BREAST CANCER

Case Study
Submitted to:

Adelfa Candida Villaluboz

Submitted by:

Shermayne Hernandez
Gracia A. Nieves

I. INTRODUCTION
 A person diagnosed with breast cancer encounters big problem in
facing their lifestyle, decision making about therapies, especially in financial
support. A diagnosis of breast cancer marks the beginning of a journey full of
emotional, psychological, physical and practical challenges. Challenges can
relate to the shock of a cancer diagnosis and fears about the future. More
specifically, emotional problems may include concerns about
body image after treatment or periods of anxiety or worse depression. It’s not 
always easy, but over time, most women find that they are able to cope with
the changes caused by their diagnosis and return to the things that
are important to them.

Breast cancer starts when cells in the breast begin to grow out of
control. Most breast cancers begin in the ducts that carry milk to the nipple
(ductal cancers). These cells usually form a tumor that can often be seen on
an x-ray or felt as a lump. The tumor is malignant (cancer) if the cells can
grow into (invade) surrounding tissues or spread (metastasize) to distant
areas of the body. Breast cancer can have a number of symptoms, but the
first noticeable symptom is usually an area of thickened tissue in the breast,
or a lump in the breast or in an armpit. There are several types of breast
cancer which can develop in different parts of the breast. Breast cancer is
often divided into invasive and non-invasive types. About one woman is being
diagnosed with breast cancer during their lifetime.

In the survey conducted by U.S Breast Cancer they estimated About 1

in 8 U.S women (about twelve point four percent) will develop invasive breast
cancer over the course of her lifetime. In 2018, an estimated two hundred
sixty-six and one hundred twenty new cases of invasive breast cancer are
expected to be diagnosed in women in the U.S., along with sixty-three
thousand and nine hundred sixty new cases of non-invasive (in situ).Breast
cancer. Breast cancer is the most commonly diagnosed cancer among
American women.

The Philippines has the highest incidence of breast cancer in Asia. 3

out of 100 Filipino women will contract the disease before age 75; 1 will die
out of 100 before age 75, according to the Philippine Society of Medical
Oncology in 2012. According to the Department of Health and the Philippine
Cancer Society report, breast cancer is the most common cancer in the
country comprising 16% of the 80,000new cancer cases in 2010.

Today, there are many innovative therapy which offers an inspiring

hope for treating breast cancer patients. There are new approaches to nursing
interventions and medical treatment modalities. Lowering stress levels of the
body lowers the incidence of cancer. More patients survive than ever before
and the horrific side effect inflicted by conventional therapy such as
chemotherapy to patients. These conventional treatments to cancer often
leave patients partially or severely debilitated and set the stage for deadly
secondary diseases according to Logan Bromwell.
 In the Philippines, it’s long way to go. Medical treatment modalities
together with the nursing interventions, we still use radiation and
chemotherapy.

In this case study the discussion will center on the presentation of the
nursing history, nursing assessment, nursing care plans and nursing
interventions and the evaluation of nursing care. The drug study will also be
presented in the discussion.

II. ANATOMY AND PHYSIOLOGY

A. Function of the Breast

The breast is the tissue overlying the chest (pectoral) muscles.

Women's breasts are made of specialized tissue that produces milk (glandular
tissue) as well as fatty tissue. The amount of fat determines the size of the
breast.
The milk-producing part of the breast is organized into 15 to 20 sections,
called lobes. Within each lobe are smaller structures, called lobules, where
milk is produced. The milk travels through a network of tiny tubes called ducts.
The ducts connect and come together into larger ducts, which eventually exit
the skin in the nipple. The dark area of skin surrounding the nipple is called
the areola.
Connective tissue and ligaments provide support to the breast and give it its
shape. Nerves provide sensation to the breast. The breast also contains blood
vessels, lymph vessels, and lymph nodes.

B. The Normal Anatomy and Physiology of the Breast

The female breast is composed of lobules of milk producing glands

surrounded by fatty tissue. Ducks run from these glands to outlets at the
nipple. Around the nipple is a circular pigmented area called the areola, which
contains sweat glands and sebaceous glands. The breasts have no muscles
but are held in place by ligaments. A major network of lymph nodes in the
armpit area (axilla).

C.Normal Cells Versus Cancer Cells

 Normal Cells versus
Cancer Cells

All living
organisms are
composed of cells.
These cells grow and
divide in a controlled
manner in order for
the organism to
function properly.
Changes in normal
cells can cause
them to grow
uncontrollably. This
uncontrollable growth is
the hallmark of cancer
cells.

Normal Cell Properties

Normal cells have certain characteristics that are important for the proper
functioning of tissues, organs, and body systems.

These cells have the ability to reproduce correctly, stop reproducing when
necessary, remain in a specific location, become specialized for specific
functions, and self destruct when necessary.

 Cell Reproduction: Cell reproduction is needed to replenish the cell

population that ages or becomes damaged or destroyed. Normal cells
reproduce properly. Except for sex cells, all cells of the body reproduce by
mitosis. Sex cells reproduce through a process called meiosis.
 
 Cell Communication: Cells communicate with other cells through
chemical signals. These signals help normal cells to know when to reproduce
and when to stop reproducing. Cell signals are usually transmitted into a cell
by specific proteins.
 
 Cell Adhesion: Cells have adhesion molecules on their surface that
allow them to stick to the cell membranes of other cells. This adhesion helps
cells to stay in their proper location and also aids in the passage of signals
between cells.
 
 Cell Specialization: Normal cells have the ability to differentiate or
develop into specialized cells. For example, cells can develop
into heart cells, brain cells, lung cells or any other cell of a specific type.
 
 Cell Death: Normal cells have the ability to self destruct when they
become damaged or diseased. They undergo a process called apoptosis in
which cells break down and are disposed of by white blood cells.

Cancer Cell Properties

Cancer cells have characteristics that differ from normal cells.

 Cell Reproduction: Cancer cells acquire the ability to reproduce

uncontrollably. These cells may have gene mutations or chromosome
mutations that affect the reproductive properties of the cells. Cancer cells gain
control of their own growth signals and continue to multiply unchecked. They
don't experience biological aging and maintain their ability to replicate and
grow.
 
 Cell Communication: Cancer cells lose the ability to communicate
with other cells through chemical signals. They also lose sensitivity to anti-
growth signals from surrounding cells. These signals normally restrict cellular
growth.
 
 Cell Adhesion: Cancer cells lose the adhesion molecules that keep
them bonded to neighbouring cells. Some cells have the ability to metastasize
or spread to other areas of the body through the blood or lymph fluid. Once in
the bloodstream, cancer cells release chemical messengers called
chemokines that enable them to pass through blood vessels into the
surrounding tissues.
 
 Cell Specialization: Cancer cells are unspecialized and do not
develop into cells of a specific type. Similar to stem cells, cancer cells
proliferate or replicate many times, for long periods of time. Cancer cell
proliferation is rapid and excessive as these cells spread throughout the body.
 
 Cell Death: When the genes in a normal cell are damaged beyond
repair, certain DNA checking mechanisms signal for cell destruction.
Mutations that occur in gene checking mechanisms allow for the damages to
go undetected. This results in the loss of the cell's ability to
undergo programmed cell death.

Causes of Cancer

Cancer results from the development of abnormal properties in normal

cells that enable them to grow excessively and spread to other locations. This
abnormal development can be caused by mutations that occur from factors
such as chemicals, radiation, ultraviolet light, and chromosome replication
errors. These mutagens alter DNA by changing nucleotide bases and can
even change the shape of DNA. The altered DNA produces errors in DNA
replication, as well as errors in protein synthesis. These changes influence
cell growth, cell division, and cell aging.

Viruses also have the ability to cause cancer by altering cell

genes. Cancer viruses change cells by integrating their genetic material with
the host cell's DNA.

The infected cell is regulated by the viral genes and gains the ability to
undergo abnormal new growth. Several viruses have been linked to certain
types of cancer in humans. The Epstein-Barr virus has been linked to Burkitt's
lymphoma, the hepatitis B virus has been linked to liver cancer, and the
human papilloma viruses have been linked to cervical cancer.

D. Cell Cycle

Cell Cycle

The cell cycle

is the complex
sequence of events by
which cells grow and
divide. In
eukaryotic cells, this
process includes a series
of four distinct
phases. These
phases consist of the
Mitosis phase (M),
Gap 1 phase (G 1),
Synthesis phase (S),
and Gap 2 phase (G 2).
The G 1, S, and
G 2 phases of the cell cycle are collectively referred to as interphase. The
dividing cell spends most of its time in interphase as it grows in preparation for
cell division. 

Phases of the Cell Cycle

The two main divisions of the cell cycle are interphase and mitosis.

Interphase
 During this segment of the cell cycle, a cell doubles its cytoplasm and
synthesizes DNA. It is estimated that a dividing cell spends about 90-95
percent of its time in this phase.

 G1 phase: The period prior to the synthesis of DNA. In this phase, the

cell increases in mass and organelle number in preparation for cell
division. Animal cells in this phase are diploid, meaning that they have two
sets of chromosomes.
 S phase: The period during which DNA is synthesized. In most cells,
there is a narrow window of time during which DNA is synthesized. The
chromosome content is doubled in this phase.

 G2 phase: The period after DNA synthesis has occurred but prior to

the start of mitosis. The cell synthesizes additional proteins and continues to
increase in size.

Stages of Mitosis

In mitosis and cytokinesis, the contents of the dividing cell are equally

distributed between two daughter cells. Mitosis has four phases: Prophase,
Metaphase, Anaphase, and Telophase.

 Prophase: In this stage, changes occur in both the cytoplasm and

nucleus of the dividing cell. The chromatin condenses into discrete
chromosomes. The chromosomes begin to migrate toward the cell center.
The nuclear envelope breaks down and spindle fibers form at opposite poles
of the cell.

 Metaphase: In this stage, the nuclear membrane disappears

completely. The spindle fully develops and the chromosomes align at the
metaphase plate (a plane that is equally distant from the two poles).
 Anaphase: In this stage, paired chromosomes (sister chromatids)
separate and begin moving to opposite ends (poles) of the cell. Spindle fibers
not connected to chromatids lengthen and elongate the cell.

 Telophase: In this stage, the chromosomes are cordoned off into

distinct new nuclei and the genetic content of the cell is divided equally into
two parts. Cytokinesis begins prior to the end of mitosis and completes shortly
after telophase.

Once a cell has completed the cell cycle, it goes back into the G 1 phase and
repeats the cycle again. Cells in the body can also be placed in a non-dividing
state called the Gap 0 phase (G 0)at any point in their life. Cells may remain in
this stage for very long periods of time until they are signalled to progress
through the cell cycle as initiated by the presence of certain growth factors or
other signals. Cells that contain genetic mutations are permanently placed in
the G 0 phase to ensure that they are not replicated. When the cell cycle goes
wrong, normal cell growth is lost. Cancer cells may develop, which gain
control of their own growth signals and continue to multiply unchecked.

Cell Cycle and Meiosis

Not all cells divide through the process of mitosis. Organisms that reproduce
sexually also undergo a type of cell division called meiosis. Meiosis occurs
in sex cells and is similar in process to mitosis. After a complete cell cycle in
meiosis however, four daughter cells are produced. Each cell contains one
half the numbers of chromosomes as the original parent cell. This means that
sex cells are haploid cells. When haploid male and female gametes unite in a
process called fertilization, they form one diploid cell called a zygote.

E. PATHOPHYSIOLOGIC BASIS OF MALIGNANT GROWTH

Cell

Genetic Mutation of the Cellular DNA

 Genetic Mutation (Inherited / Acquired mutation) leads to abnormal cell
behavior (Egger, 2011)

The initial genetically altered cell forms a clone and begins to proliferate
abnormally

Evading normal intracellular and extracellular growth regulating processes

Invade surrounding tissue and gain access to lymph and blood vessels

Carry the cells to other areas of the body

Personal Data

Present Illness

Two months prior to admission, patient notices mass on her left breast
accompanied by slight pain and nipple retraction. There was no nipple
discharges. Two weeks prior to admission patient consulted a physician and
was referred to ZCMC for admission.
Laboratory test was ordered and surgery was advised which was left radical
mastectomy.

Past Illness

In her early years she had experience fever, coughs and colds as like any
normal child. At the age of 2, the patient had chicken pox as stated by the
mother. The patient also experienced having measles and mumps. It was
during her school age years that the family began to notice that there were
some developmental delays with the patient.
Familial

There is positive history of cancer in the family of the patient according to her
Step Mother as well as a positive history of intellectual disability in her
biological mother.

IV. GORDON’S ELEVEN FUNCTIONAL HEALTH CARE

PATTERNS

1. Health Perception

The client is compliant with her medication regimen, used of health-promotion

activities such as regular exercise, annual check up in thhealth center. She
was immunized with BCG and DPT as claimed by the mother. She buys over
the counter drugs such as Neozep and Biogesic (paracetamol). She goes to
the health center in their barangay for consultation. She often complains of
chronic pain due to her breast cancer.

2.Nutritional Metabolic Pattern

Eats more of fruits and vegetables, eats her meals 3x a day with snack in
between. She can drink up to 1.5L of water or more than 8 glasses a day. She
claims to have a good appetite.

Pre-operative
Weight =
Height =
Normal Body Mass Index =
Before operation, was infused with an IVF of Dextrose in water hooked at her
left cephalic vein.

Post-operative

Weight =
Height =
Normal Body Mass Index =

After operation, was infused with an IVF of Dextrose hooked at her

right cephalic vein (right hand)

3.Elimination Pattern

She voids 5 times a day with 250-300 ml/urination. Her urine color is amber
yellow and sometimes is dark in color. There is no burning sensation/pain felt
during urination. She usually defecates in the morning regularly, with brown
and well- formed stools. After surgery, a Foley catheter was used attached to
the urine bag draining well with dark yellow urine with an output.

4.Activities/Exercise

The patient can ambulate within the house. She can perform household
chores. She can do simple exercises on the upper and lower extremities by
means of slow dancing. She can perform activities of daily living (ADL) well
until she undergone breast surgery which hindered her from performing some
activities. Although she is verbally incapacitated, she is often seen socializing
with her neighbors.

5.Sexuality/Reproductive

Client is single, has no history of sexually transmitted disease or any disease

affecting her genitals and female reproductive organ. She has irregular
menstruation after surgery.

6.Cognitive / Perception

She is oriented to people, time and place. She has good judgment and is
aware of her environment although she has mild intellectual disability. As
observed, patient seems to know the presence of malignant disease and is
aware of the concept of death yet she stays positive because of the support of
her family.

7.Roles/ Relationship

Single, well-loved and very close to her mother and family although she is
adopted, she is treated specially because of her condition. She has also good
interpersonal relationship with all the family members. Although she is unable
to speak properly, she is often seen socializing with her neighbours.

8.Self-perception/Self concept

Prior to operation:

Before Surgery

Though weak, she still managed to appear calm and relaxed. Agreed to
undergo surgery and gave her trust to the surgical team, hopeful and positive
to have a successful operation. Before operation, she prayed all the time, with
the desire that no complication will arise, and her major concern is the
recovery. Although she denies the existence of the mass in her breast and
refused surgery at first, due to fear, she agreed eventually for surgery.
Patient was in denial at first according to the mother that her daughter has a
growing mass. Client was furious that her breast had to be removed, since
she believed that it can be cured by the faith healer. But her mother insisted
that a doctor is best for treatment. She had mood swings from anger, sad and
hostile at times due to fear of the growing mass and impending surgery. After
her mass was surgically removed, the biopsy results showed that she has
breast cancer. She did not believed it as true and was angry asking God why
she has cancer. Her mood swings are due to her condition and surgical
removal of her breast.

She feels afraid and sometimes loss of hope if she will be cured and the
cancer be treated. She feels incomplete after mastectomy.

9.Value/Belief

A Roman Catholic, have strong faith in God, always prays at night especially
post-surgery, knowing she has cancer. But at first, she questioned God why
she was given the disease. There are no restrictions in the surgical procedure
brought by her religion.

10.Coping Stress Pattern

She cries whenever under stress. Refused to have surgery and denied that
she had breast mass. But her fear of the growing mass made her decide for
surgery as part of her coping. She got support from her understanding mother
and family. Crying was her way of expressing her feelings of sadness, fear,
anger and disbelief of the growing mass in her breast.

After months of surgery

Her coping with stress was by performing light household chores and by
taking a nap or sleep as a diversion.

She verbalized that the removal of her breast made her feel that it should not
have been removed at first. She denied she had cancer. She did not like to
have her breast removed because she felt incomplete. Although the client and
the whole family were afraid of surgery, they were given no choice as surgery
is the immediate solution to a breast mass or tumor.

11.Sleep/ Stress Pattern

She can sleep 8 hours per night at present. Her earliest time in going to sleep
is at 9:30 pm. Latest time in waking up is at 6:30 am. No difficulties in going to
sleep. But when even she thinks of the growing breast mass and the surgery
she had difficulty sleeping. Post operatively, sleep is not a problem but she
sometimes wakes up at night due to pain.
 V. PHYSICAL ASSESSMENT

VI. Diagnostic Exams (before mastectomy)

A. Haematology Examination

Result Normal Value

Hemoglobin 120.0-160.0
Hematocrit 0.43 g/L 0.370-0.470
RBC Count 4.0-5.5
WBC Count 9.0 x 10^q/L 5.0-10.0
Neutrophil 64% 40-70
Lymphocyte 26% 20-45
Eosinophils 4% 0-6
Monocyte 6% 0-10
Basophils 0-1

Result Normal Value

Platelet Count 219 x 10^3 u/L 150-350 x 10^3 u/L
NRBC 0-1 /100 WBC
MCH 28-33 g/L
MCV 82-98 f/L
Bleeding Time 1-3 mins
Clotting Time 2-6 mins
Blood Type
ESR 0-20 mm/hr
Reticulocyte
Malaria Smear

B.Haematology Examination (2nd admission)

Result Normal Value

Hemoglobin 9mg% 120.0-160.0
Hematocrit 0.27 g/L 0.370-0.470
RBC Count 4.0-5.5
WBC Count 15 x 10^q/L 5.0-10.0
Neutrophil 72% 40-70
Lymphocyte 20% 20-45
Eosinophils 4% 0-6
Monocyte 4% 0-10
Basophils 0-1

Result Normal Value

Platelet Count 168 x 10^3 u/L 150-350 x 10^3 u/L
NRBC 0-1 /100 WBC
MCH 28-33 g/L
MCV 82-98 f/L
 Bleeding Time 1-5 mins
Clotting Time 2-6 mins
Blood Type
ESR 0-40 mm/hr
Reticulocyte
Malaria Smear

Histopathological Results /Biopsy

Specimen: Breast
Procedure: Modified radical mastectomy
Histologic Type: Invasive lobular carcinoma
Specimen size: 18 X19 X 6.5 cm.
Tumor size : 4 cm in its widest dimension
Multicentric

VII. DRUG STUDY

Drug Mechanis Indication Contraindication Nursing

m of Responsibilities
Action

Generic Name: Gastric Short-term Contraindicated Observe 10 rights in

Lanzoprazole acid-pump treatment of with giving medication
inhibitors. active hypersensitivity to
Brand Name: Suppresses duodenal Lansoprazole or Advice the patient to
Prevacid gastric acid ulcer any components take this drug before
secretion by meal. Swallow the
Dosage: 30mg specific Short-term Use cautiously with capsules whole- do
inhibition of treatment of pregnancy, not chew, open or
Frequency: Once a the gastric ulcer lactation crush
day hydrogen
potassium Healing of Adverse Effects: If the patient was
Route: Oral ATPase NSAID- unable to swallow
 enzyme related CNS: Headache, capsule advise to
Classification: system at gastric ulcer dizziness, asthenia open and sprinkle
Antisecretory drug, the , vertigo, insomnia, granules on apple
Proton Pump secretory Risk anxiety, sauce or use granules
Inhibitor surface of reduction for paraesthesia, which can be added to
the gastric NSAID- dream 30 ml water, stirred
parietal related to abnormalities and drink immediately
cells; blocks gastric ulcer
the final Dermatologic:
step of acid Short-term Rash,
production. treatment of Inflammation,
GERD; Urticaria, pruritus,
severe alopecia, dry skin,
erosive acne
esophagitis;
poorly GI: Diarrhea,
responsive abdominal pain,
nausea, vomiting,
Long-term constipation, dry
treatment of mouth
pathological
hypersecreto Respiratory: URI
ry conditions symptom, cough,
epistaxis
Maintenance
therapy for Others: Gastric
healing of Cancer in
erosive preclinical studies
back pain, fever
Eradication
of
Helicobacter
Pylori
infection in
patients with
active or
recurrent
duodenal
ulcers in
combination
with
clarithromyci
n and
amoxicillin

Short-term
treatment of
all grades of
erosive
esophagitis
 when patient
is unable to
take oral
medication

Drug Mechanism Indication Contraindication Nursing

of Action Responsibilities
Generic Name: Binds to Relief of Contraindicated with Observe 10 rights in
Tramadol mu-opioid moderate allergy to tramadol administering
hydrochloride receptors to or opioids or acute medication to patient
and inhibits moderately intoxication with
Brand Name: the severe alcohol, opioids or Explain to patient that
Ultram reuptake of pain psychoactive drugs. he/she may experience
norepinephr these side effects;
Dosage: 50 mg ine and Use cautiously in dizziness, sedation,
serotonin; pregnancy, drowsiness, impaired
Frequency: Three causes lactation; seizures; visual acuity (avoid
times a day many concominant use of driving or performing
effects CNS depressant, tasks that require
Route: Oral similar to MAOIs, SSRI, alertness); nausea,
the opioids TCAs; renal loss of appetite
Classification: – dizziness, impairment, hepatic
Analgesic, Centrally somnolence impairment Report severe nausea,
Acting , nausea, dizziness, severe
constipation Adverse Effect: constipation
but does
not have a CNS: sedation,
respiratory dizziness or vertigo,
depressant headache,
effect confusion,
dreaming, sweating,
anxiety, seizures

CV: Hypotension,
tachycardia,
bradycardia

Dermatology:
Sweating, pruritus,
rash, pallor, urticaria

GI: Nausea,
vomiting, dry mouth,
constipation,
flatulence

Others: Potential
forabuse;
anaphylactoid
reactions

Drug Mechanism Indication Contraindication Nursing

of Action Responsibilities
Generic Name: Unknown. Advanced Contraindicated in Observe 10 right in
Tamoxifencitrate Drug is breast patients administering
selective cancer in hypersensitive to medications
Brand Name: Xifeu, estrogen women drug
Nolvodex receptor and men Monitor lipid levels
modular Contraindicated as during long term
Dosage: 10 mg, 20 Adjunct therapy to reduce therapy in patients with
mg treatment risk if breast cancer hyperlipidemia
of breast in high risk women
Frequency: cancer who also need anti- Monitor calcium level.
coagulants or in At start of therapy,
Route: Oral To reduce women with history drug may compound
cancer of deep vein hypercalcemia related
Classification: Anti occurrence thrombosis or P.E. to bone metastases
Neoplastic
Ductal Use cautiously in Monitor CBC closely in
carcinoma patients with patients with
in situ Leukopenia or leukopenia or
(DCIS) Thrombocytopenia thrombocytopenia
after breast
surgery Adverse Effect: Women should have
and periodic eye exams
radiation CNS: Stroke, because of increased
confusion, risk of cataracts
Gynecoma weakness,
stia sleepiness,
headache
Oligosper
mia CV: Fluid retention,
hot flashes,
thrombo-embolism

EENT: Corneal
changes, cataracts,
retinopathy

GI: Nausea,
Vomiting, diarrhea

GU: Amenorrhea,
irregular menses,
vaginal discharges,
endometrial cancer,
uterine sarcoma,
vaginal bleeding

Hematologic:
Leukopedia,
thrombocytopenia
 Hepatic: Hepatic
Necrosis, fatty liver,
cholestasis

Metabolic:
Hypercalcemia,
weight gain or loss

Musculoskeletal:
brief worsening of
pain from osseous
metastases

Respiratory:
Pulmonary
embolism (PE)

Skin: Skin changes,

rash, alopecia

Other: Temporary
bone or tumor pain

Drug Mechanism Indication Contraindication Nursing

of Action Responsibilities

Generic Inhibits bine Hypercalce Contraindicated in Observe 10 rights in

Name: resorption, mia caused patients administering medication
Zoledronic probably by by hypersensitive to to patient
Acid inhibiting malignancy drug; in patients
osteoclast with hypercalcemia A patient being treated
Brand Name: activity and Multiple of malignancy with Zometa shouldn’t be
Reclast, osteoclastic myecoma whose creatinine treated with reclast
Zometa resorption of and bone level is more than
mineralized metastases 4.5 mg/dL, in Hydrate patient
Dosage: 5 bone and of solid patients with bone adequately before giving;
mg/ 100ml cartilage. tumors in metastases and urine output should be 2 L
Injection Decreases conjunction createnine level of daily
(Zometa): calcium with more than 3mg/dL
4mg/5ml release standard Monitor renal function
induce by the anti Reclast is closely
Frequency: stimulatory neoplastics contraindicated in
factors patients in patients Monitor calcium,
Route: IV produced by Paget with hypocalcemia. phosphate, magnesium
tumors disease of Patients must be and creatinine levels
Classification: bone adequately carefully
Anti costeitis supplemented with
Osteoporotic deformans calcium.
Treatment Adverse Effects
of
osteoporosi CNS: Headache,
s in men; to anxiety,
reduce somnolence,
incidence of insomnia, confusion
fracture in agitation,
post- depression,
menopausal paresthesia,
women with hypoesthesia,
osteoporosi fatigue, weakness,
s and a dizziness, fever
recent low
trauma hip CV: hypotension,
fracture hypertension, atrial
fibrillation, leg
Osteopenia edema
secondary
to androgen GI: Nausea,
deprivation constipation,
therapy in diarrhea, abdominal
prostate pain, vomiting,
cancer anorexia,
dysphagia,
Osteopenia increased appetite
in estrogen
deprived GU: increased
breast creatinine level,
cancer urinary infection,
candidiasis

Hematologic:
Anemia,
Granulocytopenia,
neutropenia,
thrombocytopenia

Metabolic:
decreased calcium
and magnesium
levels; dehydration,
weight decrease

Musculoskeletal:
Skeletal pain

Respiratory:
Dyspnea, cough,
pleural effusion
 Skin: Alopecia, rash

Other: progression
of cancer

VII. NURSING CARE PLAN

Assessmen Nursing Goal of Nursing Intervention Implementatio Evaluation

t Diagnosis care w/ Rationale n
Subjective Chronic At the Independent: Explained to Patient
cues-“ Malisud pain end of She will determine the patient and together with
gayot duele el related to the pain history, for the mother her mother is
donde ya destructio health example, location of how to able to
opera na mi n of nerve teaching pain, frequency, determine the manage
mama( pointing tissue, the duration, and location, during
on her breast lymph patient intensity using a frequency, episodes of
area;) nodes and will able rating scale (0-10) duration and her pain by
frowning face metastasis to: or verbal rating intensity of first
to bones manage scale-“no pain” to pain utilizing evaluating the
Objective cues due to her “excruciating”; and the Wong- severity of her
– breast chronic relief measures will Baker Faces of pain before
Pain scale of 5 cancer breast be use. pain rating taking any
utilizing the pain Rationale: scale (1-10) medications
Wong Baker Information
Faces of pain provides baseline Discussed with
scale so data to evaluate the patient and
patient can need for, and mother the Already know
point the level effectiveness of, management how to use
of pain interventions. Pain of pain based the pain scale
of more than 6 on the pain method and
months duration scale and the the verbal
constitutes chronic medication to rating scale.
pain, which may be
affect therapeutic administered
choices. Recurrent at home as
episodes of acute prescribed by
pain can occur the physician
within, chronic pain
requiring increase
level of intervention
note: The pain
experience is an She can
individualized one determine pain
composed of both history like
physical and location of
emotional pain,
responses. frequency,
duration, and
intensity using
a rating scale
(0-10).
And also she is
using the
verbal rating
scale.

2. Provide
nonpharmacological Demonstrate
comfort measures different
such as, comfort
repositioning and measures like
back rub; as well as repositioning
diversional and back rub
activities, such as
music, reading and
TV.
Rationale:
Promotes relaxation
and helps refocus
attention.
Assessmen Nursing Goal of Nursing Implementation Evaluation
t Diagnosis care Intervention w/
Rationale
Subjective Grieving At the Independent: She is aware of Accepted
cues: “ya related to loss end of mood swings, reality that
kita ya mi of body part the Allow patient to be evidence of the removal
mama kay ( breast was health aware of her mood conflict, of her breast
tiene surgically teaching swings, evidence of expression of is necessary
bukul.” removed due the conflict anger or due to the
(pointing to breast mass client hostility, and mass and
her breast due to breast will be Encourage client to other acting-out histopathologi
area that cancer) able to express her anger behaviour. And cal findings
body part overcom or hostility, and able to set was positive
where e her other acting-out limits on breast cancer
surgery was grief due behaviour due to inappropriate
done her to loss the removal of her behaviour and She is taught
breast was of body breast due to redirect to direct to
removed part cancer. negative negative
surgically in thinking. thinking to
a hospital Allow to set limits positive
on inappropriate thinking and
behaviour understood
Objective how
cues: Teach patient to to manage
redirect negative her mood
Anger thinking to positive swings from
sad then
Sad facial Rationale: angry, then
expression The client’s way of sad to happy
Tearful and expressing or
frowning dealing with
face feelings or despair
Mood and spiritual
swings distress, reflecting
sadness, ineffective coping
anger and need for
happy but additional
sad about interventions
her preventing
condition destructive actions
enables client to
maintain control
and sense of self-
esteem.

VI. DIAGNOSTIC PROCEDURES

VII. MEDICAL MANAGEMENTS

VIII. NURSING INTERVENTIONS