ORAL TONGUE CANCER

Presented to the Faculty of Bachelor of Science in Nursing

Tagum Doctors College Inc.,
Tagum City, Davao del Norte

In Partial Fulfillment of the Requirements in

Related Learning Experience 116

Submitted by:
Neri, Lovely Alyza P.
Palac, Jenny Faye C.
Pilos, Charlene Mae B.
Reyes, Princess Grace B.
Segundo, Ramon III L.

Submitted to:
Mr. Roberto B. Agravante Jr., RN

February 2022
 TABLE OF CONTENTS

I. Introduction
II. Objective
III. Patient’s Data
IV. Family Background/Health History
V. Developmental Data
VI. Definition of complete diagnosis
VII. Physical Assessment
VIII. Anatomy and Physiology
IX. Etiology and Symptomatology
X. Pathophysiology
XI. Doctor’s Order
XII. Diagnostic Exam
XIII. Drug Study
XIV. Surgical procedure
XV. Nursing Theories
XVI. Nursing Care Plan
XVII. Discharge Plan
XVIII. Recommendation
XIX. References/Bibliography
 ACKNOWLEDGEMENT

We'd like to express our gratitude to our adviser, Sir Roberto Agravante RN, for his
guidance and assistance during the process of creating this case study. This activity was
completed with great effort by the members of the group, despite a minor snafu among us while
working on the paper. Fortunately, all of the issues were resolved, and we were able to adjust
effectively and prudently.

Besides our adviser, we would like to thank the rest of our educators: Ma’am Willyn B. Adrias
RN MN, Sir Nolie Roy Biclar RN, Ma’am Heidi Cabanatan RN, Ma’am Racquel Donasco RN,
Ma’am Elle Baniel RN and Ma’am Myka Allene Catoto RN for their words of support and
thoughtful comments.

We also thank our groupmates in our Case Study namely: Neri, Lovely Riza, Palac, Jenny Faye,
Pilos, Charlene Mae, Reyes, Princess Grace, and Segundo Ramon III for providing a clear idea
and cooperating with this paper

Thank you to our parents and guardians for their unwavering faith in our abilities to successfully
complete this case study.

Finally, we would like to thank God for leading us through all of our hardships. We've been
following your advice on a daily basis. For our future, we will continue to place our trust in you.
 I. INTRODUCTION

This entire presentation revolved around a 26 year-old patient who was brought in the
hospital with a main complaint of a tongue lesion. The lesion was painful when the patient
moved her tongue or while eating. She further mentioned also having recurrent, poorly healing
aphtae on the right side of the tongue for a period of months before the current symptoms
presented.

The most common intraoral head and neck cancer is squamous cell carcinoma (SCC) of
the tongue. According to European statistics, the incidence is around 10–20 per 100 000 people.
Male subjects have decreased in Western Europe, despite an increase in female subjects over the
last decade. Many other parts of the world are seeing an upsurge in the incidence of oral cancer
(Curado MP & Hashibe M, 2009). The average age of people diagnosed with tongue cancer is 61
years old. Despite the fact that the prevalence of tongue SCC is increasing, only about 2% of
patients are diagnosed before they reach the age of 35, and another 7% before they reach the age
of 45 (Soudry E t al., 2010).

Globally, oral cancer was recorded in 369,200 new cases over the world, with two-thirds
of the tumors detected in poorer nations. Each year, roughly 145,328 people die as a result of
these tumors over the world. South and Southeast Asia, as well as some countries in southern
Europe, have the greatest rates of these tumors. OSCC prevalence and clinical pattern differ
substantially depending on geographic location at the time of diagnosis. At the national level, the
forecast shows mouth cancer (31.67%), tongue cancer (23.75%), and lip cancer (3.83%)
fluctuating through the year, while gum cancer (8%) will remain steady in 2020. Locally at
Davao City, the Davao Doctors Oncology Center (DDOCCI) caters to majority of cancer patients
in the region. Over the past ten years, it has treated more than 3,000 patients. Based on DDOCI
statistics, among cancer patients treated, the male to female ratio is 1:2, of which 79% us above
40 years old.

In conclusion, this paper aims to present a case study about oral cancer arising from her
past illness that it is acute myeloid leukemia and cerebral venous sinus thrombosis. This case
study will also give a student nurse the opportunity to practice treating clients with cellular
aberrations and severe biologic crises.
 II. OBJECTIVE

A.General Objectives

The main objective of this paper is to screen, identify and provide care to the patient with
Tongue Cancer. This will be achieved by providing access to adequate information on Oral
Cancer in general, its risk factors and guarantee that screening, monitoring and treatment are
available.

B.Specific Objectives

The student nurses would be able to:

COGNITIVE

 Remembering: Define oral squamous cell carcinoma

 Understanding: Understand the theoretical background of oral squamous cell carcinoma

 Applying: Apply what are the proper nursing assessments of Tongue Cancer.

 Analyzing: Compare and contrast all of the information gathered, and evaluate the issues
raised by people who are concerned.

 Evaluating: Use the most independent quality nursing interventions to avoid or reduce
possible health risks.

 Creating: Evaluate and advise on the care of patients with oral squamous cell carcinoma,
and also how they can attain and keep better health and well-being.

PSYCHOMOTOR

 Perception: Gather and evaluate information about the patient, including his or her medical
history, family medical history, medical history, and current health state.

 Set: Student nurses will rely on the patient in this situation.

 Guide Response: Follow the clinical instructors' directions for preparing this report and able
to utilize the understanding and skills learned from the experiences.

 Mechanism: Create a schedule of events for the General Assembly based on the information
you've gathered.

 Adaptation: During the case presentation, respond effectively to amendments suggested by

the clinical instructors.

 Origination: To satisfy the needs of the patient, carry out the right nursing interventions.
Assist the patient with general practice in order to maintain healthy and prevent disease.

AFFECTIVE
 Receiving: To gain the patient's trust and cooperation, generate a positive connection with
the patient.

 Responding: Providing focus and support to the patient indicates respect, genuine concern,
and empathy.

 Valuing: Providing best quality care while sticking to the nurse-patient relationship values.

 Organizing: Accept your responsibilities as a student nurse to develop your abilities and
knowledge while working on this paper.

 Characterizing: Demonstrates independent in task completion and collaborates in group

work.
 III. PATIENT’S DATA
A. Biographical Data

Patient’s code name: ABC

Age: 26 years old

Nationality: N/A

Civil status: N/A

Occupation: N/A

Sex: Female

Religion: N/A

Educational Attainment: N/A

Date of Admission: Feb 01, 2022

Date of discharge: Feb 10, 2022

Vital signs upon admission:

BP: 120/90 mmHg

HR: 105 bpm

RR: 25 cpm

Temp: 36 C

B.Chief complaints:

A 26 year-old patient presented herself at the Oral Surgery Division of the University
Hospital Zurich with a main complaint of a tongue lesion. For the last 4 months she observed
an alteration on the right side of the tongue, displaying alarming growth over a three week
period. The lesion was painful when the patient moved her tongue or while eating. She
further mentioned also having recurrent, poorly healing aphtae on the right side of the tongue
for a period of months before the current symptoms presented.

C.Admitting/final diagnosis:

Tongue Cancer related to infection as evidenced by tongue lesions.

D.Surgical procedure:

The patient was transferred to the Cranio-Maxillofacial and Oral Surgery Division of the
University Hospital Zurich. A MRI (Magnetic Resonance Imaging) as well as a PET
(Positron Emission Tomography) scan was performed as per standard oncological staging.
Eight days after the first examination at the same department a partial glossectomy was
 conducted on the right side and neck dissection of levels I-III. Due to the extent of the
resection a reconstruction of the tongue with a radialis free vascularised flap from left side
was performed. Full thickness skin graft from the medial side of the upper arm was used to
cover the donor site.

E. Attending physician: N/A

F. Source of information: N/A

IV. FAMILY BACKGROUND/HEALTH HISTORY

A. Family health history:

Patient ABC is the only child in their family and she and her family live at home
alone. She has a past history of acute myeloid leukemia (AML) before the age of 2 and 8 
years ago she had an incident of a cerebral venous sinus thrombosis. Currently she suffers
from epilepsy, but she hasn’t had any symptoms for a long time. Her mother and father suffer
also from high blood pressure.

B. Client’s health history (past illnesses, present illnesses):

Past Illness:

Regarding her medical history she suffered of acute myeloid leukemia (AML) before the
age of 2 and 8 years ago she had an incident of a cerebral venous sinus thrombosis.

Present Illness:
Patient ABC is a 26 year-old patient presented herself at the Hospital with a main
complaint of a tongue lesion. For the last 4 months she observed an alteration on the right side of
the tongue, displaying alarming growth over a three week period. The lesion was painful when
the patient moved her tongue or while eating. She further mentioned also having recurrent,
poorly healing aphtae on the right side of the tongue for a period of months before the current
symptoms presented. Currently she suffers from epilepsy, but she hasn’t had any symptoms for a
long time. She has no known allergies, takes no medicine, no antiepileptic drugs, has been
smoking for 8 years 2–3 cigarettes per day and she doesn’t drink alcohol.

V. DEVELOPMENTAL DATA

Erick Erickson’s “Theory of Psychosocial Development” believed that personality developed

in a series of stages. This described the impact of social experiences across the whole lifespan.
Erickson was interested in how social interaction and relationships played a role in the
development and growth of human beings.

STAGES NORMAL FINDINGS ACTUAL INTERPRETATION

 FINDINGS
Stages: 1  This occurs when adults meet a N/A  Infants must learn how to
child’s basic needs for survival. trust others at this point.
Birth-18 months Infants are dependent upon their Parents are the most
(Infancy) caregivers, so caregivers who are
appropriate figures to teach
responsive and sensitive to their
infant’s needs help their baby to children to believe.
develop a sense of trust; their baby
Trust vs. Mistrust will see the world as a safe,
predictable place. 
 Success in this stage will lead to the
virtue of hope. 
Stages: 2  This stage is focused on developing N/A  This newfound
a sense of personal control over independence is the result
18 months-3 physical skills and a sense of of maturation and imitation.
years (Early independence. 
Childhood)  Success in this stage will lead to the  The toddler develops
virtue of will. If children in this his/her autonomy by
stage are encouraged and supported making choices.
Autonomy vs. in their increased 
Shame and Doubt

 During the initiative versus guilt N/A  Children like to pretend and
Stages: 3 stage, children assert themselves try out new roles.
more frequently through directing
3-5 years play and other social interaction.   Fantasy and imagination
(Preschool)  A healthy balance between allow children to further
initiative and guilt is important. explore their environment.
Success in this stage will lead to the  Also at this time, children
Initiative vs. virtue of purpose, while failure  are developing their
Guilt superego or conscience.

Stages: 4  It is at this stage that the child’s N/A  School age children are
peer group will gain greater eager to apply themselves to
6-11 years significance and will become a learning socially productive
(School Age) major source of the child’s self- skills and tools.
Industry vs esteem. The child now feels the
need to win approval by  They learn to work and play
Inferiority with their peers.
demonstrating specific
competencies that are valued by  School age children thrive
society and begin to develop a on their accomplishments
sense of pride in their and praise.
accomplishments. 
Stages: 5  This is a major stage of N/A  Dramatic physiological
development where the child has to changes associated with
12-18 years learn the roles he will occupy as an sexual maturation highlight
(Adolescence) adult. It is during this stage that the this stage.
adolescent will re-examine his
identity and try to find out exactly  There is marked
who he or she is. Erikson suggests preoccupation with
Identity vs. Role
that two identities are involved: the appearance and body image.
Confusion sexual and the occupational. 
 Adolescents who are 
 successful at this stage have a
strong sense of identity and are able
to remain true to their beliefs and
 values in the face of problems and
other people’s perspectives. 

Stages: 6  During this stage, we begin to share N/A  Young adults need to form
ourselves more intimately with intimate, loving
19-40 years others. We explore relationships relationships with other
(Young leading toward longer-term people.
Adulthood) commitments with someone other
than a family member.   This is the time to become
 Avoiding intimacy, fearing fully participative in the
Intimacy vs. commitment and relationships can community, enjoying adult
Isolation lead to isolation, loneliness, and freedom and responsibility.
sometimes depression. Success in
this stage will lead to the virtue
of love. 

Jean Piaget’s “Theory of Cognitive Development” this theory includes four periods and
recognizes that children move through these specific periods at different rates but in the same
sequence or order. The four general periods of intellectual development according to Piaget are
as follows: Sensorimotor (birth to 2 years), Preoperational (2 to 7 years) Concrete Operational (7
to 11 years); Formal Operational (11 to years to adulthood).

STAGES NORMAL FINDINGS ACTUAL INTERPRETATION

FINDINGS
Stage: 1  In this stage, as what our patient N/A  The infant develops action
narrated, she elicits the proper and pattern for dealing with the
(Birth to 2 years appropriate normal findings environment. This includes
old) hitting, looking, grasping or
kicking.

Sensorimotor

Stages 2:  Children continue to build on the N/A  Children learn to think with
object representation that is the use of symbols and
(2-7 years old) significant to the sensorimotor stage mental images.
in different activities. While the
way they represent objects has no  Play is the initial method of
Preoperational logic or reasoning behind it, they non-language use of
continue to grow in this area symbols.
through dramatic play.
Imaginative play, or the art of
make.

Stages: 3
 Children begin to represent objects N/A  The child begins to explore
and ideas in a more logical way. the realm of nature. Objects
(7-11 years old) While the thought process is not on of knowledge persist as
the same level as an adult, they well.
begin to be more flexible in their
Concrete thoughts and ideas. This allows
Operational them to solve problems in a more
systematic way, leading to more
success in educational activities in
school. 

 As children move into the formal

Stages: 4 operational stage, they are able to N/A  By emotional awareness,
reason about more abstract ideas. Patient DEF is working
(11 years – towards learning the
Adulthood) Much like the concrete operational
stage, the formal operational stage universe.
gets its name from the newly
acquired skill of representing
Formal
objects or events. 
Operational

Sigmund Freud’s theory suggests that as children develop, they progress through a series
of “Psychosexual stages”. At each stage, the libido's pleasure-seeking energy is focused on a
different part of the body.

STAGES NORMAL FINDINGS ACTUAL INTERPRETATION

FINDINGS

The Oral Stage:  During the oral stage, the infant's
Age range: primary source of interaction occurs
Birth to 1 year through the mouth, so the rooting
and sucking reflex is especially
important. The mouth is vital for
eating, and the infant derives
pleasure  the infant enjoys oral
N/A  The mouth is the infant's
major means of interaction
during the oral period, the
rooting and sucking reflexes
are very crucial. The mouth
is necessary for eating, and
stimulation through
pleasurable behaviors like
tasting and sucking.

The Anal Stage  During the anal stage, Freud N/A  Toilet training is a major
Age Range: believed that the primary focus of source of tension at this age;
1 to 3 years the libido was on controlling the child must learn to
bladder and bowel movements. The control their bodily needs.
Erogenous Zone: major conflict at this stage is toilet Gaining control leads to a
training—the child has to learn to
Bowel and sense of accomplishment
control their bodily needs. 
Bladder Control and self-sufficiency.
 According to Freud, success at this
stage is dependent upon the way in
which parents approach toilet
training. Parents who utilize praise
and rewards 
The Phallic  Freud suggested that during the N/A  Children at this age start to
Stage phallic stage, the primary focus of notice the differences
Age Range: the libido is on the genitals. At this between males and females.
3 to 6 Years age, children also begin to discover
the differences between males and
Erogenous Zone: females. 
Genitals

The Latent  During this stage, the superego N/A  Much of the child's energy
Period continues to develop while the id's is directed into learning new
Age Range: energies are suppressed. Children skills and expanding his or
6 to Puberty develop social skills, values and her knowledge, and play is
relationships with peers and adults limited to youngsters of the
Erogenous Zone: outside of the family. same gender.
Sexual Feelings
Are Inactive

The Genital  The onset of puberty causes the N/A  It's a period of adolescent
Stage libido to become active once again. sexual exploration, with the
Age Range: During the final stage of successful resolution being
Puberty to death psychosexual development, the settling down in a loving
individual develops a strong sexual one-on-one relationship
Erogenous Zone: interest in the opposite sex. with another person in our
Maturing Sexual twenties.
Interest

VI. DEFINITION OF COMPLETE DIAGNOSIS

Oral cancers that are differentiated by their location in the mouth and on the tongue are
known as tongue cancers. Squamous cell cancer of the oral tongue refers to cancer that develops
on the forward section of the tongue. Squamous cell cancer at the base of the tongue occurs when
the tumour is found in the back part of the tongue.

According to World Health Organization classification 2017, buccal mucosa, the front
two-thirds of the tongue, lip, palate, vestibule, alveolus, floor of the mouth, and gingivae are all
affected by oral cancer. Oral cancer is linked to a number of premalignant lesions, including
leukoplakia, erythroplakia, and others. Squamous cell carcinoma (SCC) is the most prevalent
histology, and cigarette and alcohol use are the main etiological causes. The majority of cases are
detected in advanced stages due to the lack of distinct symptoms in the early stages. Despite
decades of medical progress, oral cancer mortality remains high, highlighting the significance of
effective treatment and screening techniques (Cancer Statistic, 2018).

Another barrier to early detection and thus better outcomes is the introduction of a virus,
HPV16, which contributes more to the incidence rate of oral cancers, particularly in the posterior
part of the mouth the oropharynx, tonsils, and base of the tongue areas, and which does not
always produce visible lesions or discolorations that have traditionally served as early warning
signs of the disease process in the anterior of the mouth.

All malignancies (neoplastic transformations) are known to be caused by alterations

(mutations) in genes that regulate cell activity. A cell with mutated genes may grow and multiply
uncontrollably, be unable to repair DNA damage within itself, or refuse to self-destruct or die
(apoptosis). To convert a cell malignant, it takes more than one mutation. To produce a
neoplastic cell that develops uncontrollably, specific classes of genes must be altered numerous
times. When a cell becomes sufficiently modified, it can transmit the mutations on to all of its
descendants when it divides. Every day, as our bodies replace billions of cells, genetic faults
occur at random. Aside from these chance events, genetic mistakes can be inherited, induced by
viruses, or developed as a result of chemical or radiation exposure. Normally, our bodies have
mechanisms in place to eliminate these aberrant cells. We're only now learning about some of the
reasons why this doesn't happen and cancer develops (Oral Cancer Foundation, 2020).

VII. PHYSICAL ASSESSMENT

A. SOCIOCULTURAL ASSESSMENT

I. Identifying data
Name: Patient ABC Sex: Female Age: 26 years old Race/Ethnicity: N/A
Date of admission/or first contact: February 1, 2022 Referral source: N/A
Previous occupation or present employer: N/A
II. Environment
a.  Describe neighborhood and geographical area in which you reside. What about it was
important to you? – N/A

b.  Describe your current or previous home and arrangement of space: What health hazards
are or were present? – N/A

c. What transportation facilities do or did you use? – N/A

d. What leisure activities or recreation do you pursue? Where?  With whom? – N/A

e.  What was or is the environment at work? What health hazards were or are present? –
N/A

III. Socioeconomic Level and Life-Style

a.  How would you describe your socioeconomic level and life-style? How do you think
these have affected your health? – N/A

b.  How has your health status affected your life-style? – N/A

c. What changes do you expect in your life-style as a result of growing older? Illness,
hospitalization, admission to hospital? – N/A

d.  What special practices or foods do you consider essential? – N/A

IV. Family Patterns
a. Marital status. – Single

b. Children. – N/A

c. Other important members of the family. – N/A

d. Who resides in the home with you? – Wife, Mrs. GHI.

e. What is the usual daily living pattern in your family? – N/A

f. What family events are important? – N/A

g. What rituals are important in your family? – N/A

h. How do daily living pattern and rituals affect your health? – N/A

V. Family Functions and Interactions:

a. What is your role in the family? – Daughter

b. How are decisions made in the family? – N/A

c. Who helps provide for the family? – N/A

d. Who has the responsibility for the various family tasks? – N/A

e. What are your special concerns in your family? – N/A

V. Religious Practices
a.  What church or religious denomination do you belong to as a member? – N/A

b. Are you active in that church? – N/A

c. Are there special beliefs that you adhere to? How do these beliefs affect your health? –
N/A

d.  How do you see your relationship to God during this time period? What affect does God
have on your health or illness? – N/A

e.  If you do not prescribe to a particular religion, what are your basic beliefs and values? –
N/A

f. How do these beliefs and values affect your health or illness? – N/A

g. What can the nurse do to assist you in practicing your religion or beliefs during your stay
at this center? – N/A

VI. Memberships
a. What groups/organizations in the community to you belong to? – N/A

b. What is your role in these groups? – N/A

c. How much satisfaction do you get from group activities? – N/A

VII. Personal Values (consider expressed ideal vs. real)

a. What are your ideas about the following:
 Man and the environment relationship? – N/A
Privacy vs. group interaction (being with others)? – N/A
Possessions (personal vs. shared)? – N/A
b.  Time orientation:
Do you like to have things done promptly? – N/A
Do you rely on past experiences primarily? – N/A
Do you like to plan ahead into the future? – N/A
How do you feel if you know that you or someone else is going to be late to an event? –
N/A
 c. Work or Activity – Leisure Orientation:
How much time do you spend in work tasks daily? – N/A
Do you prefer to be busy?  Sitting and thinking; Reading or relaxing? – N/A
What do you do to relax? – N/A
How much time do you spend in leisure daily? – N/A
 d. Attitude toward change:
How do you feel when you hear the word change? – N/A
How often do you make/have you made changes in your life? – N/A
What changes would you like to make in yourself? In others? In the environment? – N/A
e. Education:
Level of school achievement? – N/A
How important is education to you? – N/A
What do you consider necessary for achievement? – N/A
f. Health-Illness Value or Definitions:
When do you consider yourself or members of your family healthy? – N/A
When do you consider them ill? – N/A
What do you do when you or members of your family become ill? – N/A
What customs, special practices or rituals do you and your family engage in to keep
healthy? – N/A
Do you and your family have any specific beliefs or observe any specific traditions
concerning health? – N/A

PHYSICAL ASSESSMENT

The Health History Includes the Following Data:

I. Identifying Data:
Name: Patient ABC Sex: Female Address: N/A
Race/Ethnicity: N/A Age: 26 years old
Marital Status: Single If widowed, when? –
Occupation: If retired, date? – N/A
Reason for contacting health agency: – N/A
II. A concise statement of the Chief Complaint and its Duration
 Patient ABC, arrived in the hospital with a main complaint of a tongue lesion. She is
visibly in a lot of pain: grimacing and calling out. She is unable to verbalize the intensity
of his pain when asked for a score out of 10.
III. Concise chronological description: Present health status and present illness
 Patient ABC is a 26-year-old girl who presented herself at the hospital with a main
complaint of a tongue lesion. For the last 4 months she observed an alteration on the right
side of the tongue, displaying alarming growth over a three week period. The lesion was
painful when the patient moved her tongue or while eating. She further mentioned also
having recurrent, poorly healing aphtae on the right side of the tongue for a period of
months before the current symptoms presented.

 On admission, the patient showed a symmetric face and normal skin color, motor and
sensory cranial nerve functions were within normal range. No lymph nodes were palpable
in her neck on both sides. We found a tumor in the middle third position of the right side
of the tongue. The size of the tongue lesion was about 15x20x15 mm (width, length,
depth), appearing to be exophytic, with a central ulcer appearing to infiltrate the tongue
musculature that appeared to be relatively well demarcated. The oral mucosa showed
signs of leukoedema and maceration on the right buccal mucosa and on the lower lip due
to a self inflicted chewing habit. No limitation of the mouth opening was observed and a
normal dentition was apparent.
IV. Past Medical History
 Patient DEF’s past health history include acute myeloid leukemia (AML) before the age
of 2 and 8 years ago she had an incident of a cerebral venous sinus thrombosis.
(Beginning as far back as the person can remember and continuing up to the time when he
considered himself to be in good health.)
Childhood: – N/A
Medical: – N/A
Surgical, including accidents: – N/A
Psychiatric: – N/A
Obstetrical: Number/outcomes of pregnancies, abnormalities or complications. – N/A
Hospitalizations: – N/A
Include names of hospitals, dates, attending physicians and problems. – N/A
Previous routine or periodic examinations. – N/A
Exposure to known cause of illness: – N/A
Travel in foreign countries, exposure to toxic substances. – N/A
Allergies – to what and what reactions: – N/A

V. Personal and Social History

Childhood: – N/A
Birth (when & where), family group, education, environment, problems: – N/A
Adulthood – employment history, military service: – N/A
Sexual & marital history – marital status, sexual activity, children: N/A
Present life-style:
Descriptions of home, occupation, family life, affiliations, habits: – N/A
Tobacco: Type – cigarettes for 8 years 2-3 cigarettes per day
Current level of usage. – N/A
Beverages: Coffee, tea, cola. – N/A
Alcohol: Average daily use or weekly consumption. – N/A
Drugs: Drug use – including legal and illegal drugs, prescription drugs, over-the-counter drugs. –
N/A
Present schedule and dosage – Sleeping pills, aspirin, weight-control drugs, antihistamines, folk
remedies, laxatives, enemas, vitamins. – N/A

Personal Habits: Sleep, working hours, travel, vacation, hobby or leisure activities
Nutrition and hydration (sample one day’s diet and fluid intake). Special diet needs. – N/A

Family history:
Health status of close relatives: – N/A
Presence of specific diseases: Diabetes, tuberculosis, cancer, mental illness, illness similar to the
patient’s present illness: – N/A
Family tree: Include grandparents, parents, siblings, children – N/A
Religious practices: Denomination, church location, pastor, usual attendance. – N/A
Do you anticipate any specific spiritual/religious needs? If so, what? – N/A

THE REVIEW OF SYSTEMS AND THE PHYSICAL EXAMINATION

Includes the Following Data:
I. Measurement of Vital Signs

Weight: – N/A Height:– N/A Pulse: 105 bpm

Temp: 36.5°C Respiration: 25 BPM BP: 120/90 mmHg

II. General Appearance

a. HISTORY OF ANY WEAKNESS: Fatigue –Body temperature of 36.5°C which is
normal.
b. SKIN: Color, temperature, turgor, moisture, pigment changes, bruises, pressure areas,
decubitus, lesions, rashes and scars (location), dryness, texture, appearance of nails, size and
shape of fingers (clubbing), use of hair dyes or other agents. – Body temperature of 36.5°C
which is normal. The size of the tongue lesion was about 15x20x15 mm (width, length,
depth), appearing to be exophytic, with a central ulcer appearing to infiltrate the tongue
musculature that appeared to be relatively well demarcated.
c. HEAD: History of headache, head injury, dizziness, syncope. – N/A
d. EXAM:
 Skull – deformities – N/A
Scalp – scaling – N/A
Hair – color, baldness, parasites – N/A
Face – expression, edema, muscle tics, paralysis – Patient DEF is grimacing due to
pain she is experiencing.
f. EYES: History of pain, use of glasses, last change in refraction, diplopia, infection,
glaucoma,
cataract. – N/A
Vision – near, distant and peripheral – N/A
Pupils – reaction to light and accommodation, equality of size – N/A
Condition of lids, conjunctiva and sclera – movements, the expression, presence of
discharge – N/A
f. EARS: History of earaches, hearing loss, use of hearing aid, presence of tinnitus, vertigo,
discharge, infection, pain. – N/A
External – auditory meatus, tympanic membrane, general appearance – N/A
Hearing – distance whispered word heard – N/A
g. NOSE:
History of sinus pain, epistaxis, obstruction, discharge, postnasal drip, colds, sneezing. –
N/A
External – size, shape, smell, difficulty in breathing, discharge– N/A
Internal – patency, polyps, septal deviation, others. – N/A
h. MOUTH: History of toothache, recent extractions, soreness or bleeding of lips, gums, mouth,
tongue or throat, disturbance of taste, thirst, hoarseness, tonsillectomy. – N/A
Lips – pallor, cyanosis, lesions, dryness – dryness
Teeth – natural, state of repair, dentures. – N/A
Gums – bleeding, retracted, color, hypertrophic. – N/A
Tongue – color, size, deviation, hydration, lesions, tremors, paralysis. – has lesions,
15x20x15 mm (width, length, depth), showed signs of leukoedema and maceration on the
right buccal mucosa and on the lower lip due to a self inflicted chewing habit.
Pharynx – motion of palate, uvula, tonsils, gag reflex, posterior pharynx-hoarseness,
difficulty speaking or swallowing, ulcerations, inflammation. – N/A
i. NECK: History of pain, limitation of motion, thyroid enlargement. – N/A
General – stiffness, R.O.M., tenderness, veins, pulses, bruits. – N/A
Thyroid – enlargement, nodules, tenderness. – N/A
Lymph glands – size, consistency, tenderness. – N/A
j. THORAX: History of pain, breast lumps, discharge or operations. – N/A
Chest – size, shape and movements. – N/A
Breasts – nipple discharge, areola, contour, symmetry, masses (size, location, shape,
consistency, fixation), skin ulceration, axillary nodes. – N/A
k. HEART: History of pain or distress, palpitations, dyspnea (relate to effort), orthophea,
paroxysmal nocturnal dyspnea, edema, nocturia, cyanosis, heart murmur, rheumatic fever,
hypertension, coronary artery disease, anemia, last EKG. – N/A
Inspection:
Apex beat, relation to midclavicular or midsternal line. – N/A
Other pulsations. – N/A
Palpation:
Size, vigor of apex beat. – N/A
Left sterna lift, epigastric palpation, thrills. – N/A
Percussion:
Distance of dullness from midsternal line in left second to sixth or seventh interspace. –
N/A
Auscultation:
Quality and intensity of S1 and S2 in each valve area. – N/A
Splitting. – N/A
Extra sounds – S3 and S4. – N/A
Murmur – location, radiation, systolic or diastolic, intensity, frequency, character-
crescendo, decrescendo, holosystolic. – N/A
l. LUNGS: History of pain, cough, sputum (character, amount), hemoptysis, wheezing, asthma,
shortness of breath, bronchitis, pneumonia, TB, or contact with, date of last x-ray or skin test and
the results of these. – N/A
Inspection:
Breathing pattern. – N/A
Symmetry. – N/A
Venous pattern. – N/A
Palpation:
Vocal fremitus. – N/A
Use of accessory muscles. – N/A
Percussion: – N/A
Location by inter-space dullness, flatness, hyperresonance, or tympany. – N/A
Auscultation:
Type of breath sounds – vesicular, bronchial, or bronchovesicular. – N/A
Adventitious sounds – rales, cavernous breathing, asthmatic breathing, friction rub. –
N/A
Vocal resonance – bronchophony. – N/A
m. ABDOMEN: History of appetite, food intolerance, dysphagia, heartburn, pain or distress
after eating, colic, jaundice, belching, nausea, vomiting, hematemesis, flatulence, character and
color of stools, any change in bowel habits, rectal conditions, ulcer, gallbladder disease, colitis,
hepatitis, appendicitis, parasites, hernia. – N/A
Inspection:
Distention. – N/A
Masses. – N/A
Peristalsis (visible). – N/A
Palpation:
Tenderness of light or deep palpation. – N/A
 Masses (location, consistency, mobility, nodularity). – N/A
Rigidity. – N/A
Organ outlines (liver, spleen). – N/A
Percussion:
Abdominal distension (air or ascites). – N/A
Bladder distension. – N/A
Auscultation:
Bowel sounds. – N/A
Bruits. – N/A
n. EXTREMITIES AND BACK:
History of intermittent claudication, varicose veins, thrombophlebitis, joint pain,
stiffness, swelling, arthritis, gout, bursitis, flat feet, infection, fracture, muscle pain, cramps;
assistance devices utilized (prostheses, cane, crutches, walker, wheelchair). -N/A
Blood vessels – pulse veins. – N/A
Joints – tenderness, deformities, crepitation, range of motion. – N/A
Edema – location, pitting, discoloration. – N/A
Reflexes. – N/A
Sensation – pain and temperature, vibration position. – Patient cannot verbalize the
intensity of his pain but visibly shows grimace and calling out.
Muscular function – standing on toes, strength of movement. – N/A
Gait and stance – walking, standing with eyes closed. – N/A
Back – pain (location and radiation, especially to extremities), stiffness, limitation of
movement. – N/A
o. GENITOURINARY:
History of urinary tract – renal colic, frequency, nocturia, polyuria, oliguria, hesitancy,
urgency, dysuria, narrowing of stream, dribbling, incontinence, hematuria, albuminuria, pyuria,
kidney disease, facial edema, renal stone, cystoscopy; genital (male) – testicular pain, scrotal
change, nodules in scrotum; genital (female) – menstrual history, vaginal bleeding or discharge,
menopause and associated symptoms, date of last PAP smear, venereal disease – gonorrhea or
syphilis (note date, treatment, complications); sexual – drive, activity, pleasure, discomfort,
impotence. – N/A
Examination of the male genito – Urinary System:
Penis– N/A
Scrotum – size, symmetry, consistency, tenderness, masses, atrophy. – N/A
Inguinal region – pulses, lymph glands, hernia, parasites. – N/A
Character of urine – presence of indwelling catheter, date changed. – N/A
Examination of the female reproductive system:
External genitalia. – N/A
Vulva – ulceration. – N/A
Urethra – discharge – N/A
Pelvic relaxation – cystocele, rectocele, prolapse uterus (degree). – N/A
 Internal genitalia. – N/A
Speculum exam of vagina (discharge, ulcerations, irregularities). – N/A
Cervix (ulceration, irregularity), PAP smear. – N/A
Examination of the rectum:
External inspection - hemorrhoids, perianal skin, pilonidal cyst. – N/A
Internal palpation – sphincter tonicity, abscess, prostate enlargement, rectal masses,
impaction. – N/A

CENTRAL NERVOUS SYSTEM:

General history – syncope, loss of consciousness, convulsions, meningitis,
encephalitis, stroke. – N/A
Mentative – aphasia (describe), emotional status, mood, orientation, memory, change in
sleep pattern, psychiatric illness. – N/A
Motor – tremor, weakness, paralysis (describe involvement), clumsiness of movement. –
N/A
Sensory – neurological pain, reduced sensation, paresthesia. – N/A

q. HEMATOPOIETIC: Bleeding tendencies; of skin or mucous membranes; anemia and

treatments, blood type, transfusions, any reactions; blood dyscrasias, exposure to toxic agents or
radiation. – N/A

r. ENDOCRINE: History of nutrition and growth; thyroid function – (changes in skin,

relationship of appetite to weight, nervousness, tremors, thyroid medications), diabetes or its
symptoms, hirsutism, secondary sex characteristics, hormone therapy. – N/A

Activities of Daily Living Survey

Independent-Needs assistance, describe type of assistance Needed-Dependent
Bathing (Yes) Any Comments (No)
Dressing (Yes) Any Comments (No)
Toileting (Yes) Any Comments (No)
Feeding (Yes) Any Comments (No)
Transferring (Yes) Any Comments (No)
Ambulating (Yes) Any Comments (No)
Turning in Bed (Yes) Any Comments (No)

PSYCHOLOGICAL ASSESSMENT
(For use on admission to the hospital, nursing home or residence for senior citizens)
I. Identifying Data:
Name: Patient ABC Sex: Female
Age: 26 Years old Race/Ethnicity: – N/A
Marital Status: Single Children:
Where Employed: – N/A Occupation (past, present): – N/A
Ever active in a different occupation? – N/A
If yes, why did you change occupations? When? – N/A
Other members in household:
Date of admission/first contact? – February 1, 2022
Referral source? – N/A

II. Health History:

a. Have you had previous admissions to the hospital? To another nursing home or
residence? – N/A

 Describe significant aspects of your health history. Patient currently has presence of a
tongue lesion. For the last 4 months she observed an alteration on the right side of
the tongue, displaying alarming growth over a three week period. The lesion was
painful when the patient moved her tongue or while eating. She further mentioned
also having recurrent, poorly healing aphtae on the right side of the tongue for a
period of months before the current symptoms presented.
b. What does it mean to you to be in the hospital or nursing home? – N/A

c. What is your usual source of health care? – N/A

d. How accessible are health services? – N/A

Is transportation readily available? – N/A
Do you have some form of health insurance? – N/A

e. What medications do you currently use? – N/A

f. Describe any drug allergies. – N/A

g. What do you consider your major present problem or area of concern? – N/A

h. When did the problem begin? – N/A

i. Was the onset sudden or gradual? – N/A

j. What does this problem or illness mean to you? – N/A

k. What do you consider the stressful event triggering your problem? – N/A

l. Have you ever experienced a similar problem? – N/A

If you have, what was the problem? – N/A
How did you handle the problem? – N/A
Were your coping patterns successful? – N/A

III. Life-Style Patterns:

1. What is your usual pattern of living? – N/A
Are you able to care for your own ADL’s? (Activities of Daily Living.) – N/A
What time of the day do you feel the most alert? – N/A
 2. What is your present living situation and environment? Are there any hazards to health or
development? – N/A

3. How do present circumstances differ from usual pattern of living? – N/A

4. Have things changed with your aging or illness or disability?  If so, how? – N/A

IV. Perceptual Ability:
1. Describe your sensory ability or any impairment related to:
Sight                            Taste
Hearing                        Smell
Touch                          Balance

Pain or unusual body perceptions: – N/A

2. Do bright lights or loud noises bother you? – N/A

3. If you are more sensitive to light or noise now, is it related to your illness or to conditions
existing in the hospital or residence? – N/A

4. Do you have special visions? If so, describe them and when and where they occur. – N/A

5. Do you hear voices? If so, what do they say and are you able to converse with them? – N/A

6. What are your food preferences? What foods are not tasteful or enjoyable to you? – N/A

7. What kinds of feelings do you have in various body parts? Are you especially aware of any
body part or function? – N/A

8. What situations require assistance to maintain balance/mobility? What kind of assistance do

you need? – N/A

V.    Emotional Status:
Self-concept:
How would you describe yourself? – N/A
How do you feel you handle yourself and your life?    – N/A
What would you describe as your attitude toward life? – N/A
What are the most important values to you? – N/A
What do you like best about yourself? – N/A
If it were possible, what is the primary aspect of yourself that you would like to change? – N/A
Do you prefer doing things alone or with others? – N/A
Ego ideal:
What goals or aspirations do you presently have? – N/A
Do you feel you have managed to achieve your goals in life? – N/A
Super ego:
Which of the following comes first for you? – N/A
1.  Pleasure– N/A
2.  Your goals– N/A
3.  Essential tasks– N/A
How do you respond to situations that require you to do something you are reluctant to do? –
N/A
1.  Do you ignore the task? – N/A
2.  Do you plunge in and complete it as soon as possible? – N/A
3.  Do you delay the task as long as possible? – N/A
What rules or customs are difficult for you to follow? – N/A
What do you consider the most important teachings that were given to you by your parents or
family? That you have lived by? – N/A
What causes you to feel guilty? – N/A
Relations to others:
Do you share your feelings with another with ease or with difficulty? – N/A
With whom do you share your feelings? – N/A
Who can you trust to help you in time of need? – N/A
Who or what do you care about the most in your life? – N/A
Who do you think cares most about you? – N/A
How do you see your life fitting into the lives of others? – N/A
How dependent or independent of family or friends are you? – N/A
Sense of autonomy:

What does the term “fate” mean to you? – N/A

What do you feel has control over what is happening to you? – N/A
How much control do you exert over others? – N/A
How has aging or illness or hospitalization or admission to nursing home or residence affected
your feelings of control or lack of control? – N/A
Reaction and coping with situations:
What situations or persons cause you to feel calm, secure and happy? – N/A
What situations or persons cause you to feel upset, embarrassed, anxious or anger? – N/A
What usually results from your behavior? – N/A
Adaptive pattern:
What is your usual pattern of relating to those close to you? – N/A
To a group situation? – N/A
How much does another’s reaction or behavior influence how you will act? – N/A
How important is another person’s behavior or feelings to you? – N/A
What is your reaction to frustration? To success? – N/A
Which of the following are you likely to do? – N/A
Go along with the person or situation to keep peace? – N/A
Blame others if something goes wrong for you? – N/A
Consider yourself the cause if something goes wrong? – N/A
Feel more angry than is warranted by the situation? – N/A
Let others know abruptly of your feelings? – N/A
Say little about your feelings, hoping the other person will guess how you are feeling? – N/A
Feel reluctant to act in an unfamiliar situation without permission or encouragement
from someone? – N/A
Feel confident in unfamiliar situations and take charge of things if it is indicated? – N/A
Encourage others to do their best work possible? – N/A
Consider that others are unlikely to do the job as well as yourself? – N/A
What do you find best relieves your tension – eating, smoking, drinking, drubs, sleep, activity
etc.? – N/A
VI.    Use of Leisure:
1. What activities do you enjoy for recreation or relaxation? – N/A

2. How often do you engage in these activities? – N/A

3. How do these activities affect your health? – N/A

VII.    Communication Pattern: (Observe and listen for)

1. Ability to express thoughts and feelings (talks freely or hesitancy, writes, draws, uses
nonverbal behavior primarily). – N/A

2. Describes vocabulary (variety of words used, repetition of words, slang or correct

grammar). – N/A

3. Enunciation of words. – N/A

4. Rate of expression of speech (how quickly answers, rapidity in flow of speech,

hesitations, smooth vs. uneven rate, urgency of speech). – N/A

5. Ability to express his ideas (coherent, logical, confused, circumstantial, tangential,

poverty of ideation). – N/A

VIII.   Cognitive Status: (Observe and listen for)

1. Level of consciousness (alert, lethargic, confused, stuporous or comatose). – N/A

2. Orientation to time, place, person. – N/A

3. Education level. – N/A

4. Ability to recall far past, immediate past and present events (what brought you into the
hospital or residence?  Tell me about the events that led you to your hospitalization or
admission to nursing home or residence.  Tell me MAJOR things about yourself and your
past life). – N/A

5. Attention span (attends to immediate stimuli; length of concentration or attention span; is

not distracted by external stimuli; how capable of following train of thought, what stimuli
distracts, how long interview proceeded before person showed signs of fatigue,
preoccupied with self or some event). – N/A

6. Speed of response to verbal stimuli (answers immediately, quickly or slowly, hesitates,

ignores certain statements). – N/A
 7. Remains in reverie state or in primary process (daydreams, fantasizes, talks about
material that seems nonsensical or is difficult to follow). – N/A

8. Ability to grasp ideas to follow directions. – N/A

9. Ability to do logical thinking or problem solving (or unable to do cause-effect

associations, states loose, magical or nonsensical logic). – N/A

10. Ability to abstract (answers questions literally, is able to elaborate or explain, can give
meanings for behavior situations). – N/A

11. Presence of delusions or degree of reality in belief system. – N/A

12. Apparent insight into problem or situation:

What have you been told about your illness? – N/A
What do you think is the cause of your problem? – N/A
Why do you think you have been admitted to hospital or nursing home or residence? –
N/A

13. Aware of need for more knowledge about illness situation:

What questions or concerns do you have about your illness, hospital stay, admission
to nursing home or residence? – N/A

IX.        Ego Functions:
Interviewer should note the following during the interview:
 What was the primary emotion? Was it appropriate to the situation? – N/A

 During the interview, what nonverbal behavior accompanied statements? – N/A

 What questions elicited behavioral manifestations of discomfort or anxiety? – N/A

 Was there accentuated use of any one pattern of behavior during the interview? – N/A

 Did the person use “they” instead of “I” when responding to questions? – N/A

 Was he/she aware of body parts and functions without excessive preoccupation
with him or herself. – N/A

 Was the person realistic or did he/she show disturbed reality twisting? – N/A

o For example – Is the person adapting to reality? – N/A

o Does he/she show poor judgment? – N/A

o Does he/she understand the consequences of his/her behavior? – N/A

o Does reality interfere with creative behavior? – N/A

o Presence of delusions?  Hallucinations? – N/A

 Has the person learned the socially acceptable method of dealing with drives and
feelings? – N/A

 What defense mechanisms are apparently commonly used? – N/A

  What defense mechanisms were used during the interview? – N/A

 Does behavior appear over-controlled, under-controlled or without control? Describe. –

N/A

 Does the person appear able to have the various aspects of his personality integrated? –
N/A

 What aspects of his behavior appear fragmented or lacking in unity or autonomy? – N/A

Summary of impressions
(Note:  Any discrepancies between patient’s or client’s perception and that of interviewer
or caregiver.)
GERIATRIC ACTIVITIES OF DAILY LIVING
When questioning elderly patients about daily activities, use general questions that will elicit
his/her usual habits and whether he/she has problems performing them. Elderly patients may also
have personal concerns, financial or transportation problems that keep him/her from his/her daily
routine. Structure your questions as outlined here.
DIET OR ELIMINATION
What do you eat on a typical day? – N/A
Do you feel hungry between meals? – N/A
Do you prepare your own meals? – N/A
With whom do you eat? – N/A
What types of food do you enjoy most? – N/A
Do you have any problems eating? – N/A
Have you noted any changes in your sense of taste? – N/A
Do you snack? When are your snack times? – N/A
What do you usually eat for a snack? – N/A
What are your usual bowel habits? – N/A
Have you noticed any recent changes in your bowel habits? – N/A
EXERCISE/SLEEP
Do you take daily walks? – N/A
Do you do your own housework? – N/A
Do you have any difficulty moving about? – N/A
Has your doctor recently restricted your exercise? – N/A
Has your doctor recommended any special exercise programs? – N/A
What time to you go to bed at night? – N/A
What time to you awaken? – N/A
Do you follow any routines that help you sleep? – N/A
Do you sleep soundly or wake often? – N/A
Do you take a nap during the day?  If so, how long? – N/A
RECREATION
Do you belong to social groups such as seniors’ clubs or church groups? – N/A
What do you enjoy doing in your leisure time? – N/A
How many hours a day to you watch television? – N/A
Do you share leisure time with your family? – N/A
TOBACCO/ALCOHOL
 Do you use tobacco? If so, do you smoke cigarettes, cigars, pipe? – cigarettes
 How long have you smoked? How much do you smoke each day? – 8 years and 2-3
cigarettes per day
 If you quit smoking, when did you quit? – N/A
 Do you drink alcohol? How often and how much do you drink? – N/A
 Do you drink alone or with friends? Has drinking increased lately? – N/A
PERSONAL CONCERNS
Do you wear dentures? Are they a hindrance when you eat or talk? – N/A
Do you wear glasses? – N/A
Do you have problems with your vision when you wear your glasses? – N/A
Do you hear those around you with no difficulty? – N/A
Does poor hearing hinder any of your activities? – N/A
What is your source of income? – N/A
Do you shop for your own groceries?  If not, who does this for you? – N/A

GERIATRIC REVIEW OF SYSTEMS

The review of systems for an elderly patient involves keeping in mind the following physiologic
changes. These are considered normal in the aging process. These common pathologic disorders
are described in Table II (Health Assessment Handbook 1992).
SKIN, HAIR AND NAILS
- Body temperature of 36.5°C which is normal.
EYES AND VISION
– N/A
EARS AND HEARING
1. N/A
RESPIRATORY SYSTEM
2. Tachypneic (RR – 25 breaths/minute)
CARDIOVASCULAR SYSTEM
 Tachycardic (HR – 105 beats/minute)
GASTROINTESTINAL SYSTEM
– N/A
An elderly patient may also have nonspecific difficulty in swallowing. Carefully assess the
possible causes of regurgitation or heartburn.
*Ask if he/she has the same degree of difficulty swallowing solids/liquids. – N/A
*Ask if food lodges in his/her throat upon swallowing. – N/A
*Does he or she experience pain after eating, or while lying flat? – N/A
Also question him about long-term or recent weight loss, rectal bleeding, altered bowel habits
(Goldman 1991).
FEMALE REPRODUCTIVE SYSTEM
 Include questions about menopause for the elderly female. – N/A
 Ask when menopause began and ended (if ended). – N/A
 Ask what symptoms she experienced and how she felt about the process. – N/A
 Ask her whether she is now taking estrogen replacement therapy or in the past.  If so, ask
for how long and the dosage. – N/A
 Be sure to question an elderly female patient about symptoms of breast disease.  Find out
if she regularly performs a breast self-examination, if she is physically capable of doing
so. – N/A
NERVOUS SYSTEM
Inquire about changes in coordination, strength or sensory perception. Does the patient have
headaches or seizures or any temporary losses of consciousness? Has he or she had any difficulty
controlling bowel or bladder (Tom 1976). – N/A

TABLE I

SKIN:   Body temperature of 36.5°C which is normal.

NAILS:  N/A

HEAD:  N/A

EYES:  N/A

EARS:   N/A

NOSE:  N/A

MOUTH/THROAT: Has tongue lesion appearing to be exophytic

NECK:  N/A

RESPIRATORY:  Tachypneic (RR – 25 breaths/minute)

BREASTS  N/A

CARDIOVASCULAR:  Tachycardic (HR – 105 beats/minute)

RENAL:   N/A

REPRODUCTIVE: N/A

ENDOCRINE:  N/A

MUSCULOSKELETAL: N/A

NERVOUS:  N/A

VIII. ANATOMY AND PHYSIOLOGY

ORAL CAVITY
The oral cavity, often referred as the
mouth or buccal cavity, is the very first
part of the digestive system to be
addressed. It is composed of many
physically distinct elements that come
together to produce multiple functions
efficiently and effectively. Lips, tongue,
palate, and teeth are among these features.
The mouth cavity is a unique and
complicated structure with various
different nerves and blood arteries inside
it, despite its modest size. Because of its
unique and diverse significance in human
life, this complicated network is required.

The lips surround the oral cavity, which is divided into two parts: the vestibule, which is the
space between the cheeks, teeth, and lips, and the oral cavity proper. The tongue fills the oral
cavity, which is bounded anteriorly and on both sides by the alveolar processes, which contain
the teeth, and posteriorly by the isthmus of the fauces. The hard palate creates the roof anteriorly,
whereas the soft palate forms the roof posteriorly. From the soft palate, the uvula hangs
downward. The mylohyoid muscles are the muscles that make up the floor of the mouth cavity.
The oral mucosa is a mucous membrane made up of stratified squamous epithelium that lines the
inside of the mouth. To lubricate and keep the oral cavity wet, several submandibular and
sublingual salivary glands release viscous and mucoid fluid.

The mouth is necessary for the creation of speech and normal respiration, as well as for the
initial absorption and digestion of food and water. The teeth, which are the most visible
structures in the mouth, shred and ground ingested food into small enough bits to be digested.
Food is digested by the tongue compressing and forcing food against the palates, resulting in the
creation of a food bolus that is then swallowed down the esophagus. The tongue also serves as a
taste receptor for humans, as it has papillae on its dorsal surface that function as taste buds.
Furthermore, because it manipulates itself against the teeth and palate to make words, the tongue
is the most significant articulator of speech. The palate acts as a mechanical barrier between the
oral cavity and the nasal respiratory system, allowing you to breathe and eat at the same time.

IX. ETIOLOGY AND SYMPTOMATOLOGY

ETIOLOGY
PREDISPOSING ACTUAL FINDINGS IMPLICATION FACTORS
FACTORS
Age The patient is 26-years-old. The average age at which a
cancer of the tongue is
diagnosed is 61 years old.
 Before the age of 35, only about
2% of people are diagnosed.
Gender The gender of the patient is Tongue cancer is most common
female. in men, it is rare in people,
particularly women.

Genetics The patient has no report in Oral cancer is linked to several

genetics. inherited genetic abnormalities
that cause a variety of diseases
in the body.
PRECIPITATING ACTUAL FINDINGS IMPLICATION FACTORS
FACTORS
Alcohol use The patient reports that she Alcohol can irritate the tongue and
doesn’t drink alcohol. throat, especially if it is swallowed.

Tobacco use Patient shows evidence of Smoking causes stains on teeth

using tobacco for 8 years 2-3
cigarettes per day.
Poor nutrition The patient didn’t mention any
poor nutrition in her case.
Oral health The patient didn’t report any in
her oral health.
and dental restorations, as well as
the development of oral disorders
such as smoker's palate, smoker's
melanosis, coated tongue, oral
candidiasis, periodontal disease,
and implant failure.
Poor nutrition can increase our
stress levels, exhaustion, and
ability to function, as well as
increase our risk of disease and
other health issues, such as being
overweight or obese. decayed
teeth blood pressure is high.
The health of the teeth, gums, and
the overall oral-facial system,
which allows us to smile, speak,
and chew, is referred to as oral
health. Cavities are one of the
most common disorders that affect
our dental health.

SYMPTOMATOLOGY
LIST OF SYMPTOMS
Lumps or bumps, rough spots,
eroded areas, swellings and
thickening on gums, lips, and
other parts of the oral cavity.
Bleeding from the mouth.
ACTUAL FINDINGS
Upon assessment the size of
the tongue lesion was about
15x20x15 mm (width, length,
depth), appearing to be
exophytic, with a central ulcer
appearing to infiltrate the
tongue musculature that
appeared to be relatively well
demarcated.
Upon assessment there is an
unexplained bleeding in the
mouth of the patient.
IMPLICATION FACTORS
Patient has lesions and
swelling due to the tumor.
They cause lumps, rough spots
and swelling at the area of her
tongue.
As a result of having lesions
of the tongue. The bleeding
can be caused by
the cancer itself, as with local
tumor invasion, abnormal
tumor vasculature, or tumor
regression.
Ear pain Patient ABC reports that she The patient has pain in her ear
experience pain in her ear. that may radiate to the jaw and
cheeks. A feeling of fullness
in the ear.
Excessive weight loss The patient weight is from 51 Patient ABC has cancer and
kg to 45 kg. cancer cells demand more
energy than healthy cells, so
your body may burn more
calories at rest than it
normally would.
Sores on the neck, mouth, or The patient oral mucosa Patient has sores on her mouth
face that do not heal within showed signs of leukoedema especially in the tongue and
two weeks and bleed easily. and maceration on the right lip area because of biting her
buccal mucosa and on the lip, tongue or cheek. Also
lower lip due to a self inflicted because of brushing your teeth
chewing habit.  too hard, or using a hard-
bristled toothbrush.
Change in voice, hoarseness, The patient reports changes in Patient has changes in her
and extremely sore throat. her voice and difficulty in voice and has extremely sore
speaking. throat because by the cancer
pressing on a nerve in the
chest called the laryngeal
nerve. If this nerve is
squashed, one of the vocal
cords in your throat can
become paralysed, leading to a
hoarse voice.
Difficulty in speaking, moving Patient reports that she has As a result it can cause speech
the tongue or jaw, chewing, or trouble of swallowing problems and trouble of
swallowing. swallowing because it changes
how any part of your mouth
moves. 
The occurrence of velvety red, Upon the assessment of the The patient has white and red
white, or red and white patient there is a velvety white patches which it is one of the
patches inside the mouth. and red patches in the mouth. symptoms of tongue cancer
and a fungal infection called
thrush. It may be numb or firm
to feel and doesn't fade away
over time. 
Trouble wearing dentures. The patient has trouble of Patients that had tongue
wearing dentures cancer can change in the way
your teeth or dentures fit
together – a change in your
"bite".

X. PATHOPHYSIOLOGY

Precipitating Factors Predisposing Factors

Alcohol use Age
Tobacco use Gender
Poor nutrition Genetics
Oral health
 lips
gums
tongue
cheeks
roof
floor of the mouth

Develops in squamous cells lining at the

surface of the tongue

DNA mutations

grows and divide

tumors lesions
freely

leukoplakia erythroplakia

Potential for becoming

cancerous

Risk Factors
Signs & Symptoms
 People who smoke are six
 Lumps or bumps, rough spots, eroded areas, swellings and
times at a greater risk of
thickening on gums, lips, and other parts of the oral cavity.
developing oral cancers than
 Bleeding from the mouth.
those who don’t smoke.
 Ear pain.
Therefore, cigarettes or
 Excessive weight loss.
 cigars
Peoplearewhotheuse
most common
chewing
 Sores on the neck, mouth, or face that do not heal within two
causes
tobacco,ofsnuff,
mouthorcancers.
dips are 50
weeks and bleed easily.
 Alcohol
times more likely to are
consumers again
develop
 Change in voice, hoarseness, and extremely sore throat.
six times
mouth at risk of
cancers, like cheek
 Difficulty in speaking, moving the tongue or jaw, chewing, or
developing mouth
cancer, gum cancer, cancers
and
swallowing.
than
cancernon-drinkers.
inside the lining of the
 The occurrence of velvety red, white, or red and white
patches inside the mouth. lips.
 Trouble wearing dentures.  Extreme sun exposure is
also one of the common risk
factors.
 Human Papillomavirus
(HPV) strains are risk factors
for Oropharyngeal
 Squamous Cell Carcinoma.

erythroplakia

erythroplakia
 If not treated
It will spread nearby
tissue, such as the jaw
or other parts of the
oral cavity.
Life-threatening if
not diagnosed
and treated early
Survival rate with early-stage
untreated oral cancer is
around 30% for 5 years.
Patient is free from disease
XI.
Patient’s Name: Ms. ABC
Date: February 1, 2022
Laboratory:
Biopsy
MRI (Magnetic Resonance Imaging)
PET (Positron Emission Tomography)
Doctor: N/A
If treated
Diagnostic Examination
 X-rays of the mouth and
throat, including CT
(computed tomography)
scans (X-rays that show
images in thin sections).
 PET scans (positron
emission tomography)
 Biopsy (Fine needle
aspiration biopsy,
Incisional biopsy, and
Punch biopsy)
 Blood tests
 Dental check
 Nasaoendoscopy
Surgical Procedure
 Surgery
 Radiation Therapy
 Chemotherapy
 Targeted Therapy
Symptoms are relieved
No further treatment was
recommended
DOCTOR’S ORDER
Ward: Surgical Ward
Time: 07:00 AM
Nurse: Lovely Riza Neri
 Patient’s Name: Ms. ABC Ward: Surgical Ward
Date: February 9, 2022 Time: 08:00 AM
Surgery:
Partial glossectomy
Radialis free vascularised flap
Doctor: N/A Nurse: Lovely Riza Neri

XII. DIAGNOSTIC EXAM

EXAM NAME NORMAL UNIT RESULT INTERPRETATION IMPLICATIONS

MRI (Magnetic (-) (-) Normal No evidence of Patient’s MRI scan result
Resonance locoregional is normal even though
Imaging) lymphatic spread or there is a tumor and ulcer
distant metastasis in the mouth of the patient
could be found which (Only the doctor can tell if
led to a cT2N0M0 the tumor is cancerous or
staging not).
PET (Pasitron (-) (-) Normal No evidence of Patient’s PET result is
Emission locoregional normal even there is a
Tomography) lymphatic spread or small tumor because small
distant metastasis tumor may not be
could be found which detectable in this imaging
led to a cT2N0M0 test.
staging
Biopsy (-) (-) Squamous cell Bleeding from the Abnormal tumor and a
carcinoma tongue with no 2cm ulcer has been
with apparent cause and a spotted in the mouth of
surrounding red or white patch on the patient.
chronic the tongue.
inflammation
SaO2 93-100 % Phase1 Normal Patient’s oxygen
93% saturation of arterial blood
Phase2 is normal
93%
Blood Pressure 120/80 mmHg Phase1 Abnormal Uncontrolled high blood
pressure can lead to
120/129mmHg
disability, a poor quality
Phase2 of life, or even a deadly
heart attack or
112/62mmHg
stroke. Potassium has an
important role in relaxing
the blood vessels, which
helps lower a person's
blood pressure.
Heart Rate 60-100 bpm Phase1 The patient heart rate Patient’s heart rates have
105bpm is abnormal upon first. significant changes.

Phase2
87 bpm
Respiratory Rate 12-20 cpm Phase1 There is an increased Elevated respiratory rate
25bpm in patient’s respiratory may indicate inadequate
rate for several hours oxygenation.
Phase2 after arriving in
20bpm emergency
 department and it
stabilized after 3 days
of treatment.

Temperature 36.1-37.2 ◦C Phase1 Normal Patient's temperature is

normal.
36.0◦C
Phase2
36.9◦C
SpO2 95-100 % Phase1 Normal Patient’s oxygen
saturation level is normal.
97% with 6L
O2
Phase2
97% with 6L
O2
 XIII. DRUG STUDY
DATE NAME DRAWING CLASSIFICATION DOSAGE/TIME/ROUTE INDICATION MECHANISM SIDE EFFECTS NURSING RESPONSIBILITIES
OF DRUG OF ACTION
Feb 01, 2021 GENERIC Alkylating agent, Dosage: Cisplatin is This drug alters CNS:  Monitor for vital signs frequently
NAME: Platinum-containing 50 mg/50ml vial used to treat DNA structure Seizure, malaise, during administration.
08:00 AM Cisplatin compounds. various types resulting in weakness  Monitor intake and output and specific
Route: of cancer. It is inhibition of EENT: gravity of urine frequently during
BRAND IV a cell growth and ototoxicity therapy. Report discrepancies
NAME: chemotherapy reproduction. tinnitus immediately.
Cystoplast Frequency: drug that GI: severe  Assess for bleeding (bleeding gums,
OD contains nausea, vomiting, bruising petechiae, stools)
platinum. It is diarrhea,  Assess for signs of infection
Form: used to slow or hepatoxicity  Monitor for signs of anaphylaxis,
Liquid stop cancer cell GU: edema, wheezing, dizziness and
growth. nephrotoxicity, fainting.
sterility  Assess patient frequently for dizziness,
DERM: alopedia tinnitus, hearing loss, losss of
F&E: coordination, loss of taste, tingling of
hypocalcemia, extremeties. Notify physician if these
hypokalemia, occur.
hypomagnesemia
 DATE NAME OF DRAWI CLASSIFIC DOSAGE/ INDICATION MECHANISM SIDE EFFECTS NURSING RESPONSIBILITY
DRUG NG ATION TIME/ROUTE OF ACTION
Therapeuti > Route: IV Cetuximab is an Cetuximab is an CNS: asthenia,  Severe and fatal infusion reactions,
February 1, 2022 Generic c class: > Onset: epidermal growth anticancer drug depression, fever, including acute airway obstruction,
name: antineoplasti
unknown factor receptor that inhibits the headache, insomnia, urticaria, and hypotension, may occur,
Cetuximab cs Peak: unknown (EGFR) inhibitor growth and pain, peripheral usually with the first infusion. If a
Duration: with the following survival of neuropathy. severe infusion reaction occurs, stop
Brand Pharmacolo unknown FDA-approved epidermal growth CV: edema, drug immediately and permanently and
name: gic class: Dosage: 2mg/mL indications: colorect factor receptor cardiopulmonary arrest, provide symptomatic treatment.
Erbitux Monoclonal (50mL, 100mL al cancer, (EGFR)- PE.  Keep epinephrine, corticosteroids, IV
antibodies single use vials) metastatic, KRAS expressing tumor EENT: conjunctivitis. antihistamines, bronchodilators, and
wild-type (without cells with more GI: abdominal pain, oxygen available for severe infusion
mutation), and specificity and anorexia, constipation, reactions.
head and neck affinity than diarrhea, dyspepsia,  Manage mild to moderate infusion
cancer (squamous natural EGFR dysphagia, mucositis, reactions by decreasing infusion rate
cell). ligands such as nausea, stomatitis, and premedicating with an
epidermal growth vomiting, xerostomia. antihistamine for subsequent infusions.
factor (EGF) and GU: acute renal failure.  Monitor patient for infusion reactions
transforming Hematologic: anemia, for 1 hour after infusion ends.
growth factor- neutropenia,  Verify pregnancy status in women of
alpha (TGF-). leukopenia. childbearing potential before starting
Metabolic: dehydration, drug.
hypomagnesemia,  Assess patient for acute onset or
weight loss. worsening of pulmonary symptoms. If
Musculoskeletal: back ILD is confirmed, stop drug.
pain. Respiratory:  Monitor patient for skin toxicity, which
cough, dyspnea. starts most often during first 2 weeks of
Skin:alopecia, therapy. Treat with topical and oral
maculopapular rash, antibiotics.
pruritus, radiation  Periodically monitor serum electrolyte
dermatitis, acneiform levels during and for at least 8 weeks
rash, nail changes, after therapy ends.
hand-foot syndrome.  In patients also receiving radiation
Other: antibody therapy or platinum-based therapy with
development, chills, 5-FU, closely monitor electrolytes,
infection, infusion especially magnesium, potassium, and
reaction, sepsis. calcium, during and after therapy.
Cardiopulmonary arrest or sudden
death has occurred.
 Date Name of Drawing Classification Dosage/ Indication Mechanism Side Effects Nursing Responsibilities
Drug Time/Route of Action
02-01-   Methotrexate  Adults—2.5 Principally in This stops · dizziness · If methotrexate is used, the nurse must explain adverse
22 Generic belongs to a class milligrams combination cell growth · drowsiness side effects, such as nausea and vomiting; effects of
7am Name: of drugs known as (mg) 2 to 4 regimens to and therapy, such as increased abdominal pain; and the
antimetabolites. It times a week. maintain division, · headache importance of communicating any physical changes to the
Otrexup
  works by slowing induced resulting in · swollen, tender health care team.
  or stopping the remissions in the slowing gums.  · Be alert to onset of agranulocytosis (cough, extreme
Methotrexate growth of cancer neoplastic or stopping fatigue, sore throat, chills, fever) and report symptoms
· hair loss.
cells and diseases of cancer promptly.
  · reddened eyes.
suppressing the growth.
  immune system. · Monitor I&O ratio and pattern. Keep patient well
· decreased
hydrated (about 2000 mL/24 h).
    appetite.
   
 
 
 
 
 XIV. SURGICAL PROCEDURE
Purpose Surgical Procedure
Glossectomy A glossectomy is the surgical  Informed consent is a legal document that explains
removal of all or part of the the tests, treatments, or procedures that you may
tongue. It is performed in order need. Informed consent means you understand what
to curtail malignant growth will be done and can make decisions about what
such as oral cancer. Often only you want. You give your permission when you sign
a part of the tongue needs to be the consent form. You can have someone sign this
removed, in which case the form for you if you are not able to sign it. You have
procedure is called a partial the right to understand your medical care in words
removal, or partial glossectomy. you know. Before you sign the consent form,
understand the risks and benefits of what will be
done. Make sure all your questions are answered.
 You will check in at the Day Surgery Unit 2 hours
before surgery. In the Day Surgery Unit you will
get ready for surgery by changing into hospital
clothes. The nurse will go over some questions and
answer any questions you have. You will have a
thin tube put into a vein in your arm. This is called
an intravenous or IV. The IV gives you fluids and
medications when needed. The anaesthesiologist
will visit you before surgery. You will also have the
surgery area marked with a special pen.
 You go into the Operating Room when it is time for
surgery. The room is cool. The team will greet you
and help make you comfortable on a special table.
Before the team starts they take some time to make
sure you are the right patient and the right surgery
is done. This is called the “surgical pause”.

XV. NURSING THEORIES

Florence Nightingale "Environmental Theory"

Environmental Theory defined Nursing as “the act of utilizing the patient's environment
to assist him in his recovery.” She identified 5 environmental factors: fresh air, pure water,
efficient drainage, cleanliness or sanitation, and light or direct sunlight.
Metaparadigm of Nightingale
 Nursing
Nursing is different from medicine and the goal of nursing is to place the patient in the
best possible condition for nature to act.
 Person
People are multidimensional, composed of biological, psychological, social and spiritual
components.
 Health
Health is “not only to be well, but to be able to use well every power we have”.
 Environment
Environment could be altered to improve conditions so that the natural laws would allow
healing to occur."

12 Major Area a nurse could control:

 Ventilation and warming
 Light
 Noise
 Variety
 Bed making
 Cleanliness of rooms and walls
 Personal cleanliness
 Nutrition and taking food
 Chattering hopes and advises
 Observation of sicks
 Petty management

In our scenario, we adopt Florence Nightingale's Environmental Theory since it may be

used to emphasis on health studies with regard to a patient's surrounding ecosystem, in which the
patient is Mrs. ABC, a 26-year-old woman who is suffering from tongue cancer.
In cases where the patient's environment might have had a substantial impact on her
recovery or health restoration, this notion is employed to prepare a patient for her recovery.
According to Nightingale, nurses can help individuals in restoring or rehabilitating their typical
health status by altering or improving their surroundings. It is also advised that individuals
should educated on basic environmental cleanliness.

Dorothea Orem "Self-Care Deficit Nursing Theory"

This theory focuses on the Nurses role in supporting the client's ability to be responsible
for their own care. It is based on the idea that everyone must be knowledgeable about their health
problems to provide adequate self-care.
Metaparadigm of Orem:
 Person
- Individual subject to force of nature with a capacity for self-knowledge; Engage deliberate
actions.
- Can learn to meet self-care requisites; If some reasons, person cant learn, other must provide.
- Patient; a being who Functions Biologically, symbolically and Socially paternal for learning
and development .
 Environment
- Consist of Environmental factors, elements and conditions (External, Musical and
psychological surroundings) and Developmental Environment promotion of personal
Development through motivation to establish goals and to adjust behavior.
 Health
- Consist of Physical, Psychological, Interpersonal and Social aspects.
 Nursing
- Geared toward independent of client.
- Help clients establish or identify ways to perform self care act.
- Human Service; Focus on persons with inabilities to maintain continuous provisions of
healthcare.

We adopt Dorothea Orem's Self-Care Deficit Theory in our case since it is essential to the
process of health recovery. Orem's Theory is basic, but it can be utilized in a variety of patients.
Orem constructed a nursing systems theory that is grouped into three categories: "Wholly
Compensatory Nursing System," which signifies a scenario in which the individual has been
unable to care for himself or herself, "Partial Compensatory Nursing System," which claims to
represent a condition where both the nurse and the patient perform as well as provide care, and
"Supportive-Educative System," which reflects a circumstance wherein the patient can perform
or can and should know how to perform necessary procedures for health recovery. According to
Orem's definition, nursing is needed whenever a person fails to produce the quantity and quality
of self-care necessary to keep life and health, recover from illness or disorder, or manage with
the illness or damage's implications.

Martha Rogers "Science of Unitary Human Beings"

The theory views nursing as both a science and an art as it provides a way to view the unitary
human being, who is integral with the universe. The unitary human being and his or her
environment are one.
 Human-unitary human beings
A person is defined as an indivisible pam-dimensional energy field identified by a pattern and
manifesting characteristics specific to the whole. A person is also a unified whole, having its
own distinct characteristics that can't be viewed by looking at, describing, or summarizing the
parts
 Health
Rogers defines health as an expression of the life process. The characteristics and behavior
coming from the mutual, simultaneous interaction of the human and environmental fields and
health and illness are part of the same continuum.
 Nursing
It is the study of unitary, irreducible, indivisible human and environmental fields: people and
their world. Rogers claims that nursing exists to serve people, and the safe practice of nursing
depends on the nature and amount of scientific nursing knowledge the nurse brings to his or her
practice.
 Environmental field
An irreducible, indivisible, pan-dimensional energy field identified by pattern and integral with
the human field.”

We use Martha Rogers' Unitary Human Being Theory in our case since Rogers focused a
great emphasis on how a nurse should view a patient. She established concepts that highlight the
importance of a nurse seeing the client as a whole. In our instance, the patient is much more than
a patient with tongue cancer who is suffering from oral pain. Patients are seen as "unitary human
beings" who cannot be divided down into phases and must be viewed as a whole. The role of a
nurse under this model is to help people.
Nurse intervention is to help individuals in improving overall health by integrating the
rhythm between both the people and the environment sectors, helping them in the change
process.
Nursing, according to Rogers, should focus on treating pain and psycho-social
interventions for rehabilitation.
 XVI. NURSING CARE PLAN
CUES NEED NURSING OBJECTIVE OF CARE NURSING ACTION EVALUATION
DIAGNOSIS
Subjective: Cognitive- Chronic pain  Patient will be able to  Allow patient to maintain a diary of pain ratings, Goal Met.
“grabe kasakit sa akong Perceptual related to demonstrate the use of timing, precipitating events, medications, treatments,
dila, halos di nako Pattern tongue lesions different relaxation skills and and what works best to relieve pain.  Patient’s Pain level: 3/10
kakaon ug tarung” as (Gordon’s diversional activities as RATIONALE:  Patient demonstrates use of
verbalized by the Functional indicated for individual Systematic tracking of pain appears to be an important different relaxation skills and
patient. Health Patterns) situation. factor in improving pain management. diversional activities as
 Patient will report pain at a indicated for individual
Objective: level less than 3 to 4 on a 0 to  Recognize and convey acceptance of the patient’s pain situation
 Pain scale: 10/10 10 rating scale. experience.  Patient uses pharmacological
 Alteration on the  Patient will be able to use RATIONALE: and nonpharmacological pain
right side of the pharmacological and Conveying acceptance of the patient’s pain promotes a relief strategies.
tongue nonpharmacological pain more cooperative nurse-patient relationship.  Patient verbalizes acceptable
 Recurrent, poorly relief strategies. level of pain relief and ability
healing aphtae on  Patient will be able to  Aid the patient in making decisions about choosing a to engage in desired activities.
the right side of the verbalize acceptable level of particular pain management strategy.  Patient engages in desired
tongue pain relief and ability to RATIONALE: activities without an increase
Vital signs: engage in desired activities. The nurse can increase the patient’s willingness to adopt in pain level.
BP: 120/129 mmHg  Patient will be able to engage new interventions to promote pain relief through guidance
HR: 105 bpm in desired activities without and support. The patient may begin to feel confident
RR: 25 cpm an increase in pain level. regarding the effectiveness of these interventions.
Temp: 36.5 C
 Explore the need for medications from the three
classes of analgesics: opioids (narcotics), non-opioids
(acetaminophen, Cox-2 inhibitors, and nonsteroidal
anti-inflammatory drugs [NSAIDs]), and adjuvant
medications.
RATIONALE:
Analgesic combinations may enhance pain relief.

 Allow the patient to describe appetite, bowel

 elimination, and ability to rest and sleep. Administer
medications and treatments to improve these
functions. Always obtain a prescription for a
peristaltic stimulant to prevent opioid-
induced constipation.
RATIONALE:
Because there is great individual variation in the
development of opioid-induced side effects, they should be
monitored and, if their development is inevitable (e.g.,
constipation), prophylactically treated. Opioids cause
constipation by decreasing bowel peristalsis.

 Obtain prescriptions to increase or decrease analgesic

doses when indicated. Base prescriptions on the
patient’s report of pain severity and the
comfort/function goal and response to previous dose
in terms of relief, side effects, and ability to perform
the daily activities and the prescribed therapeutic
regimen.
RATIONALE:
Opioid doses should be adjusted individually to achieve
pain relief with an acceptable level of adverse effects.

 Educate patient of pain management approach that has

been ordered, including therapies, medication
administration, side effects, and complications.
RATIONALE:
One of the most important steps toward improved control
of pain is a better patient understanding of the nature of
pain, its treatment, and the role patient needs to play in
pain control.

 Review patient’s pain diary, flow sheet, and

 medication records to determine overall degree of pain
relief, side effects, and analgesic requirements for an
appropriate period (e.g., one week).
RATIONALE:
Systematic tracking of pain appears to be an important
factor in improving pain management.

 Implement nonpharmacological interventions when

pain is relatively well controlled with pharmacological
interventions.
RATIONALE:
Nonpharmacological interventions should be used to
reinforce, not replace, pharmacological interventions.
 CUES NEED NSG. DX. OBJECTIVE OF CARE NSG. ACTION EVALUATION
W/SCIENTIFIC
NASIS

Subjective: Nutritional Impaired swallowing  After 24 hrs of  Keep an eye out for indicators of difficulty After 24 hours of nursing
“Mag lisod ko og kaon kay Metabolic Pattern giving interventions swallowing (e.g., coughing, choking, spitting of care/teaching, goals are met
naay burot akong dila og the patient must be food, drooling, and etc.) as evidenced by:
sakit kaayo I tulon.” as able to demonstrate Rationale: These are all signs of swallowing
verbalized by the patient. effective swallowing impairment.  The client has been able
after fluid intake. to demonstrate effective
Objective:  The patient will  Check for coughing or choking during eating and swallowing after fluid
Pain either regain normal drinking. intake.
Discomfort swallowing capacity Rationale: These sings indicates aspiration
Tongue lesion or be able to  She regain her normal
improve nutrition by  Provide oral care before feeding. Clean and insert swallowing capacity and
Past history of: feeding. dentures before each meal. improve her nutrition by
acute myeloid leukemia Rationale: Optimal oral care promotes appetite and feeding.
(AML) eating.
had an incident of a
cerebral venous sinus  Assess ability to swallow a small amount of water.
thrombosis Rationale: If aspirated, little or no harm to the patient
Suffers from epilepsy occurs.

Vital sign as follows:  During meals, keep the patient in a high-position

> Temp 36.5 °C Fowler's with the head flexed slightly forward.
> Spo2 – 95% Rationale: Aspiration is less likely to happen in this
> RR- 15cpm position.
>HR- 99bpm
>BP: 110/80 mmHg  Tell the patient not to communicate while he or she
is eating. As needed, give verbal cues.
Rationale: Concentration must be focus on the task.

 Reassure the patient to chew thoroughly, consume

slowly, and swallow frequently, especially if they
create excessive saliva. Provide direction or
encouragement to the patient until he or she has
swallowed each mouthful.
Rationale: Such directions assist in keeping one’s focus
on the task.

 Classify food given to the patient before each

spoonful if the patient is being fed.
Rationale: Knowing what kind of food to expect can
help the patient practice proper chewing and swallowing
techniques.

 Encourage a high-calorie diet that includes foods

from all food groups, as needed. Milk and milk
products should be avoided.
Rationale: Dairy products can lead to thickened
secretions.

 Praise the patient for following instructions and

swallowing properly.
Rationale: Praise fosters good behavior and creates an
environment conducive to learning.
 CUES
Subjective:
“Maulaw ko makig sturya
sa akong family og friends
tungod sa hubag sakong
dila og mahadlok ko kay
basin ila kong i judge.” as
verbalized by the patient.
Objective:
Pain
Discomfort
Tongue lesion
Past history of:
acute myeloid leukemia
(AML)
had an incident of a
cerebral venous sinus
thrombosis
Suffers from epilepsy
NEED NSG. DX. OBJECTIVE OF CARE NSG. ACTION EVALUATION
W/SCIENTIFIC
NASIS
Self-Perception- Situational low self - After 2 hours of nursing  Welcome statements the patient reveals about After 2 hours of nursing
Self-Concept esteem interventions: himself or herself. care/teaching, goals are met
Pattern Rationale: Patients with poor self-esteem frequently as evidenced by:
 At the nurse-patient express feelings of being unwanted, inadequate, and
interaction the incompetent. The patient frequently presents as unable  The client was able to
patient will show to handle the current situation. show adaptation and
adaptation and verbalize acceptance of
verbalize acceptance  Using the scale approach, the patient will report and self in situation.
of self situation. express emotions of negativity or social  Developed coping
 Begin to develop disengagement (1 being the lowest and 10 being the mechanisms to deal
coping mechanisms highest). effectively with
to deal effectively Rationale: To evaluate the patient’s feelings. problems.
with problem.
 Encourage the patient to say if she can link the
changes to a specific incident in her life.
Rationale: The patient may be aware of current events
that have a detrimental impact on her self-esteem.
 Assess the patient’s feelings of comfort and content
with his or her own performance.
Rationale: Patients with low self-esteem may act in
Vital sign as follows: ways that contradict their own personal, moral, or
> Temp 36.5 °C ethical ideals; they may also deny their conduct, assign
> Spo2 – 95% blame, and excuse personal failure.
> RR- 15cpm
>HR- 99bpm  Evaluate the extent to which the patient feels loved
>BP: 110/80 mmHg and respected by others.
Rationale: Feelings of unworthiness might be
exacerbated by a lack of credit for accomplishments or
rejection by others. Others' care and support will be
critical in helping the sufferer establish self-esteem.

 Evaluate recent variations in the patient’s behavior.

Rationale: While patients may be able to compensate
for low self-esteem by excelling at job or in areas of
special interest, they may still struggle with how they
see themselves. In an attempt to alleviate the burden of
their low self-esteem, some patients may withdraw from
work or family circumstances. Without factoring these
concerns into the care plan, low self-esteem will persist.

 With the help of a therapist, identify the trigger or

stressor and develop healthy and desirable
behaviors.
Rationale: Identifying the correct stressors leads to an
effective management of stress.
 XVII. DISCHARGE PLAN

Medication

Cetuximab (Erbitux) is one targeted therapy used to treat mouth cancer in certain
situations. Cetuximab stops the action of a protein that's found in many types of healthy cells, but
is more prevalent in certain types of cancer cells.

Instruct the patient to understand the dosage,mode of administration, mechanism of

action, and side effects of cetuximab

Environment/Exercise

Instruct the patient's family and the patient's home care provider to keep their home tidy.
Encourage them to keep their own hygiene and give the sufferer as little attention as possible.

Treatment

For Early cancer

Early cancer means your cancer is smaller than 4cm and is contained within the
tongue surgery to remove the cancer and some of the lymph nodes in your neck
radiotherapy to the throat and neck.

For Advanced cancer

Advanced cancer means your cancer is larger than 4cm. Or it has grown outside
the tongue, invading other tissues or lymph nodes. chemotherapy and radiotherapy
together (chemoradiotherapy) to your throat and neck surgery to remove part of the
throat (including all or part of the tongue) and some of the lymph nodes in your neck,
followed by radiotherapy or chemoradiotherapy.

Health teaching

Quit smoking

Smoking has been observed as a common lifestyle habit in up to 80 to 90% of all

oral cancer patients. It is also seen that quitting smoking decreases the risk of oral cancer.

Exercise regularly

An active lifestyle helps to boost the immune system, and reduces your cancer
risk. This includes walking, jogging, cycling, swimming, strength training or weight
training.

Choose foods that prevent cancer

Eat a lot of beans, berries, leafy and fibrous vegetables (such as cabbage and
broccoli), flax seeds, garlic, grapes, green tea, soy and tomatoes for their antioxidant
properties and heightened roles in preventing cancer. Avoid fried or grilled food
preparations.

Outpatient referral
 Instruct the patient and family members to visit the doctor on a frequent basis in order to
discover and avert major issues. Instruct client to call for his provider right away if he
experiences pain when swallowing, mouth numbness, a sore throat that persist and bleeding from
your tongue

Diet

Instead of red meat, try poultry, fish, eggs, cheese, or other high-protein foods. lemon-
flavored drinks to stimulate saliva and taste. Drink lots of fluids, especially if you are undergoing
chemotherapy or have a dry, sore, or blistered mouth.

Spiritual

Encourage the patient and all of the patient's family members to have faith in all aspects
of their lives and to constantly prioritize God in their daily decisions.

XVIII. RECOMMENDATION

This case study presented the results based on the student nurse’s response towards the
indicated observations regarding the given case of a patient with Tongue Cancer. Tongue cancer
is a type of cancer that starts in the tongue's cells. The tongue can be affected by a variety of
cancers, but tongue cancer is most commonly caused by the thin, flat squamous cells that line the
tongue's surface.

To reduce the risk of complications from tongue cancer, the following are the
recommendations are offered; stop using all tobacco products, maintain good oral hygiene, do
not chew betel nuts or Paan, limit sun (UltraViolet) exposure, exercise regularly, choose foods
that prevent cancer, avoid HPV infections of the mouth.

For the healthcare providers, we propose involving the patient's family in patient
education and providing particular tongue cancer interventions. This is to aid in the prevention
and/or future enhancement of health-care delivery; we also recommend that the hospital improve
its medically-used technologies and facilities. We also advocate presenting a community seminar
or video presentation on how to lower the risk of mouth cancer.

In addition, we advise my group mates and future researchers to dive further into the
factors that really need to be discussed, as well as do additional study on tongue cancer in
investigating additional treatments and remedies for the patients' well-being.
 XIX. REFERENCE/ BIBLIOGRAPHY

https://oralcancerfoundation.org/facts/

Sidransky D. Cancer of the Head and Neck. In: De Vita Jr Vt, Hellman S, Rosenburg SA. eds.
Cancer: Principles and Practice on Oncology. 5th ed. J.B. Lippincott Company. Philadelphia,
PA; 2015:779-81 (Oral Tongue), :783-86 (Base of Tongue).

Palme CE, Gullane PJ, Gilbert RW. Current treatment options in squamous cell carcinoma of the
oral cavity. Surg Oncol Clin N Amer. 2020;13:47-70.

Lin DT, Subbaramaiah K, Shah JP, et al. Cyclooxygenase-2: a novel molecular target for the
prevention of treatment of head and neck cancer. Heasd Neck. 2019;24:792-99.

Sciubba JJ. Oral cancer. The importance of early diagnosis and treatment. Am J Clin Dermatol.
2018;2:239-51.

Llewellyn CD, Johnson NW, Warnakulasuriya KA. Risk factors for squamous cell carcinoma of
the oral cavity in young people – a comprehensive literature review. Oral Oncol. 2019;37:401-
18.

Jemal A, Bray F, Center MM, et al. Global Cancer Statistics. Ca-Cancer J Clin. 2017;61(2):69–
90. [PubMed] [Google Scholar]

Siegel R, Naishadham D, Jemal A. Cancer statistics, 2017. Ca-Cancer J Clin. 2017;63(1):11–30.

[PubMed] [Google Scholar]

Curado MP, Hashibe M. Recent changes in the epidemiology of head and neck cancer. Curr
Opin Oncol. 2009;21:194–200. doi: 10.1097/CCO.0b013e32832a68ca. [PubMed] [CrossRef]
[Google Scholar]

Shiboski CH, Schmidt BL, Jordan RC. Tongue and tonsil carcinoma: increasing trends in the
U.S. population ages 20–44 years. Cancer. 2005;103:1843–1849. doi: 10.1002/cncr.20998.
[PubMed] [CrossRef] [Google Scholar]

Soudry E, Preis M, Hod R, Hamzany Y, Hadar T, Bahar G, Strenov Y, Shpitzer T. Squamous

cell carcinoma of the oral tongue in patients younger than 30 years: clinicopathologic features
and outcome. Clin Otolaryngol. 2010;35:307–312. doi: 10.1111/j.1749-4486.2010.02164.x.
[PubMed] [CrossRef] [Google Scholar]

Epidemiology of oral cancer in Asia in the past decade--an update (2000-2012).

Krishna Rao SV, Mejia G, Roberts-Thomson K, Logan R.
Asian Pac J Cancer Prev. 2013;14(10):5567-77. doi: 10.7314/apjcp.2013.14.10.5567.
PMID: 24289546 Review.
Prevalence and incidence of oral cancer in low- and middle-income countries: A scoping review.

Shrestha AD, Vedsted P, Kallestrup P, Neupane D.

Eur J Cancer Care (Engl). 2020 Mar;29(2):e13207. doi: 10.1111/ecc.13207. Epub 2019 Dec 10.
PMID: 31820851 Review.

https://www.ddh.com.ph/the-pulse/the-scoop-on-cancer/

Dotiwala AK, Samra NS. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr
19, 2021. Anatomy, Head and Neck, Tongue. [PubMed]

Chen J, Jacox LA, Saldanha F, Sive H. Mouth development. Wiley Interdiscip Rev Dev Biol.
2017 Sep;6(5) [PMC free article] [PubMed]
Li C, Lan Y, Jiang R. Molecular and Cellular Mechanisms of Palate Development. J Dent Res.
2017 Oct;96(11):1184-1191. [PMC free article] [PubMed]