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Documenti di Professioni
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BREAST CANCER
By: BSN IV
Borre, Jessa Anne R.
Burgos, Joy Mariel Isadora U.
Mangalus, Maribel T.
Pastran, Izza Mae F.
I. INTRODUCTION
Usually breast cancer either begins in the cells of the lobules, which
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.
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
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
system
LUNGS
BONE
TREATMENT
Test /
laboratory
-Clinical
examination
-Breast self examination
-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.
Name:
2016
Rosita Asuncion
12:00pm
Admitting Diagnosis Invasive: Ductal Carcinoma Stage IV
(Bones and Pulmonary Metastasis) secondary to Modified Radical
Mastectomy.
A. MODE OF ADMISSION
_____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
Occupation:
Injury: N/A
Blood transfusion: N/A
F. Genogram
V. GORDONS 11 FUNCTIONAL
HEALTH PATTERN
DESCRIPTION
2. Nutritional-Metabolic
3. Elimination
4. Activity-Exercise
5. Cognitive-Perception
6. Sleep-Rest
7. Self-Perception / SelfConcept
8. Role-Relationship
9. Sexuality-Reproductive
11. Value-Belief
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.
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
Examinations
Results
Normal Values
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
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
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
Name:
Doxorubici
n
Hydrochlori
de
Brand
Name:
Adriamycin
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
Name:
Dexameth
asone
Brand
Name:
Dexone
Frequency:
4 mg/1
tab, 2 tabs
BID
Route:
Per orem
Classification
Action / Uses
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.