Case Study: Signet Ring Gastric Adenocarcinoma with Metastasis, Summaries of Nursing

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CASE NARRATIVE

SANDOVAL, Cassandra Maureen M. BSN 2A Mylene L. Lipa Clinical Instructor

I.General Profile Surname First Name Middle Name Bay-an Infamila Andres Date of Birth 10/28/ Age 50 Place of Birth Bugias, Benguet Address Rimando, Baguio City Sex Male__ Female__ Civil Status Married Religion Roman Catholic Nationality Filipino Occupation Teacher Date of Admission 02/12/ AM__ PM__ Date Discharged AM__ PM__ No. of Hospital Days Admitting Physician: GTAJA Admitting Diagnosis: Intractable vomiting Vital Signs at Admission BP 130/ Temp 36. PR/CR 79 RR 20 O2 Sat 92% II.Medical History/Chief Complaints One month ago, the patient had severe abdominal pain with colicky features and vomiting, leading to a two- day hospital admission for acute gastroenteritis. Treatment with Metronidazole was effective. Four days ago, she had a recurrence of severe abdominal pain, vomiting, and a loose, yellowish stool, leading to another two-day hospital admission for amoebiasis. She was discharged with metronidazole 500 mg 1 Tab x 7 days and Ciprofloxacin 500 mg 1 Tab BID x 2 days. Despite treatment, she continued to have vomiting and diarrhea, prompting her to seek further medical attention. III.History of Present Illness The patient continues to have episodes of nausea and vomiting. These episodes are minimal and go away afterwards. The amount of vomit is small and intervened with anti-emetics immediately. Doctors performed an endoscopy and exploratory laparotomy to determine the cause. She reports that they found mass/ ”bukol” which were causing her to vomit. IV.Family History There are three instances of cancer in the family history. One of her aunts on her father's side had breast cancer, while another aunt on her mother's side had cervical cancer. Additionally, her mother developed stomach cancer. She also mentions that one of her siblings had an enlarged body part and specifically mentions prostate. She reports that she eats more vegetables than meat and her main exercise is walking.

Musculoskeletal - The patient does not experience any pain in the joints, swelling, or stiffness. Integumentary - The patient does not have any rashes and lesions. There are bruises from previous IV placements. There are moles and freckles throughout her body. Her skin is dry with her nails light pink and dry cuticles. Her hair is black and full. She shows no sign of edema. Neurological- The patient has no history of seizure and neurodegenerative disorders. She does not experience headaches or numbness. She has episodes of weakness and dizziness related to her condition. Endocrine - She is has both heat and cold intolerance with excessive sweating. She notes she has increased urine production and her appetite and thirst have decreased. Hematologic - The patient has no anemia or clotting disorders and no history of past blood transfusions. Psychiatric - The patient has mild anxiety following the news of her diagnosis. She reports that she is motivated to improve her health and has identified a strong support system. Allergy/Immunologic - The patient has no allergies and received vaccination for Covid and anti-flu. VI.Diagnostics Upper gastrointestinal endoscopy/esophagogastroduodenoscopy Gastric nodular mass, greater curvature, consider malignancy, S/P biopsies erosive gastritis Transabdominal/transvagial ultrasound Myometrial uteri, intramural, thin endometrium, normal ovaries, left adrenal mass consider hydrosalphinx Biopsy results Signet ring gastric adeno CA, metastatic signet ring CA, resected ileum and jejunum and bilateral ovaries VII.Medical Diagnosis  Signet ring gastric adenocarcinoma (ACA) Type of cancer that originates from the stomach characterized by the presence of signet ring cells  Metastatic signet ring CA The cancer has spread (metastized) from its original location to the other parts of the body The signet ring cell type is still present in the metastatic site  Resected ileum and jejunum Part of the ileum and jejunum, the cancer has spread to these parts and were surgically excised VIII.Pathophysiology

IX.List of Treatment Mechanism of Action Side E. Adverse E. Indication Contraindication Paracetamol inhibit the enzyme cyclooxygenase (COX), which leads to a reduction in the synthesis of prostaglandins, substances that contribute to inflammation, fever, and pain. nausea, vomiting, and allergic reactions like rash or itching. Severe skin reactions blood disorders liver failure. relief of mild to moderate pain and fever. severe hepatic impairment or active liver disease. Tramadol (^) binding to mu- opioid receptors and inhibiting the dizziness, nausea, constipation, Seizures, respiratory depression Tramadol is used to treat moderate to severe respiratory depression, Bowel Obstruction A tumor grows to a size that obstructs the normal passage of bowel contents Vomiting Bowel obstruction prevents food and fluids passing through the digestive tract normally leading to accumulation then vomiting Imaging and Investigation Eploratory laparotomy, endoscopy, CT scan, ultrasound Done to determine the cause Diagnosis of signet ring gastric ACA A biopsy confirms the presence of signet ring cells Metastasis Further investigations reveals metastasis to the ileum, Surgical Resection Removing affected parts to remove the metastatic tumors and relieve

4. Assisted with activities of daily living (assisted with ambulation) > To promote comfort and dignity and hygiene
5. Assisted with enteral feeding > To meet daily nutritional needs
6. Assisted with medications > To help manage symptoms and treat underlying conditions
7. Documentation > To monitor the patients progress and maintain communication among healthcare providers
8. Health education > To help them manage their conditions and prevent complications