Escolar Documentos
Profissional Documentos
Cultura Documentos
In partial fulfillment of the requirements for the Degree of Bachelor of Science in Nursing
Submiited by:
Aldueza, Julie Ann Bisco, Jonathan Cueto, Glenda Dimaunahan, Dennis Encallado, Nixon Hernandez, Maria Martha Laygo, Jovan Luna, Anne Marie Marbella, Roselle Saludo, Shangrila
I.
INTRODUCTION Breast cancer is growth of malignant cells at breast. It starts when the DNA of a cell is altered due to carcinomas. There is excessive or abnormal mitosis of cells in the breast. The cancer cells may travel through bloodstream and/or lymphatic system and may spread to the other organs, which are called metastasis.
Hormone estrogen plays an important role in the development of breast cancer. Factors that affect its development is early menstruation and late menopause, obesity after menopause and having no child and lastly late pregnancy. Increase in estrogen level may increase risk of breast cancer. Another factor is family history of cancer, About 5 per cent of breast cancers are linked to family history. The risk for a woman whose mother or sister had breast cancer is at least double that of someone with no family history. If her relatives were under 40 when diagnosed, her risk is even higher.
Signs and symptoms of breast cancer includes unusual lump or increase in breast size, drawing back of nipple, swelling of the upper arm, or in the armpit, or just above the breast and/or pain. According to World Health Organization every year 1.2 million are diagnosed with breast cancer worldwide. Despite an increasing incidence rate, deaths from breast cancer are starting to decline or level off in many European countries including Britain, where deaths from the disease have fallen by 10 per cent in the past five years. Incidence and mortality vary considerably between countries. Of age-standardized rates, cases per 100,000 women, incidence and mortality are in Australia, 59.6 and 21.41; in England and Wales, 56.1 and 30.27. A study carried out in Miyagi, Japan,
produced comparatively low figures of 27.8 and 6.11. As with most cancers, the earlier breast cancer is diagnosed, the greater the chance of a cure. Stage 1 is a cancer in a very early stage; stage 4 is one which has already spread to many organs. In Britain the survival rates by stage of cancer development are: 84 per cent (stage 1), 71 per cent (stage 2), 48 per cent (stage 3), 18 per cent (stage 4). For early breast cancer, mastectomy is recommended and followed with radiotherapy while advanced breast cancer is aimed by giving the patient a manageable quality of life with the disease kept under control, rather than a cure. Conventional treatments include drugs which cut estrogen levels, and various chemotherapy combinations. Some women have bone metastases that cause pain and fractures.
II.
PATIENT S PROFILE Name: Patient X Age: 67 Address: Lapu-lapu St. West Rembo, Makati City Sex: Female Nationality: Filipino Religion: Roman Catholic Birthday: 08/19/1944 Date of Admission: January 18, 2011 Ward: Oncology Ward Attending Physician: Dr. Y Admitting Diagnosis: Breast Cancer
III.
PHYSICAL ASSESSMENT Methods used/ procedure Inspection Normal Findings Actual Findings Remarks
Color
Varies from light Varies from light to to deep brown, deep brown, from ruddy from ruddy pink pink to light pink, from to light pink, from yellow overtones to yellow overtones olive to olive Uniform within normal range(36.5-37.5) Uniform within normal range(T: 37)
Normal
Temperature
Palpation
Normal
Moisture
Inspection; palpation
Moisture in the Moisture in the skin skin folds and the folds and the axilla axilla (varies with (varies with environmental environmental temperature and temperature and humidity, body humidity, body temperature and temperature and activity) activity) Springs back to
Normal
Turgor
Springs back to normal when pinched Skin surfaces are non-tender Absence of lesions
normal when pinched within 4 seconds Skin surfaces are non-tender Presence of lesions on the Right breast Absence of edema
Normal
Edema Inspection
Absence of edema
Hair y
Distribution
Inspection
Texture
Palpation
Color
Inspection
Seborrhea
Inspection
Evenly distributed over the scalp Fine or thick hair; straight,curly or kinky; silky,resilient hair Black color or gray color,considering the age Absence of seborrhea
Thin hair
Due to aging
Absence of seborrhea
Normal
Nails
y y Appearance Color of nailbed Shape Texture Capllary refill Time Shape and size Facial features Inspection Inspection Inspection Inspection Palpation Clean nails Pink Convex to curvature Smooth Return within 2-3 seconds
Uncut nails and slightly dirty Pink Convex to curvature Smooth Return within 3seconds
y y y
Head
y y Inspection Inspection Rounded,smooth Rounded,smooth skull skull contour contour Symmetric or Symmetric or slightly slightly asymmetric facial asymmetric facial features features Symmetric facial Symmetric facial movements movements
Normal Normal
Inspection
Normal
Ears
Auricle y Position Texture Inspection Inspection At the level of the At the level of the external cantus external cantus of the of the eyes eyes Smooth without Smooth without Lesion Lesion
Normal
Normal
Inspection Inspection
None Pink
None Pink
Nose
y y y y Color Sinuses Nares Lesion/ Tenderness
Same color with the face Not inflamed No obstruction; oval and symmetric Not tender; absence of lesion
Same color with the face Not inflamed No obstruction; oval and symmetric Not tender; absence of lesion
Normal
Lips
y y y Symmetry Color Texture
Symmetrical Pinkish Smooth Free from decays, white, smooth and shiny Center Pink
Centrally located on the shoulder Able to flex and extend head without pain and resistance Not palpable
Symmetrical Pinkish Smooth With tooth decay; without teeth on the upper part
Normal Normal normal Due to aging and present condition Normal Normal
Teeth
Tongue
y y Position Color
Center Pink
Centrally located on the shoulder Able to flex and extend head without pain and resistance With palpable lymph nodes
Neck
y y Position Movement
Normal Normal
Lymph nodes
Palpation
Inspection
Normal
Normal Normal
Breast y Symmetry
Inspection
Symmetrical
Right breast enlarged with presence of mass Regular rate No murmur Flat rounded
Lesions
Inspection
Without lesions
Flat rounded
Equal size Symmetrical Evenly distributed Light to deep brown No lesions, deformities or inflammation
Musculoskeletal y Joints
Inspection
No swelling on the skin and tissues over the joints Full ROM against gravity,full resistance, 5/5
No swelling on the skin and tissues Full ROM against gravity,full resistance, 5/5
Normal
ROM
Inspection
Normal
IV.
HEALTH HISTORY History of Present Illness 10 years ago PTA, according to the patient palpated a mass on her right breast but she did not consulted any medical help until the mass erupted last 2009. She had radiotherapy and first cycle of Chemotherapy last Dec. 28, 2010. On January 18, 2011 she was admitted for her second cycle of chemotherapy under the service of Dr. Y. Past medical history The patient states that she had Diabetes Mellitus and take Metformin as maintenance drug. Family History The patient states that they have history of Cancer on her maternal side and Diabetes Mellitus on both sides of their family.
V.
ANATOMY AND PHYSIOLOGY Lymphatic System: Lymphatic Is a circulatory vessels or ducts which the fluid bathing the tissue cells or vertebrates is collected and carried to join the bloodstream. It transports digested fat from intestine to the bloodstream. This system detoxifies the bloodstream and resists spread of disease in the body. LYMPHATIC CAPILLARIES- this lymph capillary function as an ordinary capillaries and same to its structure. lymphatic capillaries are more permeable than ordinary capillaries and allow passage of larger particles than would ordinarily pass through capillary walls; large-molecule proteins, produced as a result of tissue breakdown, pass into the lymphatics for transport away from the tissues. LYMPH NODES-Along the course of the lymphatic vessels are situated the lymph nodes, more commonly called the lymph glands. These nodes are bean-shaped organs containing large numbers of leucocytes, embedded in a network of connective tissue. All the lymph being returned along the lymphatics to the bloodstream must pass through several of these nodes, which filter out infectious and toxic material and destroy it. The nodes serve as a centre for the production of phagocytes, which engulf bacteria and poisonous substances During the course of any infection, the nodes become enlarged because of the large number of phagocytes being produced; these nodes are often painful and inflamed. The swollen glands most often observed are located on the neck, in the armpit, and in the groin. Certain malignant tumors tend to travel along the lymphatics; surgical removal of all nodes that are suspected of being involved in the spread of such malignancies is an accepted therapeutic procedure. OTHER ORGAN SPLEEN-Spleen, flattened, oblong, glandlike organ, situated in the upper left abdominal cavity, in contact with the pancreas, the diaphragm, and the left kidney, and supported by bands of fibres that are attached to the peritoneum (the membrane lining the abdominal cavity). The spleen varies in size but, in adult humans, is about 13 cm (5 in) long, up to 10 cm (4 in) wide and 3.8 cm (1.5 in) thick, and weighs about 200 g (7 oz).The spleen is no longer
regarded as an endocrine gland because it apparently produces no secretions, although in disease it may elaborate a hormone that affects the production of red blood cells in the bone marrow. In the unborn child, the organ functions primarily to produce red blood cells. This activity normally ceases after birth but may be resumed later if diseases slow down this function in the bone marrow. Some people are born without spleens it also removes such waste materials as bile pigments for excretion as bile by the liver. The spleen produces antibodies against various disease organisms and manufactures a variety of blood cells. In some mammals (but not in humans) it stores red blood cells and feeds them into the circulation to maintain the volume of blood in cases of hemorrhage. LYMPH-Lymph, common name for the fluid carried in the lymphatic system. Lymph is diluted blood plasma containing large numbers of white blood cells, especially lymphocytes, and occasionally a few red blood cells. Because of the number of living cells it contains, lymph is classified as a fluid tissue.
VI.
PATHOPHYSIOLOGY
VII.
Examinations WBC count SEGMENTER LYMPHOCYTE BOSONOPHIL HEMOGLOBIN HEMATOCRIT PLETELET COUNT
Normal range 5-10 x 10 9/L 0.60-0.70 0.20-0.40 0.01-0.05 M-140-180 F-120-160 M-0.40-0.54 F-0.37-0.47 A 150-450X10 9/L NB 1595X10 9/L
VIII.
COURSE IN THE WARD DAY 1 On march 29, 2011, patient was lying on bed with ongoing IV fluid of D5 NM 1L regulated at 100 cc/hr at 550 level at 6:00 in the morning. At 8:00 am, Omeprazole 20 mg/cap, Ascorbic acid 500mg tab and Metformin 500 mg/tab was given. Patient was seen and examined by Dr. Ramos at 9:00 am she ordered to consume IV fluid and continue present management. At 11:00 in the morning CBG was monitored and her latest CBG was 168mg/dl. IV fluid was consumed at 1:00 pm and followed up by same IV fluid regulated at 100 cc/hr and metformin 500 mg was given. DAY 2 On march 30,2011, the patient was sitting beside her bed with IV fluid of D5 NM 1L on KVO. Morning care done by student nurses. At 8:00 am, Omeprazole 20 mg/cap, Ascorbic acid 500mg tab and Metformin 500 mg/tab was given. At 9:00 am Dr. Ramos ordered to consume IV fluid. Consumed IV Fluid at 10 am and was discontinued as ordered by attending physician. Vital signs were taken and recorded and no irregularities noted. At 11:00 am CBG was monitored, the result was 59mg/dl. Metformin 500 mg was given at 1:00 pm.