BREAST CANCER TYPE: Intraductal Stage III Abnormal cells develop in the ducts of the breasts.

The cancer is more advance but still contained within the breast area and lymph nodes Pt: J.R Age: 74 Female Adm: Jan 28, 2013 Dx: Intraductal Breast Cancer Stage III

NURSING DIAGNOSIS: Anxiety, severe r/t breast cancer, chemotherapy and surgical procedure: monitor VS to identify physical responses; provide accurate information; manage environmental factors; list helpful resources and people to provide support; Acute Pain r/t disease process and chemotherapy: Asses for referred pain; observe nonverbal cues and pain behaviors; monitor skin color and temp.; provide comfort measures; encourage adequate rest Fatigue r/t chemotherapy: assess VS; encourage bed rest; instruct in methods to conserve energy; assist with selfcare needs, avoid/limit exposure to temp and humidity; promote overall health measures

LABORATORY AND DIAGNOSTICS: BIRADS 5 Highly suspicious of Malignancy Ultrasound (07/2012) Multiple nodules in both breasts Left hyperechoic mass with lobulations and speculated borders Enlarged lymph nodes Mammogram (08/2012) Left breast mass Invasive ductal carcinoma, nuclear histological grade 3 Tumor present in all tissue Lymphovascular invasion
PHARMACOLOGICAL TREAMENT:
Chemotherapy

SURGICAL PROCEDURE: Modified Radical Mastectomy The removal of all breast tissue from the affected breast with the lymph node removal from the armpit on the affected side of the body.
nd

MEDICATIONS: Cefoxitin 12g IV q8h Class: 2 generation Antibiotic; inhibits bacterial cell wall synthesis Nursing Interventions: Asess for: nephrotoxicity, anaphylaxis; yogurt or buttermilk to maintain intestinal flora Clindamycin 600mg IV q8h

6 cycles of Doxobubicin (Adriamycin) Last treatment 01/17/2013 Liquid diet; increased fluid intake to 23L/day; rinsing of mouth TID-QID w/ H2O

Class: Antibiotic; suppresses protein synthesis

Nursing Interventions: adequate intake of fluids; report sore throat, fever, fatigue; D/C if bone marrow depression occurs; assess for: bowel patterns, skin problems, allergies, resp status Pantorazole 40mg IV OD Class: Proton pump inhibitor; suppresses gastric secretion Nursing Interventions: report severe diarrhea, black tarry stools, abdominal pain; hyperglycemia; avoid alcohol, NSAIDs, salicylates