PRESENTATION

ON
ROLE OF NURSE IN BREAST CANCER PATIENT WITH
PSYCHO-SOCIAL ISSUES

NIRGINA ADHIKARI
SAGINA MAHARJAN
 WHAT IS BREAST CANCER?

Breast CANCER is a cancer that develops from

breast tissue which causes a lump in the breast,
change in breast shape, dimpling of skin, fluid
coming from nipple
-Wiki answer (wikipedia.org)
 DIAGNOSIS

Ca left breast,post mrm,post CT+RT with

vertebral and brain Mets,now under
hormonal therapy tab RIBOCICLIB, tab
Lertozole and zyphos.
 HISTORY OF PAST ILLNESS

• No any History of past ILLNESS.

 HISTORY OF PRESENT ILLNESS
• known case of CA left Breast which was
diagnosed on 2014,
•MRM was done at Bharatpur Cancer Hospital
•4 cycle Adjuvant CT was taken.
•hormonal therapy from 4 years.
•PET CT was done on 2018-10-8,findings of the
scan was vertebral Mets,
•completed 10th fraction RT in Vertebra.
She came to our center for further evaluation and
treatment plan on 2019-1-23.
Spinal surgeon consultation was done and doctor
advised for complete bed rest.
PET CT scan was done on 2019-1-30 as patient was
developing SOB
left sided pleural effusion with left lung collapse
PIG TAIL insertion
Pleurodosis done
patient was clinically improved and she was discharge.
 HISTORY OF PAST ILLNESS
•she was admitted on 2019-3-11 with the complain
of multiple episode vomiting, irrelevant talk and
dysphasia. Hormonal therapy was hold at that time.
•CECT head and neck was done to rule out the
problem in which the impression was brain Mets.
After that 10th #WBRT taken by the patient and
completed on 2019-4-2.
•She was being discharge in stable health
condition. During her post evaluation, diseases was
stable. Now she is in continuous follow up as per
advice.
 HISTORY OF ANY DRUG ALLERGY

She has history of allergic reaction with injection

ketorolac.
Rashes was develop and subside after injection
avil.
 PREVIOUS HOSPITALIZATION

No any history of previous hospitalization

 HISTORY OF ANY OPERATION

No any history of previous operation

HISTORY OF ANY CHRONIC ILLNESS

No any history of Chronic Illness

PSYCHOSOCIAL ISSUES OF PATIENTS

Social
less support from her family member as well as
from her husband.
No one came to visit her during her
hospitalization.
She remained far from her son due to her long
treatment process
PSYCHOSOCIAL ISSUES OF PATIENTS

Spritual
worthless feeling
Empathy
Loneliness
Low self-esteem
PSYCHOSOCIAL ISSUES OF PATIENTS

Psychological
•difficulty in coping mechanism
•didn’t want to communicate with other.
•angry
•avoid people
•anxiety
•introverted (shy, reserved)
COMMON PSYCHOSOCIAL ISSUES
OF WOMEN WITH BREAST CANCER
•Fear of recurrence
•Physical symptoms such as fatigue, pain
•Sexual dysfunction
•Treatment related anxieties
•Intrusive thoughts about illness
•Persistent anxiety
COMMON PSYCHOSOCIAL ISSUES
OF WOMEN WITH BREAST CANCER
•OTHERS
• Marital/ partner communication
• Feeling of vulnerability
• Thought about mortality
PSYCHOSOCIAL ISSUES OF PATIENTS
•Frequently visiting to her bed side
•Repeatedly trying for communication
•Her feel free there are some others who would listen
to her issues and feelings
Psychiatric consultation
Psychiatric counselling
SYMPTOMATIC MANAGEMENT OF PATIENT
Back Pain
•Pain assessment
•Management as per NAPCare guideline
•Advice for bed rest
•Talyor Brace applied
•Medication
tab tramadol 50 mg qid
tab paracetamol
tab e-cox 90 mg od.
SYMPTOMATIC MANAGEMENT OF PATIENT
Constipation
• Dietician consultation done.
• Diet modification done, fibrous and liquid diet
provided for her.
• Stool softener i.e. tab dulcolax 2 tab po hs and
syrup evict 30ml po hs
• Even after all, constipation was still present so,
motivac enema given then stool passed.
SYMPTOMATIC MANAGEMENT OF PATIENT
Nausea and vomiting
• Dietry modification
• Diet as per her interest
• Application of antiemetics
SYMPTOMATIC MANAGEMENT OF PATIENT
Decrease appetite:
• Dietician consultation
• diet provided as her interest.
• Tab Endace appetizer
SYMPTOMATIC MANAGEMENT OF PATIENT
DVT prophylaxis:
 DVT stocking was applied for prophylaxis
Management of DVT
SYMPTOMATIC MANAGEMENT OF PATIENT
Mucositis:
• Maintain oral hygiene.
• Avoid spicy and salty foods.
• Candid drop 6-8 drops applied 3-4 times a day.
SYMPTOMATIC MANAGEMENT OF PATIENT
Dyspnea:
• Oxygen therapy
• Medicines
• Image guided pigtail insertion done due to
massive pleural effusion on left side of the chest.
• Pleurodosis was done then, pig tail was removed.