BREAST CANCER
CASE STUDY
Sabtirul, Shun, Susulan and Tusin
CONTENTS
● PATIENT DATA
● HISTORY
● CASE SCENARIO
● ASSESSMENT
● DRUG STUDY
“For two months, I fear I have seen that
near the right breast in the armpit, I feel
a hard mass, which does not move and
also my nipple is peeling and sunken.”
Patient Data
Name of patient: Rosa Irigoyen
Age: 52 years old
Place of birth: Medellin, Colombia
Place of residence: Bogota D.C
Marital status: Married
Profession: Lawyer, works in Attorney General office
Vital signs: BP: 120/70 mmHg, PR:72 bpm , RR 24 bpm, T: 36.5, O2: 98%.
Chief complains: Hard mass near the right breast, nipple is peeling and sunken.
Diagnostics: Tumor Marker Test, Positron Emission Tomography (PET)
Final diagnosis: Metastasis breast cancer, stage 2.
LMP: Menopause
History:
● Patient had hysterectomy (surgical removal of the womb (uterus), and
Adenectomy (surgical removal of all or part of a gland). on November 12,2015.
● Two pregnancies a curettage a cesarean in 1994
● Was infected by Human papillomaviruses (HPV) in 1999.
● Neoplastic lesion in the uterus , chemotherapy treatment started with Cisplastin
and 5Fu Fluorouracil.
Breast Cancer Physical Assessment:
● Size:2-5 cm
● Shape: inverted
● Hard consistency, with irregular borders
● not painful
● Nipple is retracted ,thicken ,peeling (orange peel skin), sunken and swelling.
Vital Signs:
Blood Pressure: 120/70 mmHg
Pulse Rate: 72 bpm
Respiration Rate: 24 breaths per minute
Temperature: 36.5 degrees celsius
Oxygen Saturation: 98%
DRUG STUDY
Drug data Indication/ Mechanism of Side Effects Nursing Responsibility
Drug study
Contraindication Action
Chemical name: Indication: Herceptin works by ● Fever ● Monitor vital signs
-Trastuzumab attaching itself to the ● Nausea before/after
- HER2-positive HER2 receptors on the administering the
● Vomiting
breast cancer surface of breast drug
Brand Name: cancer cells and ● Diarrhea ● Assess the patient
- Herceptin blocking them from ● Infections condition for a
Contraindication: receiving growth ● cough possible infusion
Route: ● Anemia signals. By blocking the ● Headache reaction
- I.V infusion ● Heart failure signals, Herceptin can ● Rash ● Monitor IV site
● Cardiomyopathy slow or stop the growth ● Infusion reaction carefully to avoid
● Interstitial of the breast cancer. extravasations or
Dosage:
pneumonitis Herceptin is an
- 375mg/multidose vial example of an immune infection.
● Pregnancy
● acute respiratory targeted therapy. In ● Do not add to other
Frequency: distress addition to blocking IV solutions or mix
- 30-90 minutes syndrome HER2 receptors, with other
every three weeks Herceptin can also help medications
fight breast cancer by ● Monitor or ask the
alerting the immune
patient if she is
system to destroy
cancer cells onto which experiencing any
it is attached. side effects
Drug Data Indication/ Mechanism of Action Side Effects/ Nursing
Contraindication Adverse Responsibilities
Effects
Brand Name: Indication: Estrogens are mainly derived -Hot flashes --Remind patients that
Anastrazole is used to from the action of the aromatase -Muscle/Joint they should not be
-Anastrazole taking any medication
treat breast cancer in enzyme, which converts adrenal pain
women after androgens (primarily -Stomach Upset containing estrogen
Generic Name: menopause. It androstenedione and -Decreased while taking anastrozole
decreases the amount testosterone) to estrone and energy --Discuss methods of
Arimidex
of estrogen the body estradiol. The suppression of -Mood coping with hot flashes,
makes to slow or estrogen biosynthesis in disturbances such as avoiding
Route: reverse the growth of peripheral tissues and in the -Sore throat caffeine, using fans,
- Oral dressing in layers, and
these breast cancers. cancer tissue itself can therefore -High blood
wearing lightweight
be achieved by specifically pressure
cotton clothes.
Dosage: Contraindication: inhibiting the aromatase -Depression --Monitor and check
-Pregnant or enzyme. -Nausea that drug is taken at the
- 1mg tablet breastfeeding women. -Anastrozole is a selective non- -Vomiting same time everyday.
-Patients with known steroidal aromatase inhibitor. It -Rash --When a drug is
Frequency: hypersensitivity to the significantly lowers serum -Osteoporosis missed, instruct to take
-Once a day active substance estradiol concentrations and has -Headache the drug as soon as
anastrozole no detectable effect on formation -Peripheral remembered not unless
of adrenal corticosteroids or Edema it is time for the next
aldosterone. dose.
DRUG NAME Dosage, ACTION/ INDICATION CONTRAINDI ADVERSE NSG.
Frequency, & CLASSIFICATION CATION EFFECT RESPONSIBILITY
preparation
Generic Name: Available Potent Treatment Contraindicat CNS: Alert women with
Tamoxifen forms: antiestrogenic metastatic ed with Depression,ligh DCIS and those at
Citrate effects: Competes breast cancer allergy to theadedness, high risk for breast
Tablets- 10,20 with estrogen for in women tamoxifen headache, cancer of risk for
Brand Name: mg; oral binding sites in and men; in pregnancy, corneal serious potentially
Apotamox, tissues, such as the premenopau lactation, opacity, fatal drug effects;
Solatamox, Adults: breast. sal women women who decrease discuss benefits
Tamofen Breast with require visual acuity, versus risks.
Cancer: 20- metastatic concomitant retinopathy,
40 mg/day PO breast coumarin- CVA. Administer BID in the
for 5 yrs. cancer; type morning and in the
Dosage of tamoxifen is anticoagulatio Dermatologic: evening
more than 20 an alternative n therapy or Steven-
mg/day should to in women Johnson Counsel patient use
be given in oophorectom with history of syndrome, hot contraception while
divided doses, y or ovarian DVT or PE flushes, rash. taking this drug;
morning and irradiation. Inform patient that
evening. (BID) GI: nausea serious fetal harm
Treatment of and distaste, could occur.
node positive alterations in
breast cancer liver enzyme.
in post
menopausal
women
following total
mastectomy or segmental Side effects of Report
mastectomy, axillary dissection tamoxifen may
marked
And breast irradiation. weakness,
include: sleepiness,
Treatment of axillary node mental
negative breast cancer Menopause-like confusion,
following total mastectomy or symptoms, pain or
segmental mastectomy, axillary including hot swelling of the
dissection and breast legs
flashes,
irradiation. shortness of
night sweats and breath blurred
Reduction in risk of invasive vaginal dryness, vision.
breast cancer in women with Weight gain (more
ductal carcinoma in the common) or fluid
following breast surgery and
radiation. retention (edema),
Irregular or loss of
Reduction in occurence of menstrual periods
contralateral breast cancer in ,Leg swelling,
patient receiving adjuvant
Nausea,
tamoxifen therapy for breast
cancer. Vaginal discharge,
Skin rash,
Reduction in incidence of
breast cancer in women at high Erectile dysfunctio
risk for breast cancer. n
Unlabeled use: treatment of ,Fatigue,
mastalgia; use for decreasing Headaches.
pain and size of gynecomastia.
References
● https://www.rxlist.com/herceptin-drug.htm#warnings
● https://www.scribd.com/document/427763081/Breast-CA-Drug-Study
● https://my.clevelandclinic.org/health/drugs/9785-tamoxifen
● https://www.scribd.com/document/26990513/tamoxifen-drugstudy
NCP & FDAR
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATE
Subjective: Deficient After 8 hours of Independent After 8 hours of
“For two months I have seen that knowledge nursing nursing intervention
near the right breast in the armpit, regarding illness. intervention the ● Provide clear, accurate the patient was able
I feel a hard mass/lump, which patient verbalize information in a factual to verbalize accurate
does not move and also my nipple acute information but sensitive manner. information about the
is peeling and sunken what
about the illness Answer specifically, but illness.
should I do?” As verbalized by the
patient. do not details.
● Provide anticipatory
Objectives: guidance with patient
● Statement of regarding treatment
misconception about the protocol, length of
signs and symptoms therapy, expected
present. results, possible side
● Lump at the right side effects. Be honest with
breast in the armpit the patient.
● Neeple is peeling and
sunken. ● Review with patient
● V/S taken as follows: importance of
maintaining optimal
Blood Pressure: 120/70 mmHg nutritional status.
Pulse Rate: 72 bpm
Respiration Rate: 24 breaths per
minute
Temperature: 36.5 degrees celsius
Oxygen Saturation: 98%
● Encourage diet
variations and
experimentation in
meal planning and food
preparation.
● Recommend increased
fluid intake and fiber in
diet, as well as routine
exercise.
DATE OF SHIFT TIME Focus NURSING PROGRESS, NOTES (DATA, ACTION,
AND RESPONSE)
JULY 22, 2021 8:00 AM Early signs and
symptoms of breast D- “Having early signs and symptoms of breast cancer based on the
cancer statement of the patient. The lump near the right breast and that the
mass is big as the pingpong ball and does not move. and also the
nipple is peeling and sunken.
Blood Pressure: 120/70 mmHg
Pulse Rate: 72 bpm
Respiration Rate: 24 breaths per minute
Temperature: 36.5 degrees celsius
Oxygen Saturation: 98%
A- Educated patient on early screening of breast cancer and
treatment, Provide anticipatory guidance with patient regarding
treatment protocol, length of therapy, expected results, possible side
effects. Be honest with the patient.
R- The patient stated that she feel more relaxed and comfortable
knowing that she have been able to detect her illness before it gets
worse and will undergo treatment as early as possible.
SN CI /Staff
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Subjective cues: Anxiety After 8 hours of Encourage patient to share thoughts After 8 hours of
“For two months have related to nursing and feelings.- Provides opportunity nursing intervention,
health status intervention, the to examine realistic fears and the patient was able
seen that near the
patient will be able misconceptions about diagnosis. to:
right breast in the
armpit, I feel a hard to:
Provide open environment in which Display appropriate
Control anxiety
mass, which does not patient feels safe to discuss feelings range of feelings and
responses and or to refrain from talking.- Helps lessened fear.
move and also my use effective
nipple is peeling and patient feel accepted in present
coping strategies condition without feeling judged, Appear relaxed and
sunken.” throughout the and promotes sense of dignity and report anxiety is
treatment period control. reduced to a
Objective cues: manageable level.
Nervousness, Rapid Explain procedures, providing
breathing and sweating opportunity for questions and Demonstrate use of
V/S taken as follows: honest answers. Stay with patient effective coping
Blood Pressure: 120/70 during anxiety-producing mechanisms and
mmHg procedures and consultations.-- active participation in
Pulse Rate: 72 bpm Accurate information allows patient treatment regimen.
Respiration Rate: 24 to deal more effectively with reality
breaths per minute of situation, thereby reducing
Temperature: 36.5 anxiety and fear of the unknown.
degrees celsius
Oxygen Saturation: 98%
DATE OF SHIFT TIME FOCUS Nursing Progress Notes (Data,Action and Response)
07/22/2021 8:00 AM Decrease the D- The patient verbalized that she is anxious about
anxiety level of her condition.
the patient
Vital Signs:
Blood Pressure: 120/70 mmHg
Pulse Rate: 72 bpm
Respiration Rate: 24 breaths per minute
Temperature: 36.5 degrees celsius
Oxygen Saturation: 98%
A- Assist patient and SO in recognizing and clarifying
fears to begin developing coping strategies for
dealing with these fears. Encourage patient to share
thoughts and feelings.
R-The patient displayed appropriate range of
feelings and lessened fear.She appears to be
relaxed and report anxiety is reduced to a
manageable level.
SN CI /Staff
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Subjective cue: Disturbed body After the 8 hours of • Be realistic and positive After the nursing
-The patient stated “i can image related to nursing intervention during treatments in health intervention the patient
see that there's changes patient nipple’s the patient will be teaching and in setting goals was able to
on my right nipple and it is appreance. able to accept body within limitations.- Enhances trust incorporate body
peeling and sunken”. changes without and rapport between patient and changes into self-
negating the the nurse. concept without
patient’s self negating self-esteem.
Objective cue: esteem. • Encourage patient to
Irritability monitor the site of the nipple and
Doleful assist with care as appropriate. -
Promotes acceptance and reality of
change in body and image of self
V/S result: as different
Blood Pressure: 120/70
mmHg • Provides hope with
Pulse Rate: 72 bpm parameters for the patient; do not
Respiration Rate: 24 give false reassurance. - Promotes
breaths per minute
Temperature: 36.5 degrees positive attitude and provides
celsius opportunities to set goals and plan
Oxygen Saturation: 98% for future based on reality.
• Encourage family
interaction with each other. -
Maintains lines of communication
and provides ongoing support for
the patient.
DATE OF SHIFT TIME FOCUS Nursing Progress Notes (Data,Action and Response)
07/22/2021 8:00 AM Acceptance of D- The patient verbalized that she is worried on the
body changes hard mass on her right breast and her nipple is
without negating sunken and peeling.
the patient’s self
esteem. Vital Signs:
Blood Pressure: 120/70 mmHg
Pulse Rate: 72 bpm
Respiration Rate: 24 breaths per minute
Temperature: 36.5 degrees celsius
Oxygen Saturation: 98%
A- Assist the patient with care to view the site of the
nipple and Be realistic during treatments in health
teaching. Encourage the patient by providing hope
with assurance to boost patient self esteem.
R-The patient stated that she feels more positive to
pursue her medications after the nursing intervention
and she feels more confident enough to face her
condition.
SN CI /Staff
Health Teaching
1. Breast
self-exam
Become familiar with your breasts through breast self-
exam for breast awareness. Breast awareness can't
prevent breast cancer, but it may help you to better
understand the normal changes that your breasts undergo
and identify any unusual signs and symptoms.
Self-breast exams are a great way to find breast cancer
early. Whether it is a lump, an irregularity, or something
just doesn’t feel right, you’re often the first and best line of
defense for early detection
3 STEPS BREAST SELF -EXAMINATION
A. Stand in front of a mirror
Examine your breasts with hands at sides, then
clasped overhead. Look for changes in size or
shape, or nipple changes. Squeeze both nipples
between thumb and forefinger to check for
discharge. Then press hands on hips and push
elbows forward to tighten chest muscles. Look for
dimpling, puckering, redness, scaliness or changes
in shape, size, and texture or skin color. B. In the shower.
BSE is easier when your skin is wet and
soapy. In the shower, raise your right arm
above your head. Think about the BSE
grid, as you cover your entire breast area,
using the “touch technique”.repeat for the
left side.
C. Lying down.
Lying down helps to flatten the breast, making it easier to examine
the breast tissue by pressing it.
Firmly against the chest wall. Place a pillow under right shoulder.
Begin at the armpit and make a series of three small circles. Use
light, medium and deep pressure. Think about the BSE grid pattern
and begin again. Cover your entire breast area. Repeat for left side.
2. Limit postmenopausal hormone
therapy.
· Combination hormone therapy may increase the risk of
breast cancer. Some women experience bothersome
signs and symptoms during menopause and, for these
women, the increased risk of breast cancer may be
acceptable in order to relieve menopause signs and
symptoms. To reduce the risk of breast cancer, use the
lowest dose of hormone therapy possible for the shortest
amount of time.
3. Healthy lifestyle
● Drink alcohol in moderation, if at all. Limit the amount of
alcohol you drink to no more than one drink a day, if you
choose to drink.
● Exercise most days of the week. Aim for at least 30
minutes of exercise on most days of the week.
● Maintain a healthy weight. If your weight is healthy, work to maintain
that weight. If you need to lose weight, ask your doctor about healthy
strategies to accomplish this. Reduce the number of calories you eat
each day and slowly increase the amount of exercise.
● Choose a healthy diet. Women who eat a Mediterranean diet
supplemented with extra-virgin olive oil and mixed nuts may have
a reduced risk of breast cancer. The Mediterranean diet focuses
mostly on plant-based foods, such as fruits and vegetables, whole
grains, legumes, and nuts. People who follow the Mediterranean
diet choose healthy fats, such as olive oil, over butter and fish
instead of red meat.
Laboratory result
Test Result Nursing implication
HER2 POSITIVE A test for the expression
(human epidermal growth factor of HER2 proteins or the
receptor 2) is a gene that can amplification of the
play a role in the development genes that codes for the
of breast cancer
protein: tumors that are
positive may respond
well to a medication
PR; Also called PgR ) Increase Increase levels suggest
a good response to
Estrogen receptor hormonal therapy
/progesterone receptor
GRADES:
Leader:
Susulan, Abdelmar G. 99/100
Members:
SABTIRUL, FATIMA RAYHANA SAPPAYANI: 99/100
Shun, Edrina: 99/100
Tusin, Patricia mae Linggih: 99/100
