II.

INTRODUCTION

Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. It may present with
vaginal bleeding, but symptoms may be absent until the cancer is in its advanced stages.
Treatment consists of surgery, including local excision, in early stages and chemotherapy and
radiotherapy in advanced stages of the disease.

Pap smear screening can identify potentially precancerous changes. Treatment of high grade
changes can prevent the development of cancer. In developed countries, the widespread use of
cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or
more.

Human Papillomavirus (HPV) infection is a necessary factor in the development of almost all
cases of cervical cancer. HPV vaccines effective against the two strains of HPV that currently
cause approximately 70% of cervical cancer have been licensed in the U.S, Canada, Australia
and the EU. Since the vaccines only cover some of the cancer causing “high-risk" types of HPV,
women should seek regular Pap smear screening, even after vaccination.

Worldwide, cervical cancer is twelfth most common and the fifth most deadly cancer in women.
It affects about 16 per 100,000 women per year and kills about 9 per 100,000 per year.
Approximately 80% of cervical cancers occur in developing countries. Worldwide, in 2008, it
was estimated that there were 473,000 cases of cervical cancer, and 253,500 deaths per year.

In the United States, it is only the 8th most common cancer of women. In 1998, about 12,800
women were diagnosed in the US and about 4,800 died. In 2008 in the US an estimated 11,000
new cases were expected to be diagnosed, and about 3,870 were expected to die of cervical
cancer. Among gynecological cancers it ranks behind endometrial cancer and ovarian cancer.
The incidence and mortality in the US are about half those for the rest of the world, which is due
in part to the success of screening with the Pap smear. The incidence of new cases of cervical
cancer in the United States was 7 per 100,000 women in 2004. Cervical cancer deaths decreased
by approximately 74% in the last 50 years, largely due to widespread Pap smear screening.The
annual direct medical cost of cervical cancer prevention and treatment is prior to introduction of
the HPV vaccine was estimated at $6 billion.

In the European Union, there were about 34,000 new cases per year and over 16,000 deaths due
to cervical cancer in 2004.

In the United Kingdom, the age-standardised european incidence is 8.5/100,000 per year (2006).
It is the twelfth most common cancer in women, accounting for 2% of all female cancers, and is
the second most common cancer in the under 35s females, after breast cancer. The UK's
European age-standardised mortality is 2.4/100,000 per year (2007) (Cancer Research UK
Cervical cancer statistics for the UK). With a 42% reduction from 1988-1997 the NHS
implemented screening programme has been highly successful, screening the highest risk age
group (25–49 years) every 3 years, and those ages 50–64 every 5 years.

In Canada, an estimated 1,300 women will be diagnosed with cervical cancer in 2008 and 380
will die.

In Australia, there were 734 cases of cervical cancer (2005). The number of women diagnosed
with cervical cancer has dropped on average by 4.5% each year since organised screening began
in 1991 (1991–2005). Regular two-yearly Pap tests can reduce the incidence of cervical cancer
by up to 90% in Australia, and save 1,200 Australian women dying from the disease each year.
During our duty in the infirmary ward in a hospital in Quirino, Manila, our group encountered a
patient with cervical cancer and were assigned to give nursing care to this patient. During her the
time she was admitted, we monitored vital signs, reminded her of her medication, followed-up
on laboratory reports and results and provided health teachings regarding her condition and
proper self care.

We observed and saw the severity of this condition in person and experienced this like never
before. We became intrigued and curious that we decided to focus our case study on this
condition. We saw it as a challenge that would help improve our ability to understand and
research on a topic that we find interesting.

II. OBJECTIVES
General Objective:

After conducting the case the presentation, the participants will be able to gain
knowledge about cervical carcinoma stage 2 with anemia secondary to chronic bleeding,
demonstrate adequate skills in analyzing the nursing process and appreciate the importance of
nurse’s role in providing appropriate management for a client having the disease.

To be able to apply what we have learned theoretically at the clinical setting and after that
study, we can be able to understand this disease deeper together with the help of our
Clinical Instructor and able to provide optimum or standard quality care to the patient through
making of the nursing intervention and health education regimen.

Specific Objectives:

Student-Nurse Centered

• Describe the common characteristic of cervical cervical carcinoma stage 2 with anemia
secondary to chronic bleeding.

• Present the anatomy and physiology of cervical carcinoma stage 2 with anemia secondary
to chronic bleeding related with our client’s condition.

• Discuss the etiology, pathophysiology and clinical manifestation of our client’s condition.

• Relate the significance of laboratory results to client’s conditions or the disease process.

• Identify the classification, indication, mechanism of action, special precautions, side

effects, dosage and availability and nursing responsibilities of the drug administered to
the client.

• Discuss comprehensively nursing care plans formulated specifically based on client’s

condition.

• Discuss the medical and surgical interventions related to the client.

• Formulate a comprehensive discharge plan realistic to the needs and compliance of the
client.

Client Centered

• To manage her disease

• To know the importance of her compliance to her disease

• To prevent and manage the potential complication that might occur
 • Performed emphasized health teaching and following dietary instruction and restriction as
well as performing appropriate exercise

III. PATIENT’S PROFILE

NAME: Ms. MS
ADDRESS: Muntalban
AGE: 48 y/o
GENDER: Female
DATE OF BIRTH: 10/10/1963
PLACE OF BIRTH: Masbate
ETHNIC GROUP: Bicolana
PRIMITIVE DIALECT Bicol, Tagalog
SPOKEN:
CIVIL STATUS: Single
EDUCATIONAL College graduate
ATTAINMENT:
RELIGIOUS ORIENTATION: Roman Catholic
OCCUPATION Grade school teacher
HEALTH CARE FINANCING Money from husband
AND USUAL SOURCE OF
MEDICAL CARE:
INCOME (ALLOWANCE): 14 – 15 thousand pesos per month
ADMITTING DIAGNOSIS Cervical carcinoma stage II-B with
anemia secondary to chronic bleeding
s/p chemotherapy + 3 cycles
DATE AND TIME OF February 28,2011 ; 12:41pm
ADMISSION
TOTAL NUMBER OF DAYS 3 days
ADMITTED
ATENDING PHYSICIAN Dr. RAVIE, DELA CRUZ
IV. HISTORY OF PAST ILLNESS
Patient M.S. stated that she was born healthy. She was just hospitalized when she was 17
yrs old at a hospital in Masbate because she had difficulty in breathing. She stayed at the hospital
for 3 days. She was then diagnosed with Asthma. The patient’s asthma attacks rarely and when
she is experiencing mild asthma attacks, she just used inhaler, but when severe asthma attacks,
the patient used nebulizer( ventolin).
The patient became pregnant 3 times. The first one was to a healthy baby boy. She gave
birth at home through “ hilot”. The second one was aborted and the third was a healthy baby girl.
She also gave birth through hilot again. She did not take any medications before and during
pregnancy
When the patient had fever, she just drinks Biogesic 3 times a day. She just self-
medicates when experiencing coughs and colds.
The patient has no allergies and never experienced any accidents.
IMMUNIZATIONS:

IMMUNIZATION 1ST DOSAGE 2ND DOSAGE 3RD DOSAGE

BCG 
ANTI - HEPATITIS   
DPT   
OPV   
AMV  

V. HISTORY OF PRESENT ILLNESS

Last November 2010, the patient noticed that her menstrual flow was abnormally high.
The patient used 5 pads per day and all were fully soaked with blood. The patient just
disregarded it. 2 weeks prior to admission, the patient experienced 2 episodes of vaginal
bleeding. She used 3 pediatric diapers which were slightly soaked. She also experienced
dizziness.
1 week prior to admission, the patient was advised to go to St. Luke’s Medical City for
check up. The doctor said that she has cervical problem and her hemoglobin is abnormally low.
She was also advised for blood transfusion. The patient was also prescribed with Tranexamic
Acid and Ferrous sulfate.
The patient was admitted to Ospital ng Maynila because she has a relative working in this
hospital. The patient was admitted on Feb. 28, 2011 at 12:41 pm for the complaint of vaginal
bleeding

VI. FAMILY HEALTH HISTORY / GENOGRAM

 The patient’s grand parents are deceased except for her grandmother on her mother’s
side. Both of her parents are still alive. The patient is married and has two children, one male and
one female.

Genetic diseases in her family are asthma, diabetes and hypertension. Asthma was in the
genes of her grandmother on her father’s side of the family and was inherited by her and her
father. Diabetes came from her grandfather from her father’s side of the family but was not
passed down. Hypertension originated from her grandfather on her mother’s side of the family,
passed down to her mother.

VII. OBSTETRICAL HISTORY

Menstrual History

At the age of 13 the patient experienced menarche. The duration of her period usually last
for 3 – 4 days and she usually consumes 3 pads per day. She does not experience dysmenorrheal.

Sexual History

Her first coitus was when she was 22 years old. The patient had only 1 sexual partner.
Post cervical bleeding is absent, no pain during sexual intercourse and has no sexual transmitted
disease. The patient used oral contraceptive pill on 1990 and stopped on 1993.

Obstetric Scoring

Type of
Gravida Year Gender Term Location Weight
Delivery
Home by
G1 1986 Female Full Term NSD Unremarkable
hilot
G2 1987 - Abortus - - -
Home by
G3 1989 Male Full Term NSD Unremarkable
hilot