Case Study-breast Ca

CASE STUDY: BREAST CANCER

Submitted by: Joanna Marie A. Cabildo Submitted to: Ms. Gabriel

Introduction Breast cancer is the most common malignancy in women and the second leading cause of cancer death, exceeded only by lung cancer in 1985. One woman in eight who lives to age 85 will develop breast cancer at some time during her life. Breast cancer (malignant breast neoplasm) is a cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas. There are many different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup; survival varies greatly depending on those factors. Computerized models are available to predict survival. With best treatment and dependent on staging, 10-year disease-free survival varies from 98% to 10%. Treatment includes surgery, drugs (hormonal therapy and chemotherapy), and radiation. Breast cancer is not just a woman's disease. The American Cancer Society estimates that 1600 men develop the disease yearly and about 400 may die from the disease. Breast cancer risk is higher among those who have a mother, aunt, sister, or grandmother who had breast cancer before age 50. If only a mother or sister had breast cancer, your risk doubles. Having two first-degree relatives who were diagnosed increases your risk up to five times the average. Early signs of breast cancer include the following: A lump which is usually single, firm and most often painless is detected. -An area of the skin on the breast or underarm is swollen and has an unusual appearance. -Veins on the skin surface become more prominent on one breast. -The affected breast nipple becomes inverted, develops a rash, changes in skin texture, or has a discharge other than breast milk. -A depression is found in an area of the breast surface. At present there are over 2 million women living in the United States who have been treated for breast cancer. About 41,000 women will die from the disease. The chance of dying from breast cancer is about 1 in 33.

However, the rate of death from breast cancer is going down. This decline is probably the result of early detection and improved treatment.

THEORETICAL FRAMEWORK Jean Watson’s (1979-1985) Theory of Human Caring. She emphasized that nursing is the application of the art and human science through transpersonal caring transactions to help persons achieve mindbody-soul harmony, which generates self-knowledge, self-control, self-care, and self-healing. She included health promotion and treatment of illness in nursing. She believed that a person is a valued being to be cared for, respected, nurtured, understood and assisted; a fully functional integrated self. The Ten Carative factors, transpersonal caring relationship and the caring occasion constitute the elements of Jean Watson’s Theory of Human Caring. Her ten carative factors are viewed as the guide of a nurse in honoring the human dimensions of nursing’s work and the inner life world. These carative factors point to the aspects of nursing which affect the one caring and the one being cared for thereby potentiating the therapeutic healing processes. The ten carative factors included in her work are the following: (1) Formation of a humanistic-altruistic system of values. (2) Instillation of faith-hope. (3) Cultivation of sensitivity to one’s self and to others. (4) Development of a helping-trusting, human caring relationship. (5) Promotion and acceptance of the expression of positive and negative feelings. (6) Systematic use f a creative problem-solving caring process. (7) Promotion of transpersonal-teaching learning. (8) Provision of a supportive, protective and corrective mental, physical , societal and spiritual environment. (9) Assistance with gratification of human needs. (10) Allowance for existential-phenomenologicalspiritual forces (Watson, 1979).

I. Patient’s Profile Name: Tabanquil, Adoracion Age: 73 Gender: Female Religion: Roman Catholic Occupation: None Address: Mayantoc, Tarlac Date of Admission: July 25, 2010 Admitting Diagnosis: Invasive ductal CA L II. History of Present Illness Admitted for several times from e-ward per wheel chair accompanied by husband, for 3rd cycle chemotherapy. III. Past Medical History ( + ) History of stroke ( + ) HPN ( + ) DM type II ( + ) CVD ( + ) Pulmonary disease IV. Physical Examination -Patient is conscious, coherent, alert and not in cardiorespiaratory distress. - Anecteric sclerae - No scar, no lesion, no TPC - Wheezes (-), rales (-), ronchi (-) IV. Family History ( - ) HPN ( - ) Acute MI ( - ) DM ( - ) Stroke

( ( ( (

-

) ) ) )

Kidney disease Cancer PTB Others

V. Personal Social History Occupation: (present) – none (previous) – Grade school teacher ( + ) Smoking (quit 20 years ago) ( - ) Alcohol use ( - ) Illicit drug use

DIAGNOSTIC PROCEDURES (1) CHEST CT SCAN Date of examination: July 25, 2010 CT scanning—sometimes called CAT scanning—is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. CT of the chest is used to: • Further examine abnormalities found on conventional chest xrays. • Help diagnose the cause of clinical signs or symptoms of disease of the chest, such as cough, shortness of breath, chest pain, or fever. • Detect and evaluate the extent of tumors that arise in the chest, or tumors that have spread there from other parts of the body. • Assess whether tumors are responding to treatment. • help plan radiation therapy. (2) GRAM STAIN -Gram staining is an empirical method of differentiating bacterial species into two large groups (Gram-positive and Gram-negative) based on the chemical and physical properties of their cell walls. The Gram stain is almost always the first step in the identification of a bacterial organism. Date of Examination: July 29, 2010 Specimen: Pleural fluid Result: No organism seen (3) URIINALYSIS- analysis of the urine. It is performed by collecting a urine sample from the patient in a specimen cup. Usually only small amounts (1015 ml's) may be required for urinalysis testing. Date of examination: July 29, 2010 Color: Yellow Transparency: Turbid Ph: 7.5 Specific Gravity: 1.005 (4) HEMATOLOGY – the scientific study of blood and blood-forming tissues. Date of examination: August 3, 2010 Normal values

Resul t

Hemoglobi n Hematocrit

120-160 gm/L 0.37- 0.47

145

Lymphocyt

0.20- 0.40

0.30

0.44

Interpretation Normal- adequate oxygen-carrying protein and deliver it to the body tissue Normal- adequate proportion of total blood volume made up of red blood cell. Normal- No presence of infection.

e Eosinophil 0.01-0.05 0.07 Due to presence of Neoplastic disease. Basophils 0.0-0.01 0.01 Normal (5) Chest X-ray- The chest x-ray is the most commonly performed diagnostic x-ray examination. An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. Date of examination: August 05, 2010 Findings: Pleural effusion – Bilateral SPECIAL PROCEDURES

(1) THORACENTESIS- is an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes. *The most common causes of pleural effusions are cancer, congestive heart failure, pneumonia, and recent surgery. Date: August 04, 2010

(2) CLOSED TUBE THORACOSTOMY (CTT) Date: August 11, 2010

ANATOMY AND PHYSIOLOGY Female Breast

The female breast is made up mainly of • Lobules (milk producing glands) • ducts (any tubes that carry the milk from the lobules to the nipple) • stroma (fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels) T h e

L y m p h a t i c

S y s t e m

The lymph system is important to understand because it s one of the ways in which breast cancers can spread. This system has several parts. Lymph nodes are small, bean-shaped collections of immune system cells (cells that are important in fighting infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Lymph contains tissue fluid and waste products, as well as immune system cells. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes. Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes).Some lymphatic vessels connect to lymph nodes inside the chest (internal mammary nodes) and those either above or below the collarbone (supraclavicular or infraclavicular nodes).

PATHOPHYSIOLOGY OF BREAST CANCER Predisposing Age Gender Family history

Precipitating -Exposure to radiation and certain chemicals

Etiology Unknown

Somatic mutations in the DNA

Activate oncogene / deactivate tumor suppressor gene

Neoplasm formation in the breast

Primary tumor begins in the breast

If treated: -Surgery -Chemotherapy -Radiotherapy

If not treated

Tumor becomes invasive Cancer cell destroyed

Progressed beyond the breast to regional lymph node. Compromise the functions of the major organs DEATH Travel to other organ system

DISCHARGE PLAN

Medication: * Give adequate instructions to the significant others about the importance of the following medications and dietary regimens so that the patient’s condition can remain stable as soon as possible. Exercise: * Encourage or teach the patient the proper breathing exercises. * Allow the patient to verbalize her feelings. Treatment: * Chemotherapy * Encourage the patient to have a strict compliance with regards to the medication to attain therapeutic effects. Health Teachings: * Practice good general hygiene. * Advise to have a clean, quiet, well ventilated room, conductive to rest and relaxation. OPD Check-up: * Instruct the patient and family to return to their attending physician for scheduled follow up visit Diet: * Low salt, low fat. * DM diet @ 1000 Kcal /day

Spirituality: * Encourage the patient to read the Bible and pray to God always, ask for guidance and pray for the healing and restoration of health.