Case Study Of

Breast Cancer

In Partial Fulfillment Of the Requirements

For the Degree of Bachelor Of Science In Nursing

Submitted by:

BSN III- Batch 2017

Borre, Jessa Anne

Gervacio, Jonah Micah

Mangalus, Maribel

Pastrana, Izza Mae

Submitted to:

Ms. Khristine Gay Cunanan

Clinical Instructor

October 22, 2015

Present History of Illness :

As for her present illness, one week prior to admission, the patient felt a mass on her right upper breast and seek for medical attention.After having an examination on her breast, the physician advance to have a biopsy on her right upper breast. Without any hesitation the patient agreed to the said operation. The patient has Stage 2 hypertension and Type 2 Diabetes Mellitus for unknown cause.

Anatomy and Physiology

The breast is a mass of glandular, fatty and connective tissue. The breast is made up of:

lobules – glands that produce milk

ducts – tubes that carry milk from the lobules to the nipple

fatty and connective tissue – surrounds and protects the ducts and lobules and gives shape to the breast

areola – the pink or brown, circular area around the nipple that contains small sweat glands, which release (secrete) moisture as a lubricant during breast-feeding

nipple – the area at the centre of the areola where the milk comes out

Ligaments support the breast. They run from the skin through the breast and attach to muscles on the chest.

There are several major nerves in the breast area, including nerves in the chest and arm. There are also sensory nerves in the skin of the chest and axilla.

The breast lymph nodes include:

supraclavicular nodes – above the collarbone

infraclavicular (or subclavicular) nodes – below the collarbone

axillary nodes – in the armpit (axilla)

internal mammary nodes – inside the chest around the breastbone (sternum)

Function

The breast’s main function is to produce, store and release milk to feed a baby. Milk is produced in lobules throughout the breast when they are stimulated by hormones in a woman’s body after giving birth. The ducts carry the milk to the nipple. Milk passes from the nipple to the baby during breast-feeding.

Diet Exercise Post Operative Intervention.

Health Teaching.

- Increase food high in Protein and Fiber.

Breakfast- two eggs- 1/2 cup of mixed vegetable- 1 cup of raspberrie juice.

Lunch :>Stuffed baked potato made with:-1 whole potato (skin and flesh)-2 ounces broccoli, steamed-1 ounce cheddar cheese-2 tablespoons low-fat ranch dressing-2 slices bacon, crumbled.

- Daily Exercise by means of walking(Passive).

-Avoid strenuous activity(heavy lifting) and vigorous exercise(Jogging,Riding a bicycle and other out door games like basketball, soccer etc.)until the stitches are removed.

Dependent :

PAIN :- Assess for facial grimace, Irritability.- assess for location and intensity of pain. > Encourage to use relaxation techniques (Deep breathing exercise and listening in soft music).

SKIN INTEGRITY and INFECTION :- Assess for redness, Itchiness and numbness around the wound.> Keep the area clean and dry.> Use appropriate wound covering.( Gauze pad with saline water).

Independent :- Give prescribed medication. (Mefenamic Acid)

>Perform Deep Breathing exercise to reduce pain.

> -Avoid strenuous activity(heavy lifting) and vigorous exercise(Jogging,Riding a bicycle and other out door games like basketball, soccer etc.)until the stitches are removed.

- Early Ambulation. > Fast recovery.

> Encourage an increase in protein and calorie intake. - To aim time wound healing.(2-3 weeks)

> Observe aseptic technique in cleansing the area.>Instruct proper disposal of soiled dressing. -To prevent infection.

Discharge Plan

BLOOD CHEMISTRY- Is defined simply as identifying the numerous chemical substances found in the blood.

The analysis of these substances will provide clues to the functioning of the major body systems.

Fasting Blood Sugar (FBS)- is the test most commonly used to diagnose diabetes. It measures blood glucose levels

after a period of fasting, usually at least eight hours without food or liquid (except water).

Result Normal Values InterpretationFBS (Hexokinase) 5.59 mmol/L 3.89-5.49 mmol/L Increase Creatinine 66.00 umol/L 45-84 NormalSodium 139.20Potassium 4.20mmol/L 3.50-5.30 Normal

Interpretation:- When fasting the hormone glucagon is stimulated and this increases plasma glucose

levels in the body. Body produces insulin to rebalance the increased glucose levels.

COMPLETE BLOOD COUNT- is a blood test used to evaluate your overall health and detect a wide range of disorders,

including anemia, infection and leukemia. A complete blood count test measures several components and features of your blood, including: Red blood cells, which carry oxygen.

Prothrombin Time is a blood test that measures how long it takes blood to clot.

Result Normal Values InterpretationNeutrophils 42% 34.00-71.00 NormalLymphocytes 43.80% 19.00-52.00 NormalMonocyte 9.10% 5.00-12.00 NormalEosinophils 5.30% 1.00-7.50 NormalBasophil 0.80% 0.00-1.00 NormalProthrombin Time 12.10 sec. 12.60-15.20 DecreasePt. control 14.10 sec% Activity >150INR 0.82 0.80-1.20 NormalAlk. Phosphate 83 u/L 35-104 NormalSGOT/AST 28 u/L 0.0-24.0 NormalSGPT/ALT 46 u/L 0.0-34.0 Normal

Interpretation:- Blood clots is more quickly than expected because of Vitamin K supplementation and

Fresh frozen plasma transfusion

PLATELET COUNT- Is a lab test to measure how many platelets you have in your blood. Platelets are

parts of the blood that help the blood clot. 

Red Blood Cells- The blood cells that carry oxygen. Red cells contain hemoglobin and it is the

hemoglobin which permits them to transport oxygen (and carbon dioxide).

Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs.

Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells.

HematologyResult Normal Values Interpretation

WBC 5.26x10 g/L 3.98-10.04 NormalRBC 5.72x10 12/L 3.93-5.22 IncreaseHemoglobin 158.00 g/L 112.00-157.00 IncreaseHematocrit 0.46 0.34-0.45 IncreaseMean Corpuscular Vol

80-90 79.40-94.80 Normal

Mean Corpuscular Hb 27.60% 25.60-32.20 NormalMean Corpuscular HbConc

34.10% 32.20-35.50 Normal

RBC Distri Width 12.50% 11.60-14.60 NormalPlatelet AdequateMean Platelet Vol 10.10 L 6.50-12.00 Normal

Interpretation:- red blood cell production increases to compensate for chronically low blood oxygen

levels due to poor heart or lung function.

Interpretation:- increased demand for the oxygen-carrying capacity of red blood cells at higher altitudes

where there is decreased oxygen concentration in the atmosphere.

ULTRASOUND

- sound or other vibrations having an ultrasonic frequency, particularly as used in medical imaging.

ULTRASOUND OF THE BREAST

The breast parenchyma is homogeneous.

The clinically palpable hard mass at the right 9-10 o’clock gone B position sonographically corresponds in a microlobulated, markedly hypoechoic, taller-than-wide, solid focus punctate calcifications. It measures 2.06 x 1.88 x 2.93 cm. No significant internal vascularity was noted.

A 0.41 x 0.43 cm. small cyst is seen in the right 12 o’clock zone A position.

No focal lesions seen in the left.

The right nipple is inverted. The left nipple is unremarkable.

There is a 1.69 x 2.06 x 1.54 cm. ovoid hypoechoic focus in the right axillary region, likely enlarged lymph node.

The left axilla is unremarkable.

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RADIOGRAPHY

- Is an imaging technique that uses electromagnetic radiation other than visible light, especially X-rays, to view the internal structure of a non-uniformly composed and opaque object such as the human body.

RADIOGRAPHIC REPORT

There are no active lung parenchymal infiltrates.

The heart is enlarged with a cardiothoracic ratio of 0.6.

The trachea is midline.

The costophrenic angles and hemidiaphragms are intact.

The rest of the osseous structures and the soft tissues are unremarkable.

IMPRESSION:

NO SIGNIFICANT CHEST FINDINGS. No abnormal results noted.

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MAMMOGRAM

- An X-ray of the breast that is taken with a device that compresses and flattens the breast. A mammogram can help a health professional decide whether a lump in the breast is a gland, a harmless cyst, or a tumor.

MAMMOGRAM REPORT

Craniocaudal and mediolateral oblique views on both were obtained.

These are baseline mammogram.

Report of bilateral breast ultrasound done 10/8/15 was reviewed.

FINDINGSThere is moderately dense fibrograndular tissue with obscured nodularities.

There is a mass density with obscured and speculated borders and internal microcalcification in the right upper outer quadrant.

The right nipple is retroverted.

An enlarged node is seen in the right. Unenlargednode are also seen bilaterally.

IMPRESSION:RIGHT UPPER OUTER QUADRANT MASS WITH RIGHT AXILLARY LYMPHADENOPATHY.FINDINGS AS NOTED ABOVE, SEE RECOMMENDATION BELOW.

BI-RADS: CATEGORY 5- Highly suggestive of malignancy, appropriate action should be taken

RECOMMENDATION:Follow-up per established guidelines.

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ELECTROCARDIOGRAPHIC/ECG -  Is a test that checks for problems with the electrical activity of your heart.

An EKG shows the heart's electrical activity as line tracings on paper. The spikes and dips in the tracings are called waves. The heart is a muscular pump made up of four chambers.

Left ventricular hypertrophy is a condition in which the muscle wall of heart's left pumping chamber becomes thickened 

ELECTROCARDIOGRAPHIC REPORT

Rhythm: SINUS QRS Axis: +50

PR Interval: 0.16 QRS 0.08 QT: 0.40

Rate Arterial: 80 Ventriculars: 80

Interpretation:

NORMAL SINUS RHYTHYM

NORMAL AXIS

LEFT VENTRICULAR HYPERTROPHY

NON-SPECIFIC WAVE CHANGES