XAVIER UNIVERSITY – ATENEO DE CAGAYAN

COLLEGE OF NURSING

In Partial Fulfillment of the Subject Nursing Care of Clients with Life Threatening
Conditions (Acute and Chronic)

NCM 118 LEC

Submitted to:
Marie Jean Canoy, RN, MN
Subject Moderator

Submitted by:
BSN 4 - ND (Group 2 RLE Group)

Hallazgo, Rex Macahilos, Rodolf Gerone

Jardiolin, Roland Laurence
Kho, John Carlo
Lim, Sydney Ivan
Lucagbo, Dominique Jonietz
Mabolo, Ruffa Mae
Macellones, Lance Angel
Mangubat, Xena
Nerquit, Bern Michelle
Ramos, Mikhaela Genesis
Regular, Sureen

November 2022
Triggers:
DISCUSSION RECORDING LINK:
https://drive.google.com/drive/folders/1GyGmUC0l2zho_1H5fhvnQo1upvDSrJQT?usp=sh
aring

TOPIC: Breast Disorders

1. Identify the assessment and diagnostic studies used to diagnose breast

disorders.
● Breast ultrasound. A machine that uses sound waves to make pictures, called
sonograms, of areas inside the breast.
● Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an
area of the breast looks abnormal on a screening mammogram, doctors may have you
get a diagnostic mammogram. This is a more detailed X-ray of the breast.
● Breast magnetic resonance imaging (MRI). A kind of body scan that uses a magnet
linked to a computer. The MRI scan will make detailed pictures of areas inside the
breast.
● Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a
microscope and do more testing. There are different kinds of biopsies (for example,
fine-needle aspiration, core biopsy, or open biopsy).

2. Compare and contrast the pathophysiology of benign and malignant breast

disorders.

BENIGN BREAST DISORDERS MALIGNANT BREAST DISORDERS

● Hyperplasia ● Invasive Ductal Carcinoma (IDC)

● Cysts ● Invasive lobular carcinoma (ILC)
● Fibroadenomas ● Paget’s disease
● Intraductal Papillomas ● Angiosarcoma
● Sclerosing Adenosis ● Phyllodes tumors
● Radial Scars
● Benign Phyllodes Tumors
● Fat Necrosis
● Mastitis
 SIMILARITIES DIFFERENCES

Benign Malignant
Both types of breast cancer originate
from the same starting point. With the ● Has distinct, ● Has irregular
smooth, regular borders and
mutation inactivating the BRCA1 and
borders grows faster
BRCA2 genes (both of which are ● Can grow quite ● Spreads to other
responsible for protecting the body large, but does parts of the
from certain cancers). This causes not invade body or
uncontrolled cellular proliferation that nearby tissue or metastasize and
mutates and inactivates the DNA spread to other can initiate
parts of the tumors at
repair gene that leads to the creation
body secondary sites
of a proto-oncogene which will then ● Good ● Difficult to
turn into an oncogene. As long as the candidates for contain and
cellular proliferation containing the removal by remove when
oncogene is left uncontrolled or not surgeries fully
eliminated, it will spread throughout metastasized
the region and will eventually lead to ● Grows slowly ● Grows and
over time invades other
cancer.
tissues rapidly
● Painless ● Often painful
Other similarities also include: ● Fixated to the ● Easily moves
The malignant and benign tumor skin or chest under the skin
appears the same when viewed in a wall
mammogram (rounded and mobile). ● Dimpling of skin ● Causes skin
is not observed dimpling
● Tender lumps ● Nontender
lumps
● Nipple ● Nipple
discharge is discharge is
yellow or green bloody and
in color unilateral
● Nipple retraction ● Nipple retraction
does not occur may occur

3. Summarize evidence-based guidelines for the early detection of breast cancer.

To be able to detect the possibility of breast cancer, an individual is encouraged to

undergo screening tests. Screening is defined as a series of tests and exams that enables an
individual to find signs of a disease, which in this case is the presence of breast mass
(American Cancer Society, 2022). Promoting early detection or undergoing screening promotes
early diagnosis and treatment, which as a result will increase the likelihood of preventing the
disease (breast cancer) from metastasizing.

For women who are at average risk of acquiring breast cancer, such as those with no
history of breast cancer yet have a strong familial history of breast cancer and those having an
age range between 40-54 (or older), undergoing through the following screening tests (below)
will further help in detecting breast cancer on an early stage–promoting early treatment and
improved well being.

a. Mammograms

A mammogram is a low-dose x-ray procedure of the breast. Through this, it helps detect
breast cancer at an early stage, which increases the likelihood of the treatment to be successful.
Studies have shown that women who undergo regular mammograms are more likely to
determine the presence of breast cancer at an early stage, resulting in only needing less
aggressive medical treatments. However, it should be known that mammograms do not
definitely detect the presence of breast cancers, for in other cases, it can be missed.

b. Clinical Breast Exam (CBE) and Breast Self-Exam (BSE)

Although these screening tests do not have a clear benefit of detecting breast cancer,
performing these still helps in further detecting the presence of breast cancer. Having the
woman perform her own breast exam such as observing her nipples or breasts for presence of
lumps, unusual size differentiation of the two breasts, pain upon palpation, and presence of an
inverted nipple would significantly help the woman to seek early consultation from health care
professionals in order to conduct more tests that would determine if such observations (made by
the woman herself) are signs of breast cancer.
 4. Explain the different modalities used to treat breast cancer.

The different modalities to treat breast cancer are as follows:

Surgery - The removal of cancerous or abnormal tissue and the surrounding tissue of the
breasts to prevent or treat breast cancer.

● Lumpectomy
○ This procedure involves the removal of the cancer or other abnormal tissue and a
small amount of the healthy tissue that surrounds it. The inclusion of the healthy
tissue that surrounds the abnormal tissue ensures the ni removal of the cancer.
This procedure is also referred to as excisional biopsy, quadrantectomy, and
breast-conserving surgery.
● Mastectomy
○ This procedure involves the removal of the whole breast. The procedure is both a
treatment and prevention for breast cancer. The scale of this procedure can be
relatively minor or relatively major, depending on the condition of the tumor, if it is
too large, or how much of the tissue needs to be removed.

Chemotherapy
- This procedure may be done before or after surgery, and it may become the primary
treatment for advanced breast cancer. Chemotherapy before breast surgery, which is
also known as neoadjuvant therapy or preoperative chemotherapy, is done prior to
surgery to shrink larger cancers. This provides the surgeon the best change to remove
only the cancer, rather than the whole breast. This reduces the extent of disease in the
lymph nodes, allowing for less invasive lymph node surgery. Chemotherapy before
surgery also reduces the likelihood of the cancer returning, as well as helping the doctor
understand how the tumor responds to chemotherapy and clarifying the prognosis and
best drug option for chemotherapy.
- Chemotherapy after surgery, which is also referred as adjuvant chemotherapy, can be
recommended by doctors after a surgery to destroy the remaining undetected cancer
cells and reduce the risk of the cancer from returning. Even if there is no indication of
cancer following surgery, adjuvant chemotherapy is suggested for patients who are at
 high risk of the disease reoccurring or spreading to other parts of the body (metastasis).
If cancer cells are found inside the lymph nodes near the affected breast, a patient is at a
higher risk of metastasis.

Hormonal Therapy
- Treatment for breast cancers that are sensitive to hormones. The hormones that are
oftentimes associated with breast cancer are estrogen and progesterone. These
hormones are utilized by the cancerous tumor for proliferation. This therapy is usually
done after surgery to reduce the risk for cancer recurrence. This therapy also is
applicable to shrink the size of the tumor before surgery, increasing the likelihood of the
cancer to be removed.
 5. Use the nursing process as a framework for care of the patient undergoing surgery for the treatment of breast
cancer.

Assessment Diagnosis Planning Interventions Rationale Evaluation

Objective: Impaired Skin Short Term Goals Independent Independent Short Term Goals
● Mastectomy Integrity RT At the end of 30 1. Inspect 1. Drainage occurs At the end of 30
of left breast surgical removal of minutes of nursing dressings for because of trauma minutes of nursing
skin and tissue interventions, the characteristics of of the procedure interventions, the
AEB disruption of patient will be able drainage. and manipulation of patient was able to
skin surface and to blood vessels and 2. Demonstrat
layers 1. Demonstrat lymphatics in the e behaviors
e behaviors area and
and techniques
techniques 2. Maintain a 2. This position to promote
to promote semi-fowler's assists with healing and
healing and position on the drainage of fluid prevent
prevent back or unaffected through use of complication
complication side. Avoid letting gravity.
the affected arm Long Term Goals
Long Term Goals dangle. At the end of 2
At the end of 2 weeks of nursing
weeks of nursing 3. Refrain from 3. Increases interventions, the
interventions, the measuring BP, potential of patient was able to:
patient will be able injecting constriction, 3. Achieve
to: medications, or infection, and timely
1. Achieve inserting IVs in the lymphedema on the wound
timely affected arm affected side healing, with
wound the site free
healing, with 4. Encourage the 4. Reduces of purulent
the site free patient to wear pressure on drainage
of purulent loose-fitting or compromised 4. Avoid
drainage non-constrictive tissues, which may complication
2. Avoid clothing. Inform her improve circulation s such as
 complication to avoid wearing and healing infection
s such as jewelry on the
infection affected side

5. Encourage the 5. To promote

patient to eat foods healing
rich in protein

6. Monitor surgical 6. These are signs

incisions for of infection that
erythema, swelling, may prompt further
warmth, drainage treatment

Assessment Diagnosis Planning Interventions Rationale Evaluation

Objective: Acute Pain RT Short Term Goals Independent Independent Short Term Goals
● Presence of tissue trauma At the end of 30 1. Facilitate 1. Elevation of At the end of 30
surgical aeb alteration minutes of nursing patient to arm, size of minutes of nursing
wound of muscle tone interventions, the find dressings, and interventions, the
patient will be able to position of presence of patient was able to
1. Express a comfort drains affect 1. Express a
reduction in patient’s ability reduction in
pain/discomfort to relax, rest pain/discomf
and sleep ort
Long Term Goals effectively
At the end of 1 hour of Long Term Goals
nursing interventions, 2. Provide 2. Promotes At the end of 1 hour
the patient will be able basic relaxation, of nursing
to: comfort helps refocus interventions, the
1. Appear measures attention patient was able to:
relaxed, able to and 1. Appear
sleep/rest diversional relaxed, and
appropriately activities was able to
sleep/rest
 3. Encourage 3. may enhance appropriately
early coping abilities
ambulation
and use of
relaxation
techniques

4. Splint or 4. Facilitates
support participation in
chest activity without
during undue
coughing discomfort
and
deep-breat
hing
exercises

5. Discuss 5. Provides
the reassurance
normality that sensations
of phantom are not
breast imaginary and
sensations that relief can
be obtained

Independent Independent
1. Administer 1. Provides relief
narcotics of discomfort
or and pain and
analgesics facilitates rest,
as participation in
indicated. postoperative
therapy
Assessment Diagnosis Planning Interventions Rationale Evaluation

Objective: Situational Low Short Term Goals Independent Independent Short Term Goals
● Mastectomy Self-Esteem At the end of 8 hours 1. Encourage 1. Loss of the At the end of 30
of Left RT Disfiguring of nursing questions breast causes minutes of nursing
Breast Surgical interventions, the about the many interventions, the
● Actual Procedure AEB patient will be able to: current reactions, patient was able to
changes in Changes in 1. Demonstrate situation including 1. Demonstrate
structure Structure/Body movement and future feeling movement
and body Contour toward expectation disfigured, fear toward
contour acceptance of s. Provide of viewing acceptance
self in emotional scar, and fear of self in
situation. support of the partner’s situation.
when reaction to
surgical change in the
Long Term Goals dressings body. Long Term Goals
At the end of 2 weeks are At the end of 1 hour
of nursing removed. of nursing
interventions, the interventions, the
patient will be able to: 2. Encourage 2. Loss of body patient was able to:
1. Recognize and patient to part, 1. Recognize
incorporate express disfigurement, and
change into feelings and perceived incorporate
self-concept like anger, loss of sexual change into
without hostility, desirability self-concept
negating and grief. engender without
self-esteem. grieving negating
2. Set realistic process that self-esteem.
goals and needs to be 2. Set realistic
actively dealt with so goals and
participate in a that patient actively
therapy can make participate in
program. plans for the a therapy
future. program.

3. Provide 3. Encourages
 positive the
reinforcem continuation of
ent for healthy
gains or behaviors.
improveme
nt and
participatio
n in
self-care
and
treatment
program.

4. Ascertain 4. Negative
feelings responses
and directed at
concerns patient may
of partner actually reflect
regarding partner’s
sexual concern
aspects,
and
provide
information
and
support.

Dependent Dependent
1. Provide 1. This may
temporary promote social
soft acceptance
prosthesis, and allow
if indicated. patient to feel
more
comfortable
about body
 image at the
time of
discharge.

Collaborative Collaborative
1. Review 1. If feasible,
possibilities reconstruction
for provides less
reconstruct disfiguring or
ive surgery “near-normal”
or cosmetic
prosthetic result.
augmentati
on.

2. Discuss 2. Provides a
and refer to place to
support exchange
groups, concerns and
including feelings with
Men in Our others who
Lives for have had a
SO, as similar
appropriate experience,
. and identifies
ways SO can
facilitate
patient’s
recovery.
6. Recognize the physical, psychosocial, and rehabilitative needs of the patient who
has had breast surgery for the treatment of breast cancer.
Physical
● Range of motion
After breast cancer surgery a patient may find it difficult and painful to lift her arm above
her head or behind her back. Physical therapy exercises are designed to restore these
movements and reduce pain. “And reduced range of motion may affect cancer
treatment,” Dr. Amin says. “If a patient can’t move her arm high enough, we might not be
able to radiate that area either. So, you need to do physical therapy to improve range of
motion.”
● Breast Prostheses
After surgery and before discharge from hospital, your breast nurse will talk to
you about whether wearing a prosthesis may be appropriate for you. If you
decide it is, she will provide you with a temporary soft prosthesis which can be
used while the surgical area is healing. After healing (most likely five to six weeks
post op), you may wish to obtain a permanent breast prosthesis.
● Wigs and Hairpieces
Generally, women undergoing chemotherapy will find they start to suffer hair loss
after the second treatment. A wig can be a good option to help restore
confidence and self-esteem. But there are also many attractive hats and scarves
available and many women like to wear a hat to bed because they find their head
can get cold. A specialist or breast care nurse should provide you with a list of
wig suppliers in your area or you can contact your local division of the Cancer
Society for help. When you have chosen your wig and head wear, the supplier
will make the claim to HealthPac for you or you can make it yourself if you prefer.
● Support Groups
that can help you to improve your physical health and feel better about your
physical appearance such as
Philippine Foundation for Breast Cancer
The Philippine Foundation for Breast Cancer, Inc. is the only advocate and
support group that operates and manages a breast care center in a public
hospital located at East Avenue Medical Centre in Quezon City. Founded in
2000, their breast cancer programs include an awareness campaign with free
 breast screening, mammography, stereotactic biopsy, financial assistance,
counseling, surveillance, and social events. Philippine Breast Cancer Society
The Philippine Breast Cancer Society believes that breast cancer can be a
life-wasting disease that affects the whole person as well as the families and
communities around her or him. They believe that the disease can be most
effectively managed if people work hand in hand for the benefit of breast cancer
awareness.

Psychosocial
● Fatigue has likely surpassed nausea and vomiting as the most common problem
brought about by the treatment process of breast cancer, such as in breast
surgery and chemotherapy; it is usually brief, but over 30% of women endure
enervating fatigue that can last for years.
● The cause of fatigue is multifaceted; there is undoubtedly a psychological
component, as it contributes to and/or is associated with decreased motivation,
depression, concentration, impaired activities of daily living, and poor overall
health-related quality of life. However, proinflammatory cytokines have been
identified as the most likely underlying biological mechanism.
● It's critical to start interventions as soon as possible. Although it may appear
counter-intuitive, rest is definitely the wrong option, as exercise has been
demonstrated in numerous studies to improve not only fatigue but also mood
state.
● An updated Cochrane analysis of 56 studies, 28 of which were in breast cancer,
found that aerobic exercise, but not weight training, was beneficial. Some
patients need a lot of support from their caregivers, family, and friends or
assistance from a motivational counselor in order to participate in fitness
programs after treatment, especially if they had not done so consistently before
being diagnosed with breast cancer.
● Yoga, acupuncture, and other mindfulness-based practices might be helpful for
the more resistant, albeit the evidence for these techniques is less strong. Recent
guidelines from ASCO for the detection, evaluation, and treatment of fatigue in
adult cancer survivors could be helpful for breast cancer patients if they are
incorporated into their overall cancer management strategy.
Rehabilitative
● The early postoperative rehabilitation evaluation should be considered at least
two weeks after surgery and prior to starting adjuvant treatments, such as
radiation therapy or chemotherapy, aimed at evaluating decreased ROM,
weakness, pain or other conditions requiring rehabilitation protocols (Magno et
al., 2018).
● It is imperative for the patient to start moving her arm on the surgery side as
tolerated, so as to prevent scar tissue from developing. This is because if too
much scar tissue develops, it can reduce the movement of her shoulder.
However, the patient may find it difficult and painful to lift her arm above her head
or behind her back. As such, there are specific exercises designed to restore
these movements and reduce pain, such as the following:
○ Shoulder shrugs. This is where the patient raises her shoulders up
towards her ears, bringing the shoulder blades together at the back, and
then lowering it down.
○ Head turning and tilting. This is where the patient turns her head slowly,
looking over each of her shoulders as far as possible, and then tilting her
head to one side and then the other, bringing her ear as close to her
shoulder as tolerated.
● After the patient regains a full range of motion in her shoulders, the main goal is
now to regain strength. The patient can start with light weights (about 2 to 3
pounds) or a light resistance band. The progress should occur slowly.
● Exercising can induce soreness or even some pain, and this is a normal part of
the process after surgery. If it is very painful or uncomfortable for the patient, the
patient can take breaks as long as she doesn’t stop exercising completely. She
can begin slowly, and then take things one step at a time (Loh & Nadia, 2018).
● The need for ongoing rehabilitation surveillance should be tailored to the patient’s
needs and compliance, taking into account cancer treatment plans
(chemotherapy or radiation therapy), clinical status, and individual risk factors for
morbidity (Kim et al., 2019).
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Fallowfield, L., & Jenkins, V. (2019). Psychosocial/survivorship issues in breast cancer: are we
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Kim, K. et al (2019). Early rehabilitation after total mastectomy and immediate reconstruction
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