Breast Cancer

Case Presentation
 I. Introduction

Breast cancer is an uncontrolled growth of breast cells.

Cancer occurs as a result of mutations, or abnormal
changes, in the genes responsible for regulating the
growth of cells and keeping them healthy. The genes
are in each cell’s nucleus, which acts as the “control
room” of each cell. Normally, the cells in our bodies
replace themselves through an orderly process of cell
growth: healthy new cells take over as old ones die
out.
 I. Introduction

But over time, mutations can “turn on” certain genes

and “turn off” others in a cell. That changed cell gains
the ability to keep dividing without control or order,
producing more cells just like it and forming a tumor. A
tumor can be benign (not dangerous to health) or
malignant (has the potential to be dangerous). Benign
tumors are not considered cancerous: their cells are
close to normal in appearance, they grow slowly, and
they do not invade nearby tissues or spread to other
parts of the body. Malignant tumors are cancerous.
Left unchecked, malignant cells eventually can spread
beyond the original tumor to other parts of the body.
 I. Introduction

The term “breast cancer” refers to a malignant tumor

that has developed from cells in the breast. Usually
breast cancer either begins in the cells of the lobules,
which are the milk-producing glands, or the ducts, the
passages that drain milk from the lobules to the nipple.
Less commonly, breast cancer can begin in the
stromal tissues, which include the fatty and fibrous
connective tissues of the breast.
 I. Introduction

Over time, cancer cells can invade nearby healthy

breast tissue and make their way into the underarm
lymph nodes, which are small organs that filter out
foreign substances in the body. If cancer cells get into
the lymph nodes, they then have a pathway into other
parts of the body. The breast cancer’s stage refers to
how far the cancer cells have spread beyond the
original tumor.
 I. Introduction

Breast cancer is always caused by a genetic

abnormality (a “mistake” in the genetic material).
However, only 5-10% of cancers are due to an
abnormality inherited from your mother or father.
Instead, 85-90% of breast cancers are due to genetic
abnormalities that happen as a result of the aging
process and the “wear and tear” of life in general.
Developing breast cancer is not your or anyone's fault.
Feeling guilty, or telling yourself that breast cancer
happened because of something you or anyone else
did, is not productive.
 I. Introduction

Breast Cancer is the most common cancer amongst

women in the Philippines. According to the Philippine
Statistics of Authority and the Department of Health, it
shows that 3 in every 100 Filipina women will be
diagnosed with breast cancer in their lifetime. The
Philippines had the highest prevalence of breast
cancer among 197 countries in February 2017,
according to the Philippine Obstetrical and
Gynecological Society.
​
 II. Objectives
General Objectives

At the end of this case study, the student nurse will have broaden
knowledge about the definition, etiology, signs and symptoms and
will be able to enhance not only the knowledge about Breast Cancer
but also how to administer the necessary intervention necessary to
provide quality care. Through this, the student nurses will be able to
expand their knowledge, skills and attitude in giving the appropriate
nursing care for the patient and thereby prevent severe morbidity and
mortality.
 II. Objectives
Specific Objectives
Knowledge
To widen knowledge level of healthcare professionals and their attitudes
01 towards screening methods for breast cancer, these important determinants
of the practice of these methods by their patients.
The learner will be able to explain the need to intensify education
02
on breast cancer and breast
03 To identify what sort of intervention or technique to use to the
patient with fear and anxiety due to the disease
04 Develop and demonstrate proficiency in formulating therapeutic
treatment for the patient health needs
 II. Objectives
Specific Objectives
Skills
The learner will be able to discuss the cultural diversities in
01 understanding and practicing breast self-examination as a measure
for early detection of breast cancer.
To provide proper nursing management and medical regimen
02 needed by the patient.
Be able to accurately formulate a nursing care plan for Breast
03
Cancer.
Perform a correct nursing intervention suitable for Breast
04
Cancer.
 II. Objectives
Specific Objectives
Attitude
The learner will be able to discuss the cultural diversities in
01 understanding and practicing breast self-examination as a measure
for early detection of breast cancer.
02 To apply Vincentian Core values in nursing care for Breast
Cancer.
Give importance to human dignity and emotions of the patient
03
with Breast Cancer.
To strengthen the relationship of the nurse and patient by
04
providing a genuine rapport.
 Vital Information

Patient Name: Mrs. MPR

Age: 50 years’ old
Weight: 210lbs (95kg)
Height: 5’2
Sex: F
Address: Brgy. Politiko, Roxas City
Civil Status: Married
Date & Time Admitted: December 5,
2021, 10:00am
Religion: Roman Catholic’
Ward: Medical Ward
 Vital Information
CASE SCENARIO
Mrs. MPR, a 40-year-old premenopausal woman, G1 T1 P1 A0 L1
admitted to St. Anthony College Hospital in Roxas City at 10 a.m.
on December 5,2021, for right breast pain, swelling, and blood-
stained discharge on her shirt, as well as palpable breast lumps on
her upper breast. She stated that she was diagnosed with breast
cancer last February 2020 at St. Anthony College Hospital, she said
that she had the same complaint like experiencing breast pain while
doing her SBE or self-breast exam at home before being diagnose
she felt that there is something lumpy or sponge like and it feels
firm but it was treated and had her chemotherapy.
 Vital Information

Chief Complaint: The patient verbalizes breast pain,

nipple tenderness, inward turning of nipple, bloody
discharge, enlargement of her breast last 2 days.
 
Admitting Diagnosis: Possible Breast Cancer
 Health Assessment
History of Present Illness

 
Two days prior to admission, the patient already experienced
breast pain, nipple tenderness, inward turning of nipple, there
is bloody discharge coming from her breast she didn’t take any
medicines but she continued to drink alcohol to ease the pain
away.
 
 Health Assessment
Past Medical History

 
 
The past medical and family history is
remarkable because the patient had a breast
cancer last 2020.
 
 Health Assessment
 
Menstrual History

 
 
The client had her menarche at the age of
11 with 28 days cycle lasting for 4-5 days.

 
  Family History
Health Assessment

 
 
Family history reveals that the mother has
breast cancer and her sister had cervical
cancer.

 
Review of Systems
Review of Systems
Review of Systems
Review of Systems
 Diagnostic Test Result
ECG (Electrocardiogram)

NAME: MPR
AGE: 50 years old
INTERPRETATION:
NORMAL PR INTERVAL (AFTER 3
CYCLES OF CHEMOTHERAPY)
 Diagnostic Test Result
Chest X-ray

NAME: MPR
AGE: 50 years old
INTERPRETATION:
Both lungs are clear and
expanded with no infiltrates.
Heart size is normal
 Diagnostic Test Result
Laboratory Test Result
LAB EXAM PATIENT RESULTS NORMAL FINDINGS INTERPRETATION
SIGNIFICANCE
HEMATOLOGY      
       
Platelet Count 480,000 /Ul 150,000 – 450,000/uL INCREASED
       
Hemoglobin 10g/dl 12-16 g/dl DECREASED
       
RBC 3.8 4.5- 5.5 DECREASED
       
WBC 12,000 4,500- 11, 000 INCREASED
   
   

BLOOD CHEMISTRY      
       
CREATININE 0.7 mg/dl 0.6- 1.2 mg/dl NORMAL
       
SODIUM 133 mEq/L 135-145 mEq/L DECREASED
       
POTASSIUM 5.2 mEq/L 3.5- 5.0 mEq/L INCREASED
 Diagnostic Test Result
Mammography
ASSESSMENT MANAGEMENT LIKELIHOOD OF CANCER

CATEGORY 0: Incomplete- need Recall for additional imaging N/A

additional imaging evaluation.

CATEGORY 1: Positive Routine Screening Essentially 50% likelihood of

malignancy
CATEGORY 2: Malignancy Routine Screening Essentially 50% likelihood of
malignancy
CATEGORY 3: Probably malignancy Continue surveillance 50% likelihood of malignancy

CATEGORY 4: High suspicion for Tissue Diagnosis 95% likelihood of malignancy

malignancy
CATEGORY 5:Highly suggestive of Tissue Diagnosis 95% likelihood of malignancy
malignancy
CATEGORY 6: Known biopsy-proven Surgical excision when clinically N/A
malignancy appropriate
 Diagnostic Test Result
Breast Ultrasound

NAME: MPR
Age: 50 years old
INTERPRETATION:
Breast Mass at the Right Breast
 Diagnostic Test Result
Breast MRI

NAME: MPR
Age: 50 years old
INTERPRETATION:
Irregular or spiculated borders
with internal divisions enhanced.
Rim enhancement (brightening)
on the outside of the mass.
 Diagnostic Test Result
PET Scan

NAME: MPR
Age: 50 years old
INTERPRETATION:
FDG-PET, PET-CT reveals
metastasis of breast cancer to the
right supraclavicular lymph node.
 Diagnostic Test Result
Fine Needle Biopsy

Results shows presence of

malignancy
 Textbook Discussion
ANATOMY AND
PHYSIOLOGY

Breasts are part of the female and

male sexual anatomy. For females,
breasts are both functional (for 
breastfeeding) and sexual (bringing
pleasure). Male breasts don’t have a
function. The visible parts of breast
anatomy include the nipples and
areolae.
 Textbook Discussion
ANATOMY AND
PHYSIOLOGY
What is it made of?
Several kinds of tissue form female
breasts. The different types of breast
tissue include:

Glandular: Also called lobules, glandular

tissue produces milk.
Fatty: This tissue determines breast size.
Connective or fibrous: This tissue holds
glandular and fatty breast tissue in place.
 Textbook Discussion
ANATOMY AND
PHYSIOLOGY
What parts make up the breast?
There are many different parts to female breast
anatomy, including:
Lobes: Each breast has between 15 to 20 lobes or
sections. These lobes surround the nipple like spokes
on a wheel.
Glandular tissue (lobules): These small sections of
tissue found inside lobes have tiny bulblike glands at
the end that produce milk.
Milk (mammary) ducts: These small tubes, or ducts,
carry milk from glandular tissue (lobules) to nipples.
Nipples: The nipple is in the center of the areola.
Each nipple has about nine milk ducts, as well as
nerves.
 Textbook Discussion
ANATOMY AND
PHYSIOLOGY
What parts make up the breast?
Areolae: The areola is the circular dark-colored area
of skin surrounding the nipple. Areolae have glands
called Montgomery’s glands that secrete a lubricating
oil. This oil protects the nipple and skin from chafing
during breastfeeding.
Blood vessels: Blood vessels circulate blood
throughout the breasts, chest and body.
Lymph vessels: Part of the lymphatic system, these
vessels transport lymph, a fluid that helps your body’s
immune system fight infection. Lymph vessels connect
to lymph nodes, or glands, found under the armpits, in
the chest and other places.
Nerves: Nipples have hundreds of nerve endings,
which makes them extremely sensitive to touch and
arousal.
 (Non-
Risk Factors modifiable)
Risk Factor  
Female gender 99% of cases occur in women
 
Increasing age Increasing age is associated with an increased risk.
 

Personal history of breast cancer
Having first-degree relative with breast cancer
(mother, sister, daughter) increases the risk twofold;
having two first-degree relatives increases the risk
fivefold, The risk is higher if the relatives was pre-
menopausal at the time of diagnosis.
The risk is increased if a father or brother had
breast cancer (exact risk is unknow).

Genetic mutation BRCA1 and BRCA2 mutations account for majority

of inherited cases of breast cancer (see additional
information in text).
 
 Risk Factors (Modifiable)
Risk Factor  
Hormonal factors • Before 12 years of age
• Early menarche • After 55 years of age
• Late menopausal • No full-term pregnancies
• Nulliparity • After 30 years of age
• Late age at first full-term pregnancy • Current or recent use of combined
• Hormone therapy (formerly referred to as postmenopausal hormone therapy (estrogen
hormone replacement therapy) and progesterone) Long term use (several
years).
 
Exposure to ionizing radiation during The risk is highest if breast tissue was exposed
adolescence and early adulthood while still developing (during adolescence), such as
women who received mantle radiation (to the chest
area) for treatment of Hodgkin lymphoma in their
younger years.
History of benign proliferative during Having had atypical ductal or lobular
adolescence and early adulthood hyperplasia or lobular carcinoma in situ
increases the risk.
 
 Risk Factors (Modifiable)

Risk Factor  
Obesity and weight gain during adulthood increases
the risk of postmenopausal breast cancer. During
Obesity menopause, estrogen is primarily produced in fat
tissue. More fat tissue can increase estrogen levels,
thereby increasing breast cancer risk.
 
More research is needed
High-fat diet

Two or five drinks daily increases the risk about one

Alcohol intake (beer, wine, or liquor) and a half times.
 
Pathophysiology
 Clinical Manifestations
Clinical Manifestations Clinical Manifestations (Patient)

A lump or thickening in or near the Breast Pain

breast or in the underarm that persists
through the menstrual cycle.

A mass or lump, which may feel as small as Nipple Tenderness

a pea.

A change in the size, shape, or contour of Inward Turning of Nipple

the breast.

A blood-stained or clear fluid discharge from Bloody Discharge

the nipple.
 Clinical Manifestations
Clinical Manifestations Clinical Manifestations (Patient)

A change in the look or feel of the skin

on the breast or nipple (dimpled, Swelling
puckered, scaly, or inflamed).

Redness of the skin on the breast or nipple.

Enlargement of Breast

An area that is distinctly different from

any other area on either breast. Discoloration of the Breast Skin

A marble-like hardened area under the

skin. Breast Lumps
 Diagnostic Tests
Mammogram

A mammogram is an X-ray image of your breasts. It can

be used either for breast cancer screening or for
diagnostic purposes, such as to investigate symptoms
or unusual findings on another imaging test.
Mammogram can be used either for screening or for
diagnostic purposes.
 Diagnostic Tests
Mammogram

Screening mammogram. A screening mammogram is used to detect breast

changes that could be cancerous in people who have no signs or
symptoms. The goal is to detect cancer when it's small and treatment may
be less invasive.

Diagnostic mammogram. A diagnostic mammogram is used to investigate

suspicious breast changes, such as a new breast lump, breast pain, an
unusual skin appearance, nipple thickening or nipple discharge. It's also
used to evaluate unexpected findings on a screening mammogram. A
diagnostic mammogram includes additional mammogram images.
 Diagnostic Tests
Breast Ultrasound

Ultrasound imaging of the breast uses sound waves to

produce pictures of the internal structures of the breast.
It is used to help diagnose breast lumps or other
abnormalities found during a physical exam, or on a
mammogram or breast MRI. Ultrasound is safe,
noninvasive, and does not use radiation.
 Diagnostic Tests
Fine Needle Aspiration

A breast fine needle aspiration (FNA) removes some

fluid or cells from a breast lesion (a cyst, lump, sore or
swelling) with a fine needle similar to that used for blood
tests. The sample of fluid or cells (or tissue) is examined
by a specialist doctor (a cytologist). An FNA can assist
the doctor to determine the nature or diagnosis of a
lesion and, if necessary, to plan treatment.
 Diagnostic Tests
Magnetic Resonance Imaging
(MRI)

Breast MRI uses radio waves and strong

magnets to make detailed pictures of the
inside of the breast. This is to help
determine the extent of breast cancer and
as a screening test.
 Diagnostic Tests
Positron Emission Tomography (PET)
Scan

PET scans can be useful for evaluating people after

breast cancer has already been diagnosed and to
determine whether the cancer has spread to the lymph
nodes has spread to other parts of the body, and to
assess whether metastatic breast cancer is responding
to treatment.
 Diagnostic Tests

Preoperative Testing
In the weeks or days before surgery, you’ll need
to have tests to make sure your body can
handle the anesthesia and the operation.
Although you may not need every one of these
tests, here are the most common tests:
 Diagnostic Tests

Chest X-ray and Electrocardiogram (EKG). It will show whether

your lungs and heart are working properly.
 
Blood Tests. Checks your blood counts, your liver and kidney
function, and your risk of bleeding or infection.
 
Urine Test. Finds out about your kidney function and look for
infections.
 Medical Management
Chemothera
py
Chemotherapy uses drugs to destroy
cancer cells. Chemotherapy is sometimes
given before surgery in women with larger
breast tumors. Chemotherapy is also used
in women whose cancer has already
spread to other parts of the body.
 Medical Management
Chemothera
py
Standard Chemotherapy Regimens Include:
AT: Adriamycin and Taxotere
AC ± T: Adriamycin and Cytoxan with or without Taxol or Taxotere
CMF: Cytoxan, Methotrexate, and Fluorouracil
CEF: Cytoxan, Ellence, and Fluorouracil
FAC: Fluorouracil, Adriamycin, and Cyrtoxan
CAF: Cytoxan, Adriamycin, and Fluorouracil
(The FAC and CAF regimens use the same medications but use
different doses and frequencies)
TAC: Taxotere, Adriamycin, and Cytoxan
GET: Gemzar, Ellence, and Taxol
 Medical Management
Chemothera
py
Common Drugs Include:
docetaxel (Taxotere) cisplatin
paclitaxel (Taxol) cyclophosphamide
doxorubicin eribulin (Halaven)
fluorouracil (5-FU)
epirubicin (Ellence)
Gemcitabine (Gemzar)
pegylated liposomal Ixabepilone (ixempra)
doxorubicin (doxil) Methotrexate (rheumatrex,
capecitabine (Xeloda) trexall)
carboplatin Protein-bound paclitaxel
(abraxane)
Vinorelbine (navelbine)
 Medical Management
Hormonal Therapy

Hormonal therapy is prescribed to women with ER-

positive breast cancer to block certain hormones that
fuel cancer growth. An example of hormonal therapy is
the drug Tamoxifen. This drug blocks the effects of
estrogen, which can help breast cancer cells survive
and grow. Most women with estrogen-sensitive breast
cancer benefit from this drug.
 Medical Management
Hormonal Therapy
Types of Hormonal Therapy:

Tamoxifen – is a drug that blocks estrogen from binding to breast cancer

cells. It is effective for lowering the risk of recurrence in the breast that had
cancer, the risk of developing cancer in the other breast, and the risk of
distant recurrence.

Aromatase Inhibitors (AIs) - AIs decrease the amount of estrogen made in

tissues other than the ovaries in post-menopausal women by blocking the
aromatase enzyme. This enzyme changes weak male hormones called
androgens into estrogen when the ovaries have stopped making estrogen
during menopause. These drugs include anastrozole (Arimidex), exemestane
(Aromasin), and letrozole (Femara).
 Medical Management
Radiation Therapy
Radiation therapy is an adjuvant treatment for most women who have undergone
lumpectomy and for some women who have mastectomy surgery.

 
❖ External-beam radiation therapy – this is the most common type of radiation
treatment and is given from a machine outside the body. This includes whole breast
radiation therapy and partial breast radiation therapy, as well as accelerated breast
radiation therapy, which can be several days instead of several weeks.

❖ Intra-operative radiation therapy – this is when radiation treatment is given using a

probe in the operation room.

❖ Brachytherapy – this type of radiation therapy is given by placing radioactive

sources into the tumor.
 Medical Management
Radiation Therapy

❖ Adjuvant radiation therapy – is given after surgery. Most commonly, it is

given after a lumpectomy, and sometimes, chemotherapy. Patients who
have a mastectomy may or may not need radiation therapy, depending on
the features of the tumor.

❖ Neoadjuvant radiation therapy – is radiation therapy given before surgery

to shrink a large tumor, which makes it easier to remove. This approach is
uncommon and is usually only considered when a tumor cannot be
removed with surgery.
 Medical Management
Targeted Therapy

Targeted therapy is a treatment that targets the cancer’s

specific genes, proteins, or the tissue environment that
contributes to cancer growth and survival. These
treatments are very focused and work differently than
chemotherapy. This type of treatment blocks the growth
and spread of cancer cells and limits damage to healthy
cells.
 Medical Management
Targeted Therapy
 
Trastuzumab - This drug is approved as a therapy for non-
metastatic HER2-positive breast cancer. Given in patients with stage
I to stage III breast cancer.
Pertuzumab (Perjeta) - This drug is approved for stage II and stage
III breast cancer in combination with trastuzumab and chemotherapy.
Neratinib (Nerlynx) - This oral drug is approved as a treatment for
higher-risk HER2-positive, early-stage breast cancer. It is taken for a
year, starting after patients have finished 1 year of trastuzumab.
 Medical Management
Immunotherapy

 
Immunotherapy, also called biologic therapy, is designed
to boost the body's natural defenses to fight the cancer. It
uses materials made either by the body or in a laboratory
to improve, target, or restore immune system function.
 Medical Management
  Immunotherapy
 
Pembrolizumab (Keytruda) - This is a type of immunotherapy that
is approved by the FDA to treat both high-risk, early-stage, triple-
negative breast cancer and metastatic cancer or cancer that cannot
be treated with surgery. Pembrolizumab is approved to treat people
with high-risk, early-stage, triple-negative breast cancer in
combination with chemotherapy before surgery.
Dostarlimab (Jemperli) - This type of immunotherapy is approved
by the FDA to treat recurrent or metastatic breast cancers that have
dMMR and have progressed during or after previous treatment.
 Surgical Management
LUMPECTO
MY
This is also referred to as breast-conserving
therapy. The surgeon removes cancerous area
and a surrounding margin of normal tissue. A Lobular-ductal
second incision may be made in order to remove
the lymph nodes.
 Surgical Management
MASTECTO
MY
A mastectomy is the surgical removal of the breast, non-protruding
breast tissue, the lymph nodes in the armpits and some pectoral muscle.

Breast construction surgery may be conducted after the removal of the

breast.

• Partial or Segmental Mastectomy

• Simple or Total Mastectomy
• Modified Radical Mastectomy
Surgical Management
 Surgical Management
SENTINEL LYMPH NODE
BIOPSY

In a sentinel lymph node biopsy (also called a sentinel node

biopsy or SNB), the surgeon finds and removes 1 to 3 or
more lymph nodes from under the arm that receive lymph
drainage from the breast. This procedure helps avoid
removing a large number of lymph nodes with an axillary
lymph node dissection for patients whose sentinel lymph
nodes are mostly free of cancer.
 Surgical Management
SENTINEL LYMPH NODE
BIOPSY
 Surgical Management
AXILLARY LYMPH NODE
DISSECTION

In an axillary lymph node dissection, the surgeon

removes many lymph nodes from under the arm.
These are then examined for cancer cells by a
pathologist. The actual number of lymph nodes
removed varies from person to person.
 Surgical Management
RECONSTRUCTIVE SURGERY

This is surgery to recreate a breast using either tissue taken

from another part of the body or synthetic implants.
Reconstruction is usually performed by a plastic surgeon. A
person may be able to have a reconstruction at the same
time as the mastectomy, called immediate reconstruction.
They may also have it at some point in the future, called
delayed reconstruction.
 Surgical Management
RECONSTRUCTIVE SURGERY
∙ Reconstruction with implants
 Surgical Management
RECONSTRUCTIVE SURGERY
∙ Reconstruction with implants
 Surgical Management
RECONSTRUCTIVE SURGERY
• Reconstruction with a tissue flap
 Surgical Management
RECONSTRUCTIVE SURGERY
• Transverse Rectus Abdominis Muscle (TRAM) Flap
 Surgical Management
RECONSTRUCTIVE SURGERY
• Latissimus Dorsi Flap
 Surgical Management
RECONSTRUCTIVE SURGERY
• Deep inferior epigastric perforation (DIEP) reconstruction
 Surgical Management
RECONSTRUCTIVE SURGERY
• Gluteal Free Flap
 Surgical Management
RECONSTRUCTIVE SURGERY
• Reconstruction of the nipple and areola
 Nursing Management (Surgical)
 
⮚ Discuss the importance of hand washing and wound care.

⮚ Discuss the postoperative drainage device and its management

after going home.

⮚ Assess the pain tolerance and administer analgesics as prescribed.

⮚ Encourage expressing thoughts and feelings about the body

changes.

⮚ Assess the interest in spiritual/religious support and refer if

appropriate.
 Nursing Management (Surgical)

 
⮚ Provide a list of educational resources about
chemotherapy and breast reconstruction.

⮚ Discuss the possibility of attending a breast cancer

support group.

⮚ Refer to social services for a consultation about the

changed family roles during her recovery and
treatment.
 Nursing Management (Chemotherapy)
 
▪ Instruct patient on ways to prevent infection including hand washing, proper
skin care, avoiding foods with high microorganism content and offering
information on smoking cessation assistance using educational videos and
instructional pamphlets.

▪ Instruct patient in ways to minimize risk of bleeding:

a. Avoid taking aspirin and other nonsteroidal anti-inflammatory agents (e.g.

ibuprofen) on a regular basis
b. Use an electric rather than a straight-edge razor
c. Floss and brush teeth gently
d. Use caution when ambulating to prevent falls or bumps and do not walk
barefoot.
 Nursing Management (Chemotherapy)
 
▪ Instruct patient to control any bleeding by applying firm,
prolonged pressure to the area if possible. Demonstrate
on peripheral extremity and request a return
demonstration.

▪ Eat several small meals per day instead of 3 large ones

▪ Encourage patient to eat dry foods, such as toast and

crackers) or sip cold carbonated beverages if nausea is
present. Take deep, slow breaths when nauseated.
 Nursing Management (Chemotherapy)

▪ Provide instructions related to care of a central venous catheter

(Groshong):

a. Change dressing if present according to protocol using aseptic technique

b. Observe exit site for changes in appearance, redness, swelling, and
unusual drainage
c. Flush catheter according to protocol to maintain patency
d. Replace injection cap as directed
Tape catheter securely to the chest wall to prevent accidental dislodgment
f. Notify physician if unable to flush catheter, if signs and symptoms of infection
occur at exit site, or if catheter appears to be leaking. Observe return
demonstration on mock catheter model
 Nursing Management (Chemotherapy)

❑ Monitor for adverse effects of radiation therapy such as fatigue, sore throat,
dry cough, nausea, anorexia.
❑ Monitor for adverse effects of chemotherapy; bone marrow suppression,
nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis,
anxiety, and depression.
❑ Involve the patient in planning and treatment.
❑ Prepare the patient for the effects of chemotherapy, and plan ahead for
alopecia, fatigue.
❑ Administer antiemetics prophylactically, as directed, for patients receiving
chemotherapy.
❑ Administer I.V. fluids and hyperalimentation as indicated.
❑ Help patient identify and use support persons or family or community.
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 Discharge Planning (METHODS)
MEDICATION
• Prescription pain medicine may be given. Ask your healthcare provider how to take this
medicine safely. Some prescription pain medicines contain acetaminophen. Do not take
other medicines that contain acetaminophen without talking to your healthcare provider. Too
much acetaminophen may cause liver damage. Prescription pain medicine may cause
constipation. Ask your healthcare provider how to prevent or treat constipation.

• Take nonsteroidal anti-inflammatory drug continuously to reduce the production of

certain body chemicals that causes inflammation. NSAIDs can reduce the risk of
breast cancer recurrence in patients previously treated for ductal carcinoma or
invasive cancers.
 Discharge Planning (METHODS)
MEDICATION

Take your medicine as directed. Contact your healthcare provider if you

think your medicine is not helping or if you have side effects. Tell him or her
if you are allergic to any medicine. Keep a list of the medicines, vitamins,
and herbs you take. Include the amounts, and when and why you take
them. Bring the list or the pill bottles to follow-up visits. Carry your
medicine list with you in case of an emergency.
 Discharge Planning (METHODS)
EXERCISE
• Ask your oncologist about the best exercise plan for you. Exercise may help decrease the
side effects of treatment, such as nausea, vomiting, and weakness. It may also help improve
your mood. Stop exercising if you feel pain in your chest, have trouble breathing, or feel
dizzy. Do not exercise if you have a fever or if you had anticancer medicines through an IV
in the last 24 hours.

❑ Ask for help with chores and errands while you recover.
 
❑ Don't lift anything heavy until your healthcare provider says it's OK.
 
❑ Don't vacuum or do active or strenuous housework until your healthcare provider says it's
OK.
 
❑ Do the range-of-motion exercises that you learned in the hospital.
 Discharge Planning (METHODS)
TREATMENT
 
❖ Full recovery may take 4 to 8 weeks. You may have shoulder, chest, and
arm stiffness. This stiffness gets better over time and can be helped with
physical therapy.
❖ You may have swelling in the arm on the side of your surgery. This
swelling is called lymphedema. The swelling usually occurs much later
and it can be a problem that lasts. It can also be treated with physical
therapy.
❖ You may go home with drains in your chest to remove extra fluid. Your
surgeon will decide when to remove these drains, usually in a week or
two.
 Discharge Planning (METHODS)
TREATMENT
 
❖ You may need time to adjust to losing your breast. Talking to other
women who have had mastectomies can help you deal with these
feelings. Ask your health care provider about local support groups.
Counseling can help as well.

❖ Prevent infection. Wash your hands before you touch your wound. This
will help prevent an infection. Only use antiseptic (germ-killing) medicines
if healthcare providers tell you to.
 Discharge Planning (METHODS)
 
EALTH EDUCATION
 
❖ Take prescribed medications as directed by the physician

❖ Check your incisions daily for signs of infections these includes redness,
swelling and drainage. Contact your health care provider if these signs
are noted.

❖ Wash your incisions gently. You can use mild soap and warm water if
ordered by the healthcare provider.

❖ Instruct family member to provide free from infection environment

 
OUT-PATIENT
Discharge Planning (METHODS)

❖ You will need to see your oncologist for ongoing treatment

and follow-up. Write down your questions so you remember
to ask them during your visits.
❖ A follow up check-up is necessary for evaluation and
assessment in the progression of recovery.
❖ Your surgeon will tell you when you need to have your next
visit. You may need appointments to talk about more
treatment, such as chemotherapy, radiation, or hormonal
therapy
  DIET
Discharge Planning (METHODS)

❖ Some malignancies respond well to specific foods, just as some cancers respond
well to specific treatments. The items listed below can contribute to a healthy diet
in general and may also help prevent breast cancer from developing or
progressing.

❖ Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy

products, beans, lean meats, and fish. Ask if you need to be on a special diet
❖ A variety of fruits and vegetables, including salad foods that are rich in fiber, such
as whole grains, beans, and legumes low fat milk and dairy products soybean-
based products foods rich in vitamin D and other vitamins foods, particularly
spices, with anti-inflammatory properties foods — mainly plant based — that
contain antioxidants
 SPIRITUAL
Discharge Planning (METHODS)

Spirituality confers inner strength, calm, comfort, and wholeness and acts as
a means of coping with cancer, thus it can play an important role in healing
and well-being. Religious fellowship can serve to deepen a person's
relationship with God. Although you may be experiencing unpleasant
emotions as a result of the loss of your breasts, spirituality can be a helpful
coping approach. providing a source of support, comfort, and optimism that
cut across all barriers, as well as a source of inspiration. a new perspective
on the future Emotional support from family members is especially vital for
good coping and avoiding role crises.