What is wrong with my patient??

Daytonite, BSN, RN · Sep 28, 2005

My understanding is that intraperitoneal carcinomatosis is metastasis from either a digestive or respiratory organ. Since she has tumor implants (sounds like) pretty much in most of the abdominal areas it would indicate that these are metastatic tumors. Sounds like the doc suspects ovarian as the primary site since she has a large concentration of tumor in the pelvis, but he's not sure yet. He won't really know what the primary site is until the pathology report comes back. Tumor implants often are secondary tumors or metastasis from some primary site.

9/28/05. . .I've been thinking on this a little overnight. This patient does have a history of lung cancer, doesn't she? I'll bet her doctor is thinking of mets to the abdomen which is why he has the pre-op diagnosis as carcinomatosis. He's proabably a little stumped by the amount of cancer found in the pelvis and is wondering if there is a second primary cancer going on in the ovaries because lung CA doesn't usually spread to the ovary.

Stephanie in FL · Sep 28, 2005

I would include alteration in comfort r/t incisional pain as a nursing diagnosis.

Only the pathologist is going to be able to tell what kind of cancer she has.

Stephanie RN

GrnHonu99, RN · Sep 28, 2005

as soon as you said that it made so much more sense Daytonite! :smackingf

do you guys think I rated those ND;s in the right order?

GrnHonu99, RN · Sep 28, 2005

I would include alteration in comfort r/t incisional pain as a nursing diagnosis.
Only the pathologist is going to be able to tell what kind of cancer she has.
Stephanie RN

I have: Acute Pain as r/t to surgical procedure and primary diagnosis....do you think alteration in comfort as r/t incisional pain is too simialar to the pain ND?

Editorial Team / Admin · Sep 28, 2005

Hey all,
I need some help. This may be a stupid question but I was just wondering if you guys could help. My pt. this week has a pre op diagnosis of Intraperitoneal carcinomatosis, site unknown. As I have read, I think this means that she has a tumor in abdomen somewhere. As I read on, it says "analyses showed that she had an andenocarcinoma...and There was diffuse peritoneal tumor implants throught all surfaces of the peritoeal cavity. the greatest concentration of the thumor material was in the pelvis. The sigmoid colon in the pelvis appeared to be encased with tumor or not obstructed. the omentum was involved in large cakes of tumor across its whole length. There were segrments of the ascending colon that were adherent to the omentum". Earlier on another report it says "ovarian cancer is suspected". So I was just wondering what cancer my patient actually has...colon cancer? cancer in the perionteal cavity? Cancer of the omentum, that was also mentioned...im confused;)
77 y/o female.She also has a hx of UL lung cancer (undercontrol), COPD, HTN, CAD, PAD, Vertigo and ARTH. She is also slightly anorexic. She will be post op day 4 from a total omentectomy, tumor debulking
I was thinking the the most important nursing dx were (in order from 1. most important and 4
1. Ineffective breathing pattern related to decreased lung exapnsion
2.Ineffective Tissue perfusion as related to immobility
3. Risk for infection as related to surgery
4.Imbalanced Nutrition: Less than body requirements as related to primary diagnosis
Do you guys think that about covers it? She is a full code.
I tried going to web md but when I put in her pre op and post op diagnosis it keeps giving me colon cancer, from what ive read it seems like her colon was was in tact and that the tumor was really all over inside her peritoneum..then another page said they were thinking ovarian cancer...am I missing something? Would those be the right ND's for the pt? Thanks for any input guys!!!!!!!
confused with all this nursing stuff :selfbonk:

Hello, ELKMN,:balloons:

I agree with Daytonite regarding the metastatic lesions. The primary lesion probably arose from the ovary/s.

What post op dx did you use?

GrnHonu99, RN · Sep 28, 2005

well that was kind of confusing too. The post op report I have has: Intraperitoneal carcinomatosis, site unknown

and for the Postoperative Diagnoses it has the same exact thing. For my clinical work I am just using the NDs that I think are most important for the pt all around, like Ineffective tissue perfusion (she has PVD), ineffective breathing pattern as rt decreased lung expansion (she has COPD and post op), acute pain as rt surg. and primary diagnosis, at risk for infection as rt surgical procedure and possibly imbalanced nutrition less than body requirements (shes anorexic as well).

Are there any major ones I have missed? Am I on the right track with this? Thanks so much guys.

caroladybelle, BSN, RN · Sep 28, 2005

Sometimes the origin cancer is never firmly established.

When the cancer is so poorly differentiated, that the primary cannot be established, and the mets are so scattered, the prognosis is generally extremely poor. If you cannot determine the primary, it would be difficult to prescribe chemo that will be most effective (must know primary to establish the most appropriate treatment). Chemo is ocasionally prescribed on the basis of "the most likely primary", but obviously will be less effective, even if correct, because of the poor differentiation.

A nursing diagnosis in regarding to anxiety issues regarding unknown diagnosis, or ineffective coping (if appropriate) may be indicated.

Also, tumors of the nature that you are describing, frequently have associated ascites or pleural effusions in later stages. Volume issues may occur.

Hoozdo, ADN · Sep 28, 2005

as soon as you said that it made so much more sense Daytonite! :smackingf
do you guys think I rated those ND;s in the right order?

Risks for are the least priority in ND. Also "risks for" have no signs or symptoms because it is a risk for :)

truern · Sep 29, 2005

Risks for are the least priority in ND. Also "risks for" have no signs or symptoms because it is a risk for :)

That depends....I had a patient with MULTIPLE multiple fractures (did I mention multiple??) and my top ND was Risk for Pulmonary Embolism.

Sometimes the "Risk" is so great and grievous that it warrants being first.