BREAST

CANCER
introduction
Cancer is a class of diseases in which a
group of cells display uncontrolled
growth (division beyond the normal
limits), invasion (intrusion on and
destruction of adjacent tissues), and
sometimes metastasis (spread to other
locations in the body via lymph or
blood). These three malignant properties
of cancers differentiate them from
benign tumors, which are self-limited,
and do not invade or metastasize.
Breast cancer occurs when abnormal cells
grow out of control in one or both breasts.
They can invade nearby tissues and form a
mass, called a malignant tumor. The cancer
cells can spread (metastasize) to the
lymph nodes and other parts of the body. It is
the leading cause of death in women 40-44
years old and the second most common
killer of women after lung cancer. Heightened
awareness of breast cancer risk in the past
decades has led to an increase in the
number of women undergoing
mammography for screening, leading to
detection of cancers in earlier stages and a
resultant improvement in survival rates.
Current statistics indicate that
over an entire lifetime (birth to
death), a woman’s risk for
developing cancer is 1in 8. When
broken down by age 39 years is 1
in 209, and it increases to 1 in 24
by age 59 years. Although breast
cancer in women is a form of
cancer, male breast cancer does
occur and accounts for about 1%
of all cancer deaths in men.
In the Philippines, breast cancer
accounts for 16 percent of the
50,000 cases of the dreaded
disease. It is also the leading
cause of cancer among women in
the country, accounting for 28%
of the total cases, followed by
cancer of the cervix, ovary,
thyroid and lung.
Treatment options for breast cancer may involve
surgery (removal of the cancer alone or, in some
cases, mastectomy), radiation therapy, hormonal
therapy, and/or chemotherapy. With advances in
screening, diagnosis, and treatment, the death
rate for breast cancer has declined by about 20%
over the past decade, and research is ongoing to
develop even more effective screening and
treatment programs. Staging systems have been
developed to allow doctors to characterize the
extent to which a particular cancer has spread and
to make decisions concerning treatment options.
Breast cancer treatment depends upon many
factors, including the type of cancer and the extent
to which it has spread.
 RISK
FACTORS
Family history: Having a 1st-degree relative
(mother, sister, daughter) with breast cancer
doubles or triples risk of developing the cancer,
but breast cancer in more distant relatives
increases risk only slightly. When ≥ 2 1st-
degree relatives have breast cancer, risk may
be 5 to 6 times higher. A woman's risk of breast
cancer is higher if her mother, sister, or
daughter had breast cancer. The risk is higher if
her family member got breast cancer before
age 40. Having other relatives with breast
cancer (in either her mother's or father's family)
may also increase a woman's risk.
Breast cancer genes: About 5% of women with
breast cancer carry a mutation in one of the 2
known breast cancer genes, BRCA1 or BRCA2.
If relatives of such a woman also carry the gene,
they have a 50 to 85% lifetime risk of developing
breast cancer. Women with BRCA1 mutations
also have a 20 to 40% lifetime risk of developing
ovarian cancer; risk among women with BRCA2
mutations is increased less. Women without a
family history of breast cancer in at least 2 1st-
degree relatives are unlikely to carry this gene
and thus do not require screening for BRCA1 and
BRCA2 mutations. Men who carry a BRCA2
mutation also have an increased risk of
developing breast cancer. Changes in certain
genes increase the risk of breast cancer.
These genes include BRCA1, BRCA2,
and others. Tests can sometimes show
the presence of specific gene changes in
families with many women who have had
breast cancer. Health care providers may
suggest ways to try to reduce the risk of
breast cancer, or to improve the
detection of this disease in women who
have these changes in their genes.
Personal history: Having
had in situ or invasive
breast cancer increases
risk. Risk of developing
cancer in the
contralateral breast after
mastectomy is about 0.5
to 1%/yr of follow-up.
Reproductive and menstrual
history:
Women who went through
menopause after age 50
are at an increased risk of
breast cancer.
Breast changes: History of fibrocystic changes
that require biopsy for diagnosis increases risk
slightly. Women with multiple breast lumps but no
histologic confirmation of a high-risk pattern
should not be considered at high risk. Benign
lesions that may slightly increase risk of
developing invasive breast cancer include
complex fibroadenoma, moderate or florid
hyperplasia (with or without atypia), sclerosing
adenosis, and papilloma. Risk is about 4 or 5
times higher than average in patients with
atypical ductal or lobular hyperplasia and about
10 times higher if they also have a family history
of invasive breast cancer in a 1st-degree relative.
Increased breast density seen on screening
mammography is associated with an increased
risk of breast cancer
clusive evidence about the effect of a particular diet (eg, one high in fats) is lacking. Obese postmenopausal women are at increased risk, but there is no evidence that dietary modification reduces risk. For

Diet: Diet may contribute to

development or growth of breast
cancers, but conclusive evidence
about the effect of a particular diet
(eg, one high in fats) is lacking.
Obese postmenopausal women are at
increased risk, but there is no
evidence that dietary modification
reduces risk. For obese women who
are menstruating later than normal,
risk may be decreased.
Breast density: Breast
tissue may be dense or
fatty. Older women whose
mammograms (breast x-
rays) show more dense
tissue are at increased risk
of breast cancer.
Types of breast
cancer
Infiltrating ductal carcinoma (75% of cases) - which has a
poorer prognosis than other types. The tumors arise from the
duct system and invade the surrounding tissues.
 
Infiltrating lobular carcinoma (5%-10% of cases) - these
tumors occur in an area of ill-defined thickening and are
multicentric tumors.
 
Medullary carcinoma (5% of cases) - the tumors grow in a
capsule inside a duct.
 
Mucinous carcinoma (3% of cases) – a mucin producer, the
tumor is slow-growing and thus the prognosis is more
favorable.
 
Tubular ductal cancer (2% of cases) – because axillary
metastases are uncommon with this histology, prognosis is
usually excellent.
 
Inflammatory carcinoma and Paget disease- are less common
forms of breast cancer. 
PATIENT’S
PROFILE
Mrs. X was a 57 years old Filipino female who was born on April 13,
1952. She lives in Calamba, Laguna. Her religious affiliation is
Baptist. She is married and has 3 children who are all now stable and
have their own career. Mr. X her husband is a jeepney driver. Mrs. X
is not obese because she is physically active in her household
chores. She has enough sleep, usually about 8 hours a day and feels
complete. She told us that she is neither engaged to smoking nor
drinking. According to Mr. X, his wife has a very good appetite, she
eats everything but his favorites are fatty foods specially if it is grilled.
Mrs. X has hypertension, diabetes, asthma and cancer in both side of
her family. She was hospitalized last December 8, 2009 because she
experienced local breast pain, and when she examined her breast
she felt a lump. She taught that the cause of the pain was just only
because she got tired cleaning their backyard, but when the pain got
worst she decided to consult her doctor. She had undergone several
laboratory examinations such as ECG, blood chemistry, coagulation
factors, urinalysis and hematology. Later on she was diagnosed with
mass at left lower outer quadrant of her breast that measures about 6
x 7cm by her attending physician Dr. Joseph Eric R. Fernandez,
M.D. After the diagnosis, she was scheduled for operation on
December 10, 2009 for MRM. The operation was successful and he
has now had drainage in her left part of the breast. Mrs. XXX was
fully recovered and was discharge on December 17, 2009.
 PHYSICAL
ASSESSMENT
HEAD: With thick, short, coarsely hair
Grayish white in color evenly No dandruff and lice
distributed to the whole scalp No headache noted

EARS:
With medium
sized pinna
EYES: Ears are lined
With round NOSE: with the outer
eyes, Shaped canthus of the
moderately high MOUTH AND eye
symmetrical
bridge THROAT: Ear canal
With white
Nostrils are Lips and moderately
sclera
patent oral mucosa moist with
With slightly
With septum is slightly earwax
pale conjunctiva
deviation pale No odor
With presence
No discharge With slightly
of eye bag
noted yellowish
teeth
With moist
oral
membranes

SKIN:
Brown in
complexion
With good
skin turgor
With cold
clammy skin
With fine
hair in
extremities
 Neck:
No scars

Chest and Heart:

Lungs: With normal
With drainage at heart sound
left part of the No palpitations
breast
No abnormal Abdomen:
breath sound Soft abdomen
upon
auscultation
With complaint
of pain at left
breast  Extremities:
edema noted at
left arm
With limited
ROM
Positive varicose
veins
No lesions noted
Symmetrical
With coordinated
movement
 ANATOMY
AND
PHYSIOLOG
Y
 Ana t o my a nd phy s io l o g y
The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20
lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can
produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The
nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the
lobules and ducts.
The breasts also contain lymph vessels. These vessels lead to small, round organs called
lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the
collarbone, in the chest behind the breastbone, and in many other parts of the body. The
lymph nodes trap bacteria, cancer cells, or other harmful substances.
pathogenesis
Initiation phase
 CARCINOGEN(GENETIC DUPLICATION ERRORS)

MICROSOMAL ENZYME ACTIVATION

ACTIVATION

GENOTOXIC MECHANISMS:
NON-GENOTOXIC MECHANISMS:
>DNA ADDUCTS
>INFLAMMATION
>CHROMOSOME BREAKAGE,
>IMMUNOSUPRESSION
FUSION, DELETION,
>REACTIVE OXYGEN AND NITROGEN SPECIES
MISSEGREGATION,NON-
>EPIDEMIC SILENCING
DISJUNCTION

ALTERED SIGNAL TRANSDUCTION GENOMIC DAMAGE

DAMAGE CELL PREINITIATED CELL INITIATED CELL

>ACTIVATION OF PROTOOCCOGENES
>ALTERED DNA
>LOSS OF GENE SUPPRESSOR BLOCKADE

>ABNORMAL ONCOGENE
AMPLIFICATION/MUTATION TRANSFORMATION
>GENE SUPPRESSOR
BLOCKADE(BRCA1,BRCA2,P53)
promotion phase
 ABNORMAL DNA AND CELL REPLICATION

ABNORMAL RESPONSE TO GROWTH FACTORS AND INHIBITORS

MULTIPLICATION OF GENETIC MODIFIED CELLS

PROMOTION OF BENIGN TUMOR CELL GROWTH

DOUBLING TIME OF EACH TUMOR

RAPIDLY GROWING LESIONS

progression phase
 DETERMINATION OF CLINICAL TUMOR PHENOTYPE

GAIN OF FUNCTION BY MALIGNANT CELLS VS. LOSS OF FUNCTION OF NORMAL CELLS

TISSUE NECROSIS/METASTASIS

>STROMAL CHANGES(ANGIOGENESIS SUSTAINED)

>HYPERMUTABILITY
>GENETICS INSTABILITY
>LOSS OF PROLIFERATION CONTROL
>RESISTANCE TO APOPTOSIS

INVASIVE CANCER

ALTERED BODY FUNCTIONING

MAINLY MANIFESTED BY PRESENCE OF LUMP UPON BREAST SELF EXAMINATION

ACCOMPANIED BY OTHER SIGNS AND SYMPTOMS
Clinical manifestations
Local Pain
Local obstruction caused by the tumor. 
Dimpling of the skin
Can occur with invasion of the dermal lymphatics because of retraction of Cooper
ligament or involvement of the pectoralis fascia. 
Nipple discharge in a non lactating women
Spontaneous and intermittent discharge caused by tumor obstruction.
Skin retraction
Involvement of the suspensory ligaments .
Edema
Local inflammation or lymphatic obstruction.
Nipple/areola eczema
Presence of malignancy in the ductal system below the nipple.
Pitting of the skin
This is similar to the surface of an orange
Obstruction of the subcutaneous lymphatics, resulting in the accumulation of fluid.
Reddened skin, local tenderness and warmth
Inflammation
Dilated blood vessels
Obstruction of venous return by a fast-growing tumor; obstruction dilates superficial
veins. 
Ulceration
Tumor necrosis
Hemorrhage
Erosion of blood vessels.
Edema of the left arm
Obstruction of lymphatic drainage in the axilla. 
Laboratory
results
 Examination Results Normal Values Findings
Sodium 144.50 135-145 mmol/L NORMAL
Potassium 3.78 2.4-5.3 mmol/L NORMAL
Fasting Blood Sugar 5.9
Blood Urea Nitrogen 4.6 2.8-6.4 mmol/L NORMAL
Blood Urea Ammonia 450 144-342 ↑Urinary Tract
Obstruction
Creatinine 71 53-115 umol/L NORMAL
Cholesterol 3.87 4.2-5.2 mmol/L NORMAL
Triglycerides 1.14 0.41-2.37 mmol/L ↑ Biliary obstruction,
nephritic syndrome
High Density 1.4 0.25-2.65 mmol/L NORMAL
Lipoprotein
Low Density 2.6 1.1-2.6 mmol/L NORMAL
Lipoprotein

BLOOD CHEMISTRY
 Examination Results Normal Values Findings
Protime 13.3 sec 11-14 sec NORMAL
INR 0.99 0.8-1.2 NORMAL
% Activity 103% 70-120% NORMAL
PT Control 13.2 sec. 11-14 sec NORMAL
PTT 27.8 sec 27-34 sec NORMAL
INR 1.08 0.8-1.2 NORMAL
PTT Control 33.6 sec 27-34 sec NORMAL
COAGULATION
FACTORS
 URINALYSIS

1. Physical Examination 3. Microscopic Examination Cells

Color Yellow
Appearance Slightly Hazy
Pus Cells 60-70/hpf
Specific 1.010
RBC 10-12/hpf
Gravity

2. Chemical Examination 4. Crystals

pH 8.0
Glucose Negative Amorphous Urates FEW
Protein +2 Bacteria FEW
Ketones Negative
Bilirubin Negative
Urobilinogen Normal
Blood/Hgb +1
Nitrite Negative
Leukocytes +3
 MEDICAL
MANAGEMENT
DIAGNOSTIC IMAGING REPORT:
Chests PA view:
There are no active lung infiltrates.
The heart is not enlarged. Aorta is tortuous.
The cp sulci, diaphragm and bony thorax are
unremarkable.
MACROSCOPIC AND MICROSCOPIC EXAMINATION
 
Cytology reveals malignant cells singly and in
overlapping sheets with large, irregular, hyperchromatic
nuclei surrounded by scant cytoplasm. The background
shows moderate red blood cells.
 
FINAL PATHOLOGICAL DIAGNOSIS:
FNAB, BREAST MASS
POSITIVE MALIGNANT CELLS
ECG: Normal Findings
DIAGNOSTIC
PROCEDURE
a) Self-examination - 90% of the breast masses are
discovered by the patient herself. From this manner,
self-examination appears as one of the most
important measures for the early diagnosis of breast
cancer, once it: allows the detection of small masses;
is an useful, convenient, profitable, advantageous
and opportune method: can be repeated as many
times as necessary; has no cost; is easy to be done;
its precision increases with practice.
Self-examination must be performed 7-8 days after
menstruation by every woman with more than 20
years old, in order to detect early changes in breast
parenchyma.
b) History - Verify the presence of risk factors and evaluate
the patient’s complaint
Risk Factors - sex (100 women: 1 men); familiar history;
adverse hormonal environment; other lesions on the breast
in the past
Presenting Complaint - lump - is the main complaint (70% of
the cases). Evaluate its consistence, mobility, growth,
changes with menstrual cycle, and if it is painless or not .
 Nipple discharge - investigate spontaneous discharge,
which can be watery, serous or bloody. Remember some
medications can cause nipple discharge, such as
contraceptives and reserpine.
 eczema - if it is important, unilateral and in the nipple
area, it can suggest the presence of malignancy in the
ductal system below the nipple.
 pain - especially if after menopause and if unilateral.
 other - erosion, retraction, enlargement, swelling,
redness, axillary mass and bone pain .
c) Physical Examination - Inspection of the breast is the first
step in physical examination and should be carried out with
the patient sitting, arms at sides and then overhead.
Abnormal variations in breast size and contour, minimal
nipple retraction, and slight edema, redness or retraction of
the skin can be identified. Asymmetry of the breasts and
retraction or dimpling of the skin can often be accentuated by
having the patient raise her hands overhead or press her
hands on her hips, in order to contract the pectoralis
muscles . Axillary and supraclavicular areas should be
thoroughly palpated for enlarged nodes with the patient
sitting. Palpation of the breast should be performed with the
patient both seated and supine with the arm abducted.
Every woman between 20-40 years must have her breasts
examined by a specialist every 2/3 years. After 40 years,
examinations must be annually , and in women with high-risk
for breast cancer, every semester
d) Cytology - Fine Needle Aspiration
(FNA) has a simple technique and a
high level of concordance with
hystopatological findings. The
cyto/hystopathologic relation is 83.4%,
but in malignant lesions this relation is
94.7%. It is important, however, to say
that FNA results are ONLY diagnostic
when concordant with clinical findings!
Axillary nodes can also be examined, in
order to stage disease.
e) Biopsy - It is the preferred isolated
diagnostic method before deciding
on a definite treatment. Delayed
biopsy must be preferred to frozen
biopsy, once it: allows patients to
accept their diagnosis, to decide on
their treatment, and even to look for
a second opinion. Trials have been
demonstrating that there is no
problem in delaying treatment for 1-2
weeks with this routine
 Proposed
diagnostic
procedures
a) Mammography - It is the single reliable means of
detecting breast cancer before a mass can be palpated
in the breast ( it can detect microcalcifications smaller
than 1mm of diameter, and frequently associated with
malignant lesions).
Over then for screening, indications for mammography
are as follows: to evaluate each breast when a
diagnosis of potentially curable breast cancer has been
made; to evaluate a questionable or ill-defined breast
mass or other suspicious change in the breast; to
search for an occult breast cancer in a woman with
metastatic disease in axillary nodes or elsewhere; to
screen a group of woman with high risk for breast
cancer; to screen women prior to cosmetic operations or
prior to biopsy; to follow women who have been treated
with breast-conserving surgery and radiation.
Patients with a suspicious mass must have a
cyto/hystological exam made, despite mammographic
findings . Mammography IS NOT a substitute for biopsy.
b) Ultrasound - US can distinguish between
solid and cystic lesions , although it is less
sensitive than mammography in identifying
breast cancer, especially because neoplastic
areas are difficult to be differentiated from
normal parenchyma. On the same way, it is
difficult to differ from malignant and benign
characteristics. Isolated US can rarely detect
malignant lesions smaller than 1 cm or
microcalcifications. It is generally used to
evaluate young women’s (<35 years) breasts,
once mammograms are not indicated in these
cases.
drug study
 NAME OF SPECIFIC MECHANISM SPECIFIC CONTRAINDICATI ADVERSE NURSING
DRUG ACTION OF ACTION INDICATION ON EFFECT CONSIDERATION

A first- Treatment of Contraindicated in CNS: confusion, Obtain specimen for

Cefazolin Cephalosporin generation infections of patients seizures culture and sensitivity
1 gm 1 hr prior Anti-infective cephalosporin respiratory, hypersensitive to CV: tests before giving first
to OR then 1 drug that biliary, and GU drug or other thrombophlebiti dose.
gm IV q8 Inhibits cell wall tracts; skin, cephalosporins s with IV
synthesis, soft-tissue, injection, If large doses are given,
promoting bone, and joint Use cautiously in phlebitis therapy is prolonged,
osmotic infections; breastfeeding GI: or patient is at high
instability; septicemia; women and in pseudomembran risk, monitor patient
usually endocarditis patients with a ous colitis, for signs and symptoms
bactericidal. history of colitis nausea, anorexia of superinfection.
and renal vomiting,
insufficiency diarrhea,
abdominal
cramps
Heme:
neutropenia,
leucopenia,
thrombocytopen
ia
Skin:
maculopapular
and
erythematous
rashes, urticaria,
pruritus, pain,
induration,
Stevens-Johnson
syndrome
Other:
hypersensitivity
reactions,
anaphylaxis,
drug fever
 SPECIFIC MECHANISM SPECIFIC ADVERSE NURSING
NAME OF DRUG CONTRAINDICATION
ACTION OF ACTION INDICATION EFFECT CONSIDERATION

Binds to opioid Relief of Contraindicated in CNS: dizziness, Monitor CV and

Tramadol Analgesic receptors and moderate to patients vertigo, respiratory status.
(Ultram) inhibit the moderately hypersensitive to drug headache, Withhold dose and
50 mg reuptake of severe pain. and in those with somnolence, notify prescriber if
VSIVP Q 6 then norepinephrine acute intoxication seizures respirations decrease or
prn for severe and serotonin. from alcohol, rate is below
pain hypnotics, centrally CV: vasodilation 12breathes/min.
acting analgesics,
opioids, or EENT: visual Monitor bowel and
psychotropic drugs disturbances bladder function.

Use cautiously with GI: nausea, Monitor patient at risk

impaired renal or vomiting, seizures
hepatic function, constipation,
pregnancy; patients at dyspepsia, dry
risk for seizures or mouth, anorexia
respiratory depression
RESP: respiratory
depression

Skin: pruritus,
rash, diaphoresis
NAME OF SPECIFIC MECHANISM SPECIFIC ADVERSE NURSING
CONTRAINDICATION
DRUG ACTION OF ACTION INDICATION EFFECT CONSIDERATION

Inhibits Acute or long- Contraindicated with CNS: headache, Administer drug

Diclofenac Anti- prostaglandin term treatment hypersensitivity to drug fatigue, with food or after
Sodium inflammatory synthesis to of mild to dizziness, meals if GI upset
1 amp IV q 12 (non-steroidal) cause moderate pain Contraindicated with insomnia, occurs.
antipyretic and renal impairment, tinnitus
anti- Management of pregnancy, lactation Be aware that
inflammatory inflammatory DERMA: rash, patient may be at
effects. disorders Use cautiously with pruritus, increased risk for
impaired hearing, stomatitis, CV events, GI
allergies, hepatic, CV, GI sweating bleeding, renal
conditions and in elderly insufficiency;
patients GI: nausea, monitor
vomiting, accordingly.
dyspepsia, GI
bleeding

HEME:
bleeding,
platelet
inhibition with
higher doses
 NAME OF SPECIFIC MECHANISM SPECIFIC ADVERSE NURSING
CONTRAINDICATION
DRUG ACTION OF ACTION INDICATION EFFECT CONSIDERATION

Competitively Maintenance Contraindicated with CNS: headache, Instruct patient to

Ranitidine Histamine2 inhibits the therapy for allergy to ranitidine, vertigo, malaise, take without regard
1 amp IV q 8 antagonist action of duodenal or lactation dizziness to meals or bedtime
histamine on gastric ulcer. because absorption
the H2 at Use cautiously with DERMA: rash, isn’t affected by
receptors of Gastroesophag impaired renal or alopecia food.
parietal cells of eal reflux hepatic function,
the stomach disease pregnancy GI: constipation, Urge patient to
inhibiting basal diarrhea, nausea, avoid cigarette
gastric acid Active vomiting, smoking because
secretion and duodenal and abdominal pain this may increase
gastric acid gastric ulcer gastric acid
secretion that is HEPATIC: secretion and
stimulated by Heartburn jaundice worsen the disease.
food, insulin,
histamine, LOCAL: local Advise patient to
gastrin, burning or report abdominal
pentagastrin itching at IV site pain and blood in
stool or emesis.
Arrange for follow-
up, including blood
tests, to evaluate
effects.
 NURSING
CARE PLAN
 Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective:

“Masakit ang aking Acute chest pain related to At the end of nursing  Establish Nurse-client  To gain trust and  Goal was met.
dibdib” as verbalized by post operative surgery as intervention the client’s interaction better understanding  Pain scale lessened
the client. evidenced by guarding pain will lessened. on patient’s condition from 7/10 to 4/10
behavior.  Serve as baseline data
Objective:  Take and record vital of the patient
sign
 conscious and
coherent  To prevent air
 afebrile  Check and regulate embolism and provide
 with body malaise IVF hyration.
 guarding behavior
 with slight pain at left  Environment has a
chest-pain scale of  Provide therapeutic great impact on
7/10 (faces pain scale) environment. client’s health and
 with limited range of wellness
motion  Note pain including  To rule out worsening
 negative difficulty of the location, duration, of underlying
breathing frequency and condition/developmen
intensity. Reassess t of complications.
each time pain
occurs/is reported.

 Provide comfort
measures such as:  To avoid bed sores
and other
a. Repositioning every 4 complication and to
hrs. promote non-
pharmacological pain
b. Back massage. management.

 Provide relaxation  To lessen the intensity

technique such as of pain felt by the
a. deep breathing client
exercises  To distract attention
and reduce tension.
b. yawning
 To prevent fatigue.

 Encourage adequate
rest period.
 Assessment
Subjective:
“Hindi ako masyadong
makagalaw kapag
sumasakit ang dibdib ko”
as verbalized by the client.
Objective:
 conscious and coherent
 afebrile
 with body malaise
 Pale in appearance
 with limited range of
motion
 negative difficulty of
breathing
Diagnosis
Impaired physical mobility
related to decreased muscle
strength as evidenced by
limited body movements
and body malaise
Planning
At the end of nursing
intervention the client will
regain strength and be able
to increased mobility.
Implementation Rationale Evaluation
 Establish Nurse-client  To gain trust and better  Client was able to
interaction understanding on perform activities
patient’s condition without complaints
 Serve as baseline data of pain
 Take and record vital of the patient
sign
 To prevent air
 Check and regulate IVF embolism and provide
hydration.
 Provide therapeutic  Environment has a
environment great impact on client’s
health and wellness.
 Heath teachings
rendered such as:  To prevent the spread
a. Proper hygiene of microorganisms
 To prevent
contractures
b. Apply passive
ROM  To reduce risk of
pressure ulcers.
 Instruct patient to
change position side to
side every 4 hrs.
 To maintain position of
 Support affected body function
parts or joins using
pillows or foot
supports.
 To prevent
 Massage and stretch contractures and
extremities within the increase mobility of the
clients reached. extremities.
 Instruct activities such
as:
a. socialize with patients  To divert attention of
SO the patient and to
b. read newspaper enhance self concept
c. listening to music and sense of
d. Encourage independence.
participation in self
care.
 Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective:

“Katatapos ko lang
operahan,nakakahiya na
ang itsura ko’’ verbalized by
the client.
Objective:
Disturbed body image At the end of nursing
related to post surgical intervention the client will
procedure as manifested by be able to verbalize
irritability. understanding of body
images.
 Establish Nurse-client  To gain trust and better  The patient was
interaction understanding on able to understand
patient’s condition her situation
 Take and record vital  Serve as baseline data
sign of the patient

 conscious and coherent

 afebrile  Check and regulate IVF  To prevent air
 irritable embolism and provide
 Pale in appearance hydration.
 diaphoretic  Evaluate level of
 with surgical dressing, client’s knowledge of  To indicate acceptance
dry and intact at left and anxiety related to or non-acceptance of
breast situations. Observe situations.
emotional changes.
 Assist in correcting  To promote optimal
underlying problems healing/adaptation.
 Encourage client to
look at/touch affected  To begin/to incorporate
body part. changes in to body
image.

 Encourage family  To promote self-esteem

members to treat client on the part of the
normally and not as an patient.
invalid.

 Heath teachings
rendered such as:  To prevent the spread
a. Proper hygiene of microorganisms
b. Increase protein  To facilitate healing of
intake wound.
b. Avoid lifting heavy  To prevent fatigue.
objects
d. Encourage daily  To prevent further
wound dressing and complications and
use of antiseptic infection.
solutions.
DISCHARGE
PLANNING
DISCHARGE PLAN
Goals:
Achievements of activity level sufficient for basic self-care.
Disease process, treatment plan, and prognosis understanding.
Management to anxiety.
Meeting the require needs after discharge plan.

 
Importance compliance for medication.
Always perform exercises that will enhance the strength of the muscles
such as:
a) Wall hand climbing
b) Rod or broomstick lifting
c) Pulley tugging
d) Rope turning
Avoid lifting heavy objects.
Practicing deep breathing exercise.
Encourage to perform a breast self examination monthly.
Provide emotional and physical support to the patient.
Include family members in teaching the patient about self-care.
Let the patient report any unusual feelings of pain to the physician.
Provide proper body hygiene.
Use antiseptic solution in cleaning the wound.
Teach the patient how to empty the drainage reservoir:
a) Measure first the drainage if discharged with drain in place.
b) State observations that require contacting the physician/nurse
(sudden change in color of drainage, sudden cessation of
drainage and signs or symptoms of an infection).
c) Identify when the drain is ready for removal (usually when
draining than 30 mL for a 24 hour period).
Use warm water in taking a bath.
Encourage client for follow up check up to the physician (every 3
months for 2 years then every 6 months for up to 5 years then
annually)
Let the patient report any unusual feelings of pain to the physician.
Let your client perform a positive outlook in life. Be positive and
don’t be conscious about her body image.
DIET: can eat any kind of foods as tolerated by the patient
SEX: Once discharge in the hospital most patients are physically
allowed to engage in sexual activities
a) Just assume position which they are more comfortable
b) Can express affection such as: hugging and kissing
Normalize her activities of daily living such as: walking and caring
for her children if ever.
 Presented by:

NoroÑa, minnie rose

Ona. Trisha denise

Pacia, derrick

Padua, genesis

Padua, sherilyn marie