Question

Maria is a 45 year old mother of four, who, after a needle aspiration biopsy, is diagnosed mid having a malignant breast tumor, stage 2b., in her mammogram, each code at 2.3x4.5 cm related mass at 3:00 and in her left breast. In break up was negative distant metastases. The sentinel lymph node and 11-16 lymph nodes were positive for tumor cells. She was scheduled for a modified radical mastectomy with lymph nodes dissection. An assessment her breast tissue added dimpling for orange peel appearance. She is prescribed s therapy regimen of six cycles of CAF (cyclophosphamide [cytoxan], fluorouracil, [5 -FU], and doxorubicin [Adriamycin]). Nursing diagnosis include: (a) fear and ineffective coping related to the diagnosis and (b) disturbance in self-concept related to the nature of the surgery. She vaguely remember that term palliative treatment when discussing her situation with her provider but doesn't know what it means.
1. How would you describe treatment?
2. List three common presenting signs and symptoms breast cancer.
3. Describe the biopsy technique used to diagnose Maria’s cancer
4. Using TNM staging system, what would her classification be?
5. Surgical intervention is the primary treatment for breast cancer. Describe the surgical that Maria had
6. Maria asks why she has to have chemotherapy with so many drugs if the surgeon removed all of cancer. How would you respond?
7. Compare the drug actions of cyclophosphamide (cytoxan), fluorouracil (5 -FU), and doxorubicin (Adriamycin).
8. Knowing chemotherapeutic agents Maria has received, what laboratory data the nurse monitor?
9. How can you support Maria and her family at this time?
10. During her visit, Maria’s daughter questions how likely is to get cancer. What should the nurse explain to her about risk factors and screening test?
11. What is the priority teaching measures that should be included is the teaching plan for Maria and her family to prevent infection?
12. Based on the priority nursing diagnosis presented, design a patient based nursing care plan
13. Enumerate any collaborative problems let me her to the patient.
14. The nurse assesses Maria’s pain was operatively, with Maria stating the pain is an 8 on a scale of 0 – 10. What other factors can alter Maria’s perception of pain?
15. Create a schematic diagram of the pathophysiology of breast cancer.

Answer 1

answer1:

Palliative treatment received by the patient  can be described as explained below.

Palliative treatment is a treatment to reduce pain and relieve the symptoms thereby improving the quality of life in a disease setting which is disabling and cannot be cured.Palliative treatment is generally used in the advanced stages of cancer which cannot be cured by the standard therapy and here the therapy is used in the forms of chemotherapy, radiotherapy, hormone therapy, targeted drug therapy in order to shrink the tumor and prevent it from spreading further thus improving the patient's symptoms and pain and the quality of life such that the patient has a comfortable life.

Since Maria has presented with an advanced breast tumor with skin changes[dimpling and peau'd orange appearance of the skin] nodal metastasis,she has been given palliative chemotherapy in the form of 6 cycles of cyclophosphamide, 5 fluorouracil and adriamycin to decrease the tumour size and downstage the disease.

answer 2:

The three common presenting signs and symptoms of breast cancer are listed below:

Symptoms are the patient complaints that cause the patient to seek medical consultation and signs are the findings which are found on the physical examination of the patient by the medical personnel.

The three common presenting symptoms of breast cancer are:

1.Lump or swelling in the breast or the underarm :The patient may notice a lump or swelling in the breast incidentally while bathing or while feeling oneself and seek medical attention for the same.

2. Bloody nipple discharge: The patient may experience altered or bloody nipple discharge with/without pressing the breasts/nipple and staining of the undergarments/clothes due to the bloody discharge.

3.Swelling ,redness and pitting of the breast skin on one side with discomfort and pain: These symptoms are more specific to the patients who have invasive breast cancer and seek consultation for the visible skin changes of the breast cancer.

Nipple changes such as elevation of the nipple. red flaky skin over the nipple. nipple retraction or inversion may be also reported by the patient.Jaundice and bone pains may be reported by the patient in the late presentations.

The three common presenting signs of  breast cancer

1.Hard breast lump: The common symptom observed in the palpatory findings of the breast cancer patients is the presence of hard irregular breast lump in one or more quadrants of the breast partly other adherent to the surrounding breast tissue and generally not freely mobile within the breast .Additionally lymph nodes sweelling may be palpated in the axillary/supraclavicular regions.

2. Changes in the nipple: There may be difference in the levels /symmetry of the nipples on both the sides with the nipple of the affected side [with the breast cancer] elevated. The nipple may be retracted or inverted in case of subareolar malignancies.There may be presence of bloody nipple discharge.

3.Peau’d orange appearance of the breast skin:Inflammatory breast skin, Red,flaky nipple skin.

The skin overlying the tumor may show changes of intermittent pitting and swelling due to the infiltration of the subcutaneous lymphatics by the breast cancer cells thereby causing a characteristic orange peel appearance of the breast skin. The skin may also show changes of puckering or dimpling due to the involvement of Sir Astley Cooper's ligaments or inflammatory changes with,swollen, red and tender skin as seen in inflammatory breast cancer.

The signs of hepatomegaly and bony tenderness may be observed in late metastatic stages along with brawny induration and cancer-en-curaisse of the arm on the affected side due to severe lymphatic obstruction.

Answer3. Description of  the biopsy technique used to diagnose Maria’s cancer: Needle aspiration biopsy

Needle aspiration biopsy was used for the breast biopsy of Maria to diagnose the breast cancer .The technique is described below.

1. The location of the tumor is ascertained on clinical examination with correlation to the mammographic and the ultrasonographic findings. A fine hollow needle with syringe is inserted through the skin so as to reach the tumor.

2.The skin is prepared with antiseptic solution before inserting the needle and strict aseptic precautions are followed.The.procedure is generally performed without anesthesia and slight discomfort exists as the needle is inserted into the breast.

3. The syringe is pulled back upon reaching the tumor mass as can be felt by entry into a hard tissue and the tumor tissue is aspirated into the needle , thereby taking an aspiration biopsy from the tumor tissue. In order to ensure adequacy of the sample, several needle insertions may be required in some cases.Post procedure patient may be advised rest,breast support,painkillers and antibiotics

4. The breast biopsy tissue is obtained by aspirating breast tissue into the needle using negative pressure generated by pulling back of the syringe.The breast tissue thus obtained is sent for histopathological examination for the presence of tumor cells..The biopsy reports the breast tissue as normal,benign ,atypical/indeterminate or malignant .The presence of the breast tumor cells in the histopathology confirms the diagnosis of breast cancer.

5.Complications: The common complications are pain,local redness,bruising, swelling, local infection, hematoma at the site of the biopsy. Misdiagnosis due to a false negative biopsy is possible if the needle tip is not in the tumor tissue at the time of aspiration.

6.The procedure can be performed blindly or under ultrasound guidance or stereotactic mammographic guidance .The sensitivity of fine needle aspiration biopsy for breast cancer is around 80 to 90% and specificity is around 90 to 95%

7.Core biopsy/ open surgical biopsy may be performed in cases where the fine needle aspiration biopsy fails to yield adequate sample for histopathology diagnosis