A Clinical Case Analysis

Presented to Committee and Faculty of

College of Nursing and School of Midwifery

City University of Pasay

In Partial Fulfillment of the Requirements

In NCM 114 Related Learning Experience

BREAST CANCER;STAGE IIIA

Submitted by:

Borja,Mary Grace C.

BSN-3A

Submitted to:

Ms. Rhodora Pimlott, RN

Clinical Instructor-RLE
 TABLE OF CONTENTS

I. Introduction
II. Background
a) Personal Data
b) Family History
c) Laboratory
III. Secondary Problems
IV. Pathophysiology
V. Drug Study
VI. Nursing Care Plan
VII. Health Teaching
I. Introduction
Breast cancer is the second most common cause of death form of cancer in

women.Worldwide, female breast cancer has now surpassed lung cancer as the most

commonly diagnosed cancer. An estimated 2,261,419 new cases were diagnosed in

women across the world in 2020.However, the number of women who have died of

breast cancer has decreased by 42% from 1989 to 2019 thanks to early detection and

treatment improvements. As a result, more than 431,800 breast cancer deaths were

prevented during that period.

Cancer begins when healthy cells in the breast change and grow out of control,

forming a mass or sheet of cells called a tumor.A cancerous tumor is malignant,

meaning it can grow and spread to other parts of the body. A benign tumor means the

tumor can grow but has not spread. Breast cancer most commonly spreads to nearby

lymph nodes, in which case the breast cancer is still considered a local or regional

disease, it can also spread further through the body through the blood vessels and/or

lymph nodes to areas such as the bones, lungs, liver, and brain. (American Society of

Clinical Oncology,2022)

The signs and symptoms of breast cancer is thickening,tenderness,redness,skin

irritation.And the risk factor are mostly female,it can be genetic,due to age,the

lifestyle of the person.(Tzou,MD.Mayo Clinic)

Stage 3 cancer means the breast cancer has extended to beyond the immediate

region of the tumor and may have invaded nearby lymph nodes and muscles, but has
not spread to distant organs. Although this stage is considered to be advanced, there

are a growing number of effective treatment options.(National Breast Cancer).

II. Background

Mrs. B is a 64 yrs.old who was diagnosed with Breast Mass @Right,probably

malignant Stage IIIA(T3N1M0) in this year 2021.She is complaining about the pain

on her right breast with a pain scale of 5/10 when she is massaging it and she

verbalized it getting larger as time goes by. Due to her curiosity she already decided

to have a check up and that’s when she get know that she’s currently have a stage3A

breast cancer. After the hospitalization,she stated that the result affect her so much to

the point she can’t eat enough and enjoy her time a lot.She isolate herself from her

family,she panicked,been depressed,and already write a last will. In her family they

don’t have any history of cancer,she only drink occasionally,never smoked,but have a

history of cataract and already did a surgery for her right eye.

She is now currently undergoing chemotherapy and taking a lot of medications

such as Celecoxib, Tranexamic Acid, Filgrastim, Omeprazole, Metoclopramide,

Multivaitamins because of her treatment she can’t sleep enough that resulting for

having low RBC. She doesn’t have any allergies.

a. Personal Data

⚫ Name: Benita C. Manglicmot

⚫ Age:64

⚫ Sex: Female

⚫ Religion: Roman Catholic

⚫ Civil statues:Widowed

⚫ Address:Pasay City

⚫ Birthday:April 28,1958

⚫ Birthplace: Quezon,Province

⚫ Attending Physician:Dr.Estrada,Regina Isabel

⚫ Chief Complain:Breast mass right

⚫ Admitting Diagnosis:Breast Mass right,probably malignant Stage IIIA

b. Family History
c. Laboratory

CBC Test

9-7-22

LABORATORY NORMAL RESULTS

TEST VALUES

WBC 4-10 5.90

RBC 2.50-5.50 3.77

Hemoglobin 11.00-16.0 10.9

Hematocrit 37-54 32.7

Lymphocytes 20-40 19

Monocytes 10-15 6

Platelet Count 100-300 208

CBC Test

8-8-22

LABORATORY NORMAL RESULTS

TEST VALUES

WBC 4-10 1.72

RBC 2.50-5.50 3.12

Hemoglobin 11.00-16.0 8.8

Hematocrit 37-54 25.8

Lymphocytes 20-40 30

Monocytes 10-15 12

Platelet Count 100-300 155

 CBC Test

7-16-22

LABORATORY NORMAL RESULTS

TEST VALUES

WBC 4-10 10.17

RBC 2.50-5.50 3.60

Hemoglobin 11.00-16.0 9.7

Hematocrit 37-54 29.9

Lymphocytes 20-40 12

Monocytes 10-15 -

Platelet Count 100-300 271

MAMMOGRAPHY

01-31-22

There is heterogeneously dense fibroglandular tissue which may limit the detection of

small masses.A hyperdense,bilobed mass with lobuted to partially obscured margins

is seen in the right mid to upper outer breast.The largest focus measure

(7.5x7.5x4.0cm)(CCxWxAP) while the smaller component measures

(1.7x4.7x3.0cm).The smaller of the two masses extends to the skin which causes

overlying skin thickening and a convex deformity in the right upper outer quadrant of

the breast. Few benign appearing punctate calcifications are seen scattered in both

breast.Enlarged(2.1cm in its short-axis diameter) and unenlarged solid appearing

lymph nodes are seen in the right axilla.Fat-laden axillary lymph nodes are also seen

on the left.
IMPRESSION:

⚫ Right breast mass with features highly associated with malignancy and with right

axillary lymphadenopathy.

⚫ Bilateral benign appearing breast calcification.

⚫ There is dense tissue which decrease the sensitivity of mammography

⚫ The absence of mammographic abnormality should not preclude further

evaluation or even biopsy if a clinically suspicious mass is palpable.

BREAST ULTRASOUND

12-28-2021

Both breast show normal heterogeneous texture.Parenchymal echoes are smooth with

no masses,cysts or calcifications seen on the left. There is however a large solid

hypoechoic mass with markedly irregular contour at the lateral aspect of the right

breast,measuring cystic mass is noted lateral to it near the axilla.No axillary masses

notes.Retroareolar areas are unremarkable

IMPRESSION:

Large solid hypoechoic breast mass,with adjacent complex mass.

III. Secondary Problem

⚫ Lymph-edema

swelling due to build-up of lymph fluid in the body.It usually happens in the arms or

legs, but can occur in other parts of the body.Lymph fluid is part of the lymph system

that carries fluid and cells that help fight infections throughout the body. Sometimes

this swelling develops quickly, or it may develop slowly over several months.

⚫ Cardiovascular Disease

Heart attacks and strokes are usually acute events and are mainly caused by a

blockage that prevents blood from flowing to the heart or brain. The most common

reason for this is a build-up of fatty deposits on the inner walls of the blood vessels

that supply the heart or brain. Strokes can be caused by bleeding from a blood vessel

in the brain or from blood clots.

⚫ Cording

The connective tissues in the armpit get inflamed, which forms one or more tight

bands. This usually happens within the first few weeks or months after the

operation.The scar tissue is called cording or banding or axillary web syndrome. It

can feel something like a guitar string. It can extend down the arm past the elbow,

possibly as far as the wrist or thumb.

 IV. Pathophysiology

Precipitating Factors
Daily Activity as a single Mom,
Predisposing Factor Weight Loss, and work related
Age of 64 , Female Stress

Abnormal cell formed by

Mutations of DNA in the right
breast tissue

cancer cells that is spread from Abnormal cell through breast

the lymph nodes epithelial tissue

Lump on the right breast

Mammogram Diagnostic Test

Breast Carcinoma Stage IIIA

V. Drug Study
Drug Name Action Indication Contradictio Adverse Nurse
n Effect Responsibili
ty
Celecoxib Thought to To treat With Headache Instruct to
(Celebrex) inhibit acute pain asthma GI reflux eat first
200mg cap prostaglandi from Any Nausea before
BID for n various allergies Back pain taking the
5days synthesis,im source;rheu Experiencin dizziness medication.
peding matoid g bleeding Inform her
cyclooxgen arthritis,dys in stomach that it may
ase-2,to menorrhea, Pregnant take several
produce osteoarthitis women days before
anti- hypertensio consistent
infamattory, n pain relief
analgesic occurs.
and Monitor the
anatipyretic patient renal
effects. function.
Tranexamic competitivel Use to History of Seizure Monitor the
Acid y inhibits reduce venous or Abdominal plate count
(Lysteda) activation heavy arterial pain throughout
500mg tab of bleeding thromboem Headache therapy.
q8hrs plasminoge Short term bolism fatigue Instruct
n thereby prevention Pregnant patient to
reducing for women notify the
conversion hemophilia nurse
of immediately
plasminoge if bleeding
n to plasmin occurs.
(fibrinolysin
), an
enzyme that
 degrades
fibrin clots,
fibrinogen,
and other
plasma
proteins,
including
the
procoagulan
t factors V
and VIII.
Filgrastim Binds cells Reduction Patient with Fever Assess the
(Grastofil) receptors to of the allergic Headache patient
300mcg/vial stimulate duration reactions to Sore throat Obtain CBC
proliferation and severity E.coli. Chest pain and
,differentiati of Constipatio complete
on,commit neutropenia n count
ment,and in patient before
end-cell with therapy
function of radiation Instruct
neutrophils. induced. patient and
Reduction his/her
of the family the
incidence of proper
infection timing and
manifested disposal of
by febrile subcut self
neutropenia. administrati
on.
Instruct to
report any
adverse
effect
 immediately
.
Metoclopra Stimulates To Patient with Anxiety Monitor
mide motility of prevent/red seizures Drowsiness bowel
(Reglan) upper GI uce nausea Depression Fatigue sounds
10mg tab tract,increas and Gastrointest Fever Observe
TID e lower vomiting inal Diarrhea any adverse
esophageal from bleeding. effect onto
sphincter chemothera the patient
tone and py patient Instruct to
blocks take the
dopamine medication
receptors at before meal
the and before
chemorecep bedtime
tor trigger Avoid
zone. activities
that require
alertness for
about 2hrs.
Urge patient
to report
any adverse
reactions.
Omeprazole antagonizin To treat History of Abdominal Closely
(Omeprazol g central nausea and hypersensiti pain monitor the
e) and vomiting in vity from Diarrhea patient.
40mg tab peripheral chemothera the dosage Farting Recommen
OD dopamine- py patient. form headache d
two Short term discontinuat
receptors in treatment of ion when
the peptic ulcer symptoms
medullary For gastric arise.
 chemorecep ulcer Ensure the
tor trigger proper
zone in the administrati
area on.
postrema,
usually
stimulated
by levodopa
or
apomorphin
Multivitami Absorption Treatment Patient with Constipatio Assess
ns 1tab OD from the GI and hypersensiti n patient for
tract after prevention vity to Dark stool signs of
oral of vitamin preservative Low nutritional
administrati deficiencies s and appetite deficiency
on colorants Stomach before and
Distributive With ache throughout
ly vitamins anemia therapy
A,D,E,and Observe the
K. patient for
any signs of
GI disorder
or
symptoms

VI. Nursing Care Plan

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: After 4 hours ⚫ Assess the ⚫ To have a baseline The patient
“Masakit po of nursing patient’s of information verbalized reduced
yung kanang intervention vital signs pain scale from 5/10
suso ko,”as the patient ⚫ To conduct a right to 0/10
verbalized will ⚫ Observe the intervention for And demonstrated
verbalized; right breast the patient the 4 basic steps of
Objective: ⚫ Reductio of the ⚫ To have a right massaging.
(+)palpable n in pain patient exercise planning
Lump sized of ⚫ Demonst
peso rate ⚫ Assess the
(+)tenderness massagin range of ⚫ To adjust the
(+)facial g motion of medication if
grimace treatment the patient necessary
(+)inflammatio
n
Acute
redness ⚫ Monitor her
pain
pain scale ⚫ To lessen the pain
related to
before and and discomfort
Inflamma
P/s: 5/10 after taking
tion at the
analgesic ⚫ To promote blood
right
circulation and
breast
reduce swelling.
⚫ Encourage
to ⚫ Reduce associated
V/s exercise(sho pain and reduce
Temp:36.7 ulder inflammation
Bp:120/70 exercise)
PR:88 ⚫ Educate the
RR:19 right way to
massage her
right breast
everyday
⚫ Provide cold
compress to
the right
breast
Subjective: After 4hrs of ⚫ Assess the ⚫ To provide a
The patient sleeping
“madalas na po nursing her sleeping sleeping plan andplan helped her to
akong hindi intervention: pattern by to reduce
improved her
makatulog”as ⚫ Describe providing discomfort sleeping pattern and
verbalized factors favorable verbalized the good
that atmosphere. ⚫ To promote light outcome.
prevent feeling before
or inhibit ⚫ Discourage sleep
sleep the her to
Objective: ⚫ Will lessen the
Tiredness of verbalize cafe and ⚫ For relaxation and
eyes 4 large intake concentration
Hand tremors techniqu of meal
Late responses es on before going
how to to sleep.
fall sleep ⚫ Use “white ⚫ To help the patient
V/s ⚫ Report noises”(fan,s to stay asleep
Temp:36.7 less oothing
Bp:120/70 Disturbed agitation music) ⚫ It can promote
PR:88 Sleep sleep and reduce
RR:19 Pattern fluctuation
related to ⚫ Take
overload sleeping aid
stress per doctor’s ⚫ To promote blood
order circulation and
good sensation

⚫ Encourage ⚫ To prevent feeling

to drink groggy
milk before
going to
sleep

⚫ Have a hot-
bath

⚫ Discourage
naps longer
than 90
minutes
VII. Health Teaching

⚫ Maintain a healthy body weight.Avoid fatty foods.Eat more

like high fiber foods.
⚫ Exercise regularly minimum of 30 mns of moderate to
vigorous activity at least 5x per week.
⚫ Massage your breast regularly for self examination.
⚫ Take your medications prior to the doctor’s order.
⚫ Discipline yourself to drink enough water(6-8 glass of water).