27748338 Breast Cancer Case Study

8/8/2019 27748338 Breast Cancer Case Study

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I N T R O D U C T I O N

We acquire the strength of what we have overcome.

Ralph Waldo Emerson

So many women you know may have had breast cancer

friends and neighbors, coworkers, relatives. It seems as if

every time you turn around, breast cancer is being talked

about in the newspaper or on TV. You may be fearful of

developing breast cancer for the first time or of receiving a

diagnosis after a mammogram or other testing. If youve had

breast cancer, you may be fearful of a possible recurrence or

even of the possibility that breast cancer could take your

life.

Breast cancer is an uncontrolled growth of breast cells.To better understand breast cancer, it helps to understand

how any cancer can develop.

Cancer develops when cells in a part of the body begin

to grow out of control. Although there are many kinds of

cancer, they all start because of out-of-control growth of

abnormal cells. Normal body cells grow, divide, and die in an

orderly fashion. During the early years of a person's life,

normal cells divide more rapidly until the person becomes an

adult. After that, cells in most parts of the body divideonly to replace worn-out or dying cells and to repair

injuries.

Because cancer cells continue to grow and divide, they

are different from normal cells. Instead of dying, they

outlive normal cells and continue to form new abnormal cells.

Cancer cells develop because of damage to DNA. This substance

is in every cell and directs all its activities. Most of the

time when DNA becomes damaged the body is able to repair it.

In cancer cells, the damaged DNA is not repaired. People can

inherit damaged DNA, which accounts for inherited cancers.Many times though, a persons DNA becomes damaged by exposure

to something in the environment, like smoking. Cancer cells

can invade nearby healthy breast tissue and make their way

into the underarm lymph nodes, small organs that filter out

foreign substances in the body. If cancer cells get into the

lymph nodes, they then have a pathway into other parts of the

body. The breast cancers stage refers to how far the cancer

cells have spread beyond the original tumor, A tumor can be

benign (not dangerous to health) or malignant (has the

potential to be dangerous).

The term breast cancer refers to a malignant tumorthat has developed from cells in the breast. Usually breastcancer either begins in the cells of the lobules, which are

the milk-producing glands, or the ducts, the passages that

drain milk from the lobules to the nipple. Less commonly,

breast cancer can begin in the stromal tissues, which include

the fatty and fibrous connective tissues of the breast.

Breast cancer is always caused by a genetic abnormality

(a mistake in the genetic material). However, only 5-10% of

cancers are due to an abnormality inherited from your mother

or father. About 90% of breast cancers are due to genetic

abnormalities that happen as a result of the aging processand the wear and tear of life in general.

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Breast cancer is the second leading cause of cancer

death in women, exceeded only by lung cancer. The chance that

breast cancer will be responsible for a woman's death is

about 1 in 35(about 3%). In 2008, about 40,480 women will die

from breast cancer in the United States. Death rates from

breast cancer have been declining since about 1990, with

larger decreases in women younger than 50. These decreases

are believed to be the result of earlier detection through

screening and increased awareness, as well as improved

treatment.

The risk of developing most types of cancer can be

reduced by changes in a person's lifestyle, for example, by

quitting smoking and eating a better diet. The sooner a

cancer is found and treatment begins, the better are the

chances for living for many years.

We have chosen the case because we want to broaden ourknowledge about Breast Cancer regarding to the nursing

interventions and medical management. Cancer is the second

leading cause of death and is a common case in the Surgical

Ward of Baguio General Hospital and medical Center (BGHMC)

that also prompted the group to research on the disease. The

risk of developing most types of cancer can be reduced by

changes in a person's lifestyle, for example, by quitting

smoking and eating a better diet. The sooner a cancer is

found and treatment begins, the better are the chances for

living for many years.

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P A T I E N T S P R O F I L E

B i o g r a p h i c a l D a t a

Patient X is 53 y/o, female, currently residing at

Urdaneta City, Pangasinan was born on May 28, 1956 at Dagupan

City, Benguet. She is married and was blessed with four

children. She is currently living with her sister and her

daughter here in Baguio due to her chemotherapy sessions at

Baguio General Hospital and Medical Center.

She is currently a housewife, managing the family and

her only daughter. At present, source of income comes fromher husband working as a Computer Technician on a company.

She was admitted last September 2008 at Baguio General

Hospital and Medical Center (BGHMC) form MRM (modified

Radical Mastectomy) with complaints of having pain in her

right breast last December 2007.

She attained a High school degree having the knowledge

and ability to read and write. As for hobbies and interests,

she certainly entertains herself by reading, cleaning and

doing household chores and taking care of her family. Sheverbalized that the greatest gift from her is her only

children.

P r e s e n t I l l n e s s

2 months Prior to Admission, patient complained, patient

noted a mass before the incision area of the right breast.

There was associated tenderness but no discharged.

Consultation was sought and surgery was scheduled, hence

admission.

P a s t M e d i c a l H i s t o r y

Patient X has no previous history of allergies. She had

stated that she had previous records of hospitalization and

operations. Last Operations were performed on September 2008.

She underwent MRM (Modified Radical Mastectomy) and Status

post a 6 cycle of Chemotherapy because of presence of tumor

on her right breast. She has also a history of Hypertension.

F a m i l y M e d i c a l H i s t o r y

Patient X verbalized that she is the only one in the

family that had cancer. She has stated that there were Family

Medical Diseases known in their neither family nor hereditary

sickness such as hypertension and most commonly in cancer.

She declared that she had cancer due to an unhealthy

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lifestyle established during her younger years. Her aunt had

breast cancer and survived and her cousin died due to cancer.

S o c i a l / E n v i r o n m e n t a l H i s t o r y

Patient X is married and with four children. They are

living in a bungalow type of house made of cement and wood

just. Purchase of mineral water is their source of drinking

water in the area. She also Garbage is collected on their

area daily. She is fond of eating vegetables and fruits, less

meat, and fish, and very selective on food. She dislikes and

avoids eating salty foods; she is not very fond of eating

sweets. She also stated that promotes drinking water,

hydrating herself by drinking lots of water approximately 8-

10 glasses a day, as she knows that it would be a benefit to

her health. She also stated that she is a non-alcoholic and

non-smoker.

G y n e c o l o g i c a l H i s t o r y

The patient was pregnant four times and delivered a

four healthy children via Normal Spontaneous Delivery. During

her pregnancy, she has a regular pre-natal check-up everymonth. She has a normal menstrual cycle (ranging from 3 to 4

days every month). She has not undergone any abortion. She has

no history of reproductive abnormalities.

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P H Y S I C A L A S S E S S M E N T

1 3 A R E A S O F A S S E S S M E N T

A . P s y c h o s o c i a l S t a t u s

Patient X is 53 y/o, female; currently residing at

Urdaneta City, Pangasinan was born on March 18, 1956 at

Baguio City, Benguet. She attained a High school degree

having the knowledge and ability to read and write.

As for now, she is currently a housewife, managing thefamily and her only daughter. At present, source of income

comes from her husband working as a Computer Technician on a

company. As for hobbies and interests, she certainly

entertains herself by reading, cleaning and doing household

chores and taking care of her family. She verbalized that the

greatest gift from her is her only children.

Under Erik Eriksons psychosocial development theory,

the patient is under the stage of Generativity Versus

Stagnation. She seems to have a good outlook in life.

She was attentive in conversing with the health team

members. She was cooperative to the nursing and medical

interventions. She deals well with her watcher and visitors.

They seem to have good relationship.

B.M e n t a l S t a t u s a n d E m o t i o n a lS t a t u s

The patient was conversant and was slightly oriented to

date time, place, and people and to her present condition.

During the duty, there were no observed mood swings and

emotional changes. Her positive attitude was consistent all

throughout. She answers questions and follow instructions

appropriately.

C . E n v i r o n m e n t a l S t a t u s

The patient was admitted to Baguio General Hospital and

Medical Center in Surgery East Ward of the Female Division on

Bed 16. The ward has adequate lighting, good ventilation and

warm temperature. It was maintained clean at all times by the

cooperation of the Hospital Janitor, Staff Nurses and

Watchers of each patient. The bed has no side rails. There

are clean blankets and pillows for the patients use. There

was a regular garbage collection in the hospital where in

there is proper regulation. The garbage bins are placed on

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the hallway of the ward which is managed by the Hospital

Janitor.

D . S e n s o ry S t a t u s

1. Visual Status

The patients pupils are equally rounded. There are no

reduced accommodation to light changes when the penlight was

directed to the eyes. Based on her age, she has diminished

visual acuity nor reduction in visual field. She does not

have difficulties in seeing far away objects and recognizing

people, and does wear corrective devices such as eye glasses

if needed. She has the capability to read due to good visual

acuity.

2. Auditory Status

She has no difficulties in hearing soft voices upon

seeing her conversing with her watcher in a whispering

manner. She was able to determine from what direction the

sound of the voices were coming from as observed when she

turned her head towards the direction of the person she was

talking to. There was no impacted cerumen upon inspection.

The ears are symmetrical and in lined with the outer cantus

of the eyes.

3. Olfactory Status

Air is felt in the nose when she exhaled. Nasal mucosais intact, smooth and moist pink upon inspection. She was

able to discriminate foul odor as noted when she complained

about the bad smell of the comfort room.

4. Gustatory Status

She is able to determine between different tastes such

as sour, sweet, bitter, and salty. She could also taste anyflavor or dish served to her.

5. Tactile Status

She was able to perceive hotness. She was also able to

perceive cold as noted when she asked the student nurse why

the thermometer is cold. Pain was noted when she grimaced

upon the administration of intravenous medications.

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6. Language Perception and Formation

The patient is fluent in Ilocano, Tagalog and in

English. She can understand Ilocano, Tagalog and English

language but fairly understandsother dialects. She verbalizes

her needs.

A . M o t o r S t a t u s

Patient can move all her extremities very well. She has

no limited movement from her bed and can barely stand on her

own. She could ambulate around the ward and walks to the

comfort room to refresh herself without no assistance.

B . N u t r i t i o n a l S t a t u s

During her hospitalization, The doctor advised her to

take in foods that would boost her immune system, eating a

balanced meal composing largely on fruits and vegetables and

small amount of meat. She has a good appetite. Upon

palpation, there is no abdominal tenderness.

C . E l i m i n a t i o n S t a t u s

During hospitalization, her urination ranges from 3-4

times per day only. This must have been because she takes

water at all.

On the days that we handled her, she had not defecated

during our 3-11 shift. She described her stool as brownish

and depending on the foods colors that she intake in.

D . F l u i d a n d E l e c t r o l y t e s t a t u s

Before the hospitalization, Mrs. X drinks large amounts

of water just about 8-10 glasses of water a day. She drinks

water every after meal, as she knows that it would be a

benefit to her health.

During her hospitalization, she did drink much water.

There was insertion of IV administration of D5LRS 1000 Liters

regulated at 21 drops per minute (gtts/min).

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E . C i r c u l a t o r y S t a t u s

Her pulse rate ranges from 62-95 beats per minute which

is within the normal limits. However, her blood pressure

ranges from 100/60- 130/70 which also her normal BP. She hasa history of hypertension. Her capillary refill is about 2-3

seconds which is normal.

F . R e s p i r a t o r y S t a t u s

Her respiration ranges from 16-22 breaths per minutes.

She has no episodes of difficulty in breathing.

G . T e m p e r a t u r e S t a t u s

During her first day of hospitalization, she has no

fever. Her temperature ranges from 36.9 37.2 degrees

centigrade which is within normal range.

H . I n t e g u m e n t a r y S t a t u s

Skin was moist. Lips and buccal mucosa were not dry.

There is normal Skin turgor which goes back normally. There

were noted incision on the left breast due to her mastectomy

operation last 2008 at Cagayan de Oro.

I . C o m f o r t a n d R e s t S t a t u s

During our shift, she was comfortable in sleeping butthere are episodes where she cannot sleep due to ward

setting. The lights are on and the Noise surrounding the ward

could irritate her disturbance of sleeping.

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Band 0 . 0 0 - 0 . 0 5 1 . 0 0

T O T A L 1 . 0 0

Red Cell Count F 4 . 0 4 - 5 . 4 8 x

1 0 1 2 / L

Platelet Count 1 5 0 - 4 0 0 x 1 0 g / l M a r k e d l y

i n c r e a s e d

LE Cell Prep.

Malarial Smear

Bleeding Time 1 - 5 m i n u t e s

Clotting Time 2 - 6 m i n u t e s

Lee & white C.T 5 - 1 0 m i n u t e s

P R O T H R O M B I N T I M E ( P T )

Patient 1 0 - 1 4 s e c o n d s

Control 1 0 . 8 - 1 3 . 8s e c o n d s

INR

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% Activity

P A R T I A L P R O T H R O M B I N T I M E ( P T T )

Patient 2 6 - 3 6 s e c o n d s

Control 2 9 . 6 - 3 7 . 6

s e c o n d s

E R Y T H R O C Y T E S E D I M E N T A T I O N R A T E

Wintrobe Method F 0 - 2 0 m m / H r

Westergren Method A d u l t 0 - 1 0 m m / H r

Retailocyte Count 0 . 5 - 1 . 5 %

R E M A R K S :

Midcells may include less frequently occurring and rare correlating to monotype, eosinophils, basophils,

blast and other precursor.

Blood Type: O

Rh: Positive

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I M P L I C A T I O N :

Chemotherapy affects production of white blood cells in the bone marrow. Normally white blood cells

help fight off infection. After chemotherapy, if your white blood cells are low, you are more likely to get

infections. Any infection can also worsen more quickly a trivial infection could become life threatening

within hours if it isnt treated.

When your white blood cell count is at its lowest you can feel very tired (fatigued). Some people also

say they feel depressed. This can be really hard to deal with and make you wonder if you really want to go

on with your treatment. Try to hang in there. Things should improve and you will start to feel better again

before your next treatment, as your blood counts rise. Unfortunately, they'll go down again after each

treatment. But once your treatment is finished your blood cell counts will remain at normal levels.

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http://www.cancerhelp.org.uk/help/default.asp?page=10267http://www.cancerhelp.org.uk/help/default.asp?page=13395http://www.cancerhelp.org.uk/help/default.asp?page=10267http://www.cancerhelp.org.uk/help/default.asp?page=13395


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A N A T O M Y A N D P H Y S I O L O G Y

T h e B r e a s t s

In order to understand breast cancer, it helps to have

some basic knowledge about the normal structure of the

breasts. The female breast is made up mainly of lobules

(milk-producing glands), ducts (tiny tubes that carry the

milk from the lobules to the nipple), and stroma (fatty

tissue and connective tissue surrounding the ducts and

lobules, blood vessels, and lymphatic vessels).

Most breast cancers begin in the cells that line the

ducts (ductal cancers). Some begin in the cells that line the

lobules (lobular cancers), while a small number start in

other tissues.

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

is 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).

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Knowing if the cancer cells have spread to lymph nodes

is important because if it has, there is a higher chance that

the cells could have also gotten into the bloodstream and

spread (metastasized) to other sites in the body.

The more lymph nodes that have breast cancer, the more

likely it is that the cancer may be found in other organs as

well. This is important to know because it could affect your

treatment plan. Still, not all women with cancer cells in

their lymph nodes develop metastases, and in some cases a

woman can have negative lymph nodes and later develop

metastases.

F i b r o c y s t i c c h a n g e s

Most lumps turn out to be fibrocystic changes. The term

"fibrocystic" refers to fibrosis and cysts. Fibrosis is the

formation of fibrous (scar-like) tissue, and cysts are fluid-

filled sacs.

Fibrocystic changes can cause breast swelling and pain.

This often happens just before a woman's menstrual period is

about to begin. Her breasts may feel lumpy and, sometimes, she

may notice a clear or slightly cloudy nipple discharge.

B e n i g n B r e a s t L u m p s

Benign breast tumors such as fibroadenomas or

intraductal papillomas are abnormal growths, but they are not

cancerous and do not spread outside of the breast to other

organs.They are not life threatening. Still, some benign

breast conditions are important because women with these

conditions have a higher risk of developing breast cancer.

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P A T H O P H Y S I O L O G Y O F T H E D I S E A S E

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Predisposing

Factors:

Age

Gender

ETIOLOGY:

Unknown

Precipitating Factors:

exposure toradiation andcertain chemicals

having a siblingwith leukemia

HTLV-1 virus genetic

abnormalities

Somatic mutations in

the DNA

Activate oncogene/

deactivate tumor-

supppresor gene

Malignant transformation

of lymphoid stem cells

Uncontrolled proliferation

of lymphoblast in the bone

marrow

s/sx:

bone pain

Treatment:

Analgesic

Lymphoblast replace the

normal marrow elements

Diagnostic

Test:

BM aspiration

Treatment:

RemissionInductionTherapy

ConsolidationandMaintenanceTherapy

BM

Decreased productionof normal blood cells


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P A T H O P H Y S I O L O G Y O F T H E

D I S E A S E

Breast cancer may be classified pathologically asnoninvasive (in situ) or invasive (infiltrating). The

noninvasive carcinomas are generally thought to be

antecedents of invasive carcinoma.

Intraductal carcinoma (ductal carcinoma in situ) is the

most common noninvasive carcinoma among elderly women. It is

generally multicentric, and


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Acquired gene mutations

Most DNA mutations related to breast cancer, however,

occur in single breast cells during a woman's life rather

than having been inherited. These acquired mutations ofoncogenes and/or tumor suppressor genes may result from other

factors, such as radiation or cancer(22 of 121) causing

chemicals. But so far, the causes of most acquired mutations

that could lead to breast cancer remain unknown. Most breast

cancers have several gene mutations that are acquired.

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N U R S I N G C A R E A N D

M A N A G E M E N T

L I S T O F I D E N T I F I E D P R O B L E M S

A C T U A L P R O B L E M S

1. hair loss leading to disturbed body image

2. easy bruising or bleeding (due to low blood platelet

counts)

3. fatigue (due to low red blood cell counts and other

reasons)

4. loss of appetite

P O T E N T I A L P R O B L E M S

1. nausea and vomiting

2. increased chance of infections (due to low white blood

cell counts)

3. mouth sores

P R I O R I T I Z E D P R O B L E M S

1. Fatigue (due to low red blood cell counts and otherreasons)

Fatigue is a common health complaint. It is, however,

one of the hardest terms to define, and a symptom of

many different conditions.

Fatigue, also known as weariness, tiredness, exhaustion,

or lethargy, is generally defined as a feeling of lack

of energy. Fatigue is not the same as drowsiness, but

the desire to sleep may accompany fatigue. Apathy is a

feeling of indifference that may accompany fatigue or

exist independently.

2. Hair Loss Leading Disturbed Body Image

Some medicines can cause hair loss. This type of hair

loss improves when you stop taking the medicine.Medicines that can cause hair loss include blood

thinners (also called anticoagulants), medicines used

for gout, medicines used in chemotherapy to treat

cancer, vitamin A (if too much is taken), birth control

pills and antidepressants.

Body image is the attitude a person has about the actual

or perceived structure or function of all or part of his

or her body. This attitude is dynamic and is altered

through interaction with other persons and situations

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http://www.emedicinehealth.com/script/main/art.asp?articlekey=5610http://www.emedicinehealth.com/script/main/art.asp?articlekey=26114http://www.emedicinehealth.com/script/main/art.asp?articlekey=4138http://www.emedicinehealth.com/script/main/art.asp?articlekey=59135http://www.emedicinehealth.com/script/main/art.asp?articlekey=5610http://www.emedicinehealth.com/script/main/art.asp?articlekey=26114http://www.emedicinehealth.com/script/main/art.asp?articlekey=4138http://www.emedicinehealth.com/script/main/art.asp?articlekey=59135


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and influenced by age and developmental level. As an

important part of ones self-concept, body image

disturbance can have profound impact on how individuals

view their overall selves.

3. loss of appetite

A decreased appetite is when you have a reduced desire

to eat. This occurs despite the body's basic caloric

(energy) needs.

Any illness can affect a previously hearty appetite. If

the illness is treatable, the appetite should return

when the condition is cured.

Loss of appetite can cause unintentional weight loss.

Depression in the elderly is a common cause of weightloss that is not explained by other factors.

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N U R S I N G C A R E P L A N S

ACTUAL

ASSESSMENT EXPLANATION OF

THE PROBLEM

PLANNING IMPLEMENATION RATIONALE EVALUATION

S> Medyonanghihina pa ako

O> Appears weak

Slow

Movements

noted

Good Skin

Turgor

Coherent and

Conversant

Needs

assistance in

performing

ADLs

A> Activity

Intolerance

Related to

Weakness

The length ofChemotherapy

treatment depends

on whether the

cancer shrinks,

how much it

shrinks, and how a

woman tolerates

length of

treatment. Some of

the most common

possible side

effect is fatigue

(due to low red

blood cell counts

and other reasons)

STO> After 8 hoursof Nursing

Intervention the

patient will be

able to identify

techniques to

enhance activity

tolerance such as:

- gradual increase

in activity level

as tolerated

- rest in between

activities

LTO> After 8 days

of Nursing

Intervention, the

DX> Monitor VitalSigns and Record

Assess

Ability to

ambulate

Assess

capillary

Refill

Assess skin

turgor.

TX> Promote

Adequate Rest

Assist withactivities

Anticipate

For baselinedata.

To determine

activity

intolerance

To determine

circulatory

problems.

To determine

hydration.

To enhance

ability to

participate

with

activities

To protect

client frominjury

To promote

STO> Goal is metif the patient

will be able to

identify

techniques to

enhance activity

tolerance such as:

- gradual increase

in activity level

as tolerated

- rest in between

activities

LTO> Goal is met

if the patient

will be able to

report an increase

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patient will be

able to report an

increase in

activity

intolerance.

Needs

EDX> Encourage

expression of

feelings

Suggest Use

of Relaxation

Techniques

such as

visualization

and guided

imagery.

wellness

To determine

contributing

factors

To Enhance

Ability to

participate

in activities

in activity

intolerance.

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27

ASSESSMENT EXPLANATION

OF THE

PROBLEM


S> Nakakahiya

makakalbo ako

O>

Coherent andConversant

Submits self

to Nursing

Procedure and

Care done

A> Disturbed

Body Image

realted to

illness

treatment.

The length of

Chemotherapy

treatment depends

on whether the

cancer shrinks,how much it

shrinks, and how a

woman tolerates

length of

treatment. Some of

the most common

possible side

effect is hair

loss.

STO> After 8

hours of Nursing

Intervention the

patient will be

able to verbalizeunderstanding of

body changes

LTO> After 1 day

of Nursing

Intervention, the

patient will be

able to verbalize

acceptance of

self in situation

in the effects of

therapeutic

regimen.

DX> Monitor vital

signs and record

Determine

patients

perception of

cancer and

cancer

treatments.

TX> Ask for

patient for verbal

feedback, and

correct

misconception

about individuals

type of cancer and

treatment.

Provide

anticipatory

guidance with

patient

regarding

treatment

Protocol,

length of

For baseline

data

Aids in

identification

of ideas,attitudes and

fears,

misconception

Misconceptions

about cancer may

be more

disturbing than

facts and can

interfere with

treatments/

delay healing.

Accurate and

concise

information

helps dispel

fears andanxiety, helps

clarify the

expected

routine.

STO> Goal is met

if patient will

be able to

verbalize

understanding ofbody changes.

LTO> Goal is met

if patient will

be able to

verbalize

acceptance of

self in situation

in the effects of

therapeutic

regimen.


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30

ASSESSMENT EXPLANATION

OF THE

PROBLEM


S>

O> Coherent and

Conversant

Submits selfto Nursing

Procedure and

Care done

A>Risk for

Infection

related to

inadequate

secondary

defenses and

immunosuppress

ion secondary

to dose-

limiting side

effect of

chemotherapy.

This can often

have a major

effect on the

immune system and

may reduce thebody's defenses

against infection

for some months,

both during and

after treatment.

This is because

chemotherapy

reduces the

production of

white blood cells

by the bone

marrow. People

having

chemotherapy are

particularly at

risk of picking upinfections between

714 days after

the chemotherapy,

when the level of

STO> After 8

hours of Nursing

Intervention the

patient will be

able to verbalizeunderstanding of

Having cancer or

treatment for cancer

can weaken your

immune system. This

makes it more likely

that you will pick

up an infection and

develop a fever.

LTO> After 1 day

of Nursing

Intervention, the

patient will be

able to

demonstrate proper

aseptic techniques

preventing further

infection such as

DX> Monitor Vital

Signs and record.

Monitor

Temperature

TX> Assess all

systems for signs

and symptoms of

infection on a

continual basis.

Promote

For baseline

Data.

Temperature

elevation may

occur becauseof various

factors such

as

chemotherapy

side effects.

Early

recognition

and

intervention

may prevent

progression

to more

serious

situation.

Limits

fatigue, yetencourages

sufficient

movement to

prevent

STO> Goal is met

if patient will

be able to

verbalize

understanding ofHaving cancer or

treatment for cancer

can weaken your

immune system. This

makes it more likely

that you will pick

up an infection and

develop a fever.

LTO> Goal is met

if patient will be

able to

demonstrate proper

aseptic techniques

preventing further

infection such as

proper hand

washing.
http://www.cancerbackup.org.uk/Treatments/Chemotherapyhttp://www.cancerhelp.org.uk/help/default.asp?page=118http://www.cancerhelp.org.uk/help/default.asp?page=118http://www.cancerbackup.org.uk/Treatments/Chemotherapyhttp://www.cancerhelp.org.uk/help/default.asp?page=118http://www.cancerhelp.org.uk/help/default.asp?page=118


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31


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D R U G S T U D Y

32


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33

Generic name/brand name/

classification

Action and Indication Route/Dosage/Date prescribe Nursing consideration

tamoxifen citrate(ta mox' i fen)

Apo-Tamox (CAN),

Nolvadex, Novo-Tamoxifen

(CAN), Tamofen (CAN),

Tamone (CAN)

Pregnancy Category D

Drug class

Antiestrogen

Therapeutic actions

Potent antiestrogenic effects:

competes with estrogen for binding

sites in target tissues, such as

the breast.

Indications

Adjunct with cytotoxic

chemotherapy following radical

or modified radical mastectomy

to delay recurrence of

surgically curable breast

cancer in postmenopausal women

or women >50 y with positive

axillary nodes

Treatment of advanced,

metastatic breast cancer in

women and men; alternative to

oophorectomy or ovarian

radiation in premenopausal

women Preventative therapy for women

at high risk for breast cancer

Unlabeled uses: treatment of

Dosage

Available Forms: Tablets--10,

20 mg

Adult

Breast cancer:

20---40 mg/d PO for 5 y.

Reduction in breast cancer

incidence:

20 mg/d PO for 5 y.

Pharmacokinetics

Metabolism: Hepatic, T1/2:

7---14 d

Distribution: Crosses

placenta; enters breast

milk

Excretion: Feces

Take the drug

twice a day, in

the morning and

evening.

The following

side effects may

occur: bone pain;

hot flashes

(staying in cool

temperatures may

help); nausea,

vomiting (small,

frequent meals

may help); weight

gain; menstrual

irregularities;

dizziness,

headache, light-

headedness (use

caution if

driving or

performing tasks

that require

alertness).

This drug can

cause serious

fetal harm and

must not be taken

during pregnancy.

Ro

ut

e

On

se

t

Pe

akOr

al

Va

ri

es

4-

--

7

h


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S U M M A R Y O F F I N D I N G S

Vital Signs were assessed and properly documented. The

patient was on IVF of D5NSS 1L, it was regulated and

monitored. IVF flow rate and patency on site were checked.

The significant others was encouraged to converse with the

patient and instructed to maintain bed rest. The significant

others was endorsed to increase fluid intake. The diet as

tolerated was encouraged promoting vegetables and fruits in

giving vitamins and minerals that could support the bodys

defenses. Medications were prepared to the patient Treatment

for these symptoms are a standard fluid rehydration therapy

in order to maintain blood pressure. If circulatory failure

is not reversed, death may follow. Rapport was established

and integrated with the significant others. Safety was

ensured with the close monitoring on the patient.

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C O N C L U S I O N

If a newly diagnosed Breast cancer patient asked you to

define cancer, could you tell her that she has still hope? We

all have heard the word "cancer" many times, however very few

people understand the disease and how it develops.

Cancer is a complex group of over 100 different types of

cancer. Cancer can affect just about every organ in the human

body.

All cancers are different, and require different

treatment. What may be effective for prostate cancer,

probably will not be for bladder cancer. Diagnosing cancer

will vary as well, depending on the organ affected.

End-of-Life Issues

Palliative care, which provides physical, emotional, and

spiritual relief, must be provided with attempts for curative

therapy and becomes the exclusive goal when cure cannot be

expected at all stages of breast cancer, treatment needs to

be modified for life expectancy. For patients with metastatic

disease for which cure is not attainable, the physician

should clarify the goals of care through frequent, clear

discussions with the patient and, when appropriate, the

family.

All should recognize that cognitive impairment alone

does not exclude the patient from participating in decision

making, because some patients with impaired cognition are

able to understand, explain the consequences of, and voice an

opinion about certain treatment options. Pain from bony

metastases should be treated as described above with

nonsteroidal anti-inflammatory drugs, pamidronate, local

radiation, and strontium 89 rather than with opioids if

possible. Palliative chemotherapy may be useful when the

tumor invades vital organs.

37
http://cancer.about.com/od/cancerlistaz/a/typesofcancers.htmhttp://cancer.about.com/od/cancerlistaz/a/typesofcancers.htmhttp://cancer.about.com/od/treatmentoptions/a/options.htmhttp://cancer.about.com/od/prostatecancer/http://cancer.about.com/od/bladdercancer/http://cancer.about.com/od/cancerlistaz/a/typesofcancers.htmhttp://cancer.about.com/od/cancerlistaz/a/typesofcancers.htmhttp://cancer.about.com/od/treatmentoptions/a/options.htmhttp://cancer.about.com/od/prostatecancer/http://cancer.about.com/od/bladdercancer/


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R E C O M M E N D A T I O N

Health care providers should:

a. Should continuously monitor the vital signs of the

patient.

b. Observe the patient to avoid development of

complications.

c. Promote safety of the patient.

d. Educate patient and significant others about the

disease, and

e. Explain the procedure done to the patient. The

evaluation and diagnosis of Breast Cancer is based on

the presenting symptoms and history combined with a

focused physical assessment, imaging studies, and

possibly a functional study of the breast.

Significant others should:

a. Actively cooperate in the rendering of care for the

patient.

b. Be sensitive to the needs.

c. In addition, every effort is made to retrieve andanalyze breast has passed spontaneously or retrieved

through aggressive interventions.

d. Cooperate with the health care providers in the

implementation of her Health Care programs.

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A P P E N D I C E S

S t a g e s o f B r e a s t C a n c e r

Stage Definition

Stage0

Cancer cells remain inside the breast duct, withoutinvasion into normal adjacent breast tissue.

StageI

Cancer is 2 centimeters or less and is confined to thebreast (lymph nodes are clear).

Stage

IIA

No tumor can be found in the breast, but cancer cellsare found in the axillary lymph nodes (the lymph nodesunder the arm)ORthe tumor measures 2 centimeters or smaller and has

spread to the axillary lymph nodesORthe tumor is larger than 2 but no larger than 5centimeters and has not spread to the axillary lymphnodes.

StageIIB

The tumor is larger than 2 but no larger than 5centimeters and has spread to the axillary lymph nodesORthe tumor is larger than 5 centimeters but has notspread to the axillary lymph nodes.

StageIIIA

No tumor is found in the breast. Cancer is found in

axillary lymph nodes that are sticking together or toother structures, or cancer may be found in lymph nodesnear the breastboneORthe tumor is any size. Cancer has spread to theaxillary lymph nodes, which are sticking together or toother structures, or cancer may be found in lymph nodesnear the breastbone.

StageIIIB

The tumor may be any size and has spread to the chestwall and/or skin of the breastAND

may have spread to axillary lymph nodes that areclumped together or sticking to other structures, orcancer may have spread to lymph nodes near thebreastbone.

Inflammatory breast cancer is considered at least stageIIIB.

Stage

IIIC

There may either be no sign of cancer in the breast ora tumor may be any size and may have spread to thechest wall and/or the skin of the breastAND

the cancer has spread to lymph nodes either above orbelow the collarboneANDthe cancer may have spread to axillary lymph nodes orto lymph nodes near the breastbone.

StageIV

The cancer has spread or metastasized to otherparts of the body.

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B r e a s t C a n c e r R i s k F a c t o r s

A risk factor is anything that increases your risk of

developing breast cancer. Many of the most important risk

factors for breast cancer are beyond your control, such as

age, family history, and medical history. However, there are

some risk factors you can control, such as weight, physicalactivity, and alcohol consumption.

Be sure to talk with your doctor about all of your

possible risk factors for breast cancer. There may be steps

you can take to lower your risk of breast cancer, and your

doctor can help you come up with a plan. Your doctor also

needs to be aware of any other risk factors beyond your

control, so that he or she has an accurate understanding of

your level of breast cancer risk. This can influence

recommendations about breast cancer screening what tests to

have and when to start having them.

I . R i s k f a c t o r s y o u c a n c o n t r o l

Weight. Being overweight is associated with increased risk ofbreast cancer, especially for women after menopause. Fat

tissue is the bodys main source of estrogen after menopause,

when the ovaries stop producing the hormone. Having more fat

tissue means having higher estrogen levels, which can

increase breast cancer risk.

Diet. Diet is a suspected risk factor for many types ofcancer, including breast cancer, but studies have yet to show

for sure which types of foods increase risk. Its a good idea

to restrict sources of red meat and other animal fats

(including dairy fat in cheese, milk, and ice cream), because

they may contain hormones, other growth factors, antibiotics,

and pesticides. Some researchers believe that eating too much

cholesterol and other fats are risk factors for cancer, and

studies show that eating a lot of red and/or processed meats

is associated with a higher risk of breast cancer. A low-fat

diet rich in fruits and vegetables is generally recommended.

For more information, visit our page on healthy eating to

reduce cancer risk in the Nutrition section.

Exercise. Evidence is growing that exercise can reduce breastcancer risk. The American Cancer Society recommends engaging

in 45-60 minutes of physical exercise 5 or more days a week.

Alcohol consumption. Studies have shown that breast cancerrisk increases with the amount of alcohol a woman drinks.

Alcohol can limit your livers ability to control blood

levels of the hormone estrogen, which in turn can increase

risk.

Smoking. Smoking is associated with a small increase inbreast cancer risk.

Exposure to estrogen. Because the female hormone estrogenstimulates breast cell growth, exposure to estrogen over long

periods of time, without any breaks, can increase the risk of

breast cancer. Some of these risk factors are under your

control, such as:

taking combined hormone replacement therapy (estrogen

and progesterone; HRT) for several years or more, or

taking estrogen alone for more than 10 years

being overweight

regularly drinking alcohol

Recent oral contraceptive use. Using oral contraceptives(birth control pills) appears to slightly increase a womans

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risk for breast cancer, but only for a limited period of

time. Women who stopped using oral contraceptives more than

10 years ago do not appear to have any increased breast

cancer risk.

Stress and anxiety. There is no clear proof that stress and

anxiety can increase breast cancer risk. However, anythingyou can do to reduce your stress and to enhance your comfort,

joy, and satisfaction can have a major effect on your quality

of life. So-called mindful measures (such as meditation,

yoga, visualization exercises, and prayer) may be valuable

additions to your daily or weekly routine. Some research

suggests that these practices can strengthen the immune

system.

I . R i s k f a c t o r s y o u c a n tc o n t r o l

Gender. Being a woman is the most significant risk factor fordeveloping breast cancer. Although men can get breast cancer,too, womens breast cells are constantly changing and

growing, mainly due to the activity of the female hormones

estrogen and progesterone. This activity puts them at much

greater risk for breast cancer.

Age. Simply growing older is the second biggest risk factorfor breast cancer. From age 30 to 39, the risk is 1 in 233,

or .43%. That jumps to 1 in 27, or almost 4%, by the time you

are in your 60s.

Family history of breast cancer. If you have a first-degree

relative (mother, daughter, sister) who has had breastcancer, or you have multiple relatives affected by breast or

ovarian cancer (especially before they turned age 50), you

could be at higher risk of getting breast cancer.

Personal history of breast cancer. If you have already beendiagnosed with breast cancer, your risk of developing it

again, either in the same breast or the other breast, is

higher than if you never had the disease.

Race. White women are slightly more likely to develop breastcancer than are African American women. Asian, Hispanic, and

Native American women have a lower risk of developing anddying from breast cancer.

Radiation therapy to the chest. Having radiation therapy tothe chest area as a child or young adult as treatment for

another cancer significantly increases breast cancer risk.

The increase in risk seems to be highest if the radiation was

given while the breasts were still developing (during the

teen years).

Breast cellular changes. Unusual changes in breast cellsfound during a breast biopsy (removal of suspicious tissue

for examination under a microscope) can be a risk factor for

developing breast cancer. These changes include overgrowth ofcells (called hyperplasia) or abnormal (atypical) appearance.

Exposure to estrogen. Because the female hormone estrogenstimulates breast cell growth, exposure to estrogen over long

periods of time, without any breaks, can increase the risk of

breast cancer. Some of these risk factors are not under your

control, such as:

starting menstruation (monthly periods) at a young age

(before age 12)

going through menopause (end of monthly cycles) at a

late age (after 55)

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exposure to estrogens in the environment (such as

hormones in meat or pesticides such as DDT, which

produce estrogen-like substances when broken down by the

body)

Pregnancy and breastfeeding. Pregnancy and breastfeeding

reduce the overall number of menstrual cycles in a womanslifetime, and this appears to reduce future breast cancer

risk. Women who have never had a full-term pregnancy, or had

their first full-term pregnancy after age 30, have an

increased risk of breast cancer. For women who do have

children, breastfeeding may slightly lower their breast

cancer risk, especially if they continue breastfeeding for 1

1/2 to 2 years. For many women, however, breastfeeding for

this long is neither possible nor practical.

DES exposure. Women who took a medication calleddiethylstilbestrol (DES), used to prevent miscarriage from

the 1940s through the 1960s, have a slightly increased riskof breast cancer. Women whose mothers took DES during

pregnancy may have a higher risk of breast cancer as well.

For more detailed information about risk factors for breast

cancer, visit our Lower Your Risk section.

S y m p t o m s & D i a g n o s i s

Breast cancer symptoms vary widely from lumps to

swelling to skin changes and many breast cancers have no

obvious symptoms at all. Symptoms that are similar to thoseof breast cancer may be the result of non-cancerous

conditions like infection or a cyst.

Breast self-exam should be part of your monthly health care

routine, and you should visit your doctor if you experience

breast changes.

Mammogram.

If you're over 40 or at a high risk for the

disease, you should also have an annual mammogram.

Physical Exam by a doctor. The earlier breast cancer is found

and diagnosed, the better your chances of beating it.

The actual process of diagnosis can take weeks and involve

many different kinds of tests. Waiting for results can feel

like a lifetime. The uncertainty stinks. But once you

understand your own unique big picture, you can make better

decisions. You and your doctors can formulate a treatment

plan tailored just for you.

R i s k o f D e v e l o p i n g B r e a s t

C a n c e r

The term risk is used to refer to a number or

percentage that describes how likely a certain event is to

occur. When we talk about factors that can increase or

decrease the risk of developing breast cancer, either for the

first time or as a recurrence, we often talk about two

different types of risk: absolute risk and relative risk.

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I . A b s o l u t e r i s k

Absolute risk is used to describe an individualslikelihood of developing breast cancer. It is based on thenumber of people who will develop breast cancer within a

certain time period. Absolute risk also can be stated as a

percentage.

The absolute risk of developing breast cancer during a

particular decade of life is lower than 1 in 8. The younger

you are, the lower the risk. For example:

From age 30 to 39, absolute risk is 1 in 233, or 0.43%. This

means that 1 in 233 women in this age group can expect to

develop breast cancer. Put another way, your odds of

developing breast cancer if you are in this age range are 1 in

233.

From age 40 to 49, absolute risk is 1 in 69, or 1.4%.



I . R e l a t i v e r i s k

Relative risk is a number or percentage that comparesone groups risk of developing breast cancer to anothers.This is the type of risk frequently reported by research

studies, which often compare groups of women with different

characteristics or behaviors to determine whether one group

has a higher or lower risk of breast cancer than the other

(either as a first-time diagnosis or recurrence).

E n d - o f - L i f e I s s u e s

Palliative care, which provides physical, emotional, and

spiritual relief, must be provided with attempts for curative

therapy and becomes the exclusive goal when cure cannot be

expected. At all stages of breast cancer, treatment needs to

be modified for life expectancy.

For patients with metastatic disease for which cure is

not attainable, the physician should clarify the goals of

care through frequent, clear discussions with the patientand, when appropriate, the family. All should recognize that

cognitive impairment alone does not exclude the patient from

participating in decision making, because some patients with

impaired cognition are able to understand, explain the

consequences of, and voice an opinion about certain treatment

options.

Pain from bony metastases should be treated as described

above with nonsteroidal anti-inflammatory drugs, pamidronate,

local radiation, and strontium 89 rather than with opioids if

possible. Palliative chemotherapy may be useful when the

tumor invades vital organs.

C h e m o t h e r a p y

Chemotherapy is treatment with cancer-killing drugs that may

be given intravenously (injected into a vein) or by mouth.

The drugs travel through the bloodstream to reach cancer

cells in most parts of the body. The chemotherapy is given in

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cycles, with each period of treatment followed by a recovery

period. Treatment usually lasts for several months.

W h e n i s c h e m o t h e r a p y u s e d ?There are several situations in which chemotherapy may be

recommended.

Adjuvant chemotherapy: Systemic therapy given to patientsafter surgery who have no evidence of cancer spread is called

adjuvant therapy. When used as adjuvant therapy after

breast-conserving surgery or mastectomy, chemotherapy reduces

the risk of breast cancer coming back. Even in the early

stages of the disease, cancer cells may break away from the

primary breast tumor and spread through the bloodstream.

These cells don't cause symptoms, they don't show up on

imaging tests, and they can't be felt during a physical exam.

But if they are allowed to grow, they can establish new

tumors in other places in the body. The goal of adjuvantchemotherapy is to kill undetected cells that have traveled

from the breast.

Neoadjuvant chemotherapy: Chemotherapy given before surgeryis called neoadjuvant therapy. The major benefit of

neoadjuvant chemotherapy is that it can shrink large cancers

so that they are small enough to be removed by lumpectomy

instead of mastectomy. Another possible advantage of

neoadjuvant chemotherapy is that doctors can see how the

cancer responds to chemotherapy. If the tumor does not

shrink, your doctor may try different chemotherapy drugs.So far, it's not clear that neoadjuvant chemotherapy improves

survival, but it seems to be at least as effective as

adjuvant therapy after surgery.

Chemotherapy for advanced breast cancer: Chemotherapy canalso be used as the main treatment for women whose cancer has

already spread outside the breast and underarm area at the

time it is diagnosed, or if it spreads after initial

treatments. The length of treatment depends on whether the

cancer shrinks, how much it shrinks, and how a woman tolerates

length of treatment. Some of the most common possible sideeffects include:

hair loss

mouth sores

loss of appetite

nausea and vomiting

increased chance of infections (due to low white blood cell

counts)

easy bruising or bleeding (due to low blood platelet counts)

fatigue (due to low red blood cell counts and other reasons)

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D E F I N I T I O N O F T E R M S

B r e a s t c a n c e r g e n e r a l t e r m s

It is important to understand some of the key words used todescribe breast cancer.

CarcinomaThis is a term used to describe a cancer that begins in

the lining layer (epithelial cells) of

organs such as the breast. Nearly all breast cancers are

carcinomas (either ductal carcinomas or lobular carcinomas).

AdenocarcinomaIs a type of carcinoma that starts in glandular tissue

(tissue that makes and secretes a substance). The ducts andlobules of the breast are glandular tissue (they make breast

milk), so cancers starting in these areas are sometimes

called adenocarcinomas.

Carcinoma in situThis term is used for the early stage of cancer, when it

is confined to the layer of cells where it began. In breast

cancer, in situ means that the cancer cells remain confined

to ducts (ductal carcinoma in situ) or lobules (lobular

carcinoma in situ). They have not invaded into deeper

tissues in the breast or spread to other organs in the body,

and are sometimes referred to as non-invasive breast cancers.

Invasive (infiltrating) carcinomaAn invasive cancer is one that has already grown beyond

the layer of cells where it started(as opposed to carcinoma

in situ). Most breast cancers are invasive carcinomas either

invasive ductal carcinoma or invasive lobular carcinoma.

SarcomaSarcomas are cancers that start from connective tissues

such as muscle tissue, fat tissue, or blood vessels. Sarcomas

of the breast are rare.

Triple-negative breast cancerThis term is used to describe breast cancers (usually

invasive ductal carcinomas) whose cells lack estrogen

receptors and progesterone receptors. Breast cancers with

these characteristics tend to occur more often in younger

women and in African-American women, and they tend to grow

and spread more quickly than most other types of breast

cancer. Because the tumor cells lack these receptors, neither

hormone therapy nor drugs that target HER2 are effective

against these cancers (although chemotherapy may be useful ifneeded).

Mixed tumorsMixed tumors are those that contain a variety of cell

types, such as invasive ductal cancer combined with invasive

lobular breast cancer. In this situation, the tumor is

treated as if it were an invasive ductal cancer.

Medullary carcinomaThis special type of infiltrating breast cancer has a

rather well defined boundary between tumor tissue and normaltissue. It also has some other special features, including

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the large size of the cancer cells and the presence of immune

system cells at the edges of the tumor. Medullary carcinoma

accounts for about 3% to 5% of breast cancers. The outlook

(prognosis) for this kind of breast cancer is generally

better than for the more common types of invasive breast

cancer. Most cancer specialists think that true medullary

cancer is very rare, and that cancers that are called

medullary cancer should be treated as the usual invasive

ductal breast cancer.

Metaplastic carcinomaIs a very rare type of invasive ductal cancer. These

tumors include cells that are normally not found in the

breast, such as cells that look like skin cells (squamous

cells) or cells that make bone. These tumors are treated like

invasive ductal cancer.

Mucinous carcinomaAlso known as colloid carcinoma, this rare type of

invasive breast cancer is formed by mucus-producing cancer

cells. The prognosis for mucinous carcinoma is usually better

than for the more common types of invasive breast cancer.

Paget disease of the nippleThis type of breast cancer starts in the breast ducts

and spreads to the skin of the nipple and then to the areola,

the dark circle around the nipple. It is rare, accounting for

only about 1% of all cases of breast cancer. The skin of the

nipple and areola often appears crusted, scaly, and red, withareas of bleeding or oozing. The woman may notice burning or

itching.

Paget disease is almost always associated with either

ductal carcinoma in situ (DCIS) or, more often, with

infiltrating ductal carcinoma. If no lump can be felt in the

breast tissue and the biopsy shows DCIS but no invasive

cancer, the prognosis is excellent.

Tubular carcinoma

Tubular carcinomas are another special type of invasiveductal breast carcinoma. They are called tubular because of

the way the cells are arranged when seen under the

microscope. Tubular carcinomas account for about 2% of all

breast cancers and tend to have a better prognosis than most

other infiltrating ductal or lobular carcinomas.

Papillary carcinomaThe cells of these cancers tend to be arranged in small,

finger-like projections when viewed under the microscope.

These cancers are most often considered to be a subtype of

ductal carcinoma in situ (DCIS), and are treated as such. Inrare cases they are invasive, in which case they are treated

like invasive ductal carcinoma, although the outlook is

likely to be better. These cancers tend to be diagnosed in

older women, and they make up no more than 1% or 2% of all

breast cancers.

Adenoid cystic carcinoma (adenocystic carcinoma)These cancers have both glandular (adenoid) and

cylinder-like (cystic) features when seen under the

microscope. They make up less than 1% of breast cancers. They

rarely spread to the lymph nodes or distant areas, and

they tend to have a very good prognosis.

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Phyllodes tumorThis very rare breast tumor develops in the stroma

(connective tissue) of the breast, in contrast to carcinomas,

which develop in the ducts or lobules. Other names for these

tumors include phylloides tumorand cystosarcoma phyllodes.

These tumors are usually benign but on rare occasions may be

malignant. Benign phyllodes tumors are treated by removing

the mass along with a margin of normal breast tissue. A

malignant phyllodes tumor is treated by removing it along

with a wider margin of normal tissue, or by mastectomy. While

surgery is often all that is needed, these cancers may not

respond as well to the other treatments used for invasive

ductal or lobular breast cancer.

AngiosarcomaThis is a form of cancer that starts from cells that

line blood vessels or lymph vessels. It rarely occurs in the

breasts. When it does, it is usually seen as a complicationof radiation to the breast. It tends to develop about 5 to 10

years after radiation treatment. However, this is an

extremely rare complication of breast radiation therapy.

Angiosarcoma can also occur in the arm of women who develop

lymphedema as a result of lymph node surgery or radiation

therapy to treat breast cancer. These cancers tend to grow

and spread quickly. Treatment is generally the same as for

other sarcomas.

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B I B L I O G R A P H Y

Huether, S.E., McCance K.L., (2004). Understanding Pathophysiology

3rd edition. USA: Mosby

Doenges, M E., Moorehouse, M.F., (2002). Nursing Care Plans:

Guidelines for individualizing patient cares 6th edition.

Philadelphia USA: Davis company

Lee, E.C., Banasik, J., (2005). Pathophysiology 3rd edition.

Philippines: Elsevier Saunders

Lemone, P., Burke, K., (2004). Medical-surgical Nursing: Critical

Thinking in Client Care 3

rd

edition. USA: Pearson

Schilling, J.A., Kelly, W.J., et al (2007). Nursing Drug Handbook

27th edition. Philippines: Lippincott William and Wilkins.

Smeltzer, S.C., Bare, B.G., Hinkle, J.L., and Cheever, K.H. (2008).

Brunner and Suddarths Textbook of Medical-Surgical Nursing 11th

edition. Philippines: Lippincott Williams and Wilkins.

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27748338 Breast Cancer Case Study

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