CASE SCENARIO

Ayesha Curry who is a 65-year-old 5ft. 4in 170 lbs. female who has a family
history of breast cancer. In addition, she had an early menstruation at age 11,
has a history of taking oral contraceptives, and had her first child at the age of
40. She also likes to drink alcoholic beverages every day. She started to feel
pain at her right breast. She also noticed a deformation of her right breast. Her
nipple was retracted, and she also noticed that her breast has an "orange" like
Predisposing Precipitating appearance. She felt a lump at the upper outer quadrant of her right breast
Case Scenario
factors factors through self-breast examination. She didn?t get a check up and 1 month later
she started to have chest pains, persistent coughing, and shortness of breath.
She finally went to get a check up and she was diagnosed for Stage IV invasive
ductal carcinoma at the right breast and it has metastasized to her lungs.

Signs and
Pathophysiology
Symptoms

Predisposing factors Precipitating factors

-Female -5ft. 4in. and weighs 170
Nursing -Age 65 pounds (obese)
Medical
Complication -Family history of breast -History of taking oral
Management Mnagement
cancer contraceptives
-Early menstruation (age 11) -Had first child at age 40
-Drinks alcohol

Increased Levels of estrogen

DRUG ALERT
- Irregular vaginal bleeding or spotting may
occur.
Estrogen binds with estrogen - Decreased visual acuity, corneal opacity,
receptors of the cells in the and retinopathy can occur if receiving high
breast doses (240-320 mg/day for >17 mo). These
Tamoxifen (Nolvadex)
problems may be irreversible.
Estrogen receptor blocker
- Instruct patient to immediately report
decreased visual acuity.
- Monitor for signs of deep vein thrombosis,
pulmonary embolism, and stroke, including
shortness of breath, leg cramps, and
weakness.

Stimulation of cell growth

A compression wrap may be

Treated by
applied to the incision for
unclogging the
approximately 12 hours, or the
drain or manually
patient may be returned to the
aspirating the fluid
operating room so that the
with a needle and
ncision may be reopened to
Mutation of cellular DNA in the syringe.
identify the source of bleeding.
ducts of the right breast

Swelling, Swelling,
tightness, pain, heaviness,
Activation of oncogenes and
inactivation of tumor suppresor and bruising of the discomfort, and a
skin. sloshing of fluid. NURSING INTERVENTIONS:
genes (BRCA1 and BRCA2)
1. Review disease process, surgical procedure, and future expectations.
NURSING INTERVENTIONS: 2. Have patient demonstrate care of drains and wound sites.
1. Assess clients ability to manage activities of 3. Encourage continuation of exercises, increasing program as healing
daily living and period of time since a loss has progresses, for at least a year.
occurred 4. Discuss necessity for well-balanced, nutritious meals and adequate fluid
2. Note stage of grief is experiencing intake.
Develop Develop temporarily after the 3. Encourage the client and SO to identify healthy 5. Suggest alternating schedule of frequent rest and activity periods, especially
Epithelial cells begins to divide within the first 12 drain is removed coping skills they have used in the past in situations when sitting or standing is prolonged.
rapidly at the wall of the ducts hours after or if the drain is in place and 4. Refer to other sources as needed, counseling, 6. Demonstrate holding affected arm appropriately by not dangling the arm,
into the lumen (Tumor surgery. becomes obstructed. psychotherapy, significance of loss religious swinging arms with elbows bent when walking, placing arm above heart level
formation) references, grief support group when sitting or lying down.
5. Stay with the client and ensure privacy during 7. Warn against having blood withdrawn or receiving IV fluids, medications or
emotional periods BP measurements on the affected side.
6. Acknowledge the client?s grief and reinforce 8. Suggest gentle massage of the healed incision with emollients.
that feeling angry or sad is normal and expected 9. Encourage regular self-examination of remaining breast. Stress importance of
CT scan 7. Encourage sharing with those who can be regular medical follow-up.
-Dx: Stage IV empathic, such as another breast cancer survivor 10. Address additional concerns as indicated like ongoing therapies and
Invasive ductal Mamoography Hematoma Seroma expected adverse side effects
carcinoma on the Left untreated and continues to (collection of blood (collection of
right breast inside the cavity) serous fluid)
rapidly divide

Pain at the right Dysfunctional

breast grieving r/t loss of
the right breast
and change to
physical
appearance as Deficient
Modified Radical evidence by knowledge r/t
Lump on the Tumor cells broke through the patient states she
SBE Mastectomy questions and
upper outer wall of the milk duct and begun has been crying
(Self Breast w/ request for
quadrant of the to invade the tissues of the and is depressed
Examination) Axillary Lymph information
right breast breast about her body
Node Dissection
appearance

New blood vessels form to

Invasion of cancer cells of the Cancer cells enters and blocks
feed the cancer cells Local inflammation Lyphedema
pectoral muscles and skin lymphatic vessels
(Angiogenesis)

Accumulation of
lymph in soft tissue
Cancer cells enter the Dimpling of the Lymph builds up in interstial Damage to suspensory
bloodstream skin space ligaments and lactiferous ducts

Obstructive pressure
on the veins and
venous return.
Swelling but suspensory
Retraction (pulling
Metastasize to the lungs ligaments do not allow the skin Fibrosis
in of the nipple)
to stretch

Impaired Physical Mobility related to

Heaviness, pain, lymph-dema, nerve & muscle damage,
impaired motor function in and pain as evidence by patient unable to
Skin become thickened and Peau'd orange the arm, and numbness get to bed from chair without assistance
dimpled appearance and paresthesia and unable to push herself up in bed.
Shortness of of the fingers.
breath, chest pain,
persistent cough

Cystic fibrosis on
Cellulitis
the skin
(bacterial infection
(salt taste skin due
redness, warmth,
to affected sweat
swelling, and pain)
glands) NURSING INTERVENTIONS:
1. Elevate affected arm as indicated.
2. Have patient move fingers, noting sensations and color of hand on affected
side.
3. Encourage patient to use affected arm for personal hygiene (feeding,
combing hair, washing face).
4. Help with self-care activities as necessary.
5. Assist with ambulation and encourage correct posture
6. Advance exercise as indicated such as active extension of arm and rotation
of shoulder while lying in bed, pendulum swings, rope turning, elevating arms to
touch fingertips behind the head.
7. Teach patient proper breathing technique of slow, deep breaths during
exercise.
8. Evaluate the presence and degree of exercise-related pain and changes in
joint mobility. Measure upper arm and forearm if edema develops.
9. Discuss types of exercises to be done at home to regain strength and
enhance circulation in the affected arm.
10. Assist patient to identify signs and symptoms of shoulder tension (inability to
maintain posture, burning sensation in post scapular region). Instruct patient to
avoid sitting or holding the arm in dependent position for extended periods.