Andres Bonifacio College

School of Nursing
College Park, Dipolog City

Care of Patient with

Breast Cancer

Submitted by:
Ms. Mechelle B. Penaso, SN

Submitted to:
Mr. Rojeniel Dagpin, RN

February 9, 2023
 TABLE OF CONTENTS

I. Institutional and School of Nursing’s Mission and

Vision

II. Objectives of the Case Study

III. Introduction of the Disease/Condition

IV. Anatomy and Physiology

V. Patient's Profile

VI. Laboratories and Interpretation

VII. Pathophysiology

VIII. Drug Study

IX. Nursing Care Plan

X. Related study

XI. References
 ANDRES BONIFACIO COLLEGE
INSTITUTIONAL VISION

A center of excellence in instruction, research, technology, extension,

athletics, and the arts.

INSTITUTIONAL MISSION

We commit to provide affordable quality of education with values in industry, intelligence,

integrity and undertake relevant research and socially responsive community service using

innovative technologies.

SCHOOL OF NURSING

VISION

Excellent Nursing Education

MISSION

The School of Nursing shall generate competent, safe and compassionate professional

nurses committed to:

a. Practice high standards of nursing care utilizing research and evidence-based practices

that are culturally appropriate and sensitive.

b. Be effectively involved in local, national, global issues affecting nursing, people’s

health and environment.

c. Ongoing holistic growth and development of the self and others.

GENERAL OBJECTIVES

At the end of the case study, the student nurse will be able to comprehend and utilize critical

thinking, manifest competence, provide comprehensive collaboration with all the knowledge

they have learned in order to render high quality nursing care to the patient who has been

diagnosed with Breast Cancer.

SPECIFIC OBJECTIVES

At the end of the case study, I the student nurse will be able to:

a. Discuss and elaborate Breast Cancer is.

b. Provide all the informaton about Breast Cancer.

c. Review the Patient’s Profile.

d. Recall the Anatomy and Physiology involved in the health problem.

e. Analyze and interpret the collected data completely and accurately.

f. Present appropriate Drug Study and three Nursing Care Plans for the patient’s health

condition and identify the rationale behind the intervention rendered.

g. Illustrate the Pathophysiology of the Breast Cancer.

h. Provide and discuss modern related study about the health problem.
III. INTRODUCTION

Breast Cancer is a cancer that develops in the breast

cells and progresses in stages. Few early symptoms may

include new lump in the underarm or in breast, itching or

discharge from the nipples, and skin texture change of the

nipple or breast.

Etiology of the disease include genetics, hormonal,

lifestyle and environmental factors.

Signs and symptoms of breast cancer may include a lump in the breast, a change in breast

shape, dimpling of the skin, milk rejection, fluid coming

from the nipple, a newly inverted nipple, or a red or scaly

patch of skin. In those with distant spread of the disease,

there may be bone pain, swollen lymph nodes, shortness

of breath, or yellow skin. Lumps found in lymph nodes

located in the armpits may also indicate breast cancer.

Pain ("mastodynia") is an unreliable tool in determining

the presence or absence of breast cancer, but may be

indicative of other breast health issues. Another symptom

complex of breast cancer is Paget's disease of the breast.

This syndrome presents as skin changes resembling

eczema; such as redness, discoloration or mild flaking of the

nipple skin. As Paget's disease of the breast advances,

symptoms may include tingling, itching, increased

sensitivity, burning, and pain. There may also be discharge

from the nipple. 

 Risk Factors

Risk factors can be divided into two categories:

 modifiable risk factors (things that people can

change themselves, such as consumption of

alcoholic beverages).

 fixed risk factors (things that cannot be changed,

such as age and physiological sex).

The primary risk factors for breast cancer are being

female and older age. Other potential risk factors include

genetics, lack of childbearing or lack of breastfeeding, higher levels of certain hormones,

certain dietary patterns, and obesity. One study indicates that exposure to light pollution is a

risk factor for the development of breast cancer.

If all adults maintained the healthiest possible lifestyles, including not drinking alcoholic

beverages, maintaining a healthy body composition, never smoking, eating healthful food, and

other actions, then almost a quarter of breast cancer cases worldwide could be prevented. The

remaining three-quarters of breast cancer cases cannot be prevented through lifestyle changes.

Risk factors for developing breast cancer include obesity, a lack of physical

exercise, alcoholism, hormone replacement therapy during menopause, ionizing radiation, an

early age at first menstruation, having children late in life or not at all, older age, having a prior

history of breast cancer, and a family history of breast cancer. About 5–10% of cases are the

result of an inherited genetic predisposition, including BReast CAncer gene (BRCA)

mutations among others. Breast cancer most commonly develops in cells from the lining

of milk ducts and the lobules that supply these ducts with milk. Cancers developing from the

ducts are known as ductal carcinomas, while those developing from lobules are known

as lobular carcinomas. There are more than 18 other sub-types of breast cancer. Some, such

as ductal carcinoma in situ, develop from pre-invasive lesions. The diagnosis of breast cancer is

confirmed by taking a biopsy of the concerning tissue. Once the diagnosis is made, further tests
are done to determine if the cancer has spread beyond the breast and which treatments are most

likely to be effective.

Outcomes for breast cancer vary depending on the cancer type, the extent of disease, and

the person's age. The five-year survival rates in England and the United States are between 80

and 90%. In developing countries, five-year survival rates are lower. Worldwide, breast cancer

is the leading type of cancer in women, accounting for 25% of all cases. In 2018, it resulted in 2

million new cases and 627,000 deaths. It is more common in developed countries and is more

than 100 times more common in women than in men.

DIAGNOSTIC METHOD

 Tissue Biopsy  is a medical test commonly

performed by a surgeon, interventional

radiologist, or an interventional cardiologist. The

process involves extraction

of sample cells or tissues for examination to

determine the presence or extent of a disease.

 Mammography (also called mastography) is the

process of using low-energy X-rays (usually

around 30 kVp) to examine the human breast for

diagnosis and screening. The goal of

mammography is the early detection of breast

cancer, typically through detection of

characteristic masses or microcalcifications.

TREATMENT

 Radiation therapy or radiotherapy, often

abbreviated RT, RTx, or XRT, is a therapy

using ionizing radiation, generally provided as part

 of cancer treatment to control or kill malignant cells and

normally delivered by a linear accelerator.

 Chemotherapy (often abbreviated to chemo and

sometimes CTX or CTx) is a type of cancer

treatment that uses one or more anti-cancer drugs

(chemotherapeutic agents or alkylating agents) as part

of a standardized chemotherapy regimen.

 Hormonal therapy in oncology is hormone

therapy for cancer and is one of the major modalities

of medical oncology (pharmacotherapy for cancer),

others being cytotoxic chemotherapy and targeted

therapy (biotherapeutics). Hormonal therapy is used

for several types of cancers derived from hormonally

responsive tissues, including

the breast, prostate, endometrium, and adrenal cortex.

Hormonal therapy may also be used in the treatment

of paraneoplastic syndromes or to ameliorate certain

cancer- and chemotherapy-associated symptoms, such

as anorexia. 

 Targeted therapy or molecularly targeted therapy is

one of the major modalities of medical treatment

(pharmacotherapy) for cancer, others being hormonal

therapy and cytotoxic chemotherapy. As a form

of molecular medicine, targeted therapy blocks the

growth of cancer cells by interfering with specific

 targeted molecules needed

for carcinogenesis and tumor growth, rather than by simply

interfering with all rapidly dividing cells (e.g. with

traditional chemotherapy).

 Surgery

LIFESTYLE

Drinking alcoholic beverages increases the risk of breast cancer, even among very light

drinkers (women drinking less than half of one alcoholic drink per day). The risk is highest

among heavy drinkers. Globally, about one in 10 cases of breast cancer is caused by women

drinking alcoholic beverages. Drinking alcoholic beverages is among the most common

modifiable risk factors. Dietary factors that may increase risk include a high-fat diet and

obesity-related high cholesterol levels. Dietary iodine deficiency may also play a role. Evidence

for fiber is unclear. A 2015 review found that studies trying to link fiber intake with breast

cancer produced mixed results. Smoking tobacco appears to increase the risk of breast cancer,

with the greater the amount smoked and the earlier in life that smoking began, the higher the

risk. A lack of physical activity has been linked to about 10% of cases. Sitting regularly for

prolonged periods is associated with higher mortality from breast cancer. Breast

feeding reduces the risk of several types of cancers, including breast cancer. In the 1980s,

the abortion–breast cancer hypothesis posited that induced abortion increased the risk of

developing breast cancer. This hypothesis was the subject of extensive scientific inquiry, which

concluded that neither miscarriages nor abortions are associated with a heightened risk for

breast cancer.

IV. ANATOMY ANG PHYSIOLOGY

BREAST

The breast is an organ whose structure reflects its

special function: the production of milk for

lactation (breast feeding). The epithelial component of the tissue consists of lobules, where milk

is made, which connect to ducts that lead out to the nipple. Most cancers of the breast arise from

the cells which form the lobules and terminal ducts. These lobules and ducts are spread

throughout the background fibrous tissue and adipose tissue (fat) that make up the majority of

the breast. The male breast structure is nearly identical to the female breast, except that the male

breast tissue lacks the specialized lobules, since there is no physiologic need for milk

production by males.

Anatomically, the adult breast sits atop the pectoralis

muscle (the "pec" chest muscle), which is atop the

ribcage. The breast tissue extends horizontally (side-to-

side) from the edge of the sternum (the firm flat bone

in the middle of the chest) out to the midaxillary line

(the center of the axilla, or underarm). A tail of breast

tissue called the "axillary tail of Spence” extend into

the underarm area. This is important because a breast

cancer can develop in this axillary tail, even though it

might not seem to be located within the actual breast.

The breast tissue is encircled by a thin layer of connective tissue called fascia. The deep

layer of this fascia sits immediately atop the pectoralis muscle, and the superficial layer sits just

under the skin. The skin covering the breast is similar to skin elsewhere on the body and has

similar sweat glands, hair follicles, and other features. A clinician will examine the skin in

addition to the breast tissue itself when performing a breast exam.

BLOOD SUPPLY & LYMPH NODES

The blood supply from the breast comes primarily from the internal mammary artery, which

runs underneath the main breast tissue. The blood supply provides nutrients, such as oxygen, to

the breast tissue. The lymphatic vessels of the breast flow in the opposite direction of the blood
supply and drain into lymph nodes. It is through

these lymphatic vessels that breast cancers

metastasize or spread to lymph nodes. Most

lymphatic vessels flow to the axillary (underarm)

lymph nodes, while a smaller number of

lymphatic vessels flow to internal mammary

lymph nodes located deep to the breast.

Knowledge of this lymphatic drainage is

important, because when a breast cancer

metastasizes, it usually involves the first lymph

node in the chain of lymph nodes. This is called the "sentinel lymph node,” and a surgeon may

remove this lymph node to check for metastases in a patient with breast cancer.

Many additional changes are seen in the breast tissue during pregnancy and lactation due to

the changes in hormones during those times.

V. PATIENT’S PROFILE

Name: Patient Y

Address: Miputak, Dipolog City

Sex: Female

Marital Status: Single

Age: 46 years old

Birth Place: June 20, 1977

Nationality: Filipino

Religion: Roman Catholic

Ward: Medical Ward, RM 1

Type of Admission: New

Admission Date: February 7, 2023

Admission Time: 8:00 am

Attending Physician: Dr. Santos

Admitting Diagnosis: Breast Lump

Chief Compliant: “My breast have been naturally cystic, but I have a new lump in my right
breast has me concerned.”

HISTORY OF PRESENT ILLNESS

- Client noticed a small,painless lump in the upper outer quadrant of her right breast six
weeks ago. No history of dysmennorhea associated with her periods. Lumps become larger,
denies tenderness,pain, nipple discharge,and skin changes in her breast. And also denies
masses in the axillary region of the right arm.

PAST MEDICAL HISTORY

- Ashma x 23 years

- Hypothyroidism x 8 years

FAMILY HISTORY

 Paternal grandmother was diagnosed with breast cancer before menopause at age 45.
 Mother died from breast cancer 15 years ago at age 73; cancer was diagnosed before
menopause at age 45; in long-term remission twice, but recurred again 16 years ago.

 Farher is alive at age 91 but suffers from HTN, CAD, DM type 2, and Alzheimer
disease and is being cared for in a nursing home facility.

SOCIAL HISTORY
 Drinks 6-8 cups of coffee daily
 Denies tobacco, alcohol, or illegal drug use
 Exercises 3 times a week
 Graduated from a local university with a degree in jouranalism and has been a reporter
for a local newspaper, but now works as a realtor.
 Has been happily married for 21 years.

MEDICATIONS
- Levothyroxine 100 mg po QD
- Albuterol inhaler PRN

ALLERGIES
- Latex and adhesive tape produce rash

REVIEW OF SYSTEMS
- Unremarkable, except for complaints noted above
- Both asthma and hypothyroid disease have been well controlled with medication
VI. LABORATORIES AND INTERPRETATION

LABORATORY BLOOD TEST RESULT

EXAMINATION RESULT REFERENCE VALUE INTERPRETATION

EXAMINATION RESULT REFERENCE VALUE INTERPRETATION
Sodium (Na) 137 meq/L 135- 145 meq/L Within Normal
Hemoglobin (Hb) 13.3 g/dL 12-16 g/dL Within Normal
Potassium(K) 4.2 meq/L 3.5- 5.0 meq/ L Within Normal
Hematocrit (Hct) 38.5% 37-48% Within Normal
Chloride (Cl) 104 meq/L 98-106 meq/L Within Normal
Platelet (Plt) 313 x 10^3/mm63 140 - 415 x10E3/uL. Within Normal
HCO2 24 meq/L 23-29 meq/L Within Normal
WBC 7.0 x 10^3/mm^3 5-10 x 10 9/L Within Normal
BUN 8 mg/dL 7-20 mg/dL Within Normal
 Neutros 60% 45-75% Within Normal
Creatinine (Cr) 1.0 mg/dL 0.84- 1.21 mg/dL Within Normal
 Lymphs 32% 20-40% Within Normal
Glucose, Fasting 90 mg/dL 70-100 mg/dL Within Normal
 Eos 2% 0.0- 0.6% Indicates allergic
VIII. DRUG STUDY
reactions to drugs
and asthma
Name of Drug
 Monos Dosage, 6% Mechanism Indication
2-8% Contraindic Side Effects Nursing
Within Normal
Route, of Action ation Considerations
AST 37
Frequency, IU/L 8-33 IU/L Indicates going to
and Timing menopause and bone
Generic Dosage: disease like Paget’s
Name: 100mg PO disease
Levothyroxine
ALT every 4 hrs.
30 IU/L 7-55 IU/L Within Normal
Alk phos 97 IU/L 20-140 IU/L Within Normal
Brand/Trade Route:
T Bilirubin PO, QD 0.3 mg/dL
Name: 0. 1-1.2 mg/dL Within Normal
Levoxyl,
T Protein 6.9 g/dL 6- 8.3 g/dL Within Normal
Euthyrox
Albumin (Alb) 4.0 g/dL 3.5- 5.5 g/dL Within Normal
Classification
:
Thyroid drugs
Name of Drug Dosage, Mechanism Indication Contraindic Side Effects Nursing
Route, of Action ation Considerations
Frequency,
and Timing
Generic Dosage:
Name: 100mg PO
Levothyroxine every 4 hrs.

Brand/Trade Route:
Name: PO, QD
Levoxyl,
Euthyrox

Classification
:
Thyroid drugs