Nursing of Adults I

Breast Cancer Case Study

Mrs. Jones, a 64 year old female finds a lump in the upper inner quadrant of the right breast
during her monthly self breast exam. Her last annual mammogram was negative and she has no
family history of breast cancer. She comes to the physician office concerned she may have
breast cancer. Information in chapter 11 and chapter 42 will help you to answer the following
questions.

1. What is cancer? (1 pt)

Cancer is a group of cells that grow out of control. These cells are poorly
constructed, loosely formed, and disorganized. (pg. 174)

2. Mrs. Jones asks you, the clinic nurse, what diagnostic test the physician is going to

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order. What would you tell her? Explain the test. (2pt)

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A mammogram or ultrasound.

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3. What other assessment data would you collect for Mrs. Jones (hint – WHAT’S UP – p.

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6)? (2pt)
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Where is it? How does it feel? Describe the quality. Aggravating or alleviating
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factors? Timing? Severity? Useful other data? Patient’s perception of the problem? (pg. 6)

4. What risk factors does Mrs. Jones have? What other questions may you ask her
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concerning risk factors? (2pt)

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She could be at risk for metastasis. You could ask her about any specific viruses in
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the past? What her diet consists of? If she is on any hormone replacements?
General immunity? (pg. 175)
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Mrs. Jones is scheduled for a mammogram and ultrasound of the breast which does show a
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tumor in the upper inner quadrant of the right breast. The physician then schedules her for a
fine needle breast biopsy.
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5. What is a fine needle biopsy? What is the purpose of performing a fine needle
biopsy? (2pt) This is done by sticking a needle into the lump and aspirating fluid or
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cells. This is done to test the cells of the lump to see if they are cancerous or not.
(pg. 953)
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The fine needle biopsy does confirm the diagnosis of breast cancer. Mrs. Jones is tearful and
scared. She tells you she wanted to live to see her grandchildren grow up.

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 1. State what therapeutic communication skills you would use to demonstrate caring
behaviors to Mrs. Jones (1 pt)
I would use reflection and say, “so you think you won’t live to see your
grandchildren grow?” I would also use silence when it is appropriate or therapeutic
touch. (Dewit, pg. 103)

2. She asks you what treatment options are available. What would you tell her
including advantages and disadvantages of each (Chemotherapy, Radiation and
Surgery)? (9 pts)
Surgery is curative if they can remove the whole tumor, if they can’t remove it all
you may still need chemo or radiation after surgery. You may also need it prior to
surgery to help shrink the tumor down.
Radiation can be curative if the tumor is localized. Symptoms can last 2-4 weeks
after treatment. Treatment can cause nausea, vomiting, fatigue, mucositis,
xerostomia. However, we will try to control these symptoms to the best of our

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ability.

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Chemotherapy is a drug used to treat cancer. They destroy the cancer cells,

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however, they also destroy your normal good cells. Cancer also has bad side effects
similar to radiation, we will do our best to control these symptoms as well. I would

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also teach her with chemo and radiation she would have to limit her family visitors
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until the drugs get out of her system.
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A simple mastectomy is done to remove the tumor. The tumor was staged as a T2, M0, N0.
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Estrogen and progesterone receptors were negative. A bone scan was negative for metastasis.
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Mrs. Jones is told she will need chemotherapy. This will consist of four treatments, three weeks
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apart. The medications used would be Adriamycin and Cytoxan in high dosages. A peripherally
inserted central catheter (PICC) line will be inserted before the chemotherapy.
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1. What is a simple mastectomy? (1 pt)

A simple mastectomy removes the breast tissue, nipple, areola, skin-but not all the lymph
nodes. (www.cancercenter.com/breast)
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2. What does T2, M0, N0 mean? (1 pt)

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Size is a 2, no distant metastasis, no regional lymph nodes involved. (pg. 185)

3. Why is a PICC line necessary when giving vesicant drugs? (Central lines page 106)
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(2pt)
Because vesicant drugs can only be given via into a large vein. This is used when
therapy is longer then 2 weeks. (pg. 190 and 106)

4. Mrs. Jones nurse develops a care plan. List two to three nursing interventions for
each of the following nursing diagnoses: ( 2 pts each diagnosis, total of 12 pts)

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 Pages 193-197

a. Pain
1. Assess pain level on 0-10 scale.
2. Administer analgesics as ordered and check pain relief within 1 hour
3. Explain relaxation techniques.

b. Risk for infection

1. Promote good handwashing.
2. Monitor temperature.
3. Monitor WBC.

c. Risk for injury related to bleeding

1. Monitor platelet count.
2. Advise patient to use electric razor.

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3. Observe for bruising, petechia, or bleeding gums

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d. Inbalanced nutrition: less than body requirements related to nausea and
vomiting

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1. Monitor food intake and fluid every hours.
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2. Daily weights.
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3. Consults a dietician for dietary supplements.

e. Fatique
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1. Assess what the patient can do for themself.

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2. Provide assistive devices to help assist the patient.

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f. Risk for ineffective tissue perfusion (page 973-974)

1. Monitor O2 saturation and vital signs.
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2. Elevate effected arm.

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3. Avoid use of arm with blood pressure, injections, or venipuncture.

5. Mrs. Jones asks what she can do to prevent getting cancer in the other breast.
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What prevention teaching would you give Mrs. Jones? (2pt)

Teach Mrs. Jones how to self examine herself and cancer screening programs. Teach
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her to get mammograms yearly. (pg, 180)

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