presentation of breast carcinoma by heena

57
J G COLLEGE OF NURSING AHMEDABAD SUB- MEDICAL SURGICAL NURSING TOPIC- BREAST CARCINOMA

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Page 1: Presentation of breast carcinoma by heena

J G COLLEGE OF NURSING AHMEDABAD

SUB-MEDICAL SURGICAL NURSING

TOPIC-BREAST CARCINOMA

Page 3: Presentation of breast carcinoma by heena

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

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• 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

Page 5: Presentation of breast carcinoma by heena

PRESENTING COMPLAINS• Patient having complained of following:• -Fever• -Pain in left breast• -heavyness in left breast• -Lump in left breast• -Anorexia• -Weight loss• -Undigesion•

Page 6: Presentation of breast carcinoma by heena

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.

Page 7: Presentation of breast carcinoma by heena

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.

Page 8: Presentation of breast carcinoma by heena

• 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 .

Page 9: Presentation of breast carcinoma by heena

DIET HISTORY:Jubedabivi’s family is non vegetarian so her family eats non vegetarian diet. He cooked all type of non vegetarian diet .

Page 10: Presentation of breast carcinoma by heena

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

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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.

Page 12: Presentation of breast carcinoma by heena

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 - -

Page 13: Presentation of breast carcinoma by heena

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.

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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

Page 16: Presentation of breast carcinoma by heena

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. •

Page 17: Presentation of breast carcinoma by heena

GENERAL APPERANCE:

Page 18: Presentation of breast carcinoma by heena

• 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

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• SKIN CONDITION:• Color: pallor• Texture: Rough skin• Temperature: warm• Lesions: no lesions present• HEAD & FACE:• Scalp: clean• Face: pale, fatigue, fear, anxiety

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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

Page 21: Presentation of breast carcinoma by heena

EAR•External ear: no discharge present•Hearing: normal

Page 22: Presentation of breast carcinoma by heena

NOSE:

•External nares: Redness present•Nostrils: normal. keeping face mask for proper oxygenation

Page 23: Presentation of breast carcinoma by heena

MOUTH & PHARYNX:

•Lips: dry •odour of the mouth: not present•Teeth: normal •Mucus membrane: dry •Tongue: pale and moist

Page 24: Presentation of breast carcinoma by heena

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.

Page 25: Presentation of breast carcinoma by heena

CHEST:

•Thorax: expansion •Breath sound: No any sound heard•Heart: normal

Page 26: Presentation of breast carcinoma by heena

ABDOMEN:

•Observation: no skin rashes and scar•Auscultation: reduced bowel sound•Palpation: no tenderness presentPercussion: not presence of gas, fluid or masses

Page 27: Presentation of breast carcinoma by heena

EXTREMITIES:

•Lower extremities: fully movements of lower extremities. mild oedema present•Upper extremities: can move both hands but mild oedema is present

Page 28: Presentation of breast carcinoma by heena

Genital and rectum:

•No enlarged inguinal lymph nodes, No hemorrhoids, no enlargement of prostate glands.

•Bladder & Bowel Pattern: Abnormal.

Page 30: Presentation of breast carcinoma by heena

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

Page 31: Presentation of breast carcinoma by heena

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

Page 32: Presentation of breast carcinoma by heena

X-RAY CHEST:

•Olcg in bothlungs

Page 33: Presentation of breast carcinoma by heena

• 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.

Page 34: Presentation of breast carcinoma by heena

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.

Page 35: Presentation of breast carcinoma by heena

• 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

Page 36: Presentation of breast carcinoma by heena

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.

Page 37: Presentation of breast carcinoma by heena
Page 38: Presentation of breast carcinoma by heena

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.

Page 39: Presentation of breast carcinoma by heena

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.

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Arterial and Lymphatic Anatomy of the Breast

Page 41: Presentation of breast carcinoma by heena

• 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.

• •

Page 42: Presentation of breast carcinoma by heena

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.

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CAUSES:

In Book In PatientHormonal imbalance

yes

Changes in DNA bond of cell

May be

Genetic abnormality any

no

Page 44: Presentation of breast carcinoma by heena

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.

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• 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.

Page 46: Presentation of breast carcinoma by heena

• 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.

Page 47: Presentation of breast carcinoma by heena

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

Page 48: Presentation of breast carcinoma by heena

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

Page 49: Presentation of breast carcinoma by heena

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.

Page 50: Presentation of breast carcinoma by heena

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.

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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.

Page 52: Presentation of breast carcinoma by heena

• 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.

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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 .

Page 54: Presentation of breast carcinoma by heena

• 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.

Page 55: Presentation of breast carcinoma by heena

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

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• 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.

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THANK YOU AND HAVE A NICE DAY