You are on page 1of 48


Stage IV
BSN IV Group 1B Feb. 8, 2011

Cancer is a major health problem worldwide and the morbidity and mortality from cancer give rise to much suffering. The risk of developing cancer in an individual's lifetime is about 33%, and the risk of dying of cancer is 25%. Cancer is not only a disease of the elderly although for many cancers the incidence increases with age. Breast cancer in the US and Western Europe is the commonest female cancer, and accounts for the most cancer deaths in women. Eighteen percent of women who develop breast cancer will be under 50 years of age and with an average of 50% mortality this will produce a significant number of deaths in a population of wives and mothers who are making major contributions to the nurture of future generations and the economy.

Loss of life in this age group has very serious consequences both for society in general and for the individual families involved. There are now major health programs throughout the world involved in research and development into prevention, early detection, and new treatments with the aim of reducing the morbidity and mortality from breast cancer. It is of some considerable interest that the East in general has amongst the lowest rates of breast cancer in the world. This is assumed to be a combination of environmental and genetic factors and their interaction.

In the UK 30,000 new cases of breast cancer are diagnosed each year making this the commonest malignancy in women and causing nearly 15,000 deaths per year. Randomized studies of prevention strategies particularly with the antioestrogens Tamoxifen and more recently raloxifene, and retinoids have either been completed or are ongoing. The final analysis is awaited but it is likely that effective preventive measures will be available in the not too distant future.

which demonstrate a reduction in breast cancer mortality from screening. . which centers on the question of cost-effectiveness. to discover the reasons for their increase in risk.INTRODUCTION A national population-based breast-screening program was commenced 6 years ago on the evidence from randomized trials. In the not too distant future it should be possible to better define women who are at increased risk of breast cancer. This remains an area of considerable medical debate. and then to target both specific preventive and early detection strategies at this "at risk" population.

2 in 2003-2005.000 females. and most Eastern European countries. the Republic of the Philippines has the highest reported incidence rate of breast cancer. including Spain. Italy. and this figure exceeds the rate reported for several Western countries. the age standardizedincidence rate (ASR) is now 47.7 per 100. From 43. .INTRODUCTION In Asia.

INTRODUCTION Many breast cancers are diagnosed among 35 to 50-year-old Filipino women. incurring savings for the government by almost 3 million Philippine Pesos or US $60.000 women. Mammography is neither readily available nor affordable especially in the rural areas. a local study revealed that the use of breast self-examination (BSE) and aspiration biopsy/open biopsy are the most costeffective strategies in the Philippine setting. . In terms of breast cancer detection.000 (1989 value) per year per 100.


Hopeful Age: 51 y/o Sex: Female Civil Status: Married Religion: Roman Catholic Address: Naguilian. Isabela Birthday: May 12.PATIENT’S DATA Name: Mrs. 1959 Diagnosis: Pleural Effussion. PTB . Breast CA.

CHIEF COMPLAINT Difficulty of breathing and edema on the left upper extremity. .

No other serious illnesses were noted base from the family health history. . her grandmother died due to cancer.FAMILY HISTORY On her father side.

Furthermore. She had coughs and colds once in a while and managed it with OTC (over the counter) drugs. . Aside from that no other illnesses were noted. she does not have any allergy on foods nor on medicines. she had measles and chicken pox in her grade school. She didn’t recall if she had immunizations.PAST HISTORY According to the patient.

She went home to the Philippines and on October 6. she also had undergone Cobalt therapy at the Jose Reyes Hospital. 2006 she had undergone left mastectomy operation at the PGH (Philippine General Hospital). on 2007 at the same hospital she underwent chemotherapy for 6 months. Next. . she was working as a domestic helper in Hongkong at that time.PAST HISTORY (Con’t. she palpated a mass on her left upper breast.) She stated that last June of 2006. She had her checked up in one of the hospitals in Hongkong and undergone biopsy and was diagnosed to have a breast cancer Stage II. Then.

the patient had an edema on her left upper extremity. followed with body weakness and difficulty of breathing. .PRESENT HISTORY 1 year PTA.

SOCIAL HISTORY They originally come from an Ilocano background. she and her husband are from Isabela. She doesn't smoke nor drink alcoholic beverages. She had a good relationship with her family. . her only daughter was already married and the family lives with them.


Our health reflects the consequences of our actions. .Health Perception/ Health Management BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She regards health as a momentous part of life. it is something not to be taken for granted. She realizes that it is a must to take responsibility in our health. brushes her teeth 2x a day. It was her 5th hospital experience. she values health and her health status somehow gave her realization that actions of staying healthy is more important than just merely knowing on how to be healthy. She take vitamins.

she usually eats vegetable and meat. Lesser appetite because of her medication and condition (dysphagia). she doesn’t have too much appetite.NUTRITIONAL – METABOLIC BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She sometimes skips her meals. . however. Some of her medication suppresses her appetite which aggravates her usual appetite even before hospitalization.

She usually for 2-3 hours in a goes to bed at day. She admits that she can’t help thinking about her condition especially at night. she also mentioned that she had a hard time breathing especially when her lips are dry. 10pm and wakes up at about 4am in the morning. .SLEEP – REST BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She sleeps 4-6 She only sleeps hours.

Changes in bowel movement is due to decrease mobility or exercise. Urinates 1-2 times a day with slightly yellowish urine and defecates every other day with hard formed stool.ELIMINATION BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She usually defecates not more than two times a day and micturates 3-5 times. .

Confessed that she gets tired easily these past few days. She also do household chores which is the activities that keeps her fit. Still performs her daily living activities but with an assistance. she helps her daughter in taking good care of their kids.ACTIVITY – EXERCISE BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She is a very hardworking mother. . Her body is still weak brought about prolonged disease process and decline of her body system.

she use eyeglasses when reading. other than that she doesn’t wear any other aids or prosthesis. since the operation performed was localized at her breast. and still wear glasses when reading.COGNITIVE – PERCEPTUAL BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE Her senses are functional. Her senses are still functional. . No change. However.

she tries her best to help her family especially in taking good care of her grandchildren. but tries her best not to show it to her family. She’s strong enough to accept her illness. however. as part of a woman it is expected for her to be emotional at times. she admits that there are times when she just lose hopes. .SELF-PERCEPTION/ SELF CONCEPT BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She is a strong willed and reliable person. Her personality as a strong-willed person somehow helps her to accept her condition but nevertheless.

Being an optimist and dependable person. She admitted that she had a good relationship with her husband and to her daughter.ROLE – RELATIONSHIP BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She did not mention any specific problems with her family. . she values relationship with others regardless of her condition. however. She sometimes feels sad and fears that she might not be able to perform her role in the family. She gets along well with other patient and to health care providers. she can’t help to have fears to the anticipated procedures she have to undergo if her illness will get worse.

Her hospitalization caused her to have limited movements. she had her menopausal period. Her husband just stays with her for support and confidant.SEXUALITY – REPRODUCTIVE BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE At the age of 49. She admits that her relationship with her husband are already in platonic level and do not practice coitus. she admits that she rarely had sexual urges (decrease libido) and her husband was contented just to be with her even without coitus. At her age. .

which influenced her coping mechanism in dealing with life’s unexpected challenges. She had a strong faith in God and it’s one of the reasons that keep her going. she strongly believes in the power of prayer in solving problems and in making decisions in her life. they were very supportive on her condition. Her family supports her and she tries her best to stay strong for them. . She is a familyoriented person.COPING/ STRESS TOLERANCE BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She had a very close relationship with her family. She values her family and her faith. In addition.

She bravely faces this obstacle. She became closer with her faith. and admits at times she questions it but her faith is much stronger than her doubts. She values the gift of life.VALUE – BELIEF BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE She is a Roman Catholic. . She have a strong belief in God above all things and attend mass if have the chance. despite the odds and ironies it brings. The values she had remains with her no matter how difficult things are.


Is female) • Late Menopausal (Pt.’s grandmother died because of cancer) PRECIPITATING FACTORS: • Unknown Neoplasm formation in the breast Primary tumor begins in the breast Surgery (Pt. is 51 y/o) • Gender (Pt. was menopaused at 49) • Lifestyle (Stress) • Hereditary (Pt. undergone mastectomy) S/Sx: pain on the left upper breast Tumor becomes invasive .PREDISPOSING FACTORS: • Age (Pt.

Travel (metastasize) to other organ systems in the body Progress beyond breast to regional lymph nodes It becomes systemic Primary cancer spreads • Chemotherapy • Radiotherapy • Interstitial laser thermotherapy Progress beyond breast to regional lymph nodes .

Pleural Efussion LIVER S/Sx: RLQ pain NECK S/Sx: Horseness of voice BONES S/Sx: Back & bone pain BRAIN S/Sx: Headache . Cough.Removal of the breast Cancer cell spreads into major organs Cancer cell destroyed/ removed Some cancer cell remains LUNGS S/Sx: DOB.


and betaadrenergic receptors and on specific dopaminergic receptors in mesenteric and renal vascular beds.DOPAMINE HYDROCHLORIDE BRANDS: Dopastat. Intropin. Alpha. Revimine CLASSIFICATIONS: Autonomic Nervous System Agent. Major cardiovascular effects produced by direct action on alpha.and Beta-adrenergic Agonist (Sympathomimetic) ACTION: Naturally occurring neurotransmitter and immediate precursor of nor-epinephrine. .

lactation. Safe use during pregnancy (category C). CONTRA INDICATIONS: Pheochromocytoma. tachyarrhythmias or ventricular fibrillation. trauma. endotoxic septicemia (septic shock). or children is not established. . open heart surgery. and CHF.DOPAMINE HYDROCHLORIDE INDICATION: To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock).

and urinary output at intervals prescribed by physician. • Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension. cyanosis. disproportionate rise in diastolic pressure (marked decrease in pulse pressure). signs of peripheral ischemia (pallor. or burning sensation). mottling. ascending tachycardia. numbness. complaints of tenderness. dysrhythmias. peripheral pulses.DOPAMINE HYDROCHLORIDE NURSING RESPONSIBILITIES: • Monitor blood pressure. Precise measurements are essential for accurate titration of dosage. pain. pulse. . coldness.

increase in toe temperature.DOPAMINE HYDROCHLORIDE NURSING RESPONSIBILITIES: • Monitor therapeutic effectiveness. adequacy of nail bed capillary filling. In addition to improvement in vital signs and urine flow. . and reversal of confusion or comatose state. other indices of adequate dosage and perfusion of vital organs include loss of pallor.


Mastectomy is usually performed as a treatment of breast cancer. . women with breast cancer can decide whether to be treated with a lumpectomy or a mastectomy. A lumpectomy is the removal of the cancerous breast tissue as well as a surrounding rim of healthy breast tissue.MASTECTOMY Mastectomy is an operation in which the entire breast. is removed. A lumpectomy is a breast-conserving surgery that is usually followed by radiation therapy (high-dose X-rays or other high-energy rays to kill cancer cells). In general. usually including the nipple and the areola.

most of the lymph nodes under the arm and often the lining over the chest muscles Lumpectomy . size of the tumor. Many women have breast reconstruction to rebuild the breast after a mastectomy. size of the breast and whether the lymph nodes are involved.the removal of the breast.removal of breast tissue and nipple Modified radical mastectomy . This is no longer common Which surgery you have depends on the stage of cancer.MASTECTOMY There are four main types: Total mastectomy . lymph nodes and chest to remove the tumor and a small amount of normal tissue around it Radical mastectomy .removal of the breast. .


which means it affects the whole body by going through the bloodstream. In many cases. Chemotherapy. . a combination of two or more medicines will be used as chemotherapy treatment for breast cancer. There are quite a few chemotherapy medicines. often shortened to just "chemo." is a systemic therapy. including cells at the original cancer site and any cancer cells that may have spread to another part of the body.CHEMOTHERAPY Chemotherapy treatment uses medicine to weaken and destroy cancer cells in the body.

CHEMOTHERAPY Chemotherapy is used to treat: •EARLY-STAGE INVASIVE BREAST CANCER to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back • ADVANCED-STAGE BREAST CANCER to destroy or damage the cancer cells as much as possible ***In some cases. chemotherapy is given before surgery to shrink the cancer.*** .

they travel to all parts of the body in order to reach cancer cells that may have spread beyond the breast -.therefore chemotherapy is considered a "systemic" form of breast cancer treatment.How Is Chemotherapy Given for Breast Cancer? For breast cancer. Chemotherapy is given in cycles of treatment followed by a recovery period. depending on the type of drugs given. The entire chemotherapy treatment generally lasts several months to one year. . chemotherapy drugs are given intravenously (directly into a vein) or orally (by mouth). Once the drugs enter the bloodstream.

sometimes called radiotherapy. cobalt therapy. . or irradiation uses high energy. electron beam therapy. proton rays. penetrating waves or particles such as x rays. gamma rays. x-ray therapy radiation treatment.RADIATION THERAPY Radiation therapy. or neutron rays to destroy cancer cells or keep them from reproducing.

It is used in more than half of all cancer cases. Radiation therapy can be used: • alone to kill cancer • before surgery to shrink a tumor and make it easier to remove • during surgery to kill cancer cells that may remain in surrounding tissue after the surgery (called intraoperative radiation) • after surgery to kill cancer cells remaining in the body • to shrink an inoperable tumor in order to reduce pain and improve quality of life • in combination with chemotherapy .RADIATION THERAPY Purpose The purpose of radiation therapy is to kill or damage cancer cells. Radiation therapy is a common form of cancer therapy.

This blocks their ability to grow and increase in number.RADIATION THERAPY How Radiation Therapy Works The protein that carries the code controlling most activities in the cell is called deoxyribonucleic acid or DNA. but because normal cells are growing more slowly. . When a cell divides.or seven-week period. One of the characteristics of cancer cells is that they grow and divide faster than normal cells. This makes them particularly vulnerable to radiation. Highenergy radiation kills cells by damaging their DNA. its DNA must also double and divide. radiation treatments are often given in small doses over a six. they are better able to repair radiation damage than are cancer cells. In order to give normal cells time to heal and reduce side effects. Radiation also damages normal cells.

its size. and the method of application are calculated by a radiation oncologist based on the tumor type. the size and location of the patient's tumor are determined very precisely using magnetic resonance imaging (MRI) and/or computed tomography scans (CT scans). The patient's skin is marked with a semi-permanent ink to help the radiation technologist achieve correct positioning for each treatment. the number of sessions. the interval between sessions. .RADIATION THERAPY Preparation Before radiation therapy. The correct radiation dose. Molds may be built to hold tissues in exactly the right place each time. and the sensitivity of the nearby tissues.

..Thank You..