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RISK
FACTORS
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et: iet may contribute to evelopment or growth o breast cancers, but conclusive evi ence about the e ect o a particular iet (eg, one high in ats) is lacking. bese postmenopausal women are at i et: iet may contribute to evelopment or growth o breast cancers, but conclusive evi ence about the e ect o a particular iet (eg, one high in ats) is lacking. bese postmenopausal women are at i et: iet may contribute to evelopment or growth o breast cancers, but conclusive evi ence about the e ect o a particular iet (eg, one high in ats) is lacking. bese postmenopausal women are at i
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Mrs. X was a 57 years old Filipino female who was born on April 13,
1952. She lives in Calamba, Laguna. Her religious affiliation is
Baptist. She is married and has 3 children who are all now stable and
have their own career. Mr. X her husband is a jeepney driver. Mrs. X
is not obese because she is physically active in her household
chores. She has enough sleep, usually about 8 hours a day and feels
complete. She told us that she is neither engaged to smoking nor
drinking. According to Mr. X, his wife has a very good appetite, she
eats everything but his favorites are fatty foods specially if it is grilled.
Mrs. X has hypertension, diabetes, asthma and cancer in both side of
her family. She was hospitalized last December 8, 2009 because she
experienced local breast pain, and when she examined her breast
she felt a lump. She taught that the cause of the pain was just only
because she got tired cleaning their backyard, but when the pain got
worst she decided to consult her doctor. She had undergone several
laboratory examinations such as ECG, blood chemistry, coagulation
factors, urinalysis and hematology. Later on she was diagnosed withmass at left lower outer quadrant of her breast that measures about 6
x 7cm by her attending physician Dr. Joseph Eric R. Fernandez, M.D.
After the diagnosis, she was scheduled for operation on December
10, 2009 forMRM. The operation was successful and he has now
had drainage in her left part of the breast. Mrs. XXX was fully
recovered and was discharge on December 17, 2009.
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PHYSI LSSESSMENT
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ANATOMY
AND
PHYSIOLOGY
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ANATOMY AND PHYSIOLOGY
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C INICA
MANIFESTATIONS
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Local Pain
Local obstruction caused by the tumor.
Dimpling ofthe skin
Can occur with invasion of the dermal lymphatics because of retraction of Cooper
ligament or involvement of the pectoralis fascia.Nipple dischargein a non lactating women
Spontaneous and intermittent discharge caused by tumor obstruction.
Skin retraction
Involvement of the suspensory ligaments .
Edema
Local inflammation or lymphatic obstruction.
Nipple/areola eczema
Presence of malignancy in the ductal system below the nipple.Pitting ofthe skin
This is similar to the surface of an orange
Obstruction of the subcutaneous lymphatics, resulting in the accumulation of fluid.
Reddened skin, local tenderness and warmth
Inflammation
Dilated blood vessels
Obstruction of venous return by a fast-growing tumor; obstruction dilates
superficial veins.Ulceration
Tumor necrosis
Hemorrhage
Erosion of blood vessels.
Edema ofthe left arm
Obstruction of lymphatic drainage in the axilla.
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LABORATORYRESULTS
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Examination Results Normal Values Findings
Sodium 144.50 135-145 mmol/L NORMALPotassium 3.78 2.4-5.3 mmol/L NORMAL
Fasting Blood Sugar 5.9Blood Urea Nitrogen 4.6 2.8-6.4 mmol/L NORMALBlood Urea Ammonia 450 144-342 Urinary Tract
Obstruction
Creatinine 71 53-115 umol/L NORMALCholesterol 3.87 4.2-5.2 mmol/L NORMALTriglycerides 1.14 0.41-2.37 mmol/L Biliary obstruction,
nephritic syndromeHigh DensityLipoprotein
1.4 0.25-2.65 mmol/L NORMAL
Low DensityLipoprotein
2.6 1.1-2.6 mmol/L NORMAL
BLOOD HEMISTRY
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Examination Results Normal Values Findings
Protime 13.3 sec 11-14 sec NORMALINR 0.99 0.8-1.2 NORMAL% Activity 103% 70-120% NORMAL
PT Control 13.2 sec. 11-14 sec NORMALPTT 27.8 sec 27-34 sec NORMAL
INR1.08
0.8-1.2 NORMALPTT Control 33.6 sec 27-34 sec NORMAL
COAGULATION ACTORS
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URINALYSIS
1. Physical Examination 3. Microscopic Examination Cells
Color Yellow
Appearance Slightly Hazy
Specific
Gravity
1.010
2. Chemical Examination 4. Crystals
pH 8.0
Glucose Negative
Protein +2
Ketones NegativeBilirubin Negative
Urobilinogen Normal
Blood/Hgb +1
Nitrite Negative
Leukocytes +3
Pus Cells 60-70/hpf
RBC 10-12/hpf
Amorphous Urates FEW
Bacteria FEW
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DIAGNOSTICPROCEDURE
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a) Self-examination - 90% of the breast masses are
discovered by the patient herself. From this manner,
self-examination appears as one of the most
important measures for the early diagnosis of breast
cancer, once it: allows the detection of small masses;
is an useful, convenient, profitable, advantageous
and opportune method: can be repeated as many
times as necessary; has no cost; is easy to be done;
its precision increases with practice.
Self-examination must be performed 7-8 days after
menstruation by every woman with more than 20
years old, in order to detect early changes in breast
parenchyma.
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PROPOSEDDIAGNOSTIC
PROCEDURES
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DRUGSTUDY
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NURSINGCAREPLAN
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Assessment Diagnosis Planning Implementation
ationale valuation
ubjective:
Masakit ang akingdibdib as verbalized bythe client.
Objective:
conscious andcoherent
afebrile with body malaiseguarding behavior
with slight pain at leftchest-pain scale of7/10 (faces pain scale)
with limited range ofmotion
negative difficulty ofbreathing
Acute chest pain related topost operative surgery asevidenced by guardingbehavior.
At the end of nursingintervention the clientspain will lessened.
Establish urse-clientinteraction
Take and record vitalsign
Check and regulateIVF
Provide therapeuticenvironment.
Note pain includingthe location, duration,frequency andintensity.
eassesseach time painoccurs/is reported.
Provide comfortmeasures such as:
a.
epositioning every 4hrs.
b. Back massage.
Provide relaxationtechnique such as
a. deep breathingexercises
b. yawning
Encourage adequaterest period.
To gain trust andbetter understandingon patients condition
Serve as baseline dataof the patient
To prevent airembolism and providehyration.
Environment has agreat impact onclients health andwellness
To rule out worseningof underlyingcondition/development of complications.
To avoid bed soresand other
complication and topromote non-pharmacological painmanagement.
To lessen the intensityof pain felt by the
client To distract attention
and reduce tension.
To prevent fatigue.
Goal was met.Pain scale lessened
from 7/10 to 4/10
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Assessment Diagnosis Planning Implementation Rationale
valuation
ubjective:
Hindi ako masyadongmakagalaw kapagsumasakit ang dibdib koas verbalized by the client.
Objective:
conscious and coherentafebrile with body malaisePale in appearancewith limited range of
motionnegative difficulty of
breathing
Impaired physical mobilityrelated to decreased musclestrength as evidenced bylimited body movementsand body malaise
At the end of nursingintervention the client willregain strength and be ableto increased mobility.
Establish urse-clientinteraction
Take and record vitalsign
Check and regulate IVF
Provide therapeuticenvironment
Heath teachingsrendered such as:a. Proper hygiene
b. Apply passiveROM
Instruct patient tochange position side toside every 4 hrs.
Support affected bodyparts or joins usingpillows or footsupports.
Massage and stretchextremities within theclients reached.
Instruct activities suchas:
a. socialize with patientsSO
b. read newspaperc. listening to musicd. Encourage
participation in self
care.
To gain trust and betterunderstanding o npatients condition
Serve as baseline dataof the patient
To prevent airembolism and providehydration.
Environment has agreat impact on clientshealth and wellness.
To prevent the spreadof microorganisms
To preventcontractures
To reduce risk ofpressure ulcers.
To maintain position offunction
To preventcontractures andincrease mobility of theextremities.
To divert attention ofthe patient and toenhance self conceptand sense ofindependence.
Client was able toperform activitieswithout complaintsof pain
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Assessment Diagnosis Planning Implementation Rationale
valuation
ubjective:
Katatapos ko lang
operahan,nakakahiya naang itsura ko verbalized bythe client.
Objective:
conscious and coherentafebrile irritablePale in appearancediaphoreticwith surgical dressing,dry and intact at left
breast
Disturbed body image
related to post surgicalprocedure as manifested byirritability.
At the end of nursing
intervention the client willbe able to verbalizeunderstanding of bodyimages.
Establish Nurse-clientinteraction
Take and record vitalsign
Check and regulate IVF
Evaluate level ofclients knowledge ofand anxiety related to
situations. Observeemotional changes.
Assist in correctingunderlying problems
Encourage client tolook at/touch affected
body part.
Encourage familymembers to treat clientnormally and not as an
invalid.
Heath teachingsrendered such as:a. Proper hygieneb. Increase protein
intake
b. Avoid lifting heavy
objectsd. Encourage daily
wound dressing anduse of antisepticsolutions.
To gain trust and betterunderstanding onpatients condition
Serve as baseline dataof the patient
To prevent airembolism and providehydration.
To indicate acceptanceor non-acceptance ofsituations.
To promote optimalhealing/adaptation.
To begin/to incorporatechanges in to bodyimage.
To promote self-esteemon the part of thepatient.
To prevent the spreadof microorganisms
To facilitate healing ofwound.
To prevent fatigue. To prevent further
complications andinfection.
The patient wasable to understandher situation
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PRESENTEDBY:
NOROA,MINNIE ROSE
ONA.TRISHADENISE
PACIA,DERRICK
PADUA,GENESIS
PADUA,SHERIL YN MARIE