presentation of breast carcinoma by heena
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J G COLLEGE OF NURSING AHMEDABAD
SUB-MEDICAL SURGICAL NURSING
TOPIC-BREAST CARCINOMA
IDENTIFICATION DATA• PATIENT’S NAME: Jubedabivi Bharubhai Kakar• IPD . NO: F 45314• AGE:54 years• SEX:Female• DATE OF ADMISSION`: 2-1-2012• DR’S UNIT: Unit-2 Dr.prakash patel• WARD: cancer female medical ward• MARRITAL STATUS: married
• RELIGIO: Muslim• EDUCATION: 5th std .• OCCUPATION: House wife• ADDRESS: Sendava Taluko-Badwana, District-
Badwada, State-Madhya Pradesh• DIAGNOSIS: Breast carcinoma Stage-3.• OPERATION: Total Mastectomy• OPERATION DATE:4 -1-2012• HEIGHT: 146Cm• WEIGHT: 67Kg
PRESENTING COMPLAINS• Patient having complained of following:• -Fever• -Pain in left breast• -heavyness in left breast• -Lump in left breast• -Anorexia• -Weight loss• -Undigesion•
PRESENT HISTORY:
• Jubedabivi was asymptomatic before 1year than she develop pain in left breast and heaviness in the breast, this time she was admit for total mastectomy for breast carcinoma stage -3.
PAST HISTORY:• PAST MEDICAL HISTORY:• Jubedabivi was asymptomatic before 1
year than develop pain in the left breast and heaviness in the breast thus she went to privet hospital for tacking treatment but symptoms not relived finally she refered in v.s.hospital for further treatment and no any major history of major treatmemt.
• PAST SURGICAL HISTORY:• Before five month she had
done biopsy for the breast lump in the v.s.hospital and finally diagnose the carcinoma breast .
DIET HISTORY:Jubedabivi’s family is non vegetarian so her family eats non vegetarian diet. He cooked all type of non vegetarian diet .
PERSONAL HISTORY• Diet : Non vegetarian & taking all type of small amount
diet • Appetite : Decreased• Sleep :disturb• Micturation : No burning micturation• Bowel habit: Abnormal habits• Smoking : No• Alcohol : No• Drugs : No• Tobacco : No• No any other habits
FAMILY HISTORY• In her family no any family members
have history of any Hypertension, Diabetes mellitus, Ischemic heart disease, Epilepsy, Asthma, Storks, Arthritis, Cancer or any other disease. Her father suffering from the tuberculosis and expired with this disease.
Sr.No.Name of Family
Members
Age in Year
Relationship
With patient
EducationOccupatio
n
1 Bhurabhai kakar
6oYrs. Husband Old S S C Retired Railwaym
an2 Jubedabivi
Kakar54Yrs Patient 3rd pass Housewife
3 Musabhai Kakar
40Yrs Son 12th pass Raiway
driver4 Naseembiv
i Kakar.37Yrs Son’s wife 7th pass Housewife
5 Raja Kakar 10Yrs Grand son 5th std -6 Rafic
Kakar6 Yrs Grand son - -
SOCIOECONOMIC HISTORYIn her family her husband is retired person and her son is working in railwayHer family earn around 24,000 thousand rupees in the month and saving about the 2500 rupees per month.
PHYSICAL EXAMINATION• VITAL SIGN
Date Temp ( F) Pulse (/min)
Respiration(/min)
BP (mm of Hg)
4-1-2012 100 F 100/min 24/min 116/74
5-1-2012 99 F 126/min 26 min 116/64
6-1-2012 99 F 120/min 26 min 114/78
7-1-2012 98.6F 116/min 24 min 118/74
8-1-2012 98.4 F 110/min 24 min 110/70
GENERAL OBSERVATION:• Sensorium: She is conscious and well
oriented• Foul body odour: no any bad odour
from her body• Foul breath : no • Posture : normal• Hair: Brown hair, clean no any
dandruff. •
GENERAL APPERANCE:
• Body image: normal • Health: Unhealthy • Activity: less active• MENTAL STATUS:• Consciousness: conscious • Look: weakness, fatigue due to her disease.• Posture• Body curves: normal • Movement: Full movement(if given deep pain than
small reflection was done by patient)• • Height: 146cm Weight: 67kg
• SKIN CONDITION:• Color: pallor• Texture: Rough skin• Temperature: warm• Lesions: no lesions present• HEAD & FACE:• Scalp: clean• Face: pale, fatigue, fear, anxiety
EYES:
•Eyebrow: normal•Eye lashes: no infection, not open by patient•Eyelids: no any injury or oedema is present•Eye balls: not sunken•Conjunctiva: pale•Sclera: no jaundiced •Pupils: constricted •Vision: react to light
EAR•External ear: no discharge present•Hearing: normal
NOSE:
•External nares: Redness present•Nostrils: normal. keeping face mask for proper oxygenation
MOUTH & PHARYNX:
•Lips: dry •odour of the mouth: not present•Teeth: normal •Mucus membrane: dry •Tongue: pale and moist
NECK:•Lymph node: Not palpable•Thyroid gland: normal •Range of motion: flexion, extension and rotation when done by someone, patient able to done by own self.
CHEST:
•Thorax: expansion •Breath sound: No any sound heard•Heart: normal
ABDOMEN:
•Observation: no skin rashes and scar•Auscultation: reduced bowel sound•Palpation: no tenderness presentPercussion: not presence of gas, fluid or masses
EXTREMITIES:
•Lower extremities: fully movements of lower extremities. mild oedema present•Upper extremities: can move both hands but mild oedema is present
Genital and rectum:
•No enlarged inguinal lymph nodes, No hemorrhoids, no enlargement of prostate glands.
•Bladder & Bowel Pattern: Abnormal.
INVESTIGATION:
Serum Biochemistry test:Investigation In patient Normal value
HemoglobinRBCUREAWBCS.creat.SGPTS. phosphateS.BillirubinBLOOD CHEMISTERYFASTINGCHOLESTROL
12 % gm%100 mg/dl24mg/dl9,200/cumm0.59mg/dl36U/L 108 U/L0.7mg/dl
90.0mg/ dl174 mg/dl
14 – 17 gm %.153mg/ml15-45mg/dl4000-11000/cumm0.7-1.5mg/dl0-55U/L<50-150U/L0.2-1.2mg/dl
70-110mg/dl>240.0mg/dl
Serum Electrolytes:
Investigation In patient Normal value
S. Na+S.K+Chloride
144.3 meq/L4.62 meq/L105
135145meq/L3.5-5.5 meq/L97-108
X-RAY CHEST:
•Olcg in bothlungs
• ECG:• wnl• Ultrasound-• 4.5*3.9cm lesion seen in the left breast.
• MRI Breast-• 5*4*3cm lesion seen in the left breast. • MEMOGRAPHY DONE-• There is Lesion spread in to ipsilateral mammary
lymph nodes and tumor sie is more than 5cm.
MEDICATION• CHEMOTHERAPY GIVEN AFTER SURGERY• -Injection Adriamycin and cyclophosphamide
regimen every 3week for four cycle.• -Injection amikasine 500gm i/v 12hourly.• -Injection dynapar 1 ampoule i/v 12hourly. • - Injection Pentoprajol 1 vial i/v 12 hourly.• - Injection Glucose 5% 1 litre i/v slowly.
• Maintain intake and output chart daily• Contineus observation of the patient on monitor for
any abnormal symptoms. • TPR chart 1 hourly Monitoring continuously for
blood pressure, respiration rate, pulse, and for oxygen saturation.
• Care taken of catheter daily • Care taken of all tubes which are inserted • Watched for respiratory failure .• Changed the dressing and adhesive tap at the site of
intracath
DISEASE CONDITIONKnowing the various parts of the breast, what they do and why they're important is critical to identifying any abnormalities that might appear in your breasts. Understanding female breast anatomy can help you understand which changes are normal and healthy, and which may signal disease.
Female Breast Anatomy• Although the human breasts are located over the pectoral muscles of
the chest wall, the human breast doesn't actually contain any muscle tissue. Your breasts, which are made up of glandular, fatty and fibrous tissues, have a number of different functional parts:
• Areola (colored area around the nipple)• Blood vessels and lymph vessels• Ducts (milk passages)• Fatty tissue• Fibrous tissue that surrounds the lobules and ducts• Lobes• Lobules (milk glands)• Nipple.• A layer of fatty tissue surrounds the breast glands and runs
throughout the entire breast. This layer of tissue gives the female breast its soft consistency.
Female Breast Milk Production• Each breast has 15 to 20 sections (or "lobes") beneath the
nipple and areola, arranged in a circular pattern that resembles a daisy. Lobes are part of the milk production system; each lobe contains many smaller milk-producing glands called "lobules." Each lobule has tiny bulbs, called "alveoli." When a woman is lactating, the alveoli produce milk in response to hormonal signals.
• When milk is produced, the ducts transport it from the lobules to the nipple. As each duct gets closer to the nipple, it widens to form a sac called an "ampulla." The spaces between the lobules and the ducts are filled with fatty tissue, connective tissue and ligaments. As the milk production system is roughly the same size in all women, breast size and shape depend on the amount of fat in the breasts.
Arterial and Lymphatic Anatomy of the Breast
• Arteries and capillaries carry oxygen- and nutrient-rich blood to the breasts. The axillary artery, which extends from the armpit, supplies blood to the outer half of the breast. The internal mammary artery, which extends down from the neck, supplies blood to the inner part of the breast.
• The human breast also contains lymph vessels. The lymphatic system is part of your immune system and contains blood vessels, lymph ducts and lymph nodes. These work to fight off harmful or infectious substances within your body. Clusters of lymph nodes are located under your arm, above your collarbone, behind your breastbone and in various other parts of your body.
• •
DEFINITION: • Breast cancer is a malignant (cancerous)
growth that begins in the tissues of the breast. Cancer is a disease in which abnormal cells grow in an uncontrolled way. Breast cancer is the most common cancer in women, but it can also appear in men. In the U.S., it affects one in eight women.
CAUSES:
In Book In PatientHormonal imbalance
yes
Changes in DNA bond of cell
May be
Genetic abnormality any
no
PATHOPHYSIOLOGY:
• Breast cancer, like other cancers, occurs because of an interaction between the environment and a defective gene.
• Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues.
• Cells become cancerous when mutations destroy their ability to stop dividing, to attach to other cells and to stay where they belong.
• When cells divide, their DNA is normally copied with many mistakes. The mutations known to cause cancer.
• These mutations are either inherited or acquired after birth. Presumably, they allow the other mutations, which allow uncontrolled division, lack of attachment, and metastasis to distant organs.
• Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.
• Failure of immune surveillance, the removal of malignant cells throughout one's life by the immune system.
• Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.
• In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer.
CLINICAL MENIFESTATION:
In Book In PatientLump in breast Present
Thickening in the breast Present Change the size and shape of the breast
Present
Nipple discharge PresentChange size and shape of the nipple
Present
Chang color of the nipple and the areola
Present
Raches seen on the skin
Present
Skin edema Present
ASSESSMENT & DIAGNOSTIC FINDINGS:
IN BOOK IN PATIENT- Taking a thorough
history including family history
- Done
- Physical examination (note BP & weight)
- Done
- Laboratory work (cholesterol levels, glucose )
- Done
-Ultrasound - Done - Breast MRI - done- Memography - Done
MANAGEMENT:• MEDICAL MANAGEMENT:• Chemotherapy in four cycle with Adreamycine and
cyclophosphemide.• Analgesics • Antibiotics • SURGICAL MANAGEMENT:• Prepare for Total mastectomy of the patient.• Preoperative advice given to the parents signature
taken for operation, nil by mouth after 10pm before operation day.
NURSING MANAGEMENT• Identify at risk patients, & teach lifestyle
modifications to prevent development any complication.
• Teach patient to control cholesterol levels through dietary reduction of cholesterol intake, exercise, smoking cessation.
• Note & report findings from history, physical examination, & laboratory results that indicate hypertension or diabetes, & teach to control blood pressure by taking treatment in the nearest hospital.
•
NURSING DIAGNOSIS: • Altered skin integrity related to bed
ridden condition as evidence by redness on back side.
• Risk for infection related to presence of dressing at suture site.
• Altered body temperature due to presence of infection.
• Imbalance nutritional level less than body requirement related to loss of appetite.
• Activity intolerance related to surgery done.
• Impaired body image due o surgeory.• Altered self image and confidence due to
fegure.
HEALTH TEACHING:• Arrange specific services for patient(e.g.
respiratory therapy education, physical therapy for exercise & breathing)
• Explain patient’s reletives about discharge planning.
• Give advice about regular medication as per timing.
• Explain and demonstrate about chest physiotherapy by doing deep breathing exercise .
• Explain and demonstrate about coughing and how to remove cough.
• Advice given about good nutritive .
• Advide given for prevention of infection management.
• Explain about follow up care.
BIBLIOGRAPHY:• Bennette and Plum; “TEXTBOOK OF
MEDITION ; 10thedition, 1996;• W.B. Saunders Company, New York :
1996. PP : 789-794 • Black J.M; “MEDICAL SURGICAL
NURSING; 5th edition, 1999• ; W.B. Saunders Company,
Philadelphia. PP: 1217-1242
• Brunners & Suddarth’s; “TEXT BOOK OF MEDICAL SURGICAL
• NURSING VOL-_1”;10th edition, 2004; Elsevier Publishers, New Delhi,
• India. PP: 684-740 • • B T Basavanthappa;”TEXT BOOK OF NURSING
THEORIES”,Jaypee brothers Medical Publishers ,New Delhi.• PP: 40-• WEBSITES:
• http://www.wikipedia.com.• http://www.patho.coronaryarterydisease.org/.com.in• http://www.google.com.• http://www.medicine.com.
•
THANK YOU AND HAVE A NICE DAY