INTRODUCTION

This is a case of Mr. D. a retired Air Force of the Philippines

officer who was a diagnosed with Squamous Cells Carcinoma.
Cancer of the larynx is most often squamous cell and may
occur in the glottis area: vocal cords (two thirds of cases),
supraglottic area and subglottis. This cancer is potentially curable
if detected early. Risk factors include male gender, age 50 to 70year-old, tobacco use (including smokeless), alcohol use, vocal
straining, chronic laryngitis, industrial exposure to carcinogens,
nutritional deficiencies, (riboflavin), and family predisposition.
The squamous cells occur in the lining of the digestive tract,
lungs and the other areas of the body. It also occurs as a form of
cancer in diverse tissue, including the lips, mouth, esophagus,
urinary bladder, prostat, lung vagina and cervix. It arises from the
uncontrolled multiplication of cells of epithelium, or cells showing
particular cytological of tissue architectural characteristics of
squamous cell differentiation, such as the presence of keratin,
tonofilament bundles or demosomes, structures involved in cell-to
cell adhesion.
All squamous cells carcinoma lesions are thought to begin
via repeated, uncontrolled division of cancer stem cells of
epithelial lineage of characteristics. Accumulation of these cance
cells causes a microscopic focus of abnormal cells that are, at
least initially, locally confined within the specific tissue in which
progenitor cell resided.

DEMOGRAPHIC DATA PROFILE

Name of Patient: Mr. D
Age: 66
1949

Gender: Male
Date of Birth: Nov. 18,

Address: Brgy.San Pascual Paliwas, Obando, Bulacan

Religion: Roman Catholic
Occupation: Retired Philippine Air Force of the Philippines

CHIEF COMPLAINT: HOARSENESS OF VOICE

FAMILY HISTORY
(-) Hypertension
(-) Diabetic Mellitus
(-) Asthma
(-) Pulmonary Tuberculosis
PAST HISTORY
(+) Hypertension
(+) Diabetic Mellitus

PHYSICAL ASSESSMENT
A. General Assessment
The patient is conscious and coherent, alert, cooperative,
well-groomed;
Medium built; fair complexion skin. The only problem is his
communication skill. He was not able to express his
concerns and true feelings towards the disease process.

VITAL SIGNS
Temperature: 36.4C
Pulse Rate: 87bpm
Respiratory Rate: 22cpm
Blood Pressure: 120/80mmHg

AREA
ASSESSMEN

TECHNIQUE
USED

ACTUAL
FINDINGS

ANALYSIS

T
HEAD
Skull

Inspection/Palpa
tion

Proportion to the
Normal
size of the body,
round with
prominence in the
frontal area
anteriorly, smooth
skull contour

Scalp

Inspection/Palpa
tion

White, clean, free

of masses, lumps,
scars, dandruff,
and lesions. No
areas of
tenderness

Normal

Hair

Inspection

Hair is gray and

rough

Normal due
to aging
process

FACE
CN V
(Trigeminal
Testing)

Inspection/Palpa
tion

Normal
intact CN V

CN VII
(facial)

Inspection/Palpa
tion

Blink reflex intact

using a wipes of
cotton. Able to
more mandible
from side to side,
can open mouth
against resistance
Symmetrical face
when asked to
smile, frown, raise
eyebrows and can
close eyes.
Can identify
sweet, sour and

Interact
Motor
function

salty.
CN VII

Nose
CN I

Whisper test

Unable to hear
Whispered words
clearly.

Finger rub Test

Finger rub heard

at foot
distance.

Weber Test
Rinne test

Able to hear
vibratory grounds
but not as clear as
before.
No deviation, no
flaring of alarm
Newspaper at a
distance of 14
inches can read
bold letter beyond
14 inches.

Inspection/Palpa
tion
Visual Acuity

Visual Fields
CN III, IV
and V
Mouth
Lips

Interact
Sensory
Fucntion
Normal
aging
process

Normal
With
presbyopia
(normal to
aging
patent)

Intact peripheral
vision
Six Cardinal Fields
of Gaze. Able to
move eyes
without difficulty.
No lesions, dark
brown in color, no
bleeding.

Normal
Intact CNs

Abnormal
due to
smoking
usually
seen to

heavy
smoker.

Gums

Palpation

Tongue

Inspection

Tonsils

Inspection

No tenderness ,
no masses

Change of
gum color
usually
seen to
heavy
smoker.
No lesion, no
Poor
bleeding with dark hygiene
patches on
anterior portion
No
Normal
swelling/inflamma
tion;
Pinkish in color

FRAMEWORK OF THE LARYNX IS COMPOSE OF THREE

UNPAIRED
CARTILAGES AND THREE CARTILAGES
Thyroid cartilage is the largest of the unpaired
cartilages, and resembles a shield in shape. The most
anterior portion of this cartilage is very prominent in
some men, and is commonly reffered to as an Adams
Apple.
Cricoid cartilage, whose shape is often described as a
signet ring.

Modifiable
Factors

Non- modifiable
Factors

Age

Lifestyle

Heredity

Prolonged
Heavy Smoking

Gender

Nicotine Addiction

Trigger the production of abnormal cells in the epithelial

tissue/ surface of the vocal cords.

Abnormal cell proliferation

Glottic mass malignant in the

larynx/ vocal cords.

Squamous Cell Carcinoma

Interfere with the normal

vibration of the vocal cords
due to swelling

Constriction/
Irritation of the
upper airway

CT SCAN REPORT
Enlargement of the lymph
nodes in the neck

Clinical History: One-month history of hoarseness

Examination: CT-SCAN OF THE NECK
Technique
Multiple contrast and non-contrast axial tomographic
section of the oropharynx and neck using 5mm of the thoracic in
approximately 40 mm slices were obtained from the thoracic inlet
to the base of the brain. No abnormal contrast of reaction
observed.
FINDINGS:
There is asymmetry and fullness of the vocal cords
(bulging more from the right) with Nodular enhancing
contour extending superiorly there are associated cystic
changes along the right aspect of the thyroid cartilage.
Thyroid glandes is enlarged with an ill-defined
hypotenuse soft tissue focus in the inferior portion of
the right thyroid lobe.

Examinatio Result
n

Unit

Normal
Value

Analysis and
Interpretation

Calcium

1.6

Mm0/L

2.1-2.6

Analysis:
Abnormal

Abnormal
Hypocalcemia:
Level of ionized
calcium is
regulated by
parathyroid
hormone and
vitamin D.serum
and calcium
equals the sum
of ionized
calcium plus
complexed
calcium bound to
proteins(mostly
albumin)
Note:
Increases in
calcium
Hyperparathyroid
ism,
malignancies
secreting PTHlike substances
(especially
squamous cell
carcinoma of
lung, renal cell
carcinoma,)
vitamin excess,
milk-alkali.

DISCHARGE PLANNING
MEDICATIONS
Encourage the client to comply with all the prescribed
medications.
Emphasizes to the client and her family of the importance of
taking the medication at the prescribed schedule, dosage
and frequency.
Educate the client about the purpose of the drugs.
Advice the significant others not to leave the client during
medications to secure that the client has taken the
medicines.
Explain to the client side effects and adverse effects of the
drugs he takes by describing its manifestations. Client and
significant others should be aware so the prompt medical
interventions can be given if in case such reactions occur.
EXERCISE
Encourage to ambulate and assume his normal activities as
long as there will be no problems.
Educate the client the proper body mechanics to enable him
relax, be comfortable ad prevent strains.
Instruct the client to balance activities with adequate rest
periods.
TREATMENT
Discuss to the client the complication of the condition
because knowledge about the condition supports learning
that will decrease anxiety.

 Educate the client on the importance of drugs and money

compliance.
Instruct the client to report medical assistance when
abnormalities occur.
Educate the family on how to demonstrate a correct
performance of the treatment.

HYGIENE
Instruct the client to do proper personal hygiene such as
taking a bath daily. Brushing his teeth after eating and
proper grooming.
Stress out the client the importance of hand washing before
and after using comfort room and eating to defer the spread
of microorganism.
Encourage the client as well as the significant others to
follow physicians instructions regarding hygiene and selfcare.
OUT PATIENT DEPARTMENT
Instruct the patient to comply with the schedule follow up
checkup to enable the physicians to have continuous record
on the clients condition.
Advice the client to report any abnormalities observed to
provide immediate medical intervention.
DIET
Instruct the client to follow physicians order regarding
proper food intake and tell him its importance.

 Encourage the client to avoid fatty foods increase intake of

vegetables and fruits.
Advise the client to increase oral fluid intake to facilitate
proper circulation of blood and to provide needed nutrients
and electrolytes.
SPIRITUAL
Encourage the client to strengthen his faith with Almighty
Father to provide spiritual growth and promote healing.
Advice the client never forget the God, to ask Jesus help and
believe in the healing power of the Holy Spirit to promote
peace of mind and relaxation, thus promoting comfort and
healing not just to the mind but also to avoid harm and
promote a soothing and pleasant atmosphere with everyone.
GORDONS FUNCTIONAL PATTERNS

Patterns of
Functioning

Before

During

Hospitalization Hospitalization

Analysis

Health
perception and
Health
Management

Patient was
smoking at
least 4 packs a
week and
stopped in
1990. Cough
has been also
more
predominantly
occurring
before his
hospitalization
. Seldom has
that he had
fever or illness
during his
work and
make no
absences
because of
health related
reason. Annual
checkups were
done.

Patients
disease is
caused by his
smoking habit.
He is now
more health
conscious and
cooperative to
any medical
management
that could help
him heal his
disease.

Health
perception
was changed
due to his
illness and
present
condition.

Nutrition and
Metabolism

The patient
had a good
appetite and
eats various
kinds of foods
with a
frequency of
3x/day, meals,
and 2x/day,
snack. Fluid
intake of
about 10-12

The patient
obviously feels
weight loss
because of the
way of eating
he does but he
does comply
on what the
medical team
said.
Objectively, all
foods and

He lost weight
ie to his illness
and changed
diet pattern.

glasses daily.
Had a weight
of 72 kg and
height of 55.

Sexuality
and
Reproduction

Coping
and
Stress
Tolerance

Values
and
Belief

fluids are
given through
Nasogastric
tube. Given an
osteorized
regular diet.
Fluid intake of
about - 2
glasses daily.
Having a
reduced
weight of only
69kg and a
same height
as before
hospitalization
.
The patient
It changes
had healthy
because of the
sexuality and
limited
reproduction.
movement
experiencing.
The patient
The patient
copes stress
seldom
by just reading experience
anything and
stress. But if
self-alonehe does he
time is good.
copes up by
just reading
anything.
According to
The patients
the patient ,
faith to God
religion has
becomes
been a big
stronger. He
part of his
believes that
faith to God,
God will help
and it helps
him aid his

There was a
changed in his
sexuality and
production.
The patient
felt relax in
the hospital
with no stress
ad pressures
in his
environment.
The patient is
active in their
church which
he has strong
faith in God.

him go
through if
difficulties
may occur.

Name of
Drugs,
Dose,
Frequen
cy
Brand
Name:
Ultram
Generic
Name:
Tramad
ol
Dosage:
50mg
Tab BID
PRN

Classificat
ion

Analgesic
Opioid

Action

Opioid
receptor
agonist,
induces
serotonin
release, and
inhibits the
reuptake of
norepinephri
ne.

healing.

Indicati
on

Contraindicat
Nurse
ion
responsibility

Modera
te to
severe
pain.

Suicidal
patients,
acute
alcoholism;
head
injuries;
raised
intracranial
pressure;
severe renal
impairment;
lactation.

Monitor CV
and
respirator
status
Monitor
patient at
risk for
seizures
Be alert for
adverse drug
reactions.