to the persistent pain on the affected area.
Patient X is neither a known asthmatic nor had medications. She claims to have
no history of previous hospitalization or serious illness.
B. Present History
Patient X confined at Philippine Orthopedic Center having a chief complaint of
pain in right arm and diagnosis of Primary Bone Tumor L2 vertebra, No neurologic
deficit, pathologic fracture humerus @ right arm. At the time of admission the patient is
conscious and coherent. According to the patient fracture resulted from accident fall and
broke her arm. The diagnosis exam done to her are X-ray and MRI, in laboratory test, she
undergone CBC.
III. REVIEW OF SYSTEMS
IV.GORDON’S FUNCTIONAL HEALTH PATTERN
Health Perception – Health Management Pattern
The patient seeks consultation to her personal doctor, but sometimes she takes any
medication which is prescribed by the doctor. Because of persistent pain, she was forced
to go to the hospital and diagnosed of primary bone tumor.
Nutritional Metabolic Pattern
There is no restriction in the patient’s diet. She usually includes fruits and
vegetables in her diet, moreover, she is fond of eating high fat foods and she refused to
drink milk.
Elimination Pattern
Due to her condition, the patient has indwelling Foley catheter. In terms of bowel
movement, it is irregular, she told us that she moved bowel every 2 -3 days.
Activity – Exercises Pattern
The patient did not engage in any form of exercises, she considered household
chores as a means of exercises. But since she was hospitalized, she was not able to
perform any form of exercises and according to her there is numbness in her lower
extremities leading to immobilization.
Sleep – Rest Pattern
The patient experienced disturbance in sleeping because of the pain especially at
night.
Cognitive – Perceptual Pattern
She can easily understand and interact with people. The patient was able to follow
instructions as ordered by the physician; however, she lacks knowledge regarding her
condition.
Self – Perception – Self – Concept Pattern
She is conscious and coherent upon interaction. Due to her condition, she was
confined to bed and experiencing difficulty in moving associated with numbness and
weakness of lower extremities.
Role – Relationship Pattern
The patient has good relationship with the family members. According to her
daughter, she is a good mother. The family always support her financially and
emotionally especially during hospitalization.
Coping – Stress Tolerance Pattern
She used the power of praying/ prayer, rosary and bible to cope with daily stress.
Values/ Belief Pattern
She has a positive outlook in life. She believe and still hoping for her condition to
become better.
V. ANATOMY AND PHYSIOLOGY
PARTS OF THE HUMERUS
VERTEBRAL COLUMN
VI. PATHOPHYSIOLOGY
PREDISPOSING FACTORS:Children:
Genetics Teenage growth spurt Benign bone tumors Injury/Trauma Metabolic and hormonal
imbalance
PREDISPOSING FACTORS:Adults:
High fat diet Lack of exercise Smoking Alcoholism Injury/Trauma Metabolic and hormonal
imbalance
OSTEOBLAST
DNA MUTATION
MALIGNANT OSTEOBLASTPROLIFERATION OF ABNORMAL OSTEOBLAST
FORMATION OF IMMATURE BONE
Pain Swelling Tenderness
OSTEOSARCOMA
VII. LABORATORY RESULTS
HEMATOLOGY TEST:
Blood Component Normal Values ResultsHemoglobin 110 – 158 g/L 72 g/LHematocrit 0.37 – 0.54 g/L 0.23
Leucocytes Count 4.5 – 10 x 101/L 3.24Platelet Count 150 – 400 x 109/L 49
LIPID PROFILE:
Lipid Normal Values ResultsHemoglobin < 35 – 85 mg/dL 28
Hematocrit < 160 mg/dL 171
POTASSIUM LEVEL:
Potassium Normal Values ResultsK 3.5 – 5 meq/L 3.1 meq/L
VIII. DRUG STUDY
1.BRAND NAME: Kalium Durule
GENERIC NAME: Potassium Chloride
MECHANISM OF ACTION: Replaces potassium and maintains potassium level.
INDICATION: To prevent hypokalemia.
CONTRAINDICATION: Contraindicated in patient with severe renal impairement with oliguria, anuria, or with acute dehydration or other conditions linked to extensive tissue breakdown.
ADVERSE REACTION: paresthesia of limbs, confusion, weakness G.I: nausea, vomiting. abdominal pain, diarrhea.
o METABOLIC: hyperkalemia.
o RESPIRATORY: respiratory paralysis.
NURSING CONSIDERATION:
Drug is commonly used orally with potassium wasting diuretics to maintain potassium level.
Monitor ECG and electrolyte level during therapy.
Many adverse reaction may reflect hyperkalemia.
2.BRAND NAME: Feosol
GENERIC NAME: Ferrous Sulfate
MECHANISM OF ACTION: Provides elememtal iro, an essential component in the formation of hemoglobin.
INDICATION: For iron deficiency
CONTRAINDICATION: Contraindicated in patient with peptic ulcer disease, regional enteritis or ulcerative colitis.
ADVERSE REACTION: G.I: nausea, epigastric pain, vomiting, constipation. Black stool, anorexia. Other: temporarily stined teeth from suspension.
NURSING CONSIDERATION:
Check for constipation; record color and amount of stool.
G.I upset may be related to dose.
Monitor hemoglobin level, hematocrit and reticulocyte count during therapy.
Tell patient to take tablet with juice or water but not with milk or antacid.
3.BRAND NAME: Tramadol
GENERIC NAME: Ultram
MECHANISM OF ACTION: Inhibits the reuptake of serotonin and norepinephrine in CNS.
INDICATION: Moderate to moderately severe pain
CONTRAINDICATION: Contraindicated in patient who have previously demonstrated hypersensitivity to tramadol, any other component of this product or opiods.
ADVERSE REACTION:
CNS: dizziness, headache, vertigo, seizures, anxiety.
EENT: visual disturbance.
G.I: constipation, nause4a, vomiting, abdominal pain.
SKIN: diaphoresis, pruritus and rash.
NURSING CONSIDERATION:
Assess type of location and intensity of pain before and 2-3hours (peak) administration.
Assess BP, and RR before and periodically during administration.
Assess bowel function routinely.
For better analgesic effect, give drugs before onset of intense pain.
4.BRAND NAME: Losec, Prilosec
GENERIC NAME: Omeprazole
MECHANISM OF ACTION: Inhibits activity of acid (proton) pump and binds to hydrogen-potassium adenosine triphosphatase at secretory surface of gastric parietal cells to block formation of gastric acid.
INDICATION: Treatment of gastroesophageal reflux disease.
CONTRAINDICATION: Contraindicated in patient hypersensitive to drug or its component.
ADVERSE REACTION:
CNS: dizziness, headache. G.I:abdominal pain. Constipation, diarrhea, nausea, vomiting.
MUSCULOSKELETAL: back pain,
RESPIRATORY: cough, upper respiratory tract infection.
SKIN: rash
NURSING CONSIDERATION:
Instruct patient to take drugs 30mins. before meals.
Caution patient to avoid hazardous activities if he gets dizzy.
Tell patient to swallow tablet or capsule whole anot to open, crush, or chew them.
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