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Concept Map Case Study E2

Student Name: Bindu Sharma

Student No: 800-720-708
Nurs 252 : Scholarly Assignment
Professor Name: Kelly Ross
Tuesday : March 31,2015

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Main Idea

Breast cancer in Canadian women is very common (Lewis et al, 2014). Statistics show
each year in Canada, approximately 5100 women die due to breast cancer. Case Study E2
describes an 83 year old female client with stage 1 left breast cancer diagnosed in 2009. Lewis et
al .(2014) states stage 1 breast cancer is tumor < 2 cm and it is not spread to lymph nodes or
distant sites (p. 1504). Currently client is undergoing radiation. Lewis et al. (2014)) states
radiation treatment is the primary treatment to prevent breast cancer. The side effect of radiation
therapy is the impaired skin integrity. Dendaas (2012) indicates the most common and unwanted
side effect of external beam radiation therapy is the development of skin reactions. Risk factors
for the development of more severe higher grade skin reactions are treatment and patient
related. In older clients the skin is thin and have high potential to damage the skin. Hamberger et
al. (2009) states patient related factors include age, skin is thinner in older adults. Lewis et al.
(2014) states radiation could cause serious adverse effects to the skin (p.555).
Due to radiation therapy treatment, the client has stage 2 skin breakdown at radiation
site. Stage 2 skin breakdown is when skin breaks open and it is tender and painful. Open skin
wound if not treated on time can be infected. In such cases clients should be educated on
infection prevention to avoid infection. Client will have more complications such as high fever,
if not having enough intake of fluid then dehydration. Dehydration can cause confusion.
Confusion will effect ADLs and clients autonomy. This is the reason I chose priority
pathophysiology is impaired skin integrity. Client has arrived at family doctor office with
complaints of feeling unwell. Feeling unwell can include fever, fatigue, weakness, or might

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have infection at impaired skin or pain. Clients vital signs are temperature 37.9, pulse 84,
respiration 24, BP 149/50 and O2 sat is 91%.

Clinical Manifestation /Complication

The main clinical manifestation is stage 2 skin breakdown. In stage 2 skin is open and
tender. Client is undergoing radiation therapy to treat stage 1 left breast cancer. As a result of the
treatment skin is impaired. Hamberger el al. (2009) states radiation treatments change the skin
and soft tissues of the breast. Client is at risk of infection. Client needs to be treated in order to
prevent other complications such as progressing to stage 3 skin breakdown.

Nursing Interventions
The interventions I choose is to advise client to avoid massage of the site of impaired tissue
integrity, educate client on the importance of proper dieting and food intake, keep the skin clean
and dry and advise client not to rub, scratch or scrub the skin, Client should use prescribed
cream, and should be advised not to use heating pads or cold packs on the skin.
First intervention is avoid massaging the wound site of impaired tissue integrity. Client
should be informed not to massage the impaired site. Massaging will damage and slow down the
healing process. Research suggests massage may lead to deep tissue trauma (Panel for the
prediction and prevention of pressure ulcers in Adults, 1992).
Second intervention is to educate a client on the importance of proper dieting and food
intake. During radiation therapy, a lot of energy is required by the body to heal. It is very
important that the client has an intake of adequate amount of calories and proteins to maintain
the body weight. Proper nutrition and hydration are important for impaired skin and skin

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metabolism. Dendaas (2012) states intake of 2000 to 3000 calories per day, zinc, sulfur, vitamins
A and C, riboflavin, niacin, and linoleic acid are needed. In case the client is anemic, then iron
intake is essential. Client should be educated about healthy eating habits and adequate hydration.
Third intervention is the client should keep skin clean and dry to prevent the infection
and more tissue damage. Client should avoid harsh cleansing products and hot water. Avoid
cleansing the skin too frequently. Dendaas (2012) sates non aluminium based deodorants may
be used on the skin in the axilla of the treated side (in patients with breast cancer).
Fourth intervention is client should not rub, scratch or scrub the skin. Scratching, rubbing
or scrubbing will cause the damage to the skin and infection. It will delay the healing process.
Lastly, client should be educated about the use of prescribed cream. Topical treatment on
the impaired /open skin is needed to heal and to prevent serious damage to the skin.

CONCLUSION
Client had to undergo radiation treatment to treat her left breast cancer. Radiation
therapy treatment can effect normal tissue. Due to radiation client has stage 2 skin breakdown. It
is very important to prevent more damage to the skin. Skin breakdown can progress quickly from
one stage to other if not treated on time. Dendaas (2012) sates efforts to prevent, minimize, or
improve management of skin reactions are ongoing within radiation oncology. Client should be
educated and advised to take preventive measure for faster healing. According to Wong et al
(2011) health care professionals should provide relevant information and treatment related side
effects to breast cancer clients, allowing patients to cope better with sufficient knowledge.

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Reference

Dendaas, N. (2012). Toward evidence and theory based skin care in radiation oncology.
Clinical Journal of Oncology Nursing, 16, 520-525. Retrieved on March 15, 2015
http://library.humber.ca/ articles

Hamberger, A., Roukos, D. & Buchholz, T. (2009). Radiation Therapy for breast cancer.
The New England Journal of Medicine, 360, 1362-1363. doi : 10.1056/NEJMc090162
Retrieved on March 15, 2015 http://library.humber.ca/ articles

Lewis, S., Heitkemper, M., Dirksen, S., and OBrien, P. (2014). Medical- Surgical Nursing in
Canada. Assessment and Management of Clinical Problems (3rd Canadian ed).
Toronto : Elsevier

Wong, J., DAlimonte , L., Angus , J., Paszat , L., Soren , B., Szumacher , E. (2011). What do
older patients with early breast cancer want to know while undergoing adjuvant
radiotherapy ? Journal of Cancer Education, 26 (2), 254-261. Retrieved March 20,
2015 http://library.humber.ca/ peer reviewed articles