METRO VIGAN HOSPITAL

BREAST CANCER: STATUS POST

MODIFIED RADICAL MASTECTOMY
RIGHT
LESTER PAUL R. SIVILA
APPENDICITIS
Worldwide, breast cancer is the most frequently
diagnosed life-threatening cancer in women. In many
less-developed countries, it is the leading cause of cancer
death in women; in developed countries, however, it has
been surpassed by lung cancer as a cause of cancer death
in women. In the United States, breast cancer accounts
for 30% of all cancers in women and is second only to
lung cancer as a cause of cancer deaths in women
(Chalasani, 2022).
CASE:
Brought to Metro Vigan Hospital, patient PJM, a 65-year-old woman, was
diagnosed with breast cancer and had warning indications of tenderness,
swelling and redness of her breast, sore or itchy rashes on nipple, flaking skin
in the nipple area, and pain in any place of her breast. She is currently residing
in Nalasin, Sto. Domingo, Ilocos Sur. Consultation was sought and surgery
was scheduled, hence admission. The client stayed on the hospital for 8 days.
GENERAL OBJECTIVES:
The general objective of this case study is to learn in-depth knowledge about
breast cancer and modified radical mastectomy. To learn skills that can utilize
and link to correct nursing management and how the student nurse can apply
proper attitude toward a patient who will undergo this kind of surgery.
SPECIFIC OBJECTIVES:
In order to meet the general objective, the nurse aims to:
• Establish a nurse-patient relationship and rapport to the patient.
• Interpret the patients’ gathered data.
• Accurately present a through general assessment of the client which includes
physical assessment and family history taking.
• Recognize the contributing factors associated in the development of the diagnosis.
• Present the complete PEARSON assessment of the patient.
• Discuss anatomy and physiology of the organ involved to the patient’s disease.
• Understand the pathophysiology and etiology of the case being presented.
SPECIFIC OBJECTIVES:
In order to meet the general objective, the nurse aims to:
• Efficiently provide appropriate and proper nursing diagnosis in line with the client’s
medical condition and skillfully formulate nursing care plans for the problem
identified.
• Formulate specific, measurable, attainable, realistic and time bounded nursing care
plan to aid the patient’s condition.
• Understand the role of drug therapy in managing the client related to the patient’s
diagnosis.
• Appropriately apply nursing interventions necessary for the patient’s condition in
reference with the learned theories and concepts of the disease.
• Formulate an exclusive discharge home care plan, provide health teachings and
uplift importance of lifestyle modification, rehabilitation and follow-up.
PATIENT'S PROFILE
Name: Neri Imana
Age: 68
Gender: Female
Occupation: Housewife
Educational Attainment: College Graduate
Civil Status: Widowed
Nationality: Filipino
Address: Nalasin, Sto. Domingo, Ilocos Sur
Religion: Roman Catholic
CC: Deep aching pain on her right breast awakening her at night.
Date Admitted: October 11, 2022
Admitting Diagnosis: Invasive Ductal Cancer, Right Breast
Attending Physician: Dr. Lahoz
Source of Information: Patient and significant other
History of Present Illness
Patient Imana, a 68 year-old housewife, came to the hospital with complaints of Deep
aching pain on her right breast. She was admitted at Metro Vigan Hospital ward at 3pm.

During admission, vital signs were as follows: blood pressure of 160/90 mmHg, heart
rate of 89 bpm, respiratory rate of 20cpm, and a temperature of 36.5C. An oxygen
saturation of 97% was also recorded. Upon performing complete physical exam,
ulcerated breast mass on her right breast which was tender and swollen were also
reported. Pain level rated as 9/10. She was diagnosed with Invasive Ductal Cancer,
Right Breast by Dr. Lahoz her attending physician.
History of Past Illness
The client had undergone previous operations, cholecystectomy in 2014 and excision of
breast mass in 2019. No known allergies to medications and foods. The client does not
consume alcohol in a regular basis, only occasionally. She also does not smoke. Patient
Imana also had his immunization profile completed as a child. The patient also reported
that she used contraceptive pills before.
History of Past Illness
Past illnesses reported were hypertension, increased blood sugar, hyperthyroidism, Acid
Peptic Disease. Also experienced common illness such as, headache, nausea, rashes and
pain around the nipple. OTC medications such as Paracetamol for headaches, nausea,
and soreness around the breast, and Benadryl for nipple rashes, can help. In addition,
they supplement it with increasing water intake, eating a balanced diet of meat and
vegetables, and taking a rest. However, if conditions complicate, they immediately seek
help from the nearest health care facility.
Family Health History
The client reported that they do have a family history of breast cancer on both sides of
the family. The common illnesses experienced by the family are coughs and cold, fever,
head ache and body pain. They manage it with OTC drugs like paracetamol for
headache and fever, carbocisteine for cough, bioflu for colds and acetaminophen for
muscle pain. These drugs are reported to be effective but they seek medical assistance
when this conditions worsen. They also use herbal medicines as alternatives and visit
folk healers.
PEARSON ASSESSMENT
(see word file)
DIAGNOSTIC PROCEDURES &
INTERPRETATION
IDEAL
Breast Ultrasound – a machine that uses sound waves to make pictures, called sonogram, of
areas inside the breast.

Mammogram – is and x-ray of the breast, this are commonly used to screen breast cancer. If
an abnormality detected on a screening mammogram, your doctor may recommend a diagnostic
mammogram to further evaluate that abnormality.

Breast Magnetic Resonance Imaging – a kind of body scan that uses a magnet linked to a
computer. The MRI scan will make detailed pictures of areas inside the breast.

Biopsy – this is a test that removes tissue or fluid from the breast to be looked at a microscope
and do more testing.
ACTUAL
(see word file)
ANATOMY & PHYSIOLOGY
The adult breast is anatomically located on the pectorals
muscle, which is located atop the ribcage. The anatomy of the
breast reflects its unique function: the production of milk for
lactation (breast feeding). The tissue's epithelial component is
made up of lobules that produce milk and link to ducts that lead
to the nipple. The male breast structure is virtually comparable
to that of the female breast, with the exception that male breast
tissue lacks the specialized lobules because males do not have a
physiological necessity for milk production.
PATHOPHYSIOLOGY
(see word file)
MEDICAL & SURGICAL
MANAGEMENT
MEDICAL MANAGEMENT
Patient Imana was rushed at Metro Vigan Hospital Emergency Room at 3pm, October
11, 2022. She complained of deep, aching pain on her right breast awakening her at
night. She was admitted in the ward section. She was diagnosed with Invasive Ductal
Cancer, Right Breast by Dr. Lahoz.

The client was also restricted from eating and drinking in preparation for surgery post-
midnight. A Plain LR 1 liter was given intravenously to run for 8 hours. Antibiotic
therapy (cefuroxime) along with analgesic was also administered in preparation for
surgery. Ice pack was also used to help relieve pain felt by the patient. Rest was
provided, attended care needs, and close monitoring was done prior surgery.
MEDICAL MANAGEMENT
After the surgery, she was closely monitored for the effects of the anesthesia.
Surgical wound was also kept clean and dry. She was on continued meds as
ordered by the doctor. She was also observed for any signs of anxiety with
regards to her loss of breast.
SURGICAL MANAGEMENT
Due to presence of invading cancer cells as indicated in the CT scan imaging result and
findings, an informed consent for surgery was obtained from the client. She was
scheduled for surgery at 9 am on October 13, 2022 and was given a general anesthesia
an hour before surgery. Endotracheal intubation was done to assist breathing during
surgery. An NG tube was also inserted to suction air and fluid from the stomach to
prevent vomiting. The patient undergone modified radical mastectomy on her right
breast. The surgery was successful and the closing incision was done without any
untoward complications. A drainage tube was inserted and was left for 3 days.
SURGICAL MANAGEMENT
Patient RA was then then transferred at the post-anesthesia care unit 12 PM
post-surgery. Vital signs were closely monitored in order to detect anesthesia
and/or surgery related complications.
SURGICAL MANAGEMENT
After the patient was completely awake, she was moved into a hospital room to recover.
Intravenous fluids were infusing well. Pain management was continued. Antibiotics was
also continued post-surgery to treat possible infections and was discontinued when
patient became afebrile and WBC count normalized. Bowel sounds where routinely
assessed. Clear liquids were allowed the day after the surgery and advanced to a regular
diet when peristalsis returned. Fiber supplement (Metamucil) was also given to help
restore normal bowel function. Patient remained in the hospital for 3 days. Goals of his
stay included monitoring vital signs, preventing infection, pain management, fluid and
electrolytes management, restoration of normal bowel function, wound care, adequate
nutrition, ambulation, and psychosocial support.
NURSING CARE PLANS
1. IMPAIRED SKIN INTEGRITY related to surgical removal of skin or tissue as
evidence by presence of surgical incision, redness and itchiness on the surgical
wound.

2. ALTERED BODY IMAGE related to mastectomy as evidenced by loss of right

breast and negative feelings about body.

3. RISK FOR INFECTION as evidenced by a break in skin integrity.

PROMOTIVE & PREVENTIVE
THERAPEUTICS
PROMOTIVE MANAGEMENT
Anyone can spread the word about the risk of breast cancer, and aid in researching a cure such as
• Get moving – joining a breast cancer race can be a fun way to get some exercise connect with other
people affected by breast cancer and contribute to a great cause.
• Wear pink –Wearing or displaying pink gear contributes to cancer research, and reminds people
around you that it’s important to help fight breast cancer. National Breast Cancer Awareness Month
is October.
• Reach out through social media – use social media platforms to raise awareness of breast cancer.
• Involved local businesses to contribute money to breast cancer research and suggest to wear pink
for a day in supporting breast cancer awareness. A portion of the said fundraising proceeds to breast
cancer related organization.
PREVENTIVE MANAGEMENT
There is no way to prevent breast cancer. However, a person can take steps to significantly
reduce their risk.These include:
• limiting alcohol consumption, for people who drink
• having a healthy diet with plenty of fresh fruit and vegetables
• getting enough exercise
• maintaining a moderate body mass index
A person who is considering using hormone replacement therapy after menopause may wish
to discuss this with a healthcare professional.
DISCHARGE PLANNING
(see word file)
 THANK YOU!

RUPTURED APPENDICITIS: POST APPENDECTOMY

LESTER PAUL R. SIVILA