Never had a routine mammogram Never practiced Breast Self-Examination (BSE) States she deserves to have breast cancer for being so careless about her health Chose to have a lumpectomy to remove the tumor despite its large size because she believes that her breasts are critical in her relationship with her husband Objective Data Physical examination: Right breast: Healed lumpectomy breast incision and right axiliary incision Limited ROM of right arm Groshong broviac catheter in place on left upper chest Diagnostic studies.
Pathology: Estrogen receptor-positive infiltrating ductal carcinoma; 8 of 12 lymph nodes positive for malignant cells Staging: Stage IIIB carcinoma of the right breast Clinical course Lumpectomy performed to remove tumor 3 weeks ago Chemotherapy with CAF protocol planned – cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), and 5-fluorouracil (5-FU) 1. Why is chemotherapy indicated for Mrs. Thomas? It is indicated for Mrs. Thomas as adjuvant treatment and may help reduce the chance of breast cancer recurrence. 2.
Compare the three chemotherapeutic agents planned for Mrs. Thomas with respect to classification type, cell specificity and common side effects? 1) Cyclophosphamide (Cytoxan) Alkylating agent DNA replication Side effects – low blood counts, hair loss, n&v, loss of fertility, discoloration of the skin or nails 2) Doxorubicin (Adriamycin) Anthracycline antibiotic Intercalating DNA side effects – Pain (med site), n&v, low blood counts, hair loss, mouth sores 3) 5-fluorouracil (5-FU) Antimetabolite Irreversible inhibition of thymidylate synthase.
Side effects – n&v, low blood counts, mouth sores, diarrhea, poor appetite, discoloration (med site), photophobia, metallic taste in mouth during infusion 3. What can the nurse do to help Mrs. Thomas reduce or manage the common physical effects of the chemotherapy? Nausea & Vomiting – anti-emetic drug, eat and drink slowly, drinking enough fluids Mouth sores (Mucositis) – OTC anesthetics, ice chips or popsicles, gargling Diarrhea – drink plenty of fluids, high-protein foods, cooked vegetables, fresh fruits without the skin Hair loss – wear some kind of head covering (scarf, turban, hat, or wig).
4. What does the finding that Mrs. Thomas’s tumor is estrogen receptor-positive mean? What additional treatment modalities might this suggest? This means that estrogen, but not progesterone, may be supporting the growth and spread of the cancer cells. Your doctor usually will prescribe some form of hormonal therapy at some point in your treatment plan. 5. How could the nurse help Mrs. Thomas cope with her feelings of guilt and maintain a positive relationship with her husband? The nurse could listen to and explore Mrs. Thomas’s feeling of guilt.
Inform her about support groups and counseling that are available in her area. 6. What are some possible reasons that Mrs. Thomas did not perform BSE or have mammography performed? Not confident in the technique of BSE Fear that something may be found Losing her sexual identity Anxiety 7. What teaching by the nurse is indicated for Mrs. Thomas regarding follow-up care related to recurrence of the breast cancer? Have a mammogram every 12 months Have a physical exam by a health care provider every four to six months for five years, then every 12 months Perform a breast self-examination every month.
Have regular bone density tests if you have a higher risk of osteoporosis Take medications as prescribed by your doctor Maintain an active lifestyle and healthy body weight 8. Based on the assessment data presented, what are three appropriate nursing diagnoses? I. Risk for infection II. Ineffective coping III. Disturbed body image 9. What interdisciplinary problems may require assistance from other members of the health care team? Medical & Physical exams Surgery Radiation/Chemotherapy Diagnostic tests Counseling.