Republic of the Philippines

TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
NURSING DEPARTMENT
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Tel. No.: (045) 493-1865 Fax: (045) 982-0110 website: www/tsu.edu.ph

CASE ANALYSIS:
Invasive Ductal Carcinoma –
Male Breast Cancer

Submitted by:

CARREON, KENNETH C.
CONCEPCION, CAZZANDRA MAE B.
DAGOHOY, FRANCIS JOSH
ENRIQUEZ JOHN EMMANUEL M.
GUIAO, CELINE ANGELA D.
NUNAG, NEIL GERARD D.
VICENTE, CINDY LIZZ Y.
BSN 3 – 2

Submitted to:

Prof. Vanessa Licyayo, MSN

Clinical Instructor

November 5, 2021
A. ASSESSMENT

1. PERSONAL DATA
a. Demographic data
Patient’s pseudo name: Patient X

Age: 59 years old

Sex: Male

Civil Status: Married

Role/Position in the family: Husband and Father

Nationality: Filipino

Address: Tarlac City

Chief complaint: Pain and discharge from left breast mass

Usual source of medical care: Hospital

Date and Time of admission: November 5, 2021 at 9:00 AM

Admitting diagnosis: Male Breast Cancer

Final diagnosis: Invasive Ductal Carcinoma – Male Breast

Cancer

Lifestyle

According to Patient X he smokes about two packs of cigarettes each day

for 30 years. He denied any history of psychiatric illness, the use of anabolic
steroids, drug abuse, or alcohol consumption.

Environment
Patient X is a 59-year-old male living with his family in a bungalow type of
house made with cement and wood which is well ventilated and sturdy enough to live.
The dirty kitchen is separated in their house, which is made from strong materials.
They have a huge field at the back of their house which is where his grandson and
granddaughter play. His wife has a mini-garden in the backyard that has a variety of
flowers and vegetables. The source of their water is the local water system. While the
source of water for bathing, washing clothes and dishes comes from their own
Contador. There is no presence of breeding site of insects. The patient’s house is 75
meters away from church while the health care facility is 100 meters away.
History of past illness

Patient X denied any history of psychiatric illness, the use of anabolic steroids,
drug abuse, or alcohol consumption. Considering the age of the patient, according to
the son, he often experience common colds and flu. The significant other of the
patient also added that the patient has poorly controlled diabetes mellitus for almost 5
years now due to heavy smoking. The significant other also confirms no known
allergies at medication and foods.

History of family illness

According to Patient X, his father died due to a diabetes complication and his
mother was still alive and there is no known disease. The patient’s wife was
hypertensive and they have two daughters and two sons, his two daughters have no
known disease but her two sons have hypertension.

 
History of present illness: 

Physical examination of the left breast and axilla showed a hard,

erythematous, ulcerating, mass measuring approximately 9×5 cm in the subareolar
region. His left nipple was distorted by the mass with no discharge. His body
temperature was normal. Examination of the ipsilateral axilla showed an enlarged
mobile lymph node. The right breast and axilla were normal on examination. Liver
function tests showed the following results: albumin, 28 g/L; total protein, 48 g/L;
alanine aminotransferase (ALT), 38 units/L; aspartate transaminase (AST), 42
units/L; alkaline phosphatase (ALP), 87 IU; total bilirubin, 5.9 μmol/L; conjugated
bilirubin, 2.3 μmol/L; amylase, 56 units/L; and lipase, 37 units/L. All results were
within their respective normal range. Tumor markers were also within the normal
range: cancer antigen 19-9, 7 IU/mL; cancer antigen 15-3, 14.7 U/mL; prostate-
specific antigen (PSA), 1.9 ng/mL; and carcinoembryonic antigen (CEA), 2.2 ng/mL.
Other laboratory results were also unremarkable.

Vitals signs taken as follows: 

BP: 120/80 mmHg 
HR: 115 bpm  
RR: 25 cpm  
Temp: 37.0C 
SpO2: 95% 
DIAGNOSTIC PROCEDURES

 Liver function test- are blood tests used to help diagnose and monitor liver disease or
damage. The tests measure the levels of certain enzymes and proteins in your blood.

Findings: albumin, 28 g/L; total protein, 48 g/L; alanine aminotransferase (ALT), 38 units/L;
aspartate transaminase (AST), 42 units/L; alkaline phosphatase (ALP), 87 IU; total bilirubin,
5.9 µmol/L; conjugated bilirubin, 2.3 µmol/L; amylase, 56 units/L; and lipase, 37 units/L. All
results were within their respective normal range.

 Physical examination of the breast- During the examination, the physician may detect a
small lump in the breast. Physical will also check the lymph nodes under the armpit and
above the collarbone for swelling or unusual changes.

Findings: Physical examination of the left breast and axilla showed a hard, erythematous,
ulcerating, mass measuring approximately 9×5 cm in the subareolar region. His left nipple
was distorted by the mass with no discharge. His body temperature was normal. Examination
of the ipsilateral axilla showed an enlarged mobile lymph node. The right breast and axilla
were normal on examination.

 Computed tomography (CT)- Your doctor may order a CT scan if you have a large
breast cancer to see if the cancer has spread to the chest wall. This aids in determining
whether the cancer can be removed with mastectomy.

Findings: Computed tomography (CT) of the chest, abdomen, and pelvis showed a
heterogeneous necrotic exophytic mass in the left breast associated with thickening of the
skin. CT also showed an enhancing ipsilateral axillary lymph node with cortical thickening
(Figure 2A–2D) and no distant metastases were identified.
 Bone scan

Finding: did not identify bone metastases.

 Postoperative histopathology- The diagnosis and study of diseases of the tissues and
involves examining tissues and/or cells under a microscope.

Findings: The histopathology of the surgical resection specimen of the breast showed
invasive ductal carcinoma with dermal deposits and lymphovascular invasion. The tumor was
grade 3, measuring 8×8×6 cm. All surgical resection margins were free from tumor.
Dissection of the axillary lymph nodes showed metastatic deposits in one of 19 lymph nodes.

 Immunochemistry- a special staining process performed on fresh or frozen breast cancer

tissue removed during biopsy.
 Findings: strong estrogen receptor (ER) positivity (70%,) progesterone receptor (PR)
positivity (50%), and HER2 positivity (3+). The breast cancer was stage IIIB (pT4b, N1,
M0).

Medical Management

● Provide counseling regarding the importance of histopathological diagnosis and its

impact on treatment options, because of the patient’s fear of pain from these procedures.

● A psychiatric consultation was requested. The patient was diagnosed with an anxiety
disorder.

● Provided Counseling and psychotherapy.

● Administer Medications as indicated:

- Alprazolam used to treat anxiety and panic disorders. It belongs to a class of

medications called benzodiazepines which act on the brain and nerves (central
nervous system) to produce a calming effect. 0.5 mg. P.O q 6hrs.
 DRUG STUDY : ALPRAZOLAM

DRUG DOSAGE CONTRAINDICATION ACTIONS INDICATION ADVERSE NURSING

EFFECT RESPONSIBILITIES

Generic Name: Anxiety Disorders Sensitivity to Alcohol and other Alprazolam is

benzodiazepines; acute CNS indicated for the CNS: Monitor for S&S of
alprazolam drowsiness and
narrow angle glaucoma; DEPRESSANTS, acute treatment of
pulmonary ANTICONVULSAN generalized anxiety Drowsiness, sedation, especially in
Brand Name: Adult: sedation, older adults or the
TS, disorder in
Xanax disease; use alone in adults.Alprazolam is
primary depression or ANTIHISTAMINES also indicated, either light-headedness, debilitated; they may
PO psychotic disorders, , BARBITURATES, as a standard or dizziness, require supervised
bipolar NARCOTIC extended-release syncope, ambulation and/or side
0.25–0.5 mg t.i.d. ANALGESICS, formulation, for the depression, rails.
(max: 4 mg/day) disorders, organic brain
treatment of panic
disorders; myasthenia BENZODIAZEPINE headache, Lab tests: Monitor
Geriatric: disorder with or
gravis; pregnancy ( S compound CNS confusion, periodic blood counts,
without agoraphobia
category D depressant effects; insomnia, urinalyses, and blood
in adults.
), lactation; children nervousness, chemistry
younger than 18 y. Cimetidine,
PO disulfiram, Alprazolam may also fatigue,
fluoxetine. be prescribed off- clumsiness, studies, particularly
0.125–0.25 mg label for insomnia, unsteadiness, during continuing
b.i.d. Impaired hepatic premenstrual therapy.
TRICYCLIC
Panic Attacks function; history of ANTIDEPRESSAN syndrome, and rigidity, tremor,
alcoholism; renal TS increase depression. restlessness, PT/FAMILY
impairment, paradoxical TEACHING
alprazolam levels excitement,
Adult: hepatic disease; geriatric (decreased hallucinations. Adverse reactions may
and debilitated patients. metabolism); ORAL occur during early high-
Effectiveness for long- CONTRACEPTIVE CV: dose therapy. These
term treatment (greater S may increase or usually
PO
than 4 mos) not decrease alprazolam Tachycardia,
1–2 mg t.i.d. (max: established. effects.
8 mg/day); hypotension, ECG disappear with
sustained release: Herbal: changes. continuing therapy, but
Kava,valerian dosage adjustments
Initiate with 0.5–1 Special Senses: may be indicated.
mg once/day. may potentiate
Depending on the sedation; Blurred vision. Make position changes
response, the dose slowly and in stages to
may be St. John's wort Respiratory: prevent dizziness.

increased at Do not use alcohol,

decreases Dyspnea.
intervals of 3 to 4 other CNS depressants,
days in increments or OTC medications
of no more than 1 serum level of
alprazolam. containing
mg/day.
Cigarette smoking
Target range 3–6 may decrease serum antihistamines (e.g.,
mg/day (max: 10 level of sleep aids, cold, hay
mg/day). fever, or allergy
alprazolam by 50%. remedies) without
Hepatic
Impairment consulting physician.
Dosage
Adjustment Do not drive or engage
in potentially hazardous
Reduce dose by activities until response
50% in hepatic to drug is known.
impairment. Do
not discontinue
abruptly
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION
Subjective: Acute pain After 4 hours Independent: Independent: GOAL MET,
“ sobrang sakit related to of nursing -Establish rapport - To facilitate after 4 hours of
ng Disease interventions cooperation as nursing
nararamdaman process as patient will: well as to gain interventions
ko habang evidenced by trust. patient reported
hinaawakan ko guarding - Report pain comfort and
Ang kaliwang behavior, relief with a -Monitor vital signs -To obtained relief pain with a
Dede ko” As Facial pain scale of baseline data pain scale of 2/10
verbalized by the grimace and 2/10. -Position the patient
patient reported pain in a semi fowler’s or -Provide
 Pain scale of 7/10 positions of comfort. comfort and
scale of - Perform relaxation
7/10 diversional -Provide comfort
activities and measure such as
Objective: relaxation skill calm/quiet
 Facial to promote environment and -Promotes
grimace comfort and adequate ventilation relaxation and
 Guarding relaxation and Provide helps refocus
behavior diversional activities attention.
 Vital sign such as listening to
taken as music, watching TV
follows: and back rub.
 B/P:
130/80
 Temp: 37 -Promote bed rest.
*C
 HR: 80
 RR: 22 -To reduce pain
and provide
-Provide safety Comfort.
measures adequate
lighting, raised side
-This may help
rails, etc.)
to prevent injury

Dependent: Dependent:
-Administer -A wide range
analgesic medication of analgesics
as ordered. and associated
agents may be
employed
around the clock
to manage pain.
 ASSESSMENT DIAGN PLANNING INTERVENTIONS RATIONALE EVALUATION
OSIS
Subjective: Anxiety After 2 hours Independent: Independent: GOAL MET,
“ Magtatagal pa ba related of nursing 1. Establish 1. to facilitate After 2 hours
buhay ko?” as to interventions rapport, cooperation of nursing
verbalized by the threat patient will conveying as well as to intervention
patient of report reduce empathy. gain trust patient
death manifestation 2. To identify reported
Objective: as of symptoms controlled
2. Monitor physical
 Fearful evidenc of anxiety and anxiety in a
patient vital responses
attitude ed by decrease manageable
fearful anxiety in a signs associated level and
 Irritability with both
attitud manageable reduce the
 Vital signs medical and
e and level manifestatio
as follows irritabil emotional n of anxiety.
 B/P: ity. condition.
130/90 3. To promote
 Temp: maximum
37*C 3. Position in a lungs
 HR: 80 semi fowler expansion
 RR:22 position and comfort
4. Different
levels of
anxiety will
affect the
4. Assess coping
client’s level mechanism
of anxiety of the client.
5. Aids in
meeting
basic human
needs and
assisting
5. Provide client to feel
comfort less anxious.
measure
such as
calm/quiet
environment 6. To reduce
(adequate oxygen
ventilation), demand and
listening to promote
music and relaxation
back rub
7. This may
6. Promote bed help to
rest. prevent
injuries.

7. Provide
safety
8. The nurse
measures
may
 adequate respond
lighting, inappropriat
raised side ely,
rails, etc.) escalating
the situation
to a
8. Allow the nontherape
behavior to utic
belong to interaction.
the client; do
not respond 9. this may
personally. help the
client to
relax

10. The patient

9. Demonstrate may need to
and instruct be where he
to do a deep is at this
breathing time, such
exercise as grieving
after
receiving
the
10. Accept the diagnosis of
patient as is. a terminal
illness.

11. To help
11. Provide reduce
emotional stress and
and spiritual anxiety
support.

12. Explaining
12. Explain
diagnostic
procedures
and
and answer
treatment
questions for
and routine
both patient
care can
and family
ease
anxiety.
 Dependent :
Dependent :
13. Short-term
13. Administer use of
antianxiety
anxiolytic
medication medications
can enhance
as ordered
patient
coping and
reduce
physiologica
l
manifestatio
ns of anxiety
 Assessment Diagnosis Planning Interventions Rationale Evalutaion
Subjective: Deficient After 8 hrs of INDEPENDENT: After 8 hrs of
“Paano knowledge nursing -Review with -Validates proper nursing
naman related to interventions the patient current level of interventions
nangyari sa misinformation the patient understanding understanding, the patient
akin ‘to eh to disease will: of specific identifies was able to
lalaki naman diagnosis, learning needs verbalize
ako?” - Verbalize treatment and provides understanding
understanding alternatives knowledge. of disease
Objective : of disease and future process and
Agitated process and expectations. potential
Confused potential -Helps with the complications,
Anxious complications. - Provide clear adjustment to performed
Vital Signs: accurate the diagnosis necessary
- B/P: - Perform information in by providing procedures
130/80 necessary factual needed correctly and
- Temp: 37 procedures manner, information was able to
*C correctly and answer along with explain
- HR: 80 explain specifically but time to absorb reasons for
-RR: 22 reasons for do not provide it. actions,
actions. unessential -Patient has Initiated
details. the right to necessary
know and lifestyle
- Initiate - Provide participate in changes and
necessary anticipatory decision participated in
lifestyle guidance with making, treatment
changes and the patient accurate and regimen.
participate in regarding concise
treatment treatment information Goal Met.
regimen. protocol, helps dispel
length of fears and
therapy anxiety.
expected
results,
possible side
effects, be
honest with
the patient.
Patient Education

1. Encourage patient for compliance in the medication regimen

Rationale: Medication adherance is important in controlling patient condition

2. Encourage and educate patient the importance of proper nutrition

Rationale: Proper nutrition plays big role in disease prevention and recovery from illness and
ongoing good health.

3. Encourage patient to have a minimal exercise

Rationale: Physical activity can improve muscle strength and can boost their endurance.

4. Encourage patient and family to perform breast assessment

Rationale: Breast self assessment is an awareness that helps patient understand the normal look
and feel of their breast.

5. Avoid strenuous activities

Rationale: Patient needs rest periods during physical activity to avoid exhaustion

6. Provide emotional support

Rationale: Having a strong social network of family and friends improves the abikity of a patirnt
to cope up to the disease.

7. Supportive care

Rationale: The goal of this is to prevent or treat as early as possible the symptoms of a disease.