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| 1/2024 Opis przypadku Amelia J. Sobala 1 , Anna W. Szablewska 1
Nursing Problems 2024; 32 (1): 52-58 Data publikacji online: 2024/05/23 Plik artykułu: - The therapeutic process.pdf[0.63 MB] ENWEndNoteBIBJabRef, MendeleyRISPapers, Reference Manager, RefWorks, Zotero AMA APA Chicago Harvard MLA Vancouver INTRODUCTIONTumours of the vulva comprise a statistically small group among all female genital cancers, accounting for 4-5% of them [1, 2]. The incidence of this cancer is usually observed in the age group of postmenopausal women [1-3]. However, observations indicate an increasing incidence of this disease among younger patients [3-5]. The vulvar neoplasm usually develops as a single lesion, but it can also be multifocal and is usually located on the labia majora [2, 6]. A correlation between human papilloma virus (HPV) or herpes virus (HSV) type 2 infection and vulvar cancer has been demonstrated. A history of vulvar lichen sclerosus is also cited as a risk factor [6-8]. Patients with vulvar cancer most commonly report symptoms such as itching and burning of the vulva. Women with advanced vulvar cancer complain of additional complaints such as pain, unpleasant odour, blood-like discharge, or enlarged lymph nodes in the groin area. When the location of the tumour involves the urethral region, there may also be soreness and discomfort when urinating [1, 2, 9]. Whenever vulvar cancer is suspected, it is recommended that a biopsy be taken from the part of the lesion that is of concern [2, 6]. Surgical treatment is the preferred method of treatment, and its extent depends on the stage of the tumour or the presence of metastases [4, 9]. Radiotherapy and chemotherapy for this type of cancer are often complementary treatments [1, 2, 9, 10]. MATERIAL AND METHODSA case study was used in this study, which included a description of the obstetric and clinical condition. The patient gave informed consent to participate in the study, and the management of the institution where the patient was hospitalised agreed to share her medical records, which were used in this study. The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board Independent Bioethics Committee for Scientific Research at the Medical University of Gdańsk, Poland (KB/640/2023) for studies involving humans. The research techniques used were interview, observation, and analysis of medical records. A physical examination of the patient was also carried out. Viewing and palpation techniques were used in the aspect of assessing the vulvar lesion. Palpation of the abdomen and lymph nodes was performed. A gynaecological examination of the patient was hampered due to severe pain in the vulvar region. The patient’s vital signs were also measured: blood pressure, heart rate, and body temperature. Patient assessment tools from the C-HOBIC system were also used; these are indicators of quality nursing care outcomes, i.e. scales for assessing the functioning, knowledge, and skills of patients. The basic tools of the C-HOBIC system are functional scales, safety scales, clinical symptom assessment scales, and treatment recommendation scales [21, 22]. Due to the need to assess the patient’s ability to self-care and her level of performance, taking into account her age and cancer stage, the Activities of Daily Living (ADL) scale was also used. The ADL scale was used as an indicator of a person’s functional status for home care (Table 1). This scale allows assessment of the patient’s ability to move, eat, control physiological activities, and maintain body hygiene. The Activities of Daily Living (ADL) Basic Assessment Scale was developed by American gerontologist Sidney Katz. Inability to meet basic activities means total dependence and the need for constant care. The scale was assessed with a rating of 0 to 6, where 0 indicated independent and 6 indicated totally dependent. Assessment results using the ADL scale can be transferred to the ICNP system [22]. The Numerical Rating Scale (NRS) was used to monitor pain, with pain severity indicated by numbers 0-10, with 0 indicating no pain and 10 indicating unbearable pain. The patient received a score of 3 on admission due to pain in the vulvar region on the NRS scale. With analgesic treatment, the pain score on the NRS scale decreased to 2 and 1 on the following days of hospitalisation. The diagnosis of malnutrition was made on the basis of the laboratory test (Table 2) and the NRS 2002 scale carried out. A score between 0 and 3 was given for each criterion. Nutritional status was determined by 3 variables: body mass index (BMI), recent weight loss, and food intake in the past week. Disease severity was analysed by assessing increased nutritional requirements due to recent medical history (falls, fractures, surgery, oncology, and intensive care therapy) and coexisting chronic diseases. The patient scored a maximum of 3 points in the nutritional status category due to > 5% weight loss in the last month. In the disease severity category, the patient received 2 points out of a possible 3. The woman received an additional one point due to her age exceeding 70 years. The patient received a total of 6 points. Receiving 3 or more points on the NRS 2002 scale indicates the need for nutritional treatment. The diagnosis of risk of pressure ulcer was made on the basis of the Norton scale; the patient was assessed in 5 categories: physical state, mental state, activity, mobility, and urinary/faecal incontinence. The patient scored 14, which translates into a high risk of pressure ulcer. CASE STUDYThe patient is a 74-year-old woman with no history of pregnancy or childbirth, living with her husband in the city, who described her housing conditions as good. In December 2022 the patient was transferred by the Emergency Care Team to the Operative Gynaecology, Oncology, and Urogynaecology sub-unit due to purulent discharge oozing from a vulvar ulcer and significant weakness and intolerance to exercise, as well as abnormal bleeding from the genital tract. Due to significantly reduced mobility the patient’s transport was in a reclining position. INTERPRETATION OF ADL SCALE RESULTSThe ADL scale contains scores (HOBIC code) from 0 to 6, where individual scores had the following rating: 0 – independent, 1 – initial help/direction of change, 2 – requires supervision, 3 – less assistance, 4 – more assistance, 5 – maximum assistance, 6 – totally dependent. FIVE NURSING DIAGNOSES WERE CREATED BASED ON THE ADL SCALEDiagnosis 1: Impaired ability to transfer [10001005]. Diagnosis 2: Impaired mobility [10001219]. Diagnosis 3: Impaired ability to perform hygiene [10000987]. Diagnosis 4: Impaired self-toileting [10000994]. Diagnosis 5: Impaired ability to bathe [10000956]. OTHER DIAGNOSESDiagnosis 6: Pain [10013950] + L: Vulvar region [10020872] + F: Cancer pain [10003841]. Diagnosis 7: Self-care deficit [10023410]. Diagnosis 8: Lack of knowledge of disease [10021994]/Low self-control [10027469]. Diagnosis 9: Impaired acceptance of health status [10029480]. Diagnosis 10: Impaired nutritional status [10025746] + F: Malnutrition [10042077]/Dehydration [10041882]. Diagnosis 11: Risk for infection [10015133]. Diagnosis 12: Risk for pressure ulcer [10027337]. Diagnosis 13: Functional dyspnoea [10029414]. Diagnosis 14: Diabetes [10005876]. Diagnosis 15: Obese [10013457]. Diagnosis 16: Impaired cardiovascular system [10022949]. CONCLUSIONSWhen caring for an elderly patient, attention should be paid to any deficits in self-care, and it is worth using activities of daily living scales such as the ADL scale. DisclosuresThe authors declare no conflict of interest. References1. Kubiak W. Problemy pielęgnacyjne i psychologiczne u pacjentki z rakiem sromu. Krakowskie Towarzystwo Edukacyjne, Oficyna Wydawnicza AFM, Kraków 2011; 95-103. 2. Bręborowicz GH. Położnictwo i ginekologia. Tom II. PZWL Wydawnictwo Lekarskie, Warszawa 2021; 10-20. 3. Wierzba W, Jankowski M, Placiszewski K, et al. Analysis of incidence and overall survival of patients with vulvar cancer in Poland in 2008-2016 – implications for cancer registries. Ginekol Pol 2022; 93: 460-466. 4. Olawaiye AB, Cuello MA, Rogers LJ. Cancer of the vulva: 2021 update. Int J Gynaecol Obstet 2021; 155: 7-18. 5. Zweizig S, Korets S, Cain JM. Key concepts in management of vulvar cancer. Best Pract Res Clin Obstet Gynaecol 2014; 28: 959-966. 6. Maciej K, Krzysztof W. Zalecenia postępowania diagnostyczno-terapeutycznego w nowotworach złośliwych 2013 r. Tom I. VM Media, Gdańsk 2013; 267-268. 7. Maclean AB. Vulval cancer: prevention and screening. Best Pract Res Clin Obstet Gynaecol 2006; 20: 379-395. 8. Sznurkowski JJ, Bodnar L, Bidziński M, et al. Recommendations of the Polish Gynecological Oncology Society for the diagnosis and treatment of vulvar cancer. Curr Gynecol Oncol 2017; 15: 45-53. 9. Merlo S. Modern treatment of vulvar cancer. Radiol Oncol 2020; 54: 371-376. 10. Oonk MHM, Planchamp F, Baldwin P, et al. European Society of Gynaecological Oncology Guidelines for the management of patients with vulvar cancer. Int J Gynecol Cancer 2017; 27: 832-837. 11. Tan A, Bieber AK, Stein JA, Pomeranz MK. Diagnosis and management of vulvar cancer: A review. J Am Acad Dermatol 2019; 81: 1387-1396. 12. Wojciech O, Andrzej M. Rozległy rak sromu z olbrzymim guzem pochwy – opis przypadku. Ginekol Pol 2008; 79: 60-64. 13. Rabiej M, Mazurkiewicz B. Pielęgnowanie w położnictwie, ginekologii i neonatologii. PZWL Wydawnictwo Lekarskie, Warszawa 2018; 248-259. 14. Dmoch-Gajzlerska E, Rabiej M. Opieka położnej w ginekologii i onkologii ginekologicznej. PZWL Wydawnictwo Lekarskie, Warszawa 2016; 35-49. 15. Ulaniecka N. Doświadczanie choroby nowotworowej – aspekty psychospołeczne. Wydawnictwo Naukowe UAM, Poznań 2021. 16. Koper A, Koper KJ. Pielęgniarstwo onkologiczne. Tom 2. PZWL Wydawnictwo Lekarskie, Warszawa 2020; 258-259. 17. Stępień A, Trypka E. Zaburzenia psychicznie u chorych na nowotwory w wieku podeszłym. Onkol Prakt Klin 2012; 8: 45-51. 18. Stowarzyszenie Pomocy Chorym na Mięsaki i Czerniaki Sarcoma. Dlaczego się nie badamy? Profilaktyka nowotworowa Polek i Polaków. Raport 2022. Stowarzyszenie Pomocy Chorym na Mięsaki i Czerniaki Sarcoma, Warszawa 2022. https://www.sarcoma.pl/media/raport-2022.pdf (Access: 27.11.2023). 19. Główny Urząd Statystyczny. Sytuacja demograficzna Polski do roku 2022. https://stat.gov.pl/obszary-tematyczne/ludnosc/ludnosc/sytuacja-demograficzna-polski-do-roku-2022,40,3.html (Published: 4.09.2023, Access: 29.11.2023). 20. Pirogowicz I, Sobieszczańska M. Współczesna geriatria – choroby otępienne. Wrocławskie Wydawnictwo Naukowe Atla 2, Wrocław 2019; 93-100. 21. Kilańska D. Wskaźniki jakości opieki i ich wykorzystanie w praktyce. Zasady korzystania z narzędzi, ewaluacja i walidacja skal oceny statusu zdrowotnego. Akredytowane Centrum Rozwoju ICNP przy Uniwersytecie Medycznym w Łodzi 2015; 1-10. 22. Kilańska D. Międzynarodowa Klasyfikacja Praktyki Pielęgniarskiej. ICNP w praktyce pielęgniarskiej. PZWL Wydawnictwo Lekarskie, Warszawa 2014; 98-107. 23. Przeglądarka ICNP, ICN – Międzynarodowa Rada Pielęgniarek. https://www.icn.ch/what-we-do/projects/ehealthicnptm/icnp-browser (Access: 29.11.2023. 24. ICNP® – polski. https://www.icn.ch/sites/default/files/inline-files/icnp-polski_translation.pdf (Access: 29.11.2023). This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license. |
Pełny tekst: The therapeutic process and care problems of a patient with advanced vulvar cancer, Amelia J. Sobala (2024)
Table of Contents
Amelia J. Sobala 1 , Anna W. Szablewska 1
INTRODUCTION
MATERIAL AND METHODS
CASE STUDY
INTERPRETATION OF ADL SCALE RESULTS
FIVE NURSING DIAGNOSES WERE CREATED BASED ON THE ADL SCALE
OTHER DIAGNOSES
CONCLUSIONS
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