Download - BREAST CA
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.