OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF NURSING

CASE STUDY

Invasive Ductal CarcinomaBreast Cancer Stage III

Submitted by:

Kim Charmaine M. Rodriguez

BSN 4Y1-1C

Submitted to:

Ms. Lasanas RN

March 27, 2014

I. Introduction

1. Description of the disease

Breast cancer is the most common malignancy in women and the second leading cause of cancer death (exceeded by lung cancer in 1985). Breast cancer is three times more common than all gynecologic malignancies put together. The incidence of breast cancer has been increasing steadily from an incidence of 1:20 in 1960 to 1:7 women today.

Breast cancer is not exclusively a disease of women. For every 100 women with breast cancer, 1 male will develop the disease. The American Cancer society estimates that 1,600 men will develop the disease this year. The evaluation of men with breast masses is similar to that in women, including mammography.

The incidence of breast cancer is very low in the twenties (age) gradually increases and plateaus at the age of forty-five and increases dramatically after fifty. Fifty percent of breast cancer is diagnosed in women over sixty-five indicating the ongoing necessity of yearly screening throughout a woman's life.

Breast cancer is considered a heterogeneous disease, meaning that it is a different disease in different women, a different disease in different age groups and has different cell populations within the tumor itself. Generally, breast cancer is a much more aggressive disease in younger women. Autopsy studies show that 2% of the population has undiagnosed breast cancer at the time of death. Older women typically have much less aggressive disease than younger women.

Inflammatory breast cancer is a unique and uncommon type of breast cancer. It is unique in that inflammatory breast cancer does not produce a distinct mass or lump that can be felt within the breast. The lack of a lump or mass also makes inflammatory breast cancer difficult to detect by mammograms. Inflammatory breast cancer cells infiltrate the skin and lymph vessels of the breast. When the lymph vessels become blocked by the breast cancer cells the breast typically becomes red, swollen, and warm. The skin changes associated with inflammatory can cause the breast skin to look like the skin of an orange a finding called peau d'orange. The appearance of the breast is similar to other inflammatory conditions such as cellulitis or mastitis. Other possible associate symptoms include enlarged lymph nodes under the arm or above the collar bone on the affected side.

Inflammatory breast cancer is diagnosed based upon the results of a biopsy and the clinical judgment of the treating physician. Typically, inflammatory breast cancer grows rapidly and requires aggressive treatment. There are two aspects to treating all breast cancer, local treatment and systemic or total body treatment. Because inflammatory breast cancer is aggressive, most oncologists recommend both systemic and local treatment. The typical sequence of treatment is to start with chemotherapy, systemic treatment, followed by surgery and radiation therapy, which are the local treatments, often followed by additional chemotherapy and possibly hormone treatments. With aggressive treatment using this multimodality approach, the 5 year survival for inflammatory breast cancer has improved significantly from an average survival of 18 months to an approximately 50% survival rate at 5years.

2. Objective (Nurse-cantered)

As the case study progresses the group aims to achieve the following objectives:

Define the disease condition; its signs and symptoms, understand risk factors, pathophysiology, and its underlying complications

Know the effect of the condition to its family members or significant others and try to help them on how to manage such illness

Develop nursing care and diagnosis related to the illness

Create plan of care that is conducive for the patient

Give recommendation, home care, and stress management for the family members

1. Personal History

a. Demographic Data

Name: Mirabella

Age: 47 y/o

Sex: Female

Civil Status: Married

Position: Mother

Address: Salvador, Lanao Del Norte

Nationality: Filipino

Birth date: March 3, 1967

Birth place: Lanao Del Norte

Date of Admission: March, 20, 2014 7:33am

b. Socio-Economic and Cultural factors

b.1 Occupation mode of expenditure

Unemployed, full time housewife

Husband works as a military officer

B.2 Educational Attainment

College Graduate – Midwife

B.3 Religious Affiliation

Islam

B.4 Cultural factors affecting health of the family

N/A

2. Family-Health Illness History

a. Hereditary Disease in the FamilyDiabetes Mellitus - male

b. Existing disease in the family - female

Diabetes and Cancer

- DM

- Cancer

3. History of past Illness

a. Disease or ailments relevant to patient condition

N/A

b. Diseases not related to patient’s condition ( co-morbid condition)N/A

4. History of present Illness

a. Chief ComplaintDizziness and vomiting; and for chemotherapy

b. Sequence of the appearance of signs and symptoms ( include time frame ) up to the time patient was admitted

Started in the morning PTA is vomiting assisted by dizziness BP 140/90.

Father:

Daniel Padilla

Mother:

Mariel Padilla

Patient

Physical Assessment (IPPA – Cephalocaudal approach)

General Appearance:

- Mental state awake and conscious

- Placed on a supine position

- Physique with normal body built

- Easy fatigability and with guarding behaviour

Vital Signs:

8am 12pm

T=37.2 0 C T= 37 0 C

P= 89 bpm P= 833 bpm

R= 24 bpm R= 22 bpm

BP= 130/80 mmHg BP= 120/80 mmHg

SKIN: with poor skin turgor, dry lips, fair complexion, no lesions noted

HEAD: round and symmetrical to the body, no signs of any bruises or lesions upon

palpation, no lumps, with short falling hair

EYES: eyes symmetrical, anicteric sclera, no discharges noted, (+) PERRLA, able to move

eyes in different directions, pale conjunctiva

EARS: symmetrical, no discharges noted, no obstruction, no lesions

NOSE: symmetrical and at midline, no discharges, no lesions, nostrils patent, no tenderness,

no lesions

MOUTH AND THROAT: dry mucous membranes, no distention of neck veins

CHEST AND LUNGS: no bruises or lesions, no lumps noted, no abnormal breath sounds

upon auscultation

HEART: heartbeat is audible with regular rhythm and normal rate

ABDOMEN: no abdominal tenderness

GENITO URINARY: urine is color yellow to amber, voids frequently and doesn’t complain of

any pain during voiding.

EXTREMITIES: no presence of lesions or bruises, with poor skin turgor, both arms and legs

symmetrical, poor muscle tone,

Discharge Planning

a. General Condition of Client upon discharge

Upon discharge, patient is still experiencing body weakness and dizziness; light pain in lumbar area; coherent and alert; poor skin turgor.

b. METHOD

M= to continue meds as prescribed by AP. Hydrocele 500mg tab BID, Vitamoren cap OD, tramadol HCl 325mg OD

E= Passive ROM exercises as instructed; ADL as tolerated

T= Ø

H= take frequent rests; avoid over exerting self, precautions when moving around, increase fluid intake of at least 3L/day to prevent further complication in

the kidney; instructed patient to continue meds. regular exercise as tolerated to prevent body weakness

O= Ø

D= DAT

Learning Derived

I have learned a lot from this case study. Through this requirement, I am not able to

know more about breast cancer, the disease process, signs and symptoms and

management of this disease whether independent, interdependent or dependent.

One learning I knew through this case study is proper assessment. I believe that

assessment is the most important part of nursing process. The diagnosis, planning and

interventions are all drawn from a correct assessment. In line with this proper and

comprehensive assessment; student nurses should bare in mind that they should not only

rely on what is written in the chart in giving care; Independent nursing function, common

sense and devotedness to your profession goes hand in hand with the proper care given to

our clients off course accompanied with TLC to gain the trust and confidence of the pt. and

the SO. Also, during the NPI remember that patient education or proper health teachings

should be given so as the pt. and SO are informed about important matters, procedures and

care given regarding the patients’ welfare. With that, I am able to contribute to the

maintenance and promotion of health, rehabilitation and prevention of further complications

of our patient.