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Oral Cavity Cancer

A Case Study
presented to the
Faculty of School of Nursing
Manila Adventist College

In partial fulfillment
of the requirements for the course
Related Learning Experience for
Nursing Care Management 119
Second Semester, AY 2024-2025

Rizza Faye Balayang

Lorie Lyn Escullar

March 12, 2025

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Acknowledgment

We extend our sincere gratitude to all the individuals whose generous support was
crucial to the successful completion of this case study. This project would not have been
possible without their valuable contributions.

We are particularly indebted to our parents for their unwavering support and
encouragement throughout the entire research and writing process. Their enduring love
and belief in our abilities provided constant motivation.

We offer our heartfelt thanks to Mr. Val Lendel O. Lumalang, our clinical consultant,
for his steadfast dedication, patience, and expert guidance. His contributions were essential
in shaping the direction and quality of this study.

We also express our appreciation to Mr. Ryan Ray M. Mata, our post-conference
coordinator, for his commitment to this project. His efforts in facilitating connections with
other researchers and experts proved invaluable to our case study.

We acknowledge and appreciate the patience, understanding, and support offered

by our batchmates and clinical instructors during the demanding phases of this study.

Finally, we offer our thanks to our Heavenly Father, whose grace and guidance
provided the strength and clarity we needed to overcome the challenges and hardships
encountered during this project.

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Table of Contents

ACKNOWLEDGMENT ........................................................................................................ 2

INTRODUCTION ................................................................................................................. 5

PATIENT PROFILE/ DEMOGRAPHIC DATA ............................................................................. 6

CHIEF COMPLAINT ............................................................................................................. 6
HISTORY OF PRESENT ILLNESS .......................................................................................... 6
PAST MEDICAL HISTORY .................................................................................................... 7
FAMILY MEDICAL HISTORY WITH GENOGRAM ...................................................................... 7
PERSONAL, SOCIAL, ENVIRONMENTAL HISTORY .................................................................. 8

DEVELOPMENTAL TASKS ............................................................................................... 8

GORDON’S FUNCTIONAL HEALTH ASSESSMENT ........................................................ 9

PHYSICAL ASSESSMENT ............................................................................................... 12

REVIEW OF SYSTEMS .................................................................................................... 15

LABORATORY/DIAGNOSTIC PROCEDURES RESULTS ............................................... 16

COMPLETE BLOOD COUNT ........................................................................................ 16

CLINICAL CHEMISTRY ................................................................................................. 17
CLINICAL CHEMISTRY ................................................................................................. 19
COAGULATION ............................................................................................................ 20
IMMUNOLOGY.............................................................................................................. 22
BIOPSY ......................................................................................................................... 23
CHEST CT-SCAN .......................................................................................................... 24
WHOLE ABDOMEN ULTRASOUND ............................................................................. 25
NECK AND FACE CT-SCAN ......................................................................................... 26
CHEST X-RAY............................................................................................................... 27

ANATOMY AND PHYSIOLOGY ....................................................................................... 28

PATHOPHYSIOLOGY ...................................................................................................... 29

NURSING CARE PLAN .................................................................................................... 33

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NURSING PROBLEM NO. 1: PAIN IN THE MOUTH (PS 10/10)................................................ 33

NURSING PROBLEM NO. 2: W OUND UNDER THE JAW.......................................................... 37
NURSING PROBLEM NO. 3: INTERRUPTED SLEEPING PATTERN ............................................ 41
NURSING PROBLEM NO. 4: POOR FOOD INTAKE ................................................................ 44
NURSING PROBLEM NO. 5: DIFFICULTY IN SPEAKING CLEARLY............................................ 48
NURSING PROBLEM NO. 6: FEAR OF THE DISEASE PROGRESS ........................................... 51

MEDICATIONS/TREATMENT .......................................................................................... 54

DISCHARGE PLANNING (METHODS) ............................................................................ 57

CONCLUSION .................................................................................................................. 59

RECOMMENDATIONS ..................................................................................................... 59

BIBLIOGRAPHY ............................................................................................................... 61

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Introduction

Oral cancer is a commonly occurring malignancy in both developed and developing

countries. Squamous cell carcinoma (SCC) is the most frequent histological type, primarily
linked to tobacco and alcohol consumption (Ettinger et al., 2029). Oral cavity and lip
cancers are the 16th most common type of cancer worldwide. Many cases go undiagnosed
for too long because people aren’t aware of the early signs, precancerous changes, or the
major risk factors. Smoking, alcohol consumption, HPV infection, an inflammatory diet, and
poor oral hygiene all increase the chances of developing these cancers. Raising awareness
about these risks and promoting better oral health can lead to earlier detection and
improved survival rates(Gliwa et al., 2024)
Oral cavity cancer is a serious disease, especially common in low- and middle-
income countries like Pakistan. In 2022, it caused over 188,000 deaths worldwide, and
cases are expected to rise by 40% by 2040. In Pakistan, it’s the most common cancer in
men and the third most common in women. Most OCC cases stem from lifestyle and
environmental factors like smoking, betel quid chewing, poor oral hygiene, and alcohol use.
Long-term exposure to harmful substances leads to genetic damage, and socioeconomic
challenges often make the risk even higher (Shamsi et al., 2024).
Males in Taiwan (30.2), Sri Lanka (16.5), India (14.8), and Pakistan (13.2) had the
highest incidence rates for lip and oral cavity cancer in South and South-East Asia. Males
had consistently higher incidence rates than females. Overall, in the majority of the
populations assessed, trends in the incidence of cancer of the lips and oral cavity were
either stable or declining. Over the course of the study, rates among males in India
increased while rates among females decreased (Filho & Warnakulasuriya, 2024).
Based on the study of Alvarez and Reyes (2023), oral cavity cancer is the 19th most
common cancer in the Philippines, where cancer is a leading cause of illness and death.
From 1980 to 2007, its incidence in Metro Manila and Rizal was 2.9 per 100,000 in men
and 1.9 in women. Risk factors include genetics, poor oral hygiene, chronic irritation from
dentures or sharp teeth, and exposure to wood dust. Cultural habits like betel nut chewing,
along with diets low in fruits and high in red or salted meats, also play a role. Awareness
and prevention are key to reducing cases.

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Patient Profile/ Demographic Data

Patient J.C.V. is a 38 years old male,single, born in San Luis Aurora, they are 9
siblings, and he is the 5th child. He works as a farmer and is living with his parents and
siblings in Aurora. His height is 180 cm and his latest weight is 56kg. His religion is Seventh
Day Adventist, and he is a pure Filipino citizen.
This information was gathered by interviewing the patient and his brothers after our
8 hours duty and also we extracted some information from the patient’s chat, and we can
assure you that this information is 100% true and accurate.

Chief Complaint

Patient J.C.V was admitted in Adventist Medical Center Manila on the 5th of
February 2025 around 6:00 AM, with the chief complaint of enlarging mass in the oral
cavity, left and severe pain with a pain scale of 10/10. Patient J.C.V was transferred to
Pasay General Hospital on the 12th of February 2025.

History of Present Illness

90 days PTA, persistence of mass was noted and progressively increasing in size,
and there was associated pain and difficulty in mastication. Patient sought consultation to
the dentist and was prescribed Mefenamic acid and Amoxicillin, and completed the
prescribed dose but still no noted of improvement and complaints that his mass is still
increasing in size.
30 days PTC, mass is still increasing in size and associated with severe pain, noted
bloody discharge, and experiencing difficulty in speaking and sleeping. No loss of appetite
but the patient preferred only a soft diet, specifically soup. Patient underwent a punch
biopsy in other institution and was awaiting for the result.
2 days PTA, the result of punch biopsy was released and left revealed Squamous
Cell Carcinoma, Well-differentiated. Patient was referred to our institution and was
admitted.

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Past Medical History

Patient J.C.V doesn't have any past medical history such as hypertension, diabetes,
bronchial asthma, no allergies, no previous surgery and no previous hospitalization.

Family Medical History with Genogram

Among the 9, the patient is the only one who was diagnosed with cancer, and his
brother was diagnosed with hypertension. His grandparents on paternal side are both dead
but according to the patient's brother, their grandfather had hypertension and grandmother
had a stroke, while on his maternal side, his grandfather's cause of death was lung cancer
and his grandmother died due to heart disease. The second generation of their family is his
parents. In his paternal side his aunt and uncle were diagnosed with asthma, while in his
maternal side, his deceased aunt was diagnosed with tuberculosis, and his uncle died due
to colon cancer.

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Personal, Social, Environmental History

Patient J.C.V. is a farmer and he said that farming is their primary source of income.
Based on the patient’s interview, his daily routine before his hospitalization was farming
and he considered it also as his exercise since he worked from morning to afternoon. He
lived with his family in Aurora, and he said that he has a good relationship with his family,
they worked together for their daily needs, he verbalized “pinagsasama-sama namin yung
kita namin ng mga kapatid ko at magulang ko para pambili ng mga kailangan sa bahay at
pang araw-araw na gastusin”. He stated that his favorite food is vegetables and fruits.
Patient J.C.V. stated that he chose not to get married because he doesn't have any
good salary in farming and he is contented and happy even in a simple house and simple
life as long as he has a family that he loves and supports him. He said that every time that
he has a problem he handles it on his own as long as he can, but he always asks advice
and support from his family every time he feels that he cannot do it on his own.

Developmental Tasks

Freud’s Psychoanalytic Theory

As a 38-year-old adult, J.C.V. is in the genital stage, where individuals focus on

mature relationships and productivity. His decision to remain single and prioritize family
support over personal relationships suggests a strong connection to family ties rather than
independent intimacy.

Erikson’s Psycho-Social Theory of Development

J.C.V. is in the Generativity vs. Stagnation stage (middle adulthood). He contributes

to his family’s well-being through farming and values collective financial efforts. His illness
may cause a challenge in fulfilling his role, potentially leading to feelings of stagnation or
inadequacy.

Havighurst’s Developmental Tasks Theory

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In adulthood, his tasks include maintaining a livelihood, establishing a social role,

and adapting to physical changes. His illness (oral cavity cancer) disrupts his ability to work
and challenges his adaptation to physical limitations (pain, difficulty in mastication, and
communication).

Piaget’s Stages of Cognitive Development

As an adult, he is in the Formal Operational Stage, characterized by abstract

thinking and problem-solving. His decision to continue working despite financial constraints
reflects cognitive adaptability. Coping with his illness requires him to process medical
information and make informed health decisions.

Kohlberg’s Stages of Moral Development

Likely in the Post-Conventional Stage, where morality is based on personal

principles. His dedication to his family and work suggests a strong sense of duty and ethical
decision-making. He chooses to endure hardships rather than burden others, aligning with
principles of self-sacrifice and care.

Fowler’s Stages of Spiritual Development

As a Seventh-Day Adventist, his faith influences his coping mechanisms.

He may be in the Conjunctive Stage, where spirituality provides strength during illness.
His belief system likely shapes his resilience, trust in divine guidance, and acceptance of
life’s uncertainties.

Gordon’s Functional Health Assessment

Health Perception and Management

Patient J.C.V. was admitted due to his enlarging mass in the oral cavity, left and
severe pain. Concerning about his chemotherapy in other institution, he knows that it is
necessary for him to prevent any further complications and necessary for his improvement
and recovery from his condition/disease. He stated that his exercise is his work which is

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farming and for him to stay healthy, he always eats nutritious foods such as vegetables,
fruits and fish. When sick, he said that he does self medication like taking paracetamol and
proper rest, he never consulted a doctor unless it is an emergency.

Nutrition and Metabolism

Patient J.C.V. is 180cm in height and his current weight is from 68 kg to 56 kg, he
stated that since his mouth is progressively increasing in size and he’s experiencing severe
pain and difficulty in opening his mouth and mastication, he only tolerated to eat is soft
food, specifically soup. He doesn’t have any problem in swallowing and no loss of appetite.
Before his hospitalization, his favorite food was vegetables, fruits and fish.

Elimination

The patient stated that he has a regular bowel movement with a bowel activity 3-4
times a week and urine movement pattern of 6-7 times a day. His urine color is light yellow.
During his hospitalization he was ambulatory and there was no need for catheterization.

Activity and Exercise

Patient J.C.V. described his typical day of activity before his hospitalization is work,
which is farming and farming is the only exercise that he has everyday, he doesn’t have
any sports. He stated that he is a previous alcoholic drinker (5-10 bottles/day) but he
stopped since 2006, but he also stated that he is a cigarette smoker (10-20 sticks/day).

Sleep and Rest

Patient current sleeping pattern is that he sleeps around 11 PM and rises around 2
AM since he is experiencing severe pain. He stated that he cannot sleep properly, and he
only had a nap every time he asked for pain reliever. He stated that he cannot feel rested
every time he wakes up from sleeping. Prior to his illness, his sleeping pattern was normal,
he has a total of 6-7 hrs of sleep a day, he sleeps around 10PM and rises around 5 or 6 in
the morning.

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Cognition and Perception

During the interview he stated that he has been experiencing a slight blurry vision in
his left eye since last year, but doesn’t seek any consultation with an ophthalmologist.
Other than that there are no other problems noted. There are no noted problems with
regards to sensations.

Self-Perception and Self-Concept

Patient verbalized that he felt ashamed with his family due to his condition, but
through the support and love that they gave to him, he felt at ease and not alone in his
battle. He stated that he can feel the support and love from his family, and everytime that
he has a problem he always asked help from his family

Roles and Relationships

Patient J.C.V. is living with his parents and siblings. His parents are the one who
decides when it comes to family matters and households. In terms of needs, especially in
finances, he stated that they all contribute to buy their needs in their house, and when it
comes to emotional needs, they make sure that they support each other. And since he
doesn't have a wife and children, he always makes sure that he shares his salary from
farming to his family.

Sexuality and Reproduction

The patient doesn’t answer the questions with regards to this topic. But according to
him and to his brother, he is single and doesn’t have any relationship and children.

Coping and Stress Management

Patient stated that everytime he has a problem he handles it on his own but
everytime he cannot handle it on his own, he always seeks help and support from his
family. He said that one of his biggest losses was the death of his grandparents that are

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very close to him, but he stated that death is a part of life and he surrendered everything to
the Lord.

Values and Beliefs

Patient J.C.V. is a Seventh day Adventist, he believes in God, and everytime that he
is struggling he always seeks God’s guidance. He said all that he wants is to have a better
life for his family. He finds prayer helpful, and his condition never affects his relationship
with God.

Physical Assessment
Assessment of Mental Status, General Status, and Vital Signs

Patient J.C.V. seen awake, cooperative, and alert, oriented in time and place, with
slight difficulty in conversing, on semi-fowler's position, and not in cardiorespiratory
distress. His vital signs were taken and within normal range with a temperature of 36.0, BP
120/90, RR 20 bpm, PR 95, O2sat 99%, and pain scale is 10/10. Height 180cm and current
weight is 56kg, BMI: 17.4 (underweight).

Assessment of Skin, Hair, Nails

Skin is warm to touch, appears dry and brown in color. However, there is a lesion
with clear and traces of blood discharge, approximately 2 cm in size, dark violet in color to
almost black under his chin, around his mouth is tender and swollen. His hair appears black
and evenly distributed, nails appear pink and longitudinal in shape, and the capillary refill is
within normal limits.

Assessment of Head

Patient’s has a slight facial asymmetry, the scalp has dandruff but no presence of
tenderness, lesion, or swelling was observed. Presence of warm, and tender mass at oral
cavity, with limited mouth opening, trachea at midline. Complaints of pain in the mouth
radiating to his head, down to his shoulder.

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Assessment of Eyes

Patient’s eyes appear brown, the sclera appears white and the palpebral
conjunctiva appears pink, both pupils are equal in size, with no presence of jaundice, but
with eyebags due to inability to sleep. The patient reported that he has a slight blurry vision
in his left eye, but does not use any eye glasses.

Assessment of Ears

Patient’s ears are symmetrical, equal size bilaterally, and the skin around the ears
are intact; no presence of lesion, edema or swelling, there are no hearing difficulties, no
discharge and cerumen problems.

Assessment of Mouth, Throat, Nose, and Sinuses

Patient has an inability to open his mouth, and has difficulty in speaking clearly and
has difficulty in mastication. Gingiva appears dark violet to almost black in color, swollen
and tender to touch, presence of blood in the mouth. Patient complained of pain in his
mouth due to an inflamed oral cavity. Nasal mucosa appears normal with no signs of
irritation and discharge. There is no difficulty in swallowing.

Assessment of Thorax and Lungs

Patient’s chest is symmetrical and in midline alignment; no signs of lesion and

tenderness, the respiratory rate is 23 bpm. The chest expands symmetrically when
breathing,breath sounds are clear.

Assessment of Breast

Patient’s breast is symmetrical and equal in size and shape; has no mass or lesion
on the breast.

Assessment of Heart and Peripheral Vascular

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Patient's heart rate is 95 beats per minute, pulse is strong and regular, and cardiac
sounds are audible with normal intensity and duration. No murmurs, gallops, or rubs are
noted. There were no varicosities or symptoms of peripheral edema. Both skin tone and
temperature are within typical bounds on both sides. The capillary refill time was less than
two seconds, indicating sufficient peripheral perfusion.

Assessment of Abdomen

Patient’s abdomen is symmetrical with no visible distention or scars. Skin is intact

and without lesions, bowel sounds are normal in frequency and intensity, indicating no
signs of bowel obstruction, no bruits or vascular murmurs noted. All quadrants recorded
tympanic percussion sounds, which indicated normal gas-filled intestines; with dullness
sounds in solid organs; no palpable masses, organ enlargement, or pulsations were
noticed; and no rebound tenderness was elicited.

Assessment of Musculoskeletal

Patient seems a little bit weak, unable to open his mouth, but all joints including
shoulders, elbows, wrists, hips, knees, and ankles has no noted of limitation or pain except
in his mouth particularly in the temporomandibular joint.

Assessment of Neurologic System

Patient is alert and oriented to the person, place, time, and situation; no signs of
acute neurologic deficits or abnormalities noted. The patient’s memory, sensory, and motor
function are intact.

Assessment of Genitalia and Rectum

Patient reported that he doesn’t have any lesions, masses, discharge, or

abnormalities in his genitalia and free from infection, no presence of hemorrhoids
or fissures.

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Review of Systems

Skin: (-) rashes, (+)lumps on his oral cavity/mouth, (-)itching, (-)dryness, (-) color
changes, (-)changes in hair and nails, (+) wound under the jaw
Head: (+) radiating headache, (-)head injury
Eyes: (+) slight blurry vision on left eye, (-)glasses or contact lenses, (-)pain, (-)redness,
(-)double vision, (-)glaucoma, (-)cataracts
Ears: (-) hearing loss, (-)tinnitus, (-)discharge
Nose and sinuses: (-)frequent colds, (-)nasal stuffiness, (-)nose bleeds
Mouth and throat: (+) mass in the mouth, (-)sore throat, (-)hoarseness, (+)traces of
blood in the saliva, (+)dysarthria
Neck: (-)goiter
Breasts: (-)lumps, (-)pain, (-)nipple discharge
Respiratory: (-)cough, (-)sputum, (-)hemoptysis
Cardiac: (-)heart problem, (-)hypertension, (-)chest pain
GIT: (-)hematemesis, (-)food intolerance, (-)vomiting, (-)melena, (-)hemorrhoids
Urinary: (-)nocturia, (-)dysuria, (-)hematuria, etc.
Genital: male/female: (-)discharges, (-)decrease libido, (-)sexual difficulties, (-)STI’s, (-
)hernias,
Musculoskeletal: (-)joint pains, or (-)stiffness, (-)weakness, (-)limitation of movement, (-
)paralysis, (+) difficulty in mastication, (+) swollen in mandibular area
Peripheral vascular: (-)cramps, (-)thrombophlebitis
Neurological: (-)fainting, (-)blackouts, (-)seizures, (-)tingling sensations, (-)numbness
Psychiatric: (-)nervousness, (-)tension, (-)depression, (+)fear
Hematologic: (-)anemias, (-)easy bruising or bleeding, (-)past transfusions

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Laboratory/Diagnostic Procedures Results

COMPLETE BLOOD COUNT (CBC) February 05, 2025

Test Name Result Unit Reference range

CBC

RBC 5.61 X 10^12/ L 4.60 - 6.20

Hematocrit L 0.36 L/ L 0.40 - 0.54

Hemoglobin L 117 g/ L 135 - 180

WBC H 10.78 X 10^9/ L 5.00 - 10.00

Differential Count

Lymphocytes L 12 % 25 - 40

Monocytes 7 % 2-8

Eosinophils 4 % 1-4

Basophils 0 % 0-1

Segmenters H 77 % 54 - 75

Platelet Count H 486 X 10^9/ L 150 - 450

MCV L 64.9 fL 80.0 - 94.0

MCH L 20.8 pg 27.0 - 31.0

MCHC 32.1 g/ dL 32.0 - 36.0

Results with Analysis and Interpretation

The patient presents with low hemoglobin, hematocrit, MCV, and MCH, which are
consistent with microcytic hypochromic anemia. This may be related to iron deficiency or

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chronic disease. Elevated WBC and segmenters suggest a possible ongoing infection or
cancer-related inflammatory process, while a decrease in lymphocytes may indicate a
weakened immune response. The high platelet count may be a response to inflammation,
malignancy, or an increased risk of clotting (American Cancer Society, 2024).

Nursing Responsibilities
Before
● Verify patient identity and any special instructions (e.g., fasting if required).
● Monitor for symptoms related to anemia (fatigue, pallor, weakness) and possible
infections (fever, swelling, or pain).
● Review any medications or treatments, such as chemotherapy or radiation therapy,
that may affect blood counts.
● Encourage proper hydration before the test.
● Address any concerns or anxiety the patient may have.
During
● Offer reassurance and comfort to the patient, especially if they feel anxious.
● Observe any immediate complications such as excessive bleeding or dizziness.
After
● Check for bleeding, bruising, or hematoma at the site of blood collection.
● Observe the patient for signs of dizziness or fainting.
● For anemia, encourage a diet rich in iron (e.g., leafy greens, red meat) and consult
the physician about possible iron supplements or blood transfusions.
● Watch for signs of infection and administer prescribed antibiotics if necessary.
● Strengthen infection control measures and educate the patient on immune-boosting
strategies.
● Assess for potential clotting complications (e.g., swelling, shortness of breath) and
ensure proper hydration.
Reference: Ignatavicius, D. D., & Workman, M. L. (2021). Medical-surgical nursing: Patient-
centered collaborative care (10th ed.). Elsevier.

CLINICAL CHEMISTRY- February 05, 2025

Test Name Result Unit Reference range

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Potassium (K+) 4.3 mmol/ L 3.5 - 5.1

Creatinine 81.8 umol/ L 59.0 - 104.0

Sodium (Na+) 137 mmol/ L 136 - 145

Results with Analysis and Interpretation

The potassium level is within the normal range, this indicates proper electrolyte
balance, which is essential for muscle function, nerve transmission, and cardiac activity.
The creatinine level falls within the normal range, suggesting that kidney function is stable
and there is no indication of renal impairment. The sodium level is within the normal range,
this suggests proper fluid balance and no signs of dehydration or
hyponatremia/hypernatremia.

Nursing Responsibilities
Before
● Explain the purpose of the test and obtain informed consent if necessary.
● Ensure the patient is fasting if required for other metabolic tests.
● Review the patient’s medications, as some drugs (e.g., diuretics, ACE inhibitors)
may affect electrolyte levels (Smeltzer et al., 2019).
During
● Offer reassurance and comfort to the patient, especially if they feel anxious.
● Observe any immediate complications such as excessive bleeding or dizziness
(Ignatavicius & Workman, 2021).
After
● Apply pressure to the puncture site to prevent bleeding.
● Observe the patient for signs of dizziness or fainting.
● Educate the patient about possible symptoms of electrolyte imbalance (e.g., muscle
weakness, confusion).
● Report critical values immediately to the physician if they fall outside the reference
range (Potter & Perry, 2021).

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CLINICAL CHEMISTRY- February 05, 2025

Test Name Result Unit Reference range

SGOT 26.0 U/ L < 35.0

Gamma 36 U/ L 16 - 73

Glutamyl Transferase

SGPT 16.0 umol/ L < 45.0

Bilirubin (Total/ Direct?

Indirect)

Total Bilirubin 13.0 umol/ L 2 - 21

Direct Bilirubin 5.5 umol/ L 2-7

Indirect Bilirubin 7.5 umol/ L 0.0 - 338

(Bu)

Alkaline Phosphatase L 91 U/ L 104 - 338

Results with Analysis and Interpretation

Based on the results of SGOT, SGPT, Gamma, all are within normal limits,
indicating no acute liver injury or dysfunction. The total, direct, and indirect bilirubin levels
are within the normal range, indicating no jaundice or major liver dysfunction.While the
Alkaline Phosphatase (ALP), the result is low which may indicate nutritional deficiencies
(e.g., zinc, magnesium, vitamin C, or vitamin B6 deficiency), hypothyroidism, or bone
disorders.
Nursing Responsibilities
Before
● Ensure the patient follows any fasting requirements (if needed).
● Check for any medications that might affect results (e.g., hepatotoxic drugs).
● Address any patient concerns regarding blood extraction. (Fischbach & Fischbach,
2018)
During

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● Watch for signs of dizziness or fainting during blood collection.

● Offer reassurance and comfort to the patient, especially if they feel anxious
(Ignatavicius & Workman, 2021).
After
● Monitor for bleeding or bruising at the puncture site.
● Encourage fluid intake to promote circulation and prevent dizziness.
● Encourage a balanced diet rich in zinc, magnesium, and vitamin B6 if nutritional
deficiency is suspected (Potter et al., 2020).

COAGULATION - February 05, 2025

Test Name Result Unit Reference range

APTT

Patient H 41.7 sec 25.0 - 37.8

Prothrombin Time

Patient H 17.7 sec 11.4 - 14.4

Activity 60.7 %

INR 1.60

Results with Analysis and Interpretation

Prolonged APTT suggests a coagulation disorder, possible liver dysfunction, vitamin
K deficiency, or disseminated intravascular coagulation (DIC). Can also be due to
anticoagulant therapy, while prolonged PT indicates impaired clotting factor synthesis,
possible liver disease, vitamin K deficiency, or coagulation disorders. May be related to
chemotherapy or malignancy.
Nursing Responsibilities
Before
● Verify Physician’s Orders, ensure the test is ordered correctly and clarify any
unclear prescriptions (Potter & Perry, 2023).
● Obtain Informed Consent if Necessary (McCall & Tankersley, 2021).

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● Assess the Patient’s Medical and Surgical History, check for conditions such as liver
disease, malnutrition, or chemotherapy use, which can impact coagulation
(Ignatavicius & Workman, 2022).
● Assess for Signs of Bleeding Disorders, look for bruising, petechiae, gum bleeding,
and prolonged wound healing, which may indicate clotting dysfunction (Hinkle &
Cheever, 2022).
● Ensure Proper Fasting (if Required), some coagulation tests require fasting or
avoiding certain medications before the test (Pagana, 2022).
● Check for Medication Use (e.g., Anticoagulants, NSAIDs, or Chemotherapy Drugs)
this can prolong bleeding times, necessitating closer monitoring (Smeltzer & Bare,
2022)
During
● Observe excessive bleeding at the venipuncture site due to prolonged clotting time
(Lewis et al., 2023).
● Maintain Aseptic Technique, prevent contamination and infection, especially in
immunocompromised cancer patients (Gould & Brooker, 2023).
After
● Monitor the Venipuncture Site for Bleeding or Hematoma Formation, prolonged
APTT and PT, ensure no excessive bleeding occurs (Smeltzer & Bare, 2022).
● Teach the patient to report nosebleeds, blood in the stool, prolonged gum bleeding,
or hematuria (Potter & Perry, 2023).
● Encourage the patient to use a soft-bristle toothbrush to prevent gum bleeding,
avoid strenuous activity or trauma, avoid sharp foods (e.g., chips) that may cause
oral bleeding, report any unusual bruising or prolonged bleeding (Hinkle & Cheever,
2022).
● Coordinate with a Dietitian for Nutritional Support, since oral cavity cancer patients
often struggle with poor nutrition, ensure they receive adequate vitamin K and
protein for clotting factor synthesis (Smeltzer & Bare, 2022).
● Schedule Follow-Up Laboratory Tests, repeat PT, APTT, and INR as ordered to
monitor clotting function, especially if treatment is initiated ( Pagana, 2022).

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IMMUNOLOGY - February 08, 2025

Test Name Result Unit Reference range

HBsAg Quantitative 0.010 IU/ mL 0.00 - 0.050

Non-Reactive

Anti- HCV Screening 0.015 C.O.V. <1.0

Non-Reactive

Anti- HBs H 257.178 mIU/ mL <10 mIU/ mL

REACTIVE

Results with Analysis and Interpretation

The patient tested negative for Hepatitis B surface antigen (HBsAg), indicating no
active Hepatitis B infection while the anti-HCV is non-reactive, the patient tested negative
for Hepatitis C virus antibodies, suggesting no past or present infection. On the other hand,
the patient has a high level of Hepatitis B surface antibodies (Anti-HBs), indicating immunity
to Hepatitis B. This immunity could be due to prior vaccination or past resolved infection.
Nursing Responsibilities
Before
● Ensure the patient understands the procedure and obtain informed consent, as
immunology tests involve blood collection (Berman & Snyder, 2020).
● Review the patient’s history of vaccinations, infections, and risk factors for Hepatitis
B and C, especially considering the patient’s immunocompromised state due to oral
cavity cancer (Lewis et al., 2019).
During
● Observe for signs of dizziness, hematoma, or bleeding, as cancer patients may
have altered coagulation profiles due to treatment or disease progression
(Ignatavicius & Workman, 2020).
● Provide reassurance and minimize pain during blood extraction, considering the
patient's condition and discomfort from oral cavity cancer (Smeltzer et al., 2021).
After
● Apply firm pressure on the puncture site to prevent hematoma formation, especially
if the patient is at risk for bleeding due to possible cancer-related thrombocytopenia
(Perry et al., 2021).

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● If the patient had been vaccinated, reinforce the importance of continued

monitoring. If unvaccinated but immune, discuss continued precautions against
other infections (Eliopoulos, 2021).
● Since the patient has oral cavity cancer, coordinate with the oncology and infectious
disease team to determine if further monitoring or intervention is necessary
(Brunner & Suddarth, 2022).

BIOPSY - February 03, 2025

SURGICAL PATHOLOGY DIAGNOSIS:

Mass floor of the mouth; Punch Biopsy:
= Squamous Cell Carcinoma, Well-Differentiated

Results with Analysis and Interpretation

The specimen consists of three brown, irregularly shaped, soft tissue fragments
altogether measuring 1.5 x 1.0 cm. ATE. B1.
Initial and deeper sections reveal squamous cell carcinoma of well differentiation.
It is composed of sheets and nests of typical squamous cells. Keratinization is observed.
The scant intervening stroma shows neutrophils admixed with eosinophils. Hemorrhage
and necrosis are present as well.

Nursing Responsibilities
Before
● Obtain informed consent, ensure the patient or legal guardian understands the
procedure, risks, benefits, and alternatives (Potter et al., 2021).
● Review history of bleeding disorders, medications (especially anticoagulants),
allergies, and comorbidities (Hinkle & Cheever, 2022).
● Inspect for signs of infection, swelling, or ulceration that may affect the biopsy site
(Smeltzer et al., 2020).
● Explain the procedure, expected discomfort, and post-procedure care (Perry et al.,
2022).
● Ensure fasting if required, some physicians may require fasting to minimize
aspiration risk if sedation is used (Ignatavicius & Workman, 2021).
During

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● Reassure and comfort the patient to reduce anxiety (Perry et al., 2022).
● Assist the physician, hand over sterile instruments, maintain aseptic technique, and
ensure proper handling of the biopsy sample (Hinkle & Cheever, 2022).
● Monitor for complications, observe for excessive bleeding, allergic reactions, or
airway compromise (Smeltzer et al., 2020).
● Assist in controlling bleeding by applying pressure or using hemostatic agents as
ordered (Ignatavicius & Workman, 2021).
● Ensure proper specimen labeling, verify patient identity and ensure accurate
labeling of the biopsy sample for pathology (Potter et al., 2021).
After
● Monitor vital signs and airway patency, observe for signs of bleeding, swelling, or
respiratory distress (Hinkle & Cheever, 2022).
● Assess for bleeding and infection, regularly check the biopsy site for excessive
bleeding or signs of infection such as redness or pus (Smeltzer et al., 2020).
● Educate the patient on post-procedure care, provide instructions on oral hygiene,
diet modifications, and signs of complications (Perry et al., 2022).
● Manage pain with prescribed medications and suggest cold compress application if
appropriate (Ignatavicius & Workman, 2021).
● Ensure follow-up appointment, schedule or remind the patient of their follow-up visit
for biopsy results and wound assessment (Potter et al., 2021).

CHEST CT-SCAN (CHEST PLAIN) - February 08, 2025

Results with Analysis and Interpretation

Plain CT SCAN of the chest reveals no evident infiltrates, mass or calcifications.

No enlarged mediastinal or hilar nodes.
There is no pleural or pericardial effusion.
The heart is not enlarged.
The vascular structures are not unusual. Degenerative changes are noted in the spine.

IMPRESSION: THORACIC SPONDYLOSIS

Nursing Responsibilities
Before

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● Verify the order and obtain consent if necessary (ACR, 2023).

● Verify the order and check for allergies, especially to contrast media if indicated
(ACR, 2023).
● Assess kidney function (creatinine/BUN) if contrast is used to prevent nephrotoxicity
(National Kidney Foundation, 2022).
● Ensure NPO status for 4-6 hours if contrast is required (RadiologyInfo.org, 2022).

During
● Monitor the patient for allergic reactions to contrast, such as rash or difficulty
breathing (Bontrager & Lampignano, 2020).
● Encourage slow, deep breathing to minimize motion artifacts (ACR, 2023).
● Ensure IV line patency for contrast administration if needed (RadiologyInfo.org,
2022).
After
● Assist the patient back to their unit if mobility is impaired (Potter et al., 2021).
● Document the procedure and report findings to the physician as needed (Bontrager
& Lampignano, 2020).

WHOLE ABDOMEN ULTRASOUND - February 09, 2025

Results with Analysis and Interpretation

Normal Liver, Gallbladder, Pancreas, Spleen, Aorta and Para-aortic areas, Kidneys,
Urinary Bladder and Prostate gland.

Nursing Responsibilities
Before
● Ensure proper patient preparation, including fasting for 6-8 hours to reduce bowel
gas interference (RadiologyInfo.org, 2022).
● Educate the patient about the procedure and its non-invasive nature (Potter et al.,
2021).
● Verify the order and obtain consent if necessary (ACR, 2023).
During
● Assist the patient in positioning, usually supine (Bontrager & Lampignano, 2020).
● Provide privacy and ensure draping to maintain patient dignity (Potter et al., 2021).

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● Encourage the patient to follow instructions, such as holding their breath when
needed (RadiologyInfo.org, 2022).
After
● Clean the gel off the patient’s skin to prevent discomfort (Potter et al., 2021).
● Assess for any discomfort and assist with ambulation if needed (ACR, 2023).

NECK AND FACE CT-SCAN WITH CONTRAST - February 06, 2025

Results with Analysis and Interpretation

Transpatial Left Buccal space mass with extension and mass effects as detailed above
consistent with clinically known case of oral squamous cell carcinoma, clinical stage IVA
(T4a/N2c/Mx).

Nursing Responsibilities
Before
● Assess for allergies to contrast dye and iodine (ACR, 2023).
● Check renal function if contrast is used to prevent contrast-induced nephropathy
(National Kidney Foundation, 2022).
● Ensure NPO for at least 4 hours before contrast administration (RadiologyInfo.org,
2022).
During
● Monitor for contrast reactions such as itching, swelling, or difficulty breathing
(Bontrager & Lampignano, 2020).
● Ensure proper positioning to avoid motion artifacts (ACR, 2023).
● Maintain IV line patency for contrast infusion (Potter et al., 2021).
After
● Encourage fluid intake to flush out contrast dye (ACR, 2023).
● Monitor for delayed allergic reactions, including rash or dizziness
(RadiologyInfo.org, 2022).
● Document the procedure and patient response (Bontrager & Lampignano, 2020).

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CHEST X-RAY - February 05, 2025

Results with Analysis and Interpretation

The lungs show no active pulmonary infiltrates.

The heart is not enlarged.
The diaphragm, sulci and bony thorax are intact.

IMPRESSION: NORMAL CHEST FINDINGS

Nursing Responsibilities
Before
● Verify the physician’s order and patient’s identity to ensure the correct procedure is
performed (Potter et al., 2021).
● Verify the order and obtain consent if necessary (ACR, 2023).
● Remove metallic objects such as jewelry to prevent image distortion (Bontrager &
Lampignano, 2020).
During
● Ensure proper positioning of the patient (standing or lying) based on the
radiographer’s instructions (ACR, 2023).
● Provide emotional support to anxious patients, especially children and those with
respiratory distress (Potter et al., 2021).
After
● Observe any discomfort or dizziness, particularly in debilitated patients
(RadiologyInfo.org, 2022).
● Assist the patient back to their unit if mobility is impaired (Potter et al., 2021).
● Document the procedure and report findings to the physician as needed (Bontrager
& Lampignano, 2020).

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Anatomy and Physiology

The oral cavity, or mouth, is the entry point for both the digestive and respiratory
systems, playing a crucial role in digestion, respiration, speech, and sensory perception. It
consists of the vestibule and oral cavity proper, bordered by the lips, cheeks, hard and soft
palates, tongue, and floor of the mouth. The back of the oral cavity connects to the
oropharynx, allowing food and air to pass. The lips and cheeks facilitate speech and food
containment, while the teeth and gingiva aid in mechanical digestion. The tongue, covered
in papillae with taste buds, assists in food manipulation, swallowing, and speech. The hard
and soft palates provide structural support for chewing and help direct food during
swallowing. Additionally, salivary glands secrete enzymes that initiate digestion (Tortora &
Derrickson, 2020).
Functionally, the oral cavity plays a major role in digestion, beginning with
mastication, where food is broken down and mixed with saliva to ease swallowing and
initiate enzymatic digestion. The tongue pushes food toward the oropharynx, triggering the
swallowing reflex, while the soft palate and epiglottis ensure food moves safely into the
esophagus. Speech production also relies on the coordinated movements of the tongue,
lips, teeth, and palate, enabling articulation and word formation. Sensory perception is
another key function, as taste buds detect different flavors, and receptors assess texture
and temperature, influencing dietary choices and safety.
Beyond digestion and speech, the oral cavity contributes to immune defense. Saliva
contains antimicrobial proteins like lysozyme, which help combat harmful pathogens, while
the tonsils serve as the body's first line of defense against ingested or inhaled
microorganisms. Overall, the oral cavity is a multifunctional structure that integrates
muscles, glands, and neural networks to support digestion, communication, and immune
protection, making it essential to overall health (Marieb & Hoehn, 2019).

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Pathophysiology

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Oral squamous cell carcinoma (OSCC) develops due to a combination of modifiable

and non-modifiable risk factors. In this case, modifiable risk factors include a history of
smoking (3 pack-years), excessive alcohol consumption (10 bottles per day for one year),
prolonged sun exposure due to farming, and exposure to chemicals like pesticides and
fertilizers. These lifestyle factors contribute to DNA damage and increase the risk of
malignancy.Non-modifiable risk factors include being male, having a family history of
cancer on the maternal side, and the patient’s age (38 years old). These inherent factors
may predispose an individual to cancer development by influencing genetic susceptibility.

The primary etiology of OSCC is idiopathic, but it is strongly linked to chronic

exposure to carcinogens. In this case, long-term tobacco and alcohol use have likely
caused DNA damage in the oral mucosal epithelial cells. This damage triggers mutations in
tumor suppressor genes and proto-oncogenes, leading to uncontrolled cell proliferation.
The development of OSCC begins with DNA damage in the epithelial cells of the oral
mucosa, caused by chronic exposure to carcinogens. This leads to mutations in tumor
suppressor genes (such as TP53) and proto-oncogenes (such as RAS), which disrupt
normal cell regulation. As a result, squamous cells begin to proliferate abnormally, leading
to the formation of a small, round mass (2x2 cm) on the floor of the mouth, first noted in
October 2024. With tumor progression, increased angiogenesis occurs, supplying nutrients
to the malignant cells and allowing the tumor to grow further. By November 2024, the mass
had enlarged, spreading to the roof of the mouth and neck, leading to pain and insomnia.
The patient did not respond to antibiotics, indicating that the condition was not a simple
infection but a malignant process.

By December 2024, the tumor continued to grow, causing lymph node involvement,
bloody discharge, and dysarthria (difficulty speaking). This suggests local invasion and
deeper tissue infiltration. A punch biopsy was performed in January 2025, confirming the
diagnosis of well-differentiated squamous cell carcinoma of the left floor of the mouth. A CT
scan with IV contrast in February 2025 revealed a left buccal space mass with extension,
consistent with stage IVA oral squamous cell carcinoma (T4/N2c/Mx). As the tumor invades
deeper tissues, it releases pro-inflammatory cytokines, exacerbating inflammation.
Increased inflammatory response leads to tissue necrosis, further tumor enlargement, and
continued angiogenesis. By February 6, 2025, a cyst in the central inframandibular area
had ruptured, indicating progressive tissue destruction. The patient initially presented with a
small, localized oral mass, which progressively increased in size. As the disease advanced,

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the patient experienced difficulty in mastication, significant weight loss (from 68 kg to 56

kg), persistent pain, and insomnia. Lymph node involvement and bloody discharge further
indicated tumor progression. Eventually, dysarthria and increased fatigue developed,
significantly impairing the patient’s quality of life.

If left untreated, OSCC can lead to severe complications, beginning with metastasis,
where tumor cells spread through the bloodstream (hematogenous metastasis) to distant
organs such as the brain, lungs, stomach, colon, liver, bladder, and bone marrow,
potentially causing leukemia or myeloma. Additionally, regional lymph node metastasis can
contribute to further local invasion, accelerating disease progression. As the tumor
continues to grow massively, it may obstruct the airway, resulting in asphyxiation,
respiratory failure, and ultimately, cardiopulmonary arrest, which can lead to death. The
infiltration of tumor cells into deeper tissues can also cause nerve compression, leading to
severe pain and functional impairment in affected areas. Furthermore, the persistent
inflammatory response can damage surrounding tissues, causing ischemia (reduced blood
supply), cell death (gangrene), and poor perfusion, which increases susceptibility to
bacterial colonization and opportunistic infections. In cases where necrotic tissues become
infected, septicemia may develop, potentially progressing to septic shock. Additionally, liver
involvement can trigger coagulation abnormalities, leading to disseminated intravascular
coagulation (DIC), hypovolemia, hypovolemic shock, and multi-organ failure. If these
complications continue to progress without medical intervention, the patient may ultimately
succumb to respiratory failure, septic shock, or hypovolemic shock, resulting in death.

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Nursing Care Plan

Nursing Problem No. 1: Pain in the mouth (PS 10/10)

Subjective Cues Objective Cues

● “Sobrang sakit po hanggang ulo at ● Facial grimacing

likod yung sakit” as verabalized by
● Difficulty in speaking and eating
the patient
● Restlessness
● Verbal report of pain scale 10/10
● Irritability

● Vital signs: BP: 120/80, RR: 23

bpm, PR: 95 bpm, Temp: 36.4
Nursing Diagnosis
Acute pain related to tissue invasion and nerve compression as manifested by verbal
report of pain in the mouth radiating to the head, back of the head and shoulders with
the pain scale of 10/10

Rationale
Pain associated with cancer often arises due to tumor expansion, leading to tissue
invasion and nerve compression. As malignant growths spread into nearby structures,
they trigger inflammation, reduced blood flow, and direct nerve damage. This process
results in intense, persistent pain that may extend to surrounding areas. (World Health
Organization, 2018)

Goals/Objectives

Short term
Within 1 hour of nursing interventions, the patient will verbalize a decrease in pain
intensity from 10/10 to atleast 5/10

Long term
After 2 days of nursing interventions the patient pain scale will become 0/10.

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Nursing Interventions Rationale

Independent

1. Assessed the pain (COLDSPA) 1. A thorough pain assessment helps

to understand the patient's pain
Character: “para siyang tinutusok na experience and tailor interventions
sobrang sakit” effectively (Polomano & Farrar,
Onset: “ Noong December pa” 2019)
Location: “Dito sa bibig ko papunta sa
ulo, likod ng ulo at balikat”
Duration: “Pabalik balik yung sakit,
nawawala kapag binibigyan ako ng
gamot”
Severity: “10 yung sakit”
Pattern: “ Pabalik balik yung sakit niya
kaya lagi akong humihingi ng gamot”

2. Slightly elevated the head of the 2. To promote comfort and help to

bed and position the client in a reduce pain. (Curran, 2022)
comfortable position.

3. Provided cold compress. 3. Cold therapy lessens pain and

tenderness by numbing the area.
It also helps reduce swelling and
inflammation (Johns Hopkins
Medicine, 2024)

4. Provided non-pharmacological 4. Promotes relaxation, relieves

approach such as listening to stress and reduces pain
music, watching tv, deep (Cifford,2025)
breathing technique.

Dependent/Collaborative

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5. Administer pain reliever as 5. Administering pain medication is

prescribed (Tramadol 50mg TID to alleviate suffering and improve
for pai). the patient's quality of life (World
Health Organization, 2018)
Health Teaching
6. Educated the patient about pain 6. When patients understand their
management strategies. pain and how to manage it, they
feel more in control and can take
an active role in their own care
(American Pain Society, 2023).

7. Teach the patient about relaxation 7. Relaxation techniques can help

techniques such as deep patients to manage their pain and
breathing. reduce stress (Mayo Clinic, 2023)

8. Encourage the patient to report 8. Reporting pain changes early

any changes in pain. helps ensure timely and effective
care ( Agency for Healthcare
Research and Quality, 2023).

9. Educate the patient to eat soft or 9. Cancer of the oral cavity and its
moist food that is easy to swallow treatment can make eating
such as soup. difficult, while pain may further
decrease appetite and food intake
(American Cancer Society, 2019)

10. Educate the patient about stress 10. These techniques can help to
management such as relaxation reduce muscle tension and
techniques like deep breathing, promote a sense of calm, which
meditation, or guided imagery can lessen the perception of pain
and explain that pain can be exacerbated (Mayo Clinic, 2023)
by stress.
Evaluation

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Short term
Within 1 hour of nursing interventions, the patient was able to verbalize a decreased in
pain intensity from 10/10 to 3/10 . GOAL MET
Long term
After 2 days of nursing interventions the patient’s pain scale is 7/10 as evidenced by
verbalization of “Pabalik balik ang sakit kapag hindi ako nabibigyan ng gamot. Ngayon
7/10 ang sakit niya”. GOAL MET

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Nursing Care Plan

Nursing Problem No. 2: Wound under the jaw

Subjective Cues Objective Cues

“May sugat siya diyan sa parte ng ilalim ● open wound in the lower jaw
ng baba niya” as verbalized by the ● (+) clear with traces of blood in
brother saliva upon spitting
● Redness and swelling around the
wound
● warmth at the wound site
● Vital signs: BP: 120/80, RR: 23
bpm, PR: 95 bpm, Temp: 36.4
Nursing Diagnosis
Impaired Skin Integrity related to a ruptured cyst and compromised immune system
secondary to stage 4 oral cavity cancer, as evidenced by an open wound under the
jaw, redness, swelling, and warmth at the wound site.

Rationale
A ruptured cyst has led to the breakdown of the skin barrier, creating an open wound
under the jaw. This disruption in skin integrity increases susceptibility to infection,
delayed healing, and further tissue damage (Herdman & Kamitsuru, 2021).
Goals/Objectives

Short-Term Goal:

After 30 minutes of nursing interventions, the patient and caregivers will be able to
demonstrate an understanding of proper wound care and measures to prevent further
skin breakdown.

Long-Term Goal:

After 2 days of nursing interventions, the patient will show improvement in skin
integrity.

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Nursing Interventions Rationale

Independent .
1. Assessed and document the 1. Regular wound assessment is
wound condition (size, depth, crucial for identifying delayed
color, presence of drainage, odor, healing and complications,
and surrounding skin integrity) to allowing for timely interventions
monitor healing progress and (Hinkle & Cheever, 2022).
detect early signs of
complications.
2. Perform wound care using an 2. Aseptic wound care minimizes
aseptic technique to prevent bacterial contamination and
further skin breakdown and promotes optimal healing
infection. Use prescribed wound (Ostendorf et al., 2022).
care products as appropriate.
3. Keep the wound clean and dry, 3. Proper wound dressing maintains
applying appropriate dressings to a moist wound environment, which
protect the affected area and accelerates epithelialization and
promote healing. prevents infection (Perry et al.,
2022).
4. Encouraged the patient to avoid 4. Minimizing wound contact reduces
touching or scratching the wound the risk of introducing pathogens
site to prevent contamination and that can delay healing or cause
further skin damage. infections (Centers for Disease
Control and Prevention [CDC],
2021).
5. Encouraged proper positioning to 5. Reducing pressure on a wound
reduce pressure on the affected site promotes better circulation
area, preventing additional skin and tissue oxygenation, both
trauma. essential for healing (Ignatavicius
6. Promote adequate hydration and & Workman, 2021).
nutrition, especially foods rich in 6. Nutrition plays a key role in wound
protein and vitamins (A, C, and healing, particularly protein,
zinc), to enhance tissue repair and vitamin C, and zinc, which aid in
skin regeneration.

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collagen formation and immune

Dependent/Collaborative response (Collins et al., 2022).

7. Administer prescribed antibiotics 7. Antibiotics are essential for

(Co-amoxiclav 625mg/tab, 1 tab treating bacterial infections and
TID PO) as ordered to prevent preventing systemic complications
infection and promote healing. (Herdman & Kamitsuru, 2021).

Health Teaching
8. Educated the patient and 8. Early recognition of infection signs
caregivers about signs of infection allows for timely treatment,
(increased redness, warmth, reducing complications (Hinkle &
swelling, purulent discharge, Cheever, 2022).
fever) and when to seek medical
attention.
9. Taught the patient proper hand 9. Hand hygiene is one of the most
hygiene techniques before and effective ways to prevent infection
after touching the wound to in wound care (CDC, 2021).
reduce the risk of contamination.
10. Reinforce the importance of 10. Completing antibiotic therapy
completing the full course of ensures full bacterial eradication
prescribed antibiotics to prevent and reduces the risk of antibiotic
antibiotic resistance and resistance (CDC, 2021).
recurrence of infection.
Evaluation
Short term

After 30 minutes of nursing interventions, the patient and caregivers were able to
demonstrate an understanding of proper wound care and measures to prevent further
skin breakdown, as evidenced by verbalizing knowledge of wound cleaning
techniques “ah yung paglinis dapat mula sa pinakasugat niya tapos palabas”, infection
prevention, and signs of complications, and showed comprehension through
appropriate questions and feedback. GOAL MET

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Long term

After 2 days of nursing interventions, the patient wound does not show any
improvement in skin integrity, as evidenced by redness, swelling, and warmth at the
wound site, and no progression of wound healing. GOAL NOT MET

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Nursing Care Plan

Nursing Problem No. 3: Interrupted sleeping pattern

Subjective Cues Objective Cues

“Hirap siya makatulog, paidlip idlip lang” ● Observed restlessness in bed
as verbalized by the brother ● Dark circles under the eyes
● Facial grimacing
“Simula, nung Dec, di na sya nakakatulog ● Slightly irritable
ng maayos dahil sa sakit “as verbalized
by the brother

-less than 4 hours of sleep but not

continuous

Nursing Diagnosis: Disturbed Sleep Pattern related to pain and discomfort on the
oral cavity, left side as manifested by a report of less than 4 hours of sleep,
restlessness, facial grimacing, and dark circles under the eyes.

Rationale: Pain and discomfort, especially in sensitive areas like the oral cavity, can
significantly interfere with sleep. The presence of pain makes it difficult to fall asleep,
stay asleep, or achieve restful sleep (Harding et al., 2020)

Goals/Objectives

Short term: Within 8 hours of nursing intervention, the patient will be able to
demonstrate atleast 5 hours of sleep.

Long term: Within 3 days, the patient will be able to demonstrate atleast 6 hours of
sleep nightly

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Nursing Interventions Rationale

Independent
1. Ensured comfortable room 1. A comfortable environment,
temperature (patient’s preference) including preferred temperature,
promotes relaxation and facilitates
sleep. (Gulanick & Myers, 2021)

2. Provided clean and comfortable 2. Clean, comfortable bedding and

proper support enhance comfort
bedding and offered extra pillows
and can reduce physical
for support and positioning. discomfort that interferes with
sleep. (Gulanick & Myers, 2021)
3. Encouraged the patient to engage
3. Relaxing activities like listening to
in relaxing activities before bed, calming music before bed can
such as reading ( listening to decrease stress and promote a
calming music) sense of calm conducive to sleep.
(Gulanick & Myers, 2021)

4. Offered to do deep breathing 4. Deep breathing exercises are a

exercises. relaxation technique that can
reduce anxiety and promote
relaxation, which can be beneficial
for sleep. (Gulanick & Myers,
2021)

5. Proper positioning and support

5. Repositioned for comfort can alleviate pain and discomfort,
according to the patient's making it easier for the patient to
relax and fall asleep. (Gulanick &
preference.
Myers, 2021)

6. Minimizing disturbances helps

6. Minimize disturbances by reducing
create a calm and restful
noise levels, dimming the lights, environment, allowing the patient
and limiting unnecessary to fall asleep more easily and
maintain sustained sleep without
interruptions during rest periods.
frequent awakenings.(Gulanick &
Myers, 2021)
Dependent/Collaborative
Dependent/Collaborative
1. Collaborate with the physician
1. The physician is best equipped to
regarding the appropriateness of evaluate the patient's complete

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sleep medication, considering the medical status, including pain

patient's pain level, other levels, existing medications, and
any contraindications, to
medications, and overall condition.
determine if sleep medication is a
safe and appropriate option.
(Gulanick & Myers,2021)

2. It helps promote rest by reducing

2. Administer sleeping medications pain and discomfort, improving the
as prescribed by the physician. patient’s ability to achieve
sustained sleep.(Gulanick &
Myers,2021)

Health Teaching Health Teaching

1. Instruct the patient on the 1. Uncontrolled pain is a significant
barrier to sleep. Open
importance of communicating communication with the
uncontrolled pain to the healthcare healthcare team allows for timely
team, as effective pain adjustments to pain management
strategies, which can improve the
management is crucial for
patient's ability to rest. (Gulanick &
achieving restful sleep. Myers, 2021)
Evaluation
Short term: After 8 hours of nursing intervention, the patient was able to demonstrate
atleast 5 hours of sleep as evidenced by verbalization of the brother “Nakatulog sya
ng 5 hours nung nabigyan sya ng gamot”.
GOAL MET

Long term: After 3 days of nursing intervention, the patient was not able demonstrate
atleast 6 hours of sleep nightly
GOAL NOT MET

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Nursing Care Plan

Nursing Problem No. 4: Poor Food intake

Subjective Cues Objective Cues

“Anlaki nga ng pinayat nya ngayon eh” ● Weight ( from 68 kg to 56
as verbalized by the brother kg)
● Difficulty in mastication
“Dati, bago sya magkasakit, malaman pa ● Prefer soup from Nov 2024
yung katawan nyan eh” as verbalized by ● Decreased subcutaneous
the brother fat (prominent bony
landmarks)
October- 68 kg ● Low energy levels
Wt during admission- 56 kg ● Reduced food intake as
observed by caregivers/
family members

Nursing Diagnosis
Imbalanced Nutrition: Less than Body Requirements related to difficulty in mastication
as manifested by significant weight loss, decreased subcutaneous fat

Rationale:

Oral cavity cancer and its complications, such as mouth enlargement and difficulty in
mastication, can lead to decreased food intake, weight loss, and malnutrition. These
issues can contribute to fatigue, muscle wasting, and an increased risk of infections
due to impaired immune function. Nutritional interventions are essential to prevent
further deterioration and promote overall health (Grodner et al., 2022).

Goals/Objectives

Short term: Within 8 hours of nursing intervention, the patient will demonstrate
improved food intake by consuming small, frequent portions of soft foods or liquid
supplements at least every 2 to 3 hours with minimal discomfort.

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Long term: Within 3 days of nursing intervention, the patient will be able to gain
atleast 1 kg.
Independent Rationale

1. Monitoring allows early detection

1. Monitor daily food and fluid intake
of inadequate intake and helps
adjust interventions to prevent
further weight loss and
dehydration (Gulanick & Myers,
2021).
2. Small meals are easier to
2. Encouraged small, frequent meals
consume for patients with difficulty
instead of large portions.
chewing and swallowing, ensuring
better nutrient absorption without
overwhelming the patient
(Gulanick & Myers, 2021).
3. This position facilitates
3. Positioned the patient in an
swallowing, reduces aspiration
upright or slightly forward-leaning
risk, and improves comfort during
position during meals.
feeding (Gulanick & Myers, 2021).
4. Maintaining oral hygiene helps
4. Encouraged the use of cotton
prevent infections, reduces
swabs to gently clean the oral
discomfort, and promotes better
cavity.
food intake (Gulanick & Myers,
2021).
5. Stress and anxiety can suppress
5. Created a pleasant and relaxed
appetite, so a calm setting
mealtime environment.
encourages better food intake and
digestion (Gulanick & Myers,
2021).
6. These supplements provide
6. Encouraged high-calorie, high-
essential nutrients in an easily
protein liquid supplements (e.g.,
consumable form, compensating
nutritional shakes, fortified soups)

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for reduced solid food intake

(Gulanick & Myers, 2021).

Dependent Dependent Nursing Interventions:

1. A dietitian can provide specialized

1. Consult with a registered dietitian
recommendations tailored to the
for a comprehensive nutritional
patient’s condition, ensuring
assessment and individualized
adequate nutrition and preventing
meal planning.
further malnutrition (Gulanick &
Myers, 2021)
2. To ensure the patient is meeting
2. Monitor and document daily
nutritional needs and adjust the
calorie intake.
diet plan accordingly. (Gulanick &
Myers, 2021)

Health Teaching:
Health Teaching
1. Educated the patient and family 1. Proper diet education empowers
on soft and liquid diet caregivers to provide meals that
modifications, including the meet nutritional needs despite
importance of high-protein and mastication difficulties (Gulanick &
high-calorie foods to maintain Myers, 2021).
weight. 2. These techniques make feeding
2. Instructed the patient and family more manageable, prevent
on feeding techniques, such as choking, and ensure sufficient
using a small spoon, feeding nutrient intake (Gulanick & Myers,
syringe, or straw (if tolerated). 2021).
3. Good oral care prevents
3. Taught proper oral hygiene
infections, reduces pain, and
techniques.
enhances comfort, making it
easier for the patient to eat and
drink (Gulanick & Myers, 2021).

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4. Explained the signs and 4. Early recognition of malnutrition

symptoms of malnutrition and symptoms (e.g., extreme fatigue, weight
when to seek medical attention. loss, infections) allows timely
interventions to prevent severe
complications (Gulanick & Myers, 2021).

Evaluation
Short term: After 8 hours of nursing intervention, the patient was able to consume
small portions of soft foods and liquid supplements every 2 to 3 hours but still
experienced mild discomfort while eating.
GOAL PARTIALLY MET

Long term: After 3 days of nursing intervention, the patient was not able to gain 1 kg
as evidenced by a stable weight of 56 kg
GOAL NOT MET

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Nursing Care Plan

Nursing Problem No. 5: Difficulty in speaking clearly

Subjective Cues Objective Cues

“Medyo lumapit nalang kayo kapag ● Weak and unclear speech.
kakausapin niyo siya kasi hirap pa siya ● Limited mouth opening due
magsalita tapos mahina” as verbalized by to tumor growth.
the brother ● Facial grimacing when
attempting to speak.
● Difficulty in expressing
needs verbally.
Nursing Diagnosis: Impaired Verbal Communication related to restricted mouth
opening and pain secondary to oral cavity tumor, as manifested by difficulty in
articulating words, weak speech, and reliance on gestures for communication.

Rationale: The patient’s impaired ability to speak is caused by tumor invasion, leading
to trismus (limited mouth opening), pain, and potential nerve involvement. This affects
the clarity and volume of speech, resulting in difficulty expressing needs.(Lewis et al.,
2018)."

Goals/Objectives

Short term: Within 8 hours of nursing intervention, the patient will demonstrate at
least one effective alternative method of communication (writing, gestures, picture
board) to express needs.
Long term: Within 3 days of nursing intervention, the patient will be able to effectively
communicate basic needs with minimal frustration using adapted communication
strategies (non-verbal)

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Nursing Interventions Rationale

Independent
1. Assessed the degree of speech 1.This establishes a baseline and allows
impairment by observing for ongoing evaluation of the
articulation, volume, and ability to effectiveness of interventions (Gulanick &
express needs. Myers, 2021).

2. Encouraged the use of alternative 2.Provides the patient with immediate and
communication methods, such as effective ways to communicate despite
writing, pointing, gestures, or a physical limitations (Gulanick & Myers,
communication board, to facilitate 2021).
understanding.

3. Positioned the patient comfortably, 3. Reduces physical discomfort and

ensuring minimal strain while allows for better use of remaining muscle
attempting to speak. function for speech (Gulanick & Myers,
2021).

4. Communicated with the patient 4.Facilitates comprehension and shows

slowly and clearly while respect for the patient's efforts to
maintaining eye contact to communicate (Gulanick & Myers, 2021).
promote better understanding.
5.Simplifies the communication process
5. Encouraged the patient’s family to and reduces frustration for both the
use simple, yes-or-no questions to patient and family (Gulanick & Myers,
make communication easier. 2021).

Dependent/Collaborative Dependent/Collaborative
1. Coordinate with a speech therapist to 1.Speech therapists are experts in
assess speech function and recommend communication disorders and can provide
further interventions if needed. specialized strategies and exercises
(Gulanick & Myers, 2021).

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Health Teaching Health Teaching

1. Educated the patient and family about 1. Empowers the patient and family
alternative communication methods, such to use effective communication
as using writing materials or gesture- strategies (Gulanick & Myers,
based cues. 2021).

2. Informed the patient and caregivers 2. Promotes early detection and

about signs of worsening speech intervention for potential
difficulties, which may indicate complications (Gulanick & Myers,
progressive tumor growth. 2021).

Evaluation

Short term: After 8 hours of nursing intervention, the patient was able to demonstrate
at least one effective alternative method of communication (writing, gestures, picture
board) to express needs.
-Patient nods when asks with yes or no questions
GOAL MET

Long term: After 3 days of nursing intervention, the patient was able to effectively
communicate basic needs with minimal frustration using adapted communication
strategies (non-verbal).

During nursing care, the patient was pointing, nodding and writing to communicate.
His facial expression showed frustration.
GOAL MET

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Nursing Care Plan

Nursing Problem No. 6: Fear of the disease progress

Subjective Cues Objective Cues

During Gordon’s assessment, the student ● The patient appears slightly
nurse asked, “ Sir, nakakaramdam ka ba restless and tense during
ng pag-aalala sa kung ano mang interactions.
mangyari sayo? or dumating sa punto pa ● Facial expressions and body
na nawawalan po kayo ng pag-asa? language indicate distress
● Grimacing
The patient nodded yes in response ● Slightly avoidance of eye contact
during interactions
Nursing Diagnosis
Fear related to uncertainty about disease progression, potential complications as
manifested by the patient’s nodding in response to questions about worry and
hopelessness, along with non-verbal signs of distress.

Rationale:

Fear is a response to perceived threats, such as disease progression and potential

complications. In patients with cancer, fear often arises from uncertainty about
prognosis, physical decline, and loss of control, which can manifest through verbal
and non-verbal expressions of distress. (Carpenito, 2020)

Goals/Objectives

Short term: Within 8 hours of nursing intervention, the patient will demonstrate at
least one coping strategy to manage fear, with a reported decrease in fear level

Long term: Within 3 days of nursing intervention, the patient will be able to
demonstrate the use of two effective coping strategies (e.g., deep breathing and use
of a communication board) to manage fear, with an initial decrease in observed signs
of distress.

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Nursing Interventions Rationale

Independent

1. Reduces anxiety by creating a

1. Maintained a calm manner while
safe, supportive environment.
interacting with the patient.
(Gulanick & Myers, 2021)
2. Facilitates communication and
2. Allowed the patient to express
reduces frustration when
feelings and concerns using non-
verbalizing is difficult. (Gulanick &
verbal methods like writing in a
Myers, 2021)
paper, gestures.
3. Provides comfort and hope,
3. Offered spiritual support (prayed
addressing emotional and
for the patient and shared uplifting
existential needs. (Gulanick &
bible verses.
Myers, 2021)
4. Empowers patients to manage
4. Assisted the patient in developing
fear and express feelings.
fear coping strategies like deep
(Gulanick & Myers, 2021)
breathing exercises and writing
feelings and concerns in
boards/paper.
5. Used therapeutic communication 5. Builds trust and facilitates
while interacting with the patient. emotional expression. (Gulanick &
Myers, 2021)

Dependent/Collaborative:
Dependent/Collaborative
1. Collaborate with a psychologist. 1. Provides specialized
therapy for anxiety and
fear. (Gulanick & Myers,
2021)

Health Teaching Health Teaching:

1. Educate the patient regarding

1. Equips patients with skills
effective coping strategies like
to manage emotional
deep breathing exercises,

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mindfulness and expressing responses. (Gulanick &

feelings through writing on a Myers, 2021)
paper.

Evaluation

Short-Term Goal:
After 8 hours of nursing intervention, the patient independently demonstrated the
use of deep breathing exercises when prompted.
GOAL MET

Long-Term Goal :
After 3 days, the patient consistently used both the writing in a paper and deep
breathing exercises to express his concerns and manage fear, with nursing
observations noting a marked reduction in non-verbal signs of distress such as
grimacing and restlessness.
GOAL MET

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Medications/treatment

Generic/Brand/ Indication and Side effects and Nursing Considerations

Trade name, action adverse reactions
dosage, route
frequency

Date
Paracetamol Indication: Side effects: ● Monitor liver function
(Fastamol) 1g IV Pain Nausea, vomiting, (ALT, AST)
PRN, as needed management headache, ● Avoid exceeding
for pain (analgesic) insomnia daily dose (4g/day).
● Assess pain level
02/05/2025 Action: Adverse before administration
It reduces pain reactions:
and fever by Hepatotoxicity (with
inhibiting overdose), acute
prostaglandin liver failure,
synthesis in the hypersensitivity
CNS. reactions (rare)
Tramadol Indication: Side effects: ● Evaluate pain levels
(Tramalin) 50mg Pain Dizziness and before and after
IV Q8 RTC management drowsiness, administering the
nausea and medication.
02/06/25 Action: vomiting, ● Monitor vital signs,
Tramadol is a constipation, dry particularly
centrally acting mouth, excessive respiratory rate and
analgesic that sweating, blood pressure
works by headaches (withhold if the
binding to μ- respiratory rate falls
opioid receptors Adverse below 12 breaths per
and inhibiting reactions: minute).
the reuptake of

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norepinephrine Respiratory ● Screen for a history

and serotonin in depression, of seizures, as
the central seizures, serotonin tramadol can lower
nervous syndrome, low the seizure threshold.
system. This blood pressure, ● Assess for substance
dual hallucinations or use history, as
mechanism mental confusion, prolonged use may
helps relieve potential for lead to dependence.
pain while dependence,
reducing the tolerance, and
risk of withdrawal
respiratory symptoms
depression
compared to
traditional
opioids.

Co-amoxiclav Indication: A Side effects: ● Assess for Allergies

(Amoclav) broad-spectrum Nausea, vomiting, ● Monitor for a history
625mg/tab 1 tab antibiotic used diarrhea, of liver disease,
TID PO to treat bacterial abdominal pain, kidney impairment, or
infections headache, skin gastrointestinal
02/05/25 rash conditions
Action: ● Give with meals to
Amoxicillin (a Adverse reduce
beta-lactam reactions: gastrointestinal
antibiotic) Hypersensitivity discomfort (e.g.,
inhibits bacterial reactions,clostridioi nausea, vomiting).
cell wall des difficile- ● Monitor for
synthesis, associated diarrhea Immediate
leading to (CDAD), Hypersensitivity
bacterial cell hepatotoxicity, Reactions
death. Stevens-Johnson ● Assess for Liver
Syndrome/Toxic Toxicity

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Clavulanic Acid Epidermal

(a beta- Necrolysis (rare but
lactamase severe skin
inhibitor) reaction)
prevents
bacterial
resistance by
inhibiting beta-
lactamase
enzymes, which
some bacteria
produce to
destroy
amoxicillin.

Date Ordered Medication/ Treatment

02/05/2025 Paracetamol (Fastamol) 1g IV PRN, as needed for pain
02/05/25 Co-amoxiclav (Amoclav) 625mg/tab 1 tab TID PO
02/06/25 Tramadol (Tramalin) 50mg IV Q8 RTC

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Discharge Planning (METHODS)

Medications
In terms of medications, it is essential that the patient understands the prescribed
drugs, including pain relievers, antibiotics, and any additional supportive medications.
Education should be provided on the correct dosage, frequency, and potential side effects.
Since mastication may be difficult, the patient should take medications with soft food or
liquids. It is crucial to emphasize completing the full course of antibiotics to prevent
infection and to encourage reporting any adverse reactions or worsening symptoms to the
healthcare provider.

Exercise
For exercise, light physical activities such as stretching and walking are
recommended to maintain mobility and prevent muscle atrophy. However, strenuous
activities that may cause fatigue or worsen symptoms should be avoided. Frequent position
changes should be encouraged to prevent discomfort and pressure sores.

Treatment/ Therapy
For the treatment and therapy, wound care should continue using aseptic
techniques as instructed. The patient must follow up with oncology, surgery, or radiation
therapy as scheduled. Effective pain management should be maintained through
prescribed medications and non-pharmacological methods such as cold compresses and
relaxation exercises. If speech is affected, engaging in speech therapy or communication
exercises is beneficial.

Health Teaching
Health teaching plays a vital role in the patient’s recovery. Proper oral hygiene
should be emphasized to prevent infections and complications. Both the patient and
caregivers should be educated on wound care and recognizing signs of infection. Stress
management techniques, such as deep breathing, prayer, or relaxation exercises, should
be taught. Psychological support should be encouraged if the patient experiences
emotional distress. Additionally, education on managing difficulties in mastication, speech,
and saliva control is necessary.

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Outpatient follow up
Outpatient follow-up care is critical for continued monitoring. Follow-up visits should
be scheduled with oncology, surgery, or pain management specialists. Dental or ENT
specialist appointments should also be arranged for ongoing oral cavity monitoring. The
patient should be advised to seek medical attention if there are any signs of infection,
worsening pain, or changes in condition.

Diet
Dietary recommendations should focus on a soft, high-protein, high-calorie diet to
promote healing and maintain weight. Foods such as blended soups, mashed vegetables,
and protein-rich liquids should be encouraged, while spicy, acidic, or hard foods that may
irritate the oral cavity should be avoided. Proper hydration is essential to prevent
dehydration and support healing. Consulting with a dietitian for individualized meal planning
is also beneficial.

Sexual/ Spiritual Activity

For the patient’s sexual and spiritual needs is important for overall well-being.
Emotional support should be provided, with open discussions about changes in self-image
and intimacy concerns. If desired, spiritual guidance should be offered by connecting the
patient with a chaplain or religious leader. Encouraging participation in faith-based or
spiritual activities can help provide emotional strength and resilience during recovery.

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Conclusion

Cancer of the oral cavity remains a significant health concern, particularly among
individuals with high exposure to risk factors such as smoking, alcohol consumption, poor
oral hygiene, and betel nut chewing. For patient J.C.V., the disease has profoundly
impacted his physical, emotional, and social well-being, with symptoms including a
progressively enlarging oral mass, severe pain, difficulty in chewing and speaking, and
impaired wound healing, all of which highlight the aggressive nature of squamous cell
carcinoma. Effective pain management, nutritional support, wound care, and emotional
assistance are crucial in maintaining his quality of life. This case study emphasizes the
importance of early detection and timely intervention in managing oral cavity cancer, as
delayed medical attention often results in late-stage diagnoses, limiting treatment options
and reducing survival rates. The patient’s condition underscores the need for a holistic
nursing approach that integrates pain management, dietary care, psychological support,
and health education. Healthcare providers play a critical role in improving patient
outcomes by promoting early screening, educating at-risk populations on preventive
measures, and advocating for a multidisciplinary approach to cancer treatment.

Recommendations

For nursing students, early detection and holistic patient care are essential in
managing oral cavity cancer. They should focus on pain management, wound care, and
communication strategies while ensuring proper nutrition for patients with difficulty in
mastication. Palliative care knowledge is crucial, along with advocating for timely
interventions and patient support.

For patients, seeking early medical attention is vital to prevent late-stage diagnoses.
Maintaining proper nutrition with soft, high-calorie foods can help prevent weight loss. Pain
management should include prescribed medications and non-pharmacological methods like
cold compresses. Good oral hygiene and emotional or spiritual support can also improve
overall well-being.

For caregivers, emotional and physical support is key. They should assist with
wound and oral care, monitor for infections, and prepare easy-to-eat nutritious meals.

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Encouraging treatment compliance and attending follow-ups can help improve the patient’s
condition while providing reassurance and comfort.

For researchers, further studies should focus on identifying risk factors, improving
early detection, and developing advanced treatments like targeted therapy. Investigating
the psychological and social impact of oral cancer can enhance patient support, while
public health strategies should raise awareness about prevention and early screening.

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