Kingdom of Saudi Arabia.

Ministry of Education. ‫وزارة& التعلي&م الع&الي‬

Jazan University.
‫جامعة جازان‬
Farasan University College
College of Nursing
Nursing Department

S
Case Description:

The patient’s name is Afaf Abdullah Hazazi, 22 years old, from Samtah, high school education level, and single. She entered the
hospital due to severe pain and pain scale 8. She was admitted to the hospital five months ago for an operation to remove a tumor.
The patient was admitted for a second operation on October 2, and the operation was performed on October 10. The patient suffered
from anxiety, pain and high blood pressure after the operation, and she was given medication. In her left hand, a cannula was
installed. She was discharged on October 17.

The vital signs: BP: 157/124 , SPO2:100, PR:102/MIN

TEMP: 37C
 Name of Patient: Afaf Abdalla Ibrahim Hazazi Hospital no: ---
Date of Hospitalization: 2/10/2022 Duration of Hospitalization: 16 days
Patient's Demographic Data :

Age: 22 y Sex: Female Tribe: Hazazi

Address: Samta
Occupation: _ not working
Level of education: high school Nationality Saudi
Religion: _ Muslim Marital Status: single
Medical

Data:

Diagnosis :Neurofibromatosis (non malignant)

Preoperative patient: --
Postoperative patient:

Name of Operation: Plastic and Reconstructive surgery

Date: 10/10/2022 Postoperative Duration: 7 days
Health History:
Chief Complaints: sever pain

Past Medical history:

 Allergy: unknown
 Comorbidities: doesn't have
 Family history: not taken
 Past surgery: yes, first Plastic and Reconstructive surgery, in same site ,before 5 months .
 Disease: doesn’t have
Definition of the disease:
Neurofibromatosis is a hereditary condition manifested by pigmented
patches , axillary freckling, and cutaneous
neurofibromas that vary in size. Developmental changes may occur in the
nervous system, muscles, and bone. Malignant degeneration of the
neurofibromas occurs in some patients. Page (4817)

RISK FACTOR:
Neurofibromatosis:
 family history, about the half is inherited .
  The remaining cases result from a spontaneous genetic mutation occurs with unknown causes.
Source: https://www.mayoclinic.org/diseases-conditions/neurofibromatosis/symptoms-causes/syc-20350490
a
Skin Cancer
 Adults <30 years and >50 years of age
 Chronic ultraviolent light/sun exposure
a
 Family history of skin cancer
 Having a large number of nevi (i.e., moles)
 History of indoor tanning
 History of sunburns
 Immunosuppression
 People who are light skinned, have blond or red hair, or have blue or
 green eyes
a These are risks that are specific to melanoma
 Medical Management:
 The goal of treatment is to eradicate the tumor.
 The treatment method depends on the tumor location; the cell type, location, and depth; the cosmetic desires of the patient
 The management of BCC and SCC includes surgical excision, which may include Mohs micrographic surgery,
electrosurgery, or cryosurgery.
 In those patients who are not surgical candidates, alternatives such as radiation therapy, photodynamic therapy (PDT), or
topical chemotherapeutic creams may be viable options .

Nursing Management:
Because many skin cancers are removed by excision, patients are usually treated in outpatient surgical units.

 The role of the nurse is to educate the patient about prevention of skin cancer and self-care after treatment.

How prevention of skin cancer:

Minimize sun exposure:
 To the extent possible, avoid sun between the hours of 10 am and 4pm.
 Wear protective clothing (e.g., long-sleeved clothing, broad-brimmed hats).
 Seek shady areas when outdoors.
 Use caution around snow and water because of reflective sun rays.
 Use sunscreen.
Check your skin regularly:
 Perform self-examination monthly.
 Schedule an examination by primary provider yearly, if over the age of 50 years
Educating Patients About Self-Care:

The wound is covered with a dressing to protect the site

 The patient is advised when to report for a dressing change or is given written and verbal information on how to change
dressings, including the type of dressing to purchase, how to remove dressings and apply fresh ones,
 The importance of hand hygiene before and after the procedure.
 The patient is advised to watch for excessive bleeding and tight dressings that compromise circulation.
 If the lesion is in the perioral area:
the patient is instructed to drink liquids through a straw and limit talking
and facial movement. Dental work should be avoided until the area is
completely healed.
Investigations of your patient:
none

S.No Name of Investigation Results Normal range

Other Investigations /Diagnostic tests (If any) :

none
Treatment Carried Out For Your patient: (Do not include medications):
none

Etiology of Disease :

S.No According to Literature /Book In your patient

1  genetic defects (mutations) that either are passed From childhood (unknown cause)
on by a parent or occur spontaneously at
conception *

*
https://www.mayoclinic.org/diseases-conditions/neurofibromatosis/sympto
 Clinical manifestations:

S.No According to Literature /Book In your patient

1 Pigmented patches (café-au-lait macules) nevus

2 axillary freckling pain
3 Cutaneous neurofibromas that vary in size

Comment for procedures, which were incorrectly performed:

Signature of faculty
MEDICAL TREATMENT
CLASSIFACTION ROUTE DOSE FREQUENC
S. DRUG NAME SIDE EFFECT NURSING RESPONSIBILITY
No
1 Lactulose an osmotic po 15ml q.d Feeling sick (nausea)
Assess for Allergy to lactulose, low-galactose diet, diabetes,
laxative for 3 days Being sick (vomiting) lactation.
Stomach pain.
Do not freeze laxative form. Extremely dark or cloudy syrup
may be unsafe; do not use.

Give laxative syrup orally with fruit juice, water or milk to

increase palatability
2 Valsartan ngiotensin II po 80mg q.d Bloody urine. Watch for signs of impaired renal function,
(tabuvan) receptor blockers for 3 day decreased frequency or amount of including decreased urine output, cloudy urine,
(ARBs) urine. or sudden weight gain due to fluid retention.
difficult breathing.
3 Paracetamol Analgesics and IV 1g tid an allergic reaction, which can Check that the patient is not taking any other
antipyretics cause a rash and swelling. medication containing paracetamol
flushing, low blood pressure and a
fast heartbeat
4 OMEparazole proton-pump po 20mg q.d .a.m Feeling sick (nausea) ,Being sick Advise patient to avoid alcohol and foods that
inhibitors for 30 (vomiting) or diarrhoea ,Stomach may cause an increase in GI irritation.
days pain. ...
5 Amoxicillin penicillin-like po 625mg tid Abdominal or stomach cramps or Monitor signs of allergic reactions and
antibiotics for 5 days tenderness. anaphylaxis, including pulmonary symptoms
back, leg, or stomach pains. (tightness in the throat and chest, wheezing,
black, tarry stools. cough dyspnea) or skin reactions (rash, pruritus,
urticaria).
6 Amlodipine calcium channel po 10 mg q.d .a.m swelling of the hands, feet, ankles, Monitor patient carefully (BP, cardiac rhythm,
blockers for 7 days or lower legs. headache. upset and output) while adjusting drug to therapeutic
stomach dose; use special caution if patient has CHF
7 Tramadol opiate (narcotic) po 50mg Bid Constipation. Administer regular tramadol with or without
analgesics. For 7 days discouragement. food at the same time everyday. Give as-needed
drowsiness. tramadol only after pain assessment.
HEALTH HISTORY DISCHARCHAGE:
 Teaching how to change the bandage.
 After the sutures are removed, an emollient cream may be used to help reduce dryness.
 Wear protective clothing.
 Applying a sunscreen over the wound is advised to prevent postoperative hyperpigmentation if the patient spends time outdoors.
 Follow-up examinations should be at regular intervals, usually every 3 months for a year.
 Instruct the patient to seek treatment for any Moles that are subject to frequent friction and irritation and should be monitored
Indications of possible metastasis in moles as previously described.
NURSING CARE PLAN

ASSESSMENT NURSING DIGNOSIS GOAL RATIONAL EVALUATION

SUBJECTIVE \OBJECTIVE DAT NURSING INTERVANATION /OUTCOME CRITER

SUBJECTIVE: severe pain related to Relive pain Assessment of the patient's pain To promoting Expected patient
surgical excision as by asking. comfort outcomes may include:
evidenced by patient Anticipating the need for and 1. Experiences relief of
verbalizing pain administration of appropriate pain and discomfort
analgesic medications. a. States pain is
diminishing
b. Exhibits healing of
surgical scar without
heat, redness, or
swelling
pain Anxiety related to the Reduce anxiety Asses patient level of anxiety. Help patient to Expected patient
surgical procedure as ask questions that the patient relax. outcomes may include:
evidenced by alert in BP might be reluctant to ask, and 1. Experiences relief of
provide emotional support to the pain and discomfort
patient. a. States pain is
encouraging the patient to diminishing
express anxieties and feelings. b. Exhibits healing of
surgical scar without
heat, redness, or
swelling
OBJECTIVE: anxiety

BP=157/124
SPO2: 100

PR:102
discomfort
TEMP:37C
Name of student :Arwa hakami

Student NO:2021036873 Group: 668

Unite mid-surg

Date of submission:

Signature of student:

Teachers Evaluation Report:

Total marks: total marks obtained _

Signature of Teacher:

Date: