001 breast cancer presentation

8/8/2019 001 Breast Cancer Presentation

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RISK

FACTORS


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et: iet may contribute to evelopment or growth o breast cancers, but conclusive evi ence about the e ect o a particular iet (eg, one high in ats) is lacking. bese postmenopausal women are at i et: iet may contribute to evelopment or growth o breast cancers, but conclusive evi ence about the e ect o a particular iet (eg, one high in ats) is lacking. bese postmenopausal women are at i et: iet may contribute to evelopment or growth o breast cancers, but conclusive evi ence about the e ect o a particular iet (eg, one high in ats) is lacking. bese postmenopausal women are at i


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Mrs. X was a 57 years old Filipino female who was born on April 13,

1952. She lives in Calamba, Laguna. Her religious affiliation is

Baptist. She is married and has 3 children who are all now stable and

have their own career. Mr. X her husband is a jeepney driver. Mrs. X

is not obese because she is physically active in her household

chores. She has enough sleep, usually about 8 hours a day and feels

complete. She told us that she is neither engaged to smoking nor

drinking. According to Mr. X, his wife has a very good appetite, she

eats everything but his favorites are fatty foods specially if it is grilled.

Mrs. X has hypertension, diabetes, asthma and cancer in both side of

her family. She was hospitalized last December 8, 2009 because she

experienced local breast pain, and when she examined her breast

she felt a lump. She taught that the cause of the pain was just only

because she got tired cleaning their backyard, but when the pain got

worst she decided to consult her doctor. She had undergone several

laboratory examinations such as ECG, blood chemistry, coagulation

factors, urinalysis and hematology. Later on she was diagnosed withmass at left lower outer quadrant of her breast that measures about 6

x 7cm by her attending physician Dr. Joseph Eric R. Fernandez, M.D.

After the diagnosis, she was scheduled for operation on December

10, 2009 forMRM. The operation was successful and he has now

had drainage in her left part of the breast. Mrs. XXX was fully

recovered and was discharge on December 17, 2009.


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PHYSI LSSESSMENT


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ANATOMY

AND

PHYSIOLOGY


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ANATOMY AND PHYSIOLOGY


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C INICA

MANIFESTATIONS


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Local Pain

Local obstruction caused by the tumor.

Dimpling ofthe skin

Can occur with invasion of the dermal lymphatics because of retraction of Cooper

ligament or involvement of the pectoralis fascia.Nipple dischargein a non lactating women

Spontaneous and intermittent discharge caused by tumor obstruction.

Skin retraction

Involvement of the suspensory ligaments .

Edema

Local inflammation or lymphatic obstruction.

Nipple/areola eczema

Presence of malignancy in the ductal system below the nipple.Pitting ofthe skin

This is similar to the surface of an orange

Obstruction of the subcutaneous lymphatics, resulting in the accumulation of fluid.

Reddened skin, local tenderness and warmth

Inflammation

Dilated blood vessels

Obstruction of venous return by a fast-growing tumor; obstruction dilates

superficial veins.Ulceration

Tumor necrosis

Hemorrhage

Erosion of blood vessels.

Edema ofthe left arm

Obstruction of lymphatic drainage in the axilla.


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LABORATORYRESULTS


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Examination Results Normal Values Findings

Sodium 144.50 135-145 mmol/L NORMALPotassium 3.78 2.4-5.3 mmol/L NORMAL

Fasting Blood Sugar 5.9Blood Urea Nitrogen 4.6 2.8-6.4 mmol/L NORMALBlood Urea Ammonia 450 144-342 Urinary Tract

Obstruction

Creatinine 71 53-115 umol/L NORMALCholesterol 3.87 4.2-5.2 mmol/L NORMALTriglycerides 1.14 0.41-2.37 mmol/L Biliary obstruction,

nephritic syndromeHigh DensityLipoprotein

1.4 0.25-2.65 mmol/L NORMAL

Low DensityLipoprotein

2.6 1.1-2.6 mmol/L NORMAL

BLOOD HEMISTRY


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Examination Results Normal Values Findings

Protime 13.3 sec 11-14 sec NORMALINR 0.99 0.8-1.2 NORMAL% Activity 103% 70-120% NORMAL

PT Control 13.2 sec. 11-14 sec NORMALPTT 27.8 sec 27-34 sec NORMAL

INR1.08

0.8-1.2 NORMALPTT Control 33.6 sec 27-34 sec NORMAL

COAGULATION ACTORS


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URINALYSIS

1. Physical Examination 3. Microscopic Examination Cells

Color Yellow

Appearance Slightly Hazy

Specific

Gravity

1.010

2. Chemical Examination 4. Crystals

pH 8.0

Glucose Negative

Protein +2

Ketones NegativeBilirubin Negative

Urobilinogen Normal

Blood/Hgb +1

Nitrite Negative

Leukocytes +3

Pus Cells 60-70/hpf

RBC 10-12/hpf

Amorphous Urates FEW

Bacteria FEW


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DIAGNOSTICPROCEDURE


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a) Self-examination - 90% of the breast masses are

discovered by the patient herself. From this manner,

self-examination appears as one of the most

important measures for the early diagnosis of breast

cancer, once it: allows the detection of small masses;

is an useful, convenient, profitable, advantageous

and opportune method: can be repeated as many

times as necessary; has no cost; is easy to be done;

its precision increases with practice.

Self-examination must be performed 7-8 days after

menstruation by every woman with more than 20

years old, in order to detect early changes in breast

parenchyma.


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PROPOSEDDIAGNOSTIC

PROCEDURES


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DRUGSTUDY


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NURSINGCAREPLAN


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Assessment Diagnosis Planning Implementation

ationale valuation

ubjective:

Masakit ang akingdibdib as verbalized bythe client.

Objective:

conscious andcoherent

afebrile with body malaiseguarding behavior

with slight pain at leftchest-pain scale of7/10 (faces pain scale)

with limited range ofmotion

negative difficulty ofbreathing

Acute chest pain related topost operative surgery asevidenced by guardingbehavior.

At the end of nursingintervention the clientspain will lessened.

Establish urse-clientinteraction

Take and record vitalsign

Check and regulateIVF

Provide therapeuticenvironment.

Note pain includingthe location, duration,frequency andintensity.

eassesseach time painoccurs/is reported.

Provide comfortmeasures such as:

a.

epositioning every 4hrs.

b. Back massage.

Provide relaxationtechnique such as

a. deep breathingexercises

b. yawning

Encourage adequaterest period.

To gain trust andbetter understandingon patients condition

Serve as baseline dataof the patient

To prevent airembolism and providehyration.

Environment has agreat impact onclients health andwellness

To rule out worseningof underlyingcondition/development of complications.

To avoid bed soresand other

complication and topromote non-pharmacological painmanagement.

To lessen the intensityof pain felt by the

client To distract attention

and reduce tension.

To prevent fatigue.

Goal was met.Pain scale lessened

from 7/10 to 4/10


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Assessment Diagnosis Planning Implementation Rationale

valuation

ubjective:

Hindi ako masyadongmakagalaw kapagsumasakit ang dibdib koas verbalized by the client.

Objective:

conscious and coherentafebrile with body malaisePale in appearancewith limited range of

motionnegative difficulty of

breathing

Impaired physical mobilityrelated to decreased musclestrength as evidenced bylimited body movementsand body malaise

At the end of nursingintervention the client willregain strength and be ableto increased mobility.

Establish urse-clientinteraction


Check and regulate IVF

Provide therapeuticenvironment

Heath teachingsrendered such as:a. Proper hygiene

b. Apply passiveROM

Instruct patient tochange position side toside every 4 hrs.

Support affected bodyparts or joins usingpillows or footsupports.

Massage and stretchextremities within theclients reached.

Instruct activities suchas:

a. socialize with patientsSO

b. read newspaperc. listening to musicd. Encourage

participation in self

care.

To gain trust and betterunderstanding o npatients condition


To prevent airembolism and providehydration.

Environment has agreat impact on clientshealth and wellness.

To prevent the spreadof microorganisms

To preventcontractures

To reduce risk ofpressure ulcers.

To maintain position offunction

To preventcontractures andincrease mobility of theextremities.

To divert attention ofthe patient and toenhance self conceptand sense ofindependence.

Client was able toperform activitieswithout complaintsof pain


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Assessment Diagnosis Planning Implementation Rationale

valuation

ubjective:

Katatapos ko lang

operahan,nakakahiya naang itsura ko verbalized bythe client.

Objective:

conscious and coherentafebrile irritablePale in appearancediaphoreticwith surgical dressing,dry and intact at left

breast

Disturbed body image

related to post surgicalprocedure as manifested byirritability.

At the end of nursing

intervention the client willbe able to verbalizeunderstanding of bodyimages.

Establish Nurse-clientinteraction


Check and regulate IVF

Evaluate level ofclients knowledge ofand anxiety related to

situations. Observeemotional changes.

Assist in correctingunderlying problems

Encourage client tolook at/touch affected

body part.

Encourage familymembers to treat clientnormally and not as an

invalid.

Heath teachingsrendered such as:a. Proper hygieneb. Increase protein

intake

b. Avoid lifting heavy

objectsd. Encourage daily

wound dressing anduse of antisepticsolutions.

To gain trust and betterunderstanding onpatients condition


To prevent airembolism and providehydration.

To indicate acceptanceor non-acceptance ofsituations.

To promote optimalhealing/adaptation.

To begin/to incorporatechanges in to bodyimage.

To promote self-esteemon the part of thepatient.

To prevent the spreadof microorganisms

To facilitate healing ofwound.

To prevent fatigue. To prevent further

complications andinfection.

The patient wasable to understandher situation


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PRESENTEDBY:

NOROA,MINNIE ROSE

ONA.TRISHADENISE

PACIA,DERRICK

PADUA,GENESIS

PADUA,SHERIL YN MARIE

001 breast cancer presentation

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