EWING’S SARCOMA
IDENTIFICATION DATA
CLIENT NAME: Ilesh Koshtha
AGE/ SEX: 14 years / Male
DEVELOPMENTAL AGE: School going child
FATHER’S NAME: Sanjay Koshtha
MOTHER’S NAME: Mala Koshtha
HOSPITAL REGISTRATION NO. : 240900164998
WARD NO.: Pediatric Oncology
BED NO.: 11
ADDRESS: Gadarwara, Narsinghpur
EDUCATION: Father is educated till 10th standard
OCCUPATION: Tailor
MARITAL STATUS: Married
RELIGION: Hindu
DATE OF ADMISSION: 12-08-24
DIAGNOSIS: Ewing’s Sarcoma
DOCTOR IN-CHARGE: Dr. Shweta Pathak
HEALTH ILLNESS
CHIEF COMPLAINTS: Client’s mother told me that “my child had right leg curvature”
PAST MEDICAL HISTORY: Client’s mother told me that “my child had fracture in
right leg”
PRESENT MEDICAL HISTORY: Client’s mother told me that “my child had pain in
lower extremities since 1 week with difficulty in walking since 3 days and right leg
curvature since 4 days”
PAST SURGICAL HISTORY: client mother told me that “ the client didn’t had any
surgery in the past”
PRESENT SURGICAL HISTORY: the client didn’t undergo any surgical intervention
FAMILY HISTORY
HEAD OF FAMILY: Father
TYPE OF FAMILY: Nuclear
NO. OF FAMILY MEMBER: 4
NO. OF CHILDREN: 2
TABULIZATION
S. NO. OF MEMBER AGE/ SEX RELATIONSHIP HEALTH STATUS
NO. WITH PATIENT
1. Sanjay Koshtha 40 years/ male Father Healthy
2. Mala Koshtha 34 years / Mother Healthy
female
3. Ayaan Koshtha 16 years/ male Brother Healthy
4. Ilesh Koshtha 14 years/ male Client Diseased condition
GENOGRAM:
40 years 34 years
- male
16 years 14 years - female
- client
ENVIRONMENTAL HISTORY
TYPE OF HOUSE: Puccha house
NO. OF ROOM: 2
VENTILATION: Appropriate
EXCRETA DISPOSAL: Adequate
DRAINAGE SYSTEM: Closed
WATER SUPPLY: Government supply
ELECTRICITY: Nagar nigam
SOCIO-ECONOMIC STATUS
STATUS OF FAMILY: Below poverty line
NO. OF EARNING MEMBER: 1
CUSTOM AND TRADITION: they believe in custom and traditions
BELIEF OR SUPERSTITION: no
RECREATIONAL FACILITY: television
MEDICAL FACILITY: District Hospital
TOTAL MONTHLY INCOME: Rs. 12000
PER CAPITA INCOME: Rs. 12000/ 4 = Rs. 3000
PERSONAL HISTORY
PRENATAL HISTORY
WAS THE PREGNANCY PLANNED: client’s mother told me that “the pregnancy was
planned during the period of this child”
DID YOU RECEIVE PRENATAL CARE: client’s mother told me that “I received
prenatal care”
ANY PROBLEM DURING PREGNANCY: client’s mother told me that “I didn’t had
any problem during pregnancy”
ANY ACCIDENT DURING PREGNANCY: client’s mother told me that “ I didn’t had
any accident during pregnancy”
ANY MEDICATION DURING PREGNANCY : client’s mother told me that “ I took
iron, folic acid, calcium tablets as prescribed by the physician”
ANY SUBSTANCE ABUSE DURING PREGNANCY: no
INTRANATAL HISTORY:
PLACE OF DELIVERY: District Hospital Jabalpur
TYPE OF DELIVERY: Normal delivery
ANY PROBLEM ENCOUNTERED DURING DELIVERY: the clients mother told me
that “ I didn’t encountered any problem during delivery”
ANY VAGINAL INFECTION: no
CHILD APGAR SCORING: 8
POSTNATAL HISTORY:
CHILD BIRTH WEIGHT: 2.5 kg
DID THE CHILD HAVE ANY PROBLEM AFTER BIRTH: No
HAS THE CHILD EVEN EXPERIENCED ANY MAJOR INJURIES: No
NUTRITIONAL STATUS
FOOD HABITS: Non- vegetarian
DAILY INTAKE OF WATER: 7-8 glasses of water
NO. OF MEAL: thrice a day
DEVELOPMENTAL HISTORY
BIOLOGICAL GROWTH:
S.NO. FEATURES IN CHILD
1. WEIGHT 25 kg
2. HEIGHT 152 cm
3. HEAD CIRCUMFERENCE 60 cm
4. CHEST CIRCUMFERENCE 64 cm
5. MID UPPER ARM 20 cm
CIRCUMFERENCE
6. TEMPERATURE 98.6 o F
7. PULSE 96 bpm
8. RESPIRATION 24 bpm
9. BLOOD PRESSURE 100/60 mm/Hg
IMMUNIZATION SCHEDULE
AGE VACCINE DOSE ROUTE AMOUNT REMARK
At Birth BCG Single Intradermal 0.05 ml received
OPV Zero Dose Oral 2 drops
6 Weeks DPT-1 1st Intramuscular 0.5 ml received
OPV-1 1st Oral 2 drops
Hepatitis-B 1st Intramuscular 0.5 ml
10 Weeks DPT-2 2nd Intramuscular 0.5 ml received
OPV-2 2nd Oral 2 drops
Hepatitis B 2nd Intramuscular 0.5 ml
-2
14 Weeks DPT-3 3rd Intramuscular 0.5 ml received
OPV-3 3rd Oral 2 drops
rd
Hepatitis B- 3 Intramuscular 0.5 ml
3
9 Months Measles Single Subcutaneous 0.5 ml received
MMR 1st Dose Subcutaneous 0.5 ml
16- 24 DPT Booster Intramuscular 0.5 ml received
Months OPV Booster Oral 2 drops
5-6 Years DT Single Intramuscular 0.5 ml received
PHYSICAL EXAMINATION
GENERAL APPEARANCE
BODY BUILT: mesomorph
HEIGHT: 152 cm
WEIGHT: 32 kg
VITAL SIGNS: the vital signs of the client are normal
COLOUR OF SKIN: pink
HEAD
SHAPE AND SIZE OF HEAD: the shape of the head is oval and size is 60 cm
SCALP: dry
FACE
SYMMETRY OF FACE: face is round in shape and symmetrical
EYES
VISION: 6/6
SYMMETRY OF EYES: symmetrical
EYEBROW AND EYELID: no abnormalities seen
EYE BALL (MOVEMENT): appropriate
CONJUNCTIVA: healthy
SCLERA: white
EAR
EXTERNAL EAR: symmetrical
HEARING PROBLEM: no hearing problem identified
NOSE
EXTERNAL NARES: no abnormalities seen
NOSTRILS: no discharges seen, clean
MOUTH AND PHARYNX
LIPS: pink
TEETH: clean
TONGUE: moist
THROAT AND PHARYNX: no abnormalities identified
NECK
THYROID GLAND: no abnormalities seen
RANGE OF MOTON: appropriate
CHEST
BREATH SOUNDS: wheezing or stridor sound absent
LUNGS: breath sound present
BREAST NODULE: no abnormalities seen
CAPILLARY REFILLING TIME: <2 sec
ABDOMEN
INSPECTION: no abdominal distension
AUSCULTATION: bowel sounds present
PALPATION: pain present during palpating the abdomen
PERCUSSION: normal
CONGENITAL ABNORMALITY: not present
DISCHARGE: absent
BOWEL SOUND: bowel sound can be heard
UMBLICAL BLEEDING: absent
EXTREMITIES
UPPER: symmetrical and no abnormalities seed
SYMMETRY AND SPONTANEOUS MOVEMENTSOF ARM AND HANDS:
proper movements of arm and hands
CHECK THE BABY HANDS: the client’s hands are normal in shape
LOWER
SYMMETRY: curvature of right leg
RANGE OF MOTION: difficulty in flexion and extension of legs
PRESENCE OF WRINKLES IN SOLE: yes wrinkles are present in the sole
TOES AND NAILS: no abnormalities seen
BACK
HIP CONDITION: no abnormalities present
PRESENCE OF ANY DIMPLE IN THE COCCYGEAL OR SACROCOCCYGEAL:
not seen
GENITAL AND RECTUM
ANY CONGENITAL ANOMALIES: cloacal malformations or any other
malformations not seen
EWING’S SARCOMA
INTRODUCTION
Ewing sarcoma is a type of cancer that begins as a growth of cells in the bones and the
soft tissue around the bones. Ewing (Yoo-ing) sarcoma mostly happens in children and
young adults, although it can happen at any age. Ewing sarcoma most often begins in the
leg bones and in the pelvis, but it can happen in any bone.
DEFINITION
Ewing’s sarcoma is a round-cell tumor typically arising in the bones, rarely in soft tissues,
of children and adolescents.
ANATOMY OF BONE
External Structure
1. Periosteum: A thin, fibrous membrane that covers the outer surface of the bone.
2. Compact bone: A dense, compact layer of bone tissue that forms the outer shell of the
bone.
3. Cancellous bone: A spongy, porous layer of bone tissue that lies beneath the compact
bone.
Internal Structure
1. Bone marrow: A soft, spongy tissue that fills the cavity of the bone and
produces blood cells.
2. Endosteum: A thin, fibrous membrane that lines the inner surface of the
bone.
3. Haversian canals: Small channels that run through the compact bone and
contain blood vessels and nerves.
4. Volkmann's canals: Small channels that connect the Haversian canals and
allow for the exchange of nutrients and waste products.
Bone Cells
1. Osteoblasts: Cells that produce new bone tissue.
2. Osteoclasts: Cells that break down and resorb old bone tissue.
3. Osteocytes: Mature bone cells that are embedded in the bone matrix.
Bone Tissue
1. Bone matrix: A hard, calcified tissue that forms the bulk of the bone.
2. Collagen fibers: Fibers that provide strength and flexibility to the bone
matrix.
3. Hydroxyapatite crystals: Crystals that give the bone matrix its hardness and
rigidity.
Types of Bones
1. Long bones: Bones that are longer than they are wide, such as the femur and
humerus.
2. Short bones: Bones that are roughly cube-shaped, such as the carpals and
tarsals.
3. Flat bones: Bones that are thin and flat, such as the sternum and ribs.
4. Irregular bones: Bones that do not fit into any of the other categories, such as
the vertebrae and pelvis.
5. Sesamoid bones: Small bones that are embedded within tendons or muscles,
such as the patella.
PHYSIOLOGY OF BONE
1. Support: Provides structural support for the body.
2. Protection: Protects internal organs, such as the brain, heart, and lungs.
3. Movement: Serves as a site of attachment for muscles, allowing for
movement.
4. Blood cell production: Bone marrow produces blood cells, including red
blood cells, white blood cells, and platelets.
5. Mineral storage: Acts as a reservoir for minerals, such as calcium and
phosphorus.
6. Hormone regulation: Plays a role in regulating hormones, such as
parathyroid hormone and calcitonin.
PREVALANCE
Second most frequent bone sarcoma after osteosarcoma in patients younger than 20 years.
2% of cancer in childhood.
Caucasians are more frequently affected than asians, africans and african-americans
rarely affected.
Common age-10-20 years.
M>F - (M:F = 1.4:1)
SPREAD
Generally spread through bloodstream
Direct extension into adjacent bone or soft tissue.
Micromets is common in all patients.
Approximately 50% of patients who present with metastases have pulmonary
involvement.
25% - bony metastases.
20% - bone marrow involvement.
Liver and lymph node metastases are rare.
STAGING
No specific staging system for Ewing’s sarcoma
The AJCC staging systems for bone or soft- tissue sarcomas may be used.
PATHOPHYSIOLOGY
CLINICAL FEATURES
IN GENERAL IN CLIENT
Local pain and swelling of affected area. Local pain and swelling of affected area.
Tender local mass is invariably present. Tender local mass is invariably present.
Stiffness - common in involvement of long Weight loss
bone.
Limp Fever
Weight loss Anemia
Fever
Anemia
Occasionally presents with pathological
fractures.
Other symptoms depend on the site of the
lesion
INVESTIGATIONS
IN GENERAL IN CLIENT
1. Radiographic findings 1. Radiographic findings
a) MRI a) MRI
b) CT scan b) CT scan
c) Bone scan c) Bone scan
d) X- ray d) X- ray
2. LABORATORY TESTS 3. LABORATORY TESTS
a) CBC a) CBC
b) Alkaline phosphatase b) Alkaline phosphatase
c) LDH c) LDH
MANAGEMENT
MEDICAL MANAGEMENT:
IN GENERAL IN CLIENT
1. CHEMOTHERAPY 1. CHEMOTHERAPY
a) Cyclophosphamide a) Carboplatin
b) Temozolomide b) Etoposide
c) Ifosafamide, etoposide c) Mesna
d) Carboplatin
e) Docetaxel and gemcitabine
2. RADIATION THERAPY 2. RADIATION THERAPY
NURSING MANAGEMENT:
Physical examination
Pain assessment (e.g., Faces Pain Scale, FPS)
Nutritional assessment
Emotional and psychological assessment
Family dynamics and support system assessment
NURSING DIAGNOSIS:
1. Acute pain related to tumor growth or treatment
2. Anxiety related to diagnosis, treatment, and uncertainty
3. Fear related to potential loss of limb or function
4. Disturbed body image related to surgical scars or amputation
5. Risk for infection related to chemotherapy, radiation, or surgery
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS GOAL INTERVENTION IMPLEMENTATION EVALUATION
SUBJECTIVE Acute pain related to To reduce pain and Observe behavior as Observed the level of Reduced body pain
tumor growth or discomfort of the and irritability of the
DATA: indicator of pain pain, is irritable and
treatment child. child to some extent.
Mother told me that crying, because of
Child is very much pain.
irritable and always encourage the family encouraged the
crying members to mother to participate
participate in child in Childs care.
OBJECTIVE DATA care
I observe by facial
expression
provide wrinkle free provided wrinkle free
bed to the baby baby bed.
minimize the visitors, restricted the visitors
and allow the mother
to be with the baby.
ASSESSMENT DIAGNOSIS GOAL INTERVENTION IMPLEMENTATION EVALUATION
Subjective data: Risk for infection To reduced risk that To provide clean Clean environment Reduced the risk of
Parent ask more related to is associated with the infection of the child
environment provided
doubt regarding child chemotherapy, treatment and surgery to some extent.
condition and risk of radiation, or surgery
infection
To follow aseptic Aseptic measures
techniques taken
To restrict the visitors Visitors are restricted
Objective data: To provide Knowledge provided
I observed by facial
knowledge to parents regarding the disease
expression
regarding the disease and spread of
and spread of infection
infection
ASSESSMENT DIAGNOSIS GOAL INTERVENTION IMPLEMENTATION EVALUATION
Subjective data: Parental anxiety Parent will relieve Assess the level of Help to provide the Parents will free from
Parent ask more related to prognosis from fear and anxiety. anxiety of the parents. baseline data for care fear and feel
doubt regarding child and management of comfortable
condition child Explain all the To reduce the fear
procedure and
rationale
Objective data: Listen actively to the To improve the
I observed by facial parents and answering knowledge regarding
expression their question. disease
Provide psychological To reduce the anxiety
support to the parents
Encourage parent to Prevent from injury
stay with their child.
HEALTH EDUCATION
Educate the client’s relative regarding the cure of the disease
Health education regarding personal hygiene
Educate the client’s relative regarding the intake of nutritious diet
Educate the client regarding adequate bed rest
Educate the client’s relative regarding maintenance of clean and hygienic environment
CONCLUSION
Second most common primary malignant bone tumors in children. Common Age group-
10-20 years (M>F). Commonly involves diaphysis of long bone. Presents with local
swelling and tenderness. Metastasis is usually present at the time of presentation.
Diagnosis is confirmed by histopathological studies or cytogenetic studies.Treatment
modalities includes Neoadjuvant therapy followed by local control of the tumor with
surgery/radiotherapy and maintainence with adjuvant chemotherapy. 5-year event free
survival has incresed from 10% to 70% with the advent of multi-chemotheraputic agents
SUMMARY
INTRODUCTION
DEFINITION
ANATOMY
PHYSIOLOGY
INCIDENCE
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
DIAGNOSTIC EVALUATION
MANAGEMENT
HEALTH EDUCATION
NURSING CARE PLAN
CONCLUSION
BIBLIOGRAPHY
Datta Parul, A Textbook of Pediatric Nursing, Jaypee Publication, Fourth
Edition, Page no: 784
Gupta Ghai O.P , Ghai Piyush V.K., Essential Pediatrics, 6th Edition
CBS Publishers and Distributors, Page No: 1021
Kurian Somya, A Textbook of Pediatric Nursing , EMMESS Publication
Second Edition, Page no.: 548
Sharma Rimple, Essentials Of Pediatric Nursing, Jaypee Publication,
Third Edition, Page no: 630
Yadav Manoj, A Textbook of Child Health Nursing, S. Vikas &
Company (Medical Publishers), Revised Edition 2014, Page no.: 774
ONLINE REFERNCES
https://www.slideshare.net/aswaniB1/ewings-sarcoma-240523134
https://www.slideshare.net/mubinahafeezi/ewings-sarcoma-237492431
