Question

The RN is developing a plan of care for a 35-year-old female, newly diagnosed with breast cancer. Assessment findings include: the patient is teary and states, “I haven’t been sleeping since the diagnosis.” The patient doesn’tmake eye contact, has difficulty sitting still and her voice is trembling. Her mucous membranes are dry and she says she has not had an appetite. She says, “I don’t know if I am going to need surgery to remove my breasts. I don’t know how it will make me feel or look”.

• Develop a 3-part actual nursing diagnostic statement, related to therapeutic communication, stress and adaptation OR patient teaching. Use the patient data in the scenario, including the problem, etiology and symptoms.
• Develop a patient specific, measurable outcome with a time-frame, appropriate for your chosen diagnosis and this patient.
• Explain why this diagnosis is a priority for this patient.

Nurses cannot use medical diagnosis such as breast cancer in a nursing diagnosis as nurses are not doctors and cannot medical diagnose. Other answer for this are incorrect. The diagnosis of breast cancer cannot be used in the nursing diagnosis.

Answer 1

Breast cancer is a leading killer in women aged between 20 - 30 years and its most common in patients with family history. Complete history and physical examination should be done in a woman with a new breast mass.

Nursing Diagnosis:

1.   Impaired Verbal Communication

May be related to

• Fatigue
• Depression

Possibly evidenced by

• Patient trembling voice

Desired Outcomes

• Patient expresses thoughts and feelings in a coherent, logical, goal-directed manner.
• Patient demonstrates reality-based thought processes in verbal communication.
• Patient spends time with one or two other people in structured activity neutral topics.
• Patient spends two to three 5-minute sessions with nurse sharing observations in the environment within 3 days.
• Patient communicates in a manner that can be understood by others with the help of medication and attentive listening by the time of discharge.
• Patient learns one or two diversionary tactics that work for him/her to decrease anxiety, hence improving the ability to think clearly and speak more logically.
• Patient uses a form of communication to get needs met and to relate effectively with people and his or her environment.

Nursing Interventions

• Maintain eye contact with patient when speaking. Stand close, within patient’s line of vision (generally midline).
• Give patient adequate time to respond
• Use clear and short sentences
• Never hurry the patient while communicating
• Use positive words while communicating

2.   Anticipatory Grieving

Grieving: A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives

May be related to

• Anticipated loss of physiological well-being (e.g., loss of body part; change in body function); change in lifestyle

Possibly evidenced by

• Changes in eating habits, alterations in sleep patterns, activity levels, and communication patterns

Desired Outcomes

• Identify and express feelings appropriately.
• Continue normal life activities, looking toward/planning for the future, one day at a time.
• Verbalize understanding of the dying process and feelings of being supported in grief work.

Nursing Interventions:

• Assess patient for stage of grief being experienced
• Provide open, nonjudgmental environment. Use therapeutic communication skills of Active-Listening, acknowledgment, and so on.
• Encourage verbalization of thoughts or concerns and accept expressions of sadness, anger, rejection. Acknowledge normality of these feelings.
• Visit frequently and provide physical contact as appropriate, or provide frequent phone support as appropriate for setting. Arrange for care provider and support person to stay with patient
• 3. Fear/Anxiety

Fear: Response to perceived threat that is consciously recognized as a danger.

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

May be related to:

• Situational crisis (cancer)
• Threat to/change in health/socioeconomic status, role functioning, interaction patterns
• Threat of death
• Separation from family (hospitalization, treatments), interpersonal transmission/contagion of feelings

Possibly evidenced by:

• Increased tension, shakiness, apprehension, restlessness, insomnia
• Expressed concerns regarding changes in life events
• Feelings of helplessness, hopelessness, inadequacy
• Sympathetic stimulation, somatic complaints

Desired Outcomes:

• Display appropriate range of feelings and lessened fear.
• Appear relaxed and report anxiety is reduced to a manageable level.
• Demonstrate use of effective coping mechanisms and active participation in treatment regimen.

Nursing Interventions:

• Review patient’s and SO’s previous experience with cancer. Determine what the doctor has told patient and what conclusion patient has reached
• Provide open environment in which patient feels safe to discuss feelings or to refrain from talking
• Encourage patient to share thoughts and feelings
• Maintain frequent contact with patient. Talk with and touch patient as appropriate.
• Permit expressions of anger, fear, despair without confrontation. Give information that feelings are normal and are to be appropriately expressed

4.   Altered Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements:

May be related to

• Hyper metabolic state associated with cancer
• Emotional distress, fatigue, poorly controlled pain

Possibly evidenced by

• Reported inadequate food intake, altered taste sensation, loss of interest in food, perceived/actual inability to ingest food

Desired Outcomes

• Demonstrate stable weight/progressive weight gain toward goal with normalization of laboratory values and be free of signs of malnutrition.
• Participate in specific interventions to stimulate appetite/increase dietary intake.

Nursing Interventions

• Monitor daily food intake; have patient keep food diary as indicated.
• Daily measure height and weight of the patient
• Assess the dietary needs of the patient
• Identify patient likes and dislikes
• Encourage patient to eat high-calorie, nutrient-rich diet, with adequate fluid intake. Encourage use of supplements and frequent or smaller meals spaced throughout the day.
• Create pleasant dining atmosphere; encourage patient to share meals with family and friends.
• Assess skin and mucous membranes for pallor, delayed wound healing, enlarged parotid glands.