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CASE STUDY:

BREAST CANCER
By: BSN IV
Borre, Jessa Anne R.
Burgos, Joy Mariel Isadora U.
Mangalus, Maribel T.
Pastran, Izza Mae F.

I. INTRODUCTION

Breast cancer is an uncontrolled growth of breast cells.


Cancer develops when cells in a part of the body begin
togrowoutofcontrol.Althoughtherearemanykindsof
cancer,theyallstart becauseofout-of-controlgrowthof
abnormal cells. Normal body cells grow, divide, anddie
inan orderly fashion. During the early years of a person's
life, normal cells divide more rapidly until the person
becomes an adult.

Cancer cells develop because of damage to DNA. This substance


is in every cell and directs all its activities. Most of the time when
DNA becomes damaged the body is able to repair it. In cancer
cells, the damaged DNA is not repaired. People can
inherit damaged DNA, which accounts for inherited cancers.

Cancer cells can invade nearby healthy breast tissue and


make their way into the underarm lymph nodes, small
organs that filter out foreign substances in the body. If
cancer cells get into the lymph nodes, they then have
apathway into other parts ofthe body.
Thetermbreastcancerreferstoamalignanttumor
that has developed from cells in the breast.

Usually breast cancer either begins in the cells of the lobules, which

are themilk-producingglands, ortheducts,thepassagesthat


drainmilkfromthelobulestothenipple.

Breast cancer is always caused by a genetic abnormality (a


mistake inthe genetic material). However, only 5-10%of cancers
are due to an abnormality inherited from your mother
orfather.About90%ofbreastcancersareduetogenetic
abnormalities that happen as a result of the aging process and the
wear and tear of life in general.

II. LEARNING OUTCOMES

At the end of the case presentation, the students


are expected to:
1. Apply knowledge of physical, social, natural and health
sciences and humanities in the care of clients with cancer.
2. Perform safe, appropriate and holistic care to clients with
3. utilizing the nursing process.
.General Objectives: After 1 month of student nurse patient
interaction, the student nurse will be able to provide holistic
nursing care and improve her attitude, skills, and knowledge
in the care of a breast cancer patient who has undergone
chemotherapy.

III. CASE DISCUSSION

A. ANATOMY & PHYSIOLOGY

Nipple-the small projection in which the mammary


ducts of female mammals terminate and from which
milk can be secreted.

Milk Ducts-also called lactiferousducts, are the tubes


that carry yourbreast milkfrom where it is made in
the glandular tissue of yourbreastout to your nipple.

Lymph Nodes- Lymph nodesare small clumps of immune cells that act as
filters for thelymphaticsystem. Thelymphaticsystem runs throughout the
body (like the circulatory (blood) system) and carries fluid and cells.
Thelymph nodesin the underarm (the axillarylymph nodes) are the first
placebreastcancer is likely to spread.

Lobule-Abreast lobuleis a gland that makes milk. Enlarge. Anatomy of the


femalebreast. The nipple and areola are shown on the outside of
thebreast.

Blood Vessels- Thebreasthas a network ofblood vessels(called the


vascular system) and lymph channels (lymphatic system) that
carrybloodand fluid back and forth from yourbreasttissue to the rest of
the body. Vascular or lymphatic system invasion happens whenbreast
cancer cells break into theblood vesselsor lymph channels.
Fatty Tissue

ANATOMY OF BREAST CANCER


Lobes, lobules, and milk ducts. A healthy
femalebreastis made up of 1220 sections called
lobes.Both the lobes and lobules are connected by
milk ducts, which act as stems or tubes to carry
the milk to the nipple. Thesebreaststructures are
generally where thecancerbegins to form.

B. PATHOPHYSIOLOGY

Book- based
Neoplasm
formation
in the
breast

Primary
tumor
begins in
the
breast

Tumor
becomes
invasive

Travel
(metastasize) to
other organ
systems in the
body

Progressed
beyond breast
to regional
lymph nodes

It becomes
systemic

If treated:
Surgery,
Radiotherapy,
Chemotherapy
, Interstitial
thermotheraph

Primary
cancer
spreads

If not
treated:

Removal of
breast tissue

CANCER CELL
DESTROYED

Breast cancer
spread to
major organs

Compromise the
functions of the
major organs

DEATH

2. Client- based
Etiology
Non- modifiable factors:
factors:
-Gender
saturated fats
40 years old and above (53yrs. old)
lifestyle

Modifiable

- Diet with high


- Age group:
-Poor sedentary

BREAST
(Affected part)
Difference in size
Maybe caused by inflammation or a mass.
Carcinogens
precipitating
factors /
predisposing
factors

tumors.

Retractions or dimplings
Results from invasion of underlying ligaments by

Malignant tumors typically begin.


Ductal lobular epithelial cells
Abnormal
Spread via the lymphatic system to the axillary lymph cells
nodes.
formed by
Malignant
mutation.
Cell
tumors
grows
typically begin.
Metastasize
and
proliferat
Invades into the other tissue of the body blood stream or lymphatic
es

system

LUNGS

BONE

TREATMENT

Test /
laboratory
-Clinical
examination
-Breast self examination

Signs and Symptoms


C change in bowel or
bladder habits
A a sore that does not heal
U usual bleeding or
discharges
T thickening or lumps
I indigestion or difficulty in
swallowing
O obvious change in a dart
or mole
N nagging or persistent
cough or hoarseness
U- unexplained anemia
S- sudden unexplained weight
loss

-Surgery
-Chemotherapy
-Radiation

Nursing Management
-Promote measures that relieve pain and
discomfort.
-Promote measures to maintain intact skin
integrity.
-Promote measures that maintain oral mucosa.
-Promote measures to prevent injury from
abnormal bleeding.

-Promote measures that identify and prevent

IV. ASSESSMENT WORKSHEET

Name:
2016

Rosita Asuncion

Date and Time: August 01,

12:00pm
Admitting Diagnosis Invasive: Ductal Carcinoma Stage IV
(Bones and Pulmonary Metastasis) secondary to Modified Radical
Mastectomy.

A. MODE OF ADMISSION

___X__ ambulatory _____stretcher


_____wheelchair

_____brought in by ___________

_____others (specify)

_____unaccompanied

B. CLASSIFICATION
___X__ service
_____pay

_____health insurance
_____others (specify)

C. SOCIAL PROFILE

Telephone: 895-6757
Age:

53 y/o

Date of Birth: 06/15/1963


Christian

Marital Status: Married


Citizenship: Filipino
Religion: Born Again

Birth of Place: Makati City, Philippines


Housewife
Gender: Female

Occupation:

D. PRESENT HEALTH / ILLNESS


- Reason for seeking care or chief complaint: Palpated grape like
lump on left axillae, then decided to go to the hospital to seek care.
Symptom analysis:
Location: Where are the symptoms? Exact location of distress?
Left axillary down to the breast.
Quality: Describe symptom characteristics: An irregular lobulated
soft tissue mass at the left axillary space is palpated.
Quantity: Describe symptom severity (intensity): On a pain scale of
1-10 patient verbalize that pain ranges on 4/10.

Chronology: When did symptoms start?


Onset: sudden N/A gradual N/A
How often the problem occurs? N/A
How long does symptom last? N/A
Setting: Where are you and what are you doing when
symptoms occurs? Patient was at home when she
palpated a grape like lump on her left breast.
Associated Manifestations: Presence of other symptoms?
N/A

Alleviating Factors: What makes symptoms better?


Applying warm compress on affected part

Aggravating Factors: What makes symptoms worse?


Health beliefs and practices: Folk healing techniques Hilot
Health patterns: eats pizza and instant foods, no exercise
Medications: ascorbic acid
Health goals: eat more green leafy vegetable instead of eating at
fast food restaurants.

E. PAST HEALTH HISTORY


Childhood illness: chicken pox, measles
Childhood immunizations: patient is fully immunized.
Medical illnesses: N/A

Hospitalization: 1998- due to CS.


Surgery: 1998- due to CS.
April 2014- MRM Left Breast

Injury: N/A
Blood transfusion: N/A

Emotional / Psychiatric problem: N/A


Allergies (food, medication, environment, use of tobacco):
N/A

Use of alcohol: N/A


Use of illicit drugs: N/A

F. Genogram

V. GORDONS 11 FUNCTIONAL
HEALTH PATTERN

FUNCTIONAL HEALTH PATTERNS

DESCRIPTION

1. Health Perception / Health


Management

Patient R. A understands the fact that she


must be in the hospital for her to be at
ease while fighting her disease. She was
just anxious and worried because of the
financial aspect that needs to be sufficient
enough for her treatment.

2. Nutritional-Metabolic

Patient R. A admits that her favorite food is


pizza and fond of eating at fast food
restaurants and seldom eats vegetables.
She is taking ascorbic acid as her
vitamins.

3. Elimination

She usually urinates 5 times a day without


difficulty and defecates 1 times a day
every morning.

4. Activity-Exercise

5. Cognitive-Perception

6. Sleep-Rest

Patient said that she does not have any


physical/ recreational activities aside
from walking and watching t.v.

Patient has no sensory deficit. Patient is


oriented to time, place and people. She is
aware of her condition and prepared of
any possible thing that may happen to her.

Patient said that she normally sleeps for 6


hours every day. She sleeps at around 1011pm and wakes up 5 am in the morning
and does not sleep in the afternoon.

7. Self-Perception / SelfConcept

8. Role-Relationship

9. Sexuality-Reproductive

She optimistically shared that illness is just a part of


our body to respond and act against the virus and
cells that spreads inside our system- may it be
deadly or not. She knows that her immune system is
at risk during this time of her life that is why she
needs to eat nutritious foods and lessen her intake
of those restricted foods that may compromise her
health.
Patient is married with 4 children. She has a good
relationship with her husband and children. Her
husband is the one who usually takes care of her
during hospitalization.

Patient R. A verbalize that she is sexually active


despite of her condition.

10. Coping/Stress Tolerance

She said that when she is stressed she sings


and reads the bible or pray to ask for Gods
guidance.

11. Value-Belief

The patients religion is Born again. She said


that she always go to church before
hospitalization. She also adds that she always
reads bible until now and asking for guidance.

VI. PHYSICAL EXAMINATION

Date and Time performed: August 01, 2016


Vital Signs:
Temperature: 36.3 c
Pulse Rate: 88 bpm
Respiratory Rate: 20
Blood Pressure: 130/90 mmhg
Height: 53
Weight: 75 kg

General Survey:
- Patient stands at 5 feet and 3 inches tall and weighs 75 kilograms. She is awake,
conscious, coherent and oriented. Responsive when asked and well- conversant
during the interview. Her emotions were visible and vary in every emotions. She is
wearing duster and pants. She is very calm during the assessment.

BODY

TECHNIQUE
USED
Inspection

NORMAL
FINDINGS
Symmetrical
breast and
symmetrical

ACTUAL
FINDINGS
Asymmetrical
breast

axilla
Palpation

Without
lesions/

FEMALE
BREASTS

lumps/
nodules

Left breast:
-With grapelike nodules on
the L axilla

-Breast is
removed due
to mastectomy

REMARKS

BODY

TECHNIQUE
NORMAL FINDINGS
USED

Inspection
No secretions or
discharges
No crusting,
redness around
the area
Palpation

FEMALE
BREASTS

Palpation

absence of
tenderness
No masses or
nodules

ACTUAL
FINDINGS
Right breast:

(-) discharge
(+) crusting on
the surrounding
area
(+) redness and
inflammation
(-) tenderness
(-) masses and
nodules

REMARKS
-The L side of

the breast is
removed due
to mastectomy
because of the
spreading
grape-like
nodules in her
axilla.

VII. LABORATORY & DIAGNOSTYIC


EXAM

VII. LABORATORY & DIAGNOSTYIC EXAM


Name: R. A
Diagnosis: Ductile
Carcinoma
IMMUNOCHEMISTRY REPORT
ESTROGEN RECEPTOR ASSAY
Proportion of estrogen positive receptor cells: 35%
Average intensity of positively staining tumor cells:
STRONG
Interpretation: POSITIVE

PROGESTERON RECEPTOR ASSAY


Proportion of progesterone positive receptor cells: 0
Average intensity of positively staining tumor cells: 0
Interpretation: NEGATIVE

HEMATOLOGY
Complete blood
Count
Hemoglobin
Hematocrit
Red blood Cells
White Blood Cells
Neutrophils
Lymphocyte
Eosinophil
Monocyte
Basophils

Results

Normal Values

Unit

129.00
0.37
4.22
8.70
0.32
0.39
0.03
0.05
0.07

g\L

X10^12/L

Platelet Count

346

120-160
0.37-0.43
4.0-5.4
4.6-5.4
0.55-0.85
0.25-0.35
0.02-0.04
0.03-0.06
0.06-0.08

130-400

X10^9/L

Name: R. A

BLOOD CHEMISTRY FORM


July 29,2016

Examinations

Results

Normal Values

Fasting Blood Sugar


Total Cholesterol
Triglycerides
Uric Acid
Blood Urea Nitrogen
Creatinine
Calcium
Phosphorus

3.89-5.83mmol/L
0-5.2mmol/L
0.00-1.70mmol\L
150-350umol\ L
2.5-6.4mmol/L
53-97umol\L

74.91

VIII. NURSING CARE PLAN

VIII. NURSING CARE PLAN


CUES

Nursing
Scientific
Diagnosis Explanati
on

Nursing
Objective

Nursing
Scientific
Interventi Explanati
on
on

Evaluatio
n

Subjectiv
e:
ayaw
kong
Makita ang
sarili ko sa
harap ng
salamin

Disturbed
body
image
related to
loss of
body part
secondary
to curative
surgery in
cancer or
mastectom
y.

After 1
month of
nursing
interventio
n the pt
will
demonstra
tes
enhance
body
image and
selfesteem

Acknowled
ge
normalcy
of
emotional
response
to actual
or
perceived
change in
body
structure
or
function.

Goals met.
After 1
month of
nursing
interventio
n the pt
demonstra
tes
enhanced
body
image and
selfesteem.

Objective:

Facial
grimace
while
patient is

Body
image is
the
attitude a
person has
about the
actual or
perceived
structure
or function
of all or
part of his
or her
body.

Stages of
grief over
loss of a
body part
or function
is normal,
and
typically
involves a
period of
denial, the
length of
which
varies
from
individual

This
attitude
is
dynamic
and is
altered
through
interacti
on with
other
persons
and
situation
s and
influence
d by age
and
develop
mental
level.

as
evidenc
ed by
ability
to look
at,
touch,
talk
about,
and
care for
actual
or
perceiv
ed
altered
body
part or
functio
n.

Encour
age
verbali
zation
of
positiv
e or
negativ
e
feeling
s about
actual
or
perceiv
ed
change.

It is
worthwhil
e to
encourag
e the
patient to
separate
feelings
about
changes
in body
structure
and/or
function
from
feelings
about
selfworth.

as evidenced by
ability to look
at, touch, talk
about, and care
for actual or
perceived
altered body
part or
function.

Assist
patient in
incorporating
actual
changes into
ADLs, social
life,
interpersonal
relationships
, and
occupational
activities.

Opportunities
for positive
feedback and
success in
social
situations
may hasten
adaptation.

Help
patient
identify
actual
changes.

Patients
may
perceive
changes
that are
not
present
or real,
or they
may be
placing
unrealist
ic value
on a
body
structur
e or
function.

Teach
patient
adaptive
behavior
(e.g., use
of
adaptive
equipment
, wigs,
cosmetics,
clothing
that
conceals
altered
body part
or
enhances
remaining
part or
function,
use of

This
compensates
for actual
changed
body
structure and
function.

CUES

Nursing
Diagnosis

Scientific
Explanati
on

Nursing
Objective

Nursing
Scientific
Interventi Explanati
on
on

Evaluatio
n

Subjectiv
e:
natatakot
ako
makalbo
dahil sa
chemother
apy

Objective:

Facial
grimace
while
patient is
verbalizing
was noted.

Situational
loss selfesteem
related to
chemother
apy side
effects
(loss of
hair)

Thelossof
aperson,t
hing,orqu
ality,result
ingfromal
terationof
alifesituat
ion,includi
ngchanges
relatedtoi
llness,
bodyimag
e,environ
ment,and
death.

After 1
month of
nursing
interventio
n the pt
will
verbalize
understand
ing of body
changes,
acceptance
of self in
situation.

Discuss
with
patient and
SO how the
diagnosis
and
treatment
are
affecting
the
patients
personal
life, home
and work
activities.

After 1
month of
nursing
interventio
n the pt
verbalized
understand
ing of body
changes,
acceptance
of self in
situation.

Aids in
defining
concerns
to begin
problemsolving
process.

Review
anticipat
ed side
effects
associat
ed with a
particula
r
treatmen
t.

Anticipat
ory
guidance
can help
patient
and SO
begin
the
process
of
adaptati
on to
new
state
and to
prepare
for some
side
effects
(buy a
wig
before

Use touch
during
interactio
ns, if
acceptabl
e to
patient,
and
maintain
eye
contact.

Affirmation
of
individualit
y and
acceptance
is
important
in reducing
patients
feelings of
insecurity
and selfdoubt

CUES

Nursing
Diagnosi
s

Scientific Nursing
Explanat Objectiv
ion
e

Nursing
Interven
tion

Scientific Evaluati
Explanat on
ion

Objective:
Deppress
ed
immune
system

Risk for
infection
related to
inadequat
e
secondary
defenses
and
immunos
uppressio
n. (bone
marrow
suppressi
on)

At
increased
risk for
being
invaded
by
pathogeni
c
organisms

Promote
goodhan
dwashing
procedure
s by staff
and
visitors.
Screen
and limit
visitors
who may
have
infections.
Place in
reverse
isolation
as
indicated.

Protects
patient
from
sources of
infection,
such as
visitors
and staff
who may
have an
upper
respirator
y
infection
(URI).

After 48
hours of
nursing
interventi
on the pt
will
identify
and
participat
e in
interventi
ons to
prevent/re
duce of
infection

After 48
hours of
nursing
interventi
on the pt
identify
and
participat
e in
interventi
ons to
prevent/re
duce of
infection

Empha
size
person
al
hygien
e.

Limits
potenti
al
sources
of
infectio
n
andsec
ondary
overgr
owth.

Monito
r
temper
ature.

Temperat
ure
elevation
may
occur (if
not
masked
by
corticost
eroids or
antiinflamma
tory
drugs)
because
of
various
factors
(chemoth
erapy
side
effects,
disease
process,
or
infection)
. Early
identifica
tion of
infectiou
s process
enables

Monito
r CBC
with
differe
ntial
WBC
and
granul
ocyte
count,
and
platele
ts as
indicat
ed

Bone
marrow
activity
may be
inhibited
by
effects of
chemoth
erapy,
the
disease
state, or
radiation
therapy.
Monitorin
g status
of
myelosup
pression
is
importan
t for
preventin
g further
complicat
ions
(infection
,anemia,
or

IX. DISCHARGE PLAN

IX. DISCHARGE PLAN


M (Medication)- Emphasized to patient the importance of adhering to
the prescribed therapeutic regimen.
E (Environment)Advisedpatienttograduallyresumetousualactivitiesastolerated.
Advised to schedule periods ofuninterrupted rest.
T (Treatment)Taughtmethodstoalleviatepainsuchaswarmcompressesandtopical
liniments.
H (Health knowledge of disease)O (Out/In patient Referral)Referredpatienttosocialservicesandsupportgroupsthatcouldassist
them financially andpsychologically.
D (Diet)- Encouraged a high protein diet.
-Advised patient not to sip meals
-Identified foods rich in potassium and vitamins and minerals for
the patient.

X. DRUG STUDY

X. DRUG STUDY
Generic & Brand
Name

Generic
Name:
Docetaxel

Brand
Name:
Taxotere

Frequency &
Route

Frequency:
60-100
mg/m2 IV
infusion
for 1hr
every 3
weeks

Route:
Intravenou
s

Classification

Action / Uses

Antineopla
stic

Promotes
formation
and
stabilizatio
n of
nonfunctio
nal
microtubul
es. This
prevents
mitosis and
lead to cell
death.

Contraindications
& Precautions

Neutrophil
counts
<1,500
cells/mm3.
Severe
hypersensi
tivity to
Docetaxel.

Side Effects

Hematologi
cal effects,
febrile
neutropeni
a,
hypersensi
tivity
reaction,
fluid
retention,
neurosensi
tivity
symptoms,
GI effects,
alopecia,
infusion
site
reaction.

Nursing
Consideration /
Patient Teaching

Use
cautiously
in patients
with
impaired
bone
marrow
function.
Anticipate
need for
blood
transfusion
to combat
anemia.
Therapeuti
c effects

Monitor
CBC and
platelet
count.
Tell pt
to watch
for
evidence
of
infection
and
bleeding.
Tell pt
to avoid
OTC
products
contain
aspirin
NSAIDs.
Advise
pt to
avoid
sunlight
and
sunlamps
for first 2
days after

Generic & Brand


Name

Generic
Name:
Doxorubici
n
Hydrochlori
de

Brand
Name:
Adriamycin

Frequency & Route

Frequency:
60-75
mg/m3 IV
as single
dose q 3
weeks

Route:
Intravenou
s

Classification

Action / Uses

Antineopla
stic

May
interfere
with DNAdependent
RNA
synthesis
by
intercalatio
n.

Contraindications &
Precautions

Side Effects

Patient
who have
marked
myelosupp
ression
induced by
previous
chemother
apy or
radio
therapy
and those
have
already
received
cumulative
doses of
anthracycli
nes,
preexisting
heart

Myelosuppr
ession,
atrial and
ventricular
dysrhythmi
as, toxic
myocarditi
s,
cardiopath
y,
reversible
complete
alopecia,
hyper
generation
of nail
buds.
Acute
nausea
and
vomiting,

Nursing
Consideration /
Patient Teaching

Cardiac
function
studies,
including
ECG.
Take
preventive
measures.
Monitor
CBC with
differential
and hepatic
function
test.
Advise pt
to report any
pain or
burning site
of injection
during or
after
administrati
on.

Advise pt
signs and
symptoms
of
infection
and
bleeding.
Advise pt
that
orange to
red urine
for 1 to 2
days is
normal
and
doesnt
indicate
presence
of blood.
Inform pt
that
alopecia
may occur
but its
usually

Generic & Brand


Name

Generic
Name:
Dexameth
asone

Brand
Name:
Dexone

Frequency & Route

Frequency:
4 mg/1
tab, 2 tabs
BID

Route:
Per orem

Classification

Action / Uses

Corticoster Not clearly


oids
defined.
Decreases
infalamma
tion,
mainly by
stabilizing
leukocyte
lysosomal
membrane
s;
suppresses
immune
response;
stimulates
bone
marrow;
and
influences
protein,
fat, and

Contraindications &
Precautions

Contraindi
cated in
patients
hypersensi
tive to
drug or its
ingredients
and in
those with
systemic
fungal
infections.

Side Effects

Insomnia,
heart
failure,
hypertensi
on, peptic
ulceration,
hypokalem
ia,
hyperglyce
mia,
fatigue,
weakness
fever,
thromboph
lebitis

Nursing
Consideration /
Patient Teaching

Use with
extreme
caution in
pt with
recent MI.
Determine
wether pt
is sensitive
to
corticoster
oids.
Monitor
pts
weight,
blood
pressure,
and
electrolyte
s.

Tell pt
not to
stop
abruptly
without
prescribe
rs
consent.
Instruct
pt to take
food or
milk.
Warn pt
about
easy
bruising.
Advise
pt to
avoid
exposure
to
infection.

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