Question

Chapter 51 Breast Disorders

Breast Cancer      

Patient Profile

S.H., a 38-year-old married woman, goes to see her health care provider after noticing a lump in her left breast. She had two miscarriages (G2, P0). Her mother had breast cancer at age 65 years, and one sister was diagnosed with breast cancer at age 42 years

Subjective Data

• Felt a lump in her breast while showering a few days ago, and it has not gone away

• Ex-smoker, smoked one-half pack of cigarettes for 3 years; quit at age 21 years

• Drinks one to two glasses of wine/day

Objective Data

Physical Examination

• Temperature 98.2°F, pulse 84, respirations 16, blood pressure 118/72, oxygen saturation 99%

• Height 5'6", weight 155 lb, BMI 25 kg/m²

• A firm, nonmobile and nontender mass, larger than the size of a pea, is palpable in the upper, outer quadrant of left breast

• Some swelling and tenderness palpable in left axillary nodes

• Lungs clear

Diagnostic Studies

• Mammogram shows dense breast tissue; some microcalcifications in both breasts; and a 5-cm mass in the upper, outer quadrant of the left breast

• Fine-needle biopsy shows infiltrating lobular carcinoma that is both estrogen- and progesterone-receptor positive

• Sentinel node biopsy shows two positive lymph nodes

Interprofessional Care

S.H. receives a diagnosis of stage IIB breast cancer. Based on the findings and her family history, S.H. decides to undergo a left modified radical mastectomy.

Case Study Questions

1. What is the significance of S.H. having a sentinel node biopsy performed?

2. What would you teach S.H. prior to having her modified radical mastectomy, especially relating to expectations of after surgery (what would she need to know post-surgery in helping her heal?) Student must least at least six:

1.

2.

3.

4.

5.

6.

3. What is one significant post-surgery complication which could develop in S.H.?

1.

4. What are three nursing diagnoses either pre or post-operative for S.H.? Make one of the diagnosis a psychosocial one, include all threes aspects of diagnoses.

1.

2.

3.

5. A. What are risk factors that play a role in developing breast cancer? Student must list at least four.

1.

2.

3.

4.

B. And list two factors that perhaps played a role in S.H. developing breast cancer: Student must list at least two:

1.

2.  

6. Who are other disciplines to include in providing interprofessional/collaborative care for S.H.? Student must list at least five:

1.

2.

3.

4.

5.

7. Once surgery has been completed, what relevant clinical assessment data would you need to closely monitor in detecting a possible change in status? Student must list at least six:

1.

2.

3.

4.

5.

6.

Reference:

Harding, M. M., Kwong, J., Roberts, D., Hagler, D., and Reinisch, C. (2020). Lewis’s

     Medical-Surgical Nursing: Assessment and Management of Clinical Problems(11^th Edition),

     St. Louis Missouri: Elsevier.

Answer 1

Case study questions

1. Sentinal node biopsy will helps to assess the tumour weather it has make a spread into the lymphatic system.

2 sentinal nodes are the nodes which the tumour mostly first drains. So this will help the surgeon to remove those cancer affected nodes of the lymphatic system.

3. Sentinal lymph node biopsy will helps to assess the stage of cancer and status of spreading to the other lymph nodes.

4. She must be educated regarding the post op complications such as infection swelling soareness etc..

5.immobilisation of the left hand is needed after surgery and procedures must be avoided in the left hand especially B P monitoring, RBS monitoring etc...

6 explain to the patient regarding the importance of rest after surgery. Swelling and pain will be there. And a drain will be present till 5 to 10 days after surgery.

7 she must be asked for help for all the things what ever she needed so that proper rest can be given. Also she must be take the pain medication to relive the pain to gain comfort.

8 she must taught regarding keeping her arm above heart level after surgery and importance of starting mild exercise one day after surgery.

Post surgery complication

The most important complication after radical mastectomy is the issues with the wound healing process.

This includes

Swelling

Hematoma

Dehiscence

Skin necrosis

Chronic seroma

Nursing diagnosis fo SH

1. Situational low self esteem due to psychosocial factors like treat of death, feelings of lack of control and doubt regarding acceptance by others.

2. Anticipatory grieving related to loss of psychological wellbeing like loss of body part, change in body function, and change in lifestyle.

3.Acute pain related to disease condition mainly by compression or destruction of nerve tissues, obstruction of a nerve path way or inflammation.

A..Risk factors

1. Family history

2 gender

3.Age

4 Alcoholism and smoking

B..

1 Family history

2 Alcoholism and smoking.

Providing collaberative care fo SH is by

1. Surgical oncologist.

2 radiation oncologist.

3.research nurse

4. Social worker.

5 oncology nurse adviser.

Relevant clinical assessment data to monitor after the surgery

1. Patient vital signs

2. Airway patency and neurological status.

3. Surgical site assessment including dressing and any signs of bleeding.

4 maintain the fluid and electrolyte balance.

5 patency of drain.

6. Assess level of consciousness and pain status.

7. Watch for any complications..