CASE STUDY

ON
BREAST CANCER

Presented to
The Faculty
College of Nursing
Pilar College
Zamboanga City

In

Partial Fulfilment of the Requirements of the Course NCM 103

By
KASSAN, KIDZMAR A.
LA CASTE, MAY CRIS E.
MANO, FATIMA SHAM S.
MIRA-ATO, AMINA P.
MIRANDO, EUGENE S.
JOHANNES MARIUS T. MONSANTO

I. INTRODUCTION
Today cancer awareness is important because early detection will lead
to early treatment and better cure. Healthcare professionals like nurses should
advocate for health education to raise the awareness of the entire population regarding
early detection and submit to early treatment once breast cancer is diagnosed. This
case study is hereby presented with the hope that this may stimulate the awareness of
nursing students regarding breast cancer.
Cancer is a neoplastic disorder that can involve all body organs with
manifestations that vary according to the body systems. This case study utilizes the
nursing process in the course of the discussion. Specifically, Marjorie Gordons
eleven (11) functional health care patterns are being utilized in the course of the
discussion of this case study.
According to the National Cancer Institute in USA (April 2012), there
are more than 2.75 million living women with a history of breast cancer, including
those active disease and those who have been cured. Furthermore, one in eight
women (12.38%) born today will be diagnosed with breast cancer at some time in
their lives. Based on the US government statistics in 2012 5.72% of women will
develop cancer of the breast between their 50th and 70th birthdays. The median age of
diagnosis for breast cancer is 61years old and the median age of dying from breast
cancer is 68 years old. It was further stipulated that overall 5 year survival for women
with breast cancer is 90%. For those with cancer that has metastasized (stage IV),
however, just 23.8% (or fewer) remain alive 5 years after their diagnosis. There has
been a fluctuating trend in breast cancer incidence since 1975.
The Philippines has the highest incidence of breast cancer in Asia. 3 out
of 100 Filipino women will contract the disease before age 75; 1 will die out of 100
before age 75, according to the Philippine Society of Medical Oncology in 2012.
According to the Department of Health and the Philippine Cancer Society report,
breast cancer is the most common cancer in the country comprising 16% of the
80,000new cancer cases in 2010.
In Region IX of the 2014 statistical data, Zamboanga City has the
highest incidence in breast cancer 296 followed by Zamboanga Sibugay 31 cases,
Tawi-Tawi 21 cases and Lamitan Basilan 20 cases.
Today, there are many innovative therapy which offers an inspiring
hope for treating breast cancer patients. There are new approaches to nursing
interventions and medical treatment modalities. Lowering stress levels of the body
lowers the incidence of cancer. More patients survive than ever before and the horrific
side effect inflicted by conventional therapy such as chemotherapy to patients. These
conventional treatments to cancer often leave patients partially or severely debilitated
and set the stage for deadly secondary diseases according to Logan Bromwell.
Over 570,000 American are expected to die from cancer according to
US government statistics (September 2012). For those people, the dangerous mix of
chemotherapy, radiation and surgery not only failed to cure the cancer but destroyed
their remaining quality of life. Modern technologies evolved and a group of scientists
and physicians have teamed up in a study a first of its kind a human clinical trial using
sophisticated form of laser/immune therapy to treat advance breast cancer.
In the Philippines, its long way to go. Medical treatment modalities
together with the nursing interventions, we still use radiation and chemotherapy.

In this case study the discussion will center on the presentation of the
nursing history, nursing assessment, nursing care plans and nursing interventions and
the evaluation of nursing care. The drug study will also be presented in the discussion.

II. Overview of Structure Involved: The Breast

A. Function of the Breast

The breast is the tissue overlying the chest (pectoral) muscles. Women's breasts are
made of specialized tissue that produces milk (glandular tissue) as well as fatty tissue. The
amount of fat determines the size of the breast.
The milk-producing part of the breast is organized into 15 to 20 sections, called lobes. Within
each lobe are smaller structures, called lobules, where milk is produced. The milk travels
through a network of tiny tubes called ducts. The ducts connect and come together into larger
ducts, which eventually exit the skin in the nipple. The dark area of skin surrounding the
nipple is called the areola.
Connective tissue and ligaments provide support to the breast and give it its shape. Nerves
provide sensation to the breast. The breast also contains blood vessels, lymph vessels, and
lymph nodes.

B. The Normal Anatomy and Physiology of the Breast

The female breast is composed of lobules of milk producing glands surrounded by
fatty tissue. Ducks run from these glands to outlets at the nipple. Around the nipple is
a circular pigmented area called the areola, which contains sweat glands and
sebaceous glands. The breasts have no muscles but are held in place by ligaments. A
major network of lymph nodes in the armpit area (axilla).

C.Normal Cells Versus Cancer Cells

Use

to navigate.

Photo credit: National Cancer Institute. Photo Credit: Breast Cancer Cell

Normal Cells Versus Cancer Cells

All living organisms are composed of cells. These cells grow and divide in a
controlled manner in order for the organism to function properly. Changes in normal
cells can cause them to grow uncontrollably. This uncontrollable growth is the
hallmark of cancer cells.

Normal Cell Properties

Normal cells have certain characteristics that are important for the proper functioning
oftissues, organs, and body systems.

These cells have the ability to reproduce correctly, stop reproducing when necessary,
remain in a specific location, become specialized for specific functions, and self
destruct when necessary.

Cell Reproduction: Cell reproduction is needed to replenish the cell

population that ages or becomes damaged or destroyed. Normal cells reproduce
properly. Except for sex cells, all cells of the body reproduce by mitosis. Sex cells
reproduce through a process called meiosis.

Cell Communication: Cells communicate with other cells through chemical

signals. These signals help normal cells to know when to reproduce and when to stop
reproducing. Cell signals are usually transmitted into a cell by specific proteins.

Cell Adhesion: Cells have adhesion molecules on their surface that allow
them to stick to the cell membranes of other cells. This adhesion helps cells to stay in
their proper location and also aids in the passage of signals between cells.

Cell Specialization: Normal cells have the ability to differentiate or develop

intospecialized cells. For example, cells can develop
into heart cells, brain cells, lung cells or any other cell of a specific type.

Cell Death: Normal cells have the ability to self destruct when they become
damaged or diseased. They undergo a process called apoptosis in which cells break
down and are disposed of by white blood cells.

Cancer Cell Properties

Cancer cells have characteristics that differ from normal cells.

Cell Reproduction: Cancer cells acquire the ability to reproduce

uncontrollably. These cells may have gene mutations or chromosome mutations that
affect the reproductive properties of the cells. Cancer cells gain control of their own
growth signals and continue to multiply unchecked. They don't experience biological
aging and maintain their ability to replicate and grow.

Cell Communication: Cancer cells lose the ability to communicate with

other cellsthrough chemical signals. They also lose sensitivity to anti-growth signals
from surrounding cells. These signals normally restrict cellular growth.

Cell Adhesion: Cancer cells lose the adhesion molecules that keep them
bonded to neighboring cells. Some cells have the ability to metastasize or spread to
other areas of the body through the blood or lymph fluid. Once in the bloodstream,
cancer cells release chemical messengers called chemokines that enable them to pass
through blood vesselsinto the surrounding tissues.

Cell Specialization: Cancer cells are unspecialized and do not develop into
cells of a specific type. Similar to stem cells, cancer cells proliferate or replicate many
times, for long periods of time. Cancer cell proliferation is rapid and excessive as
these cells spread through out the body.

Cell Death: When the genes in a normal cell are damaged beyond repair,
certain DNA checking mechanisms signal for cell destruction. Mutations that occur in
gene checking mechanisms allow for the damages to go undetected. This results in the
loss of the cell's ability to undergo programmed cell death.

Causes of Cancer
Cancer results from the development of abnormal properties in normal cells that
enable them to grow excessively and spread to other locations. This abnormal
development can be caused by mutations that occur from factors such as chemicals,
radiation, ultraviolet light, and chromosome replication errors. These mutagens
alter DNA by changing nucleotide bases and can even change the shape of DNA. The
altered DNA produces errors in DNA replication, as well as errors in protein
synthesis. These changes influence cell growth, cell division, and cell aging.
Viruses also have the ability to cause cancer by altering cell genes. Cancer viruses
change cells by integrating their genetic material with the host cell's DNA.
The infected cell is regulated by the viral genes and gains the ability to undergo
abnormal new growth. Several viruses have been linked to certain types of cancer in
humans. The Epstein-Barr virus has been linked to Burkitt's lymphoma, the hepatitis
B virus has been linked to liver cancer, and the human papilloma viruses have been
linked to cervical cancer.
Sources:

Cancer Research UK. The Cancer Cell. Accessed 04/18/13. (http://www.cancerresearchuk.org/cancer-help/about-cancer/what-is-cancer/cells/the-cancer-cell)

Science Museum. How do healthy cells become cancerous? Accessed 04/18/13.

(http://www.sciencemuseum.org.uk/WhoAmI/FindOutMore/Yourbody/Whatiscancer/Whathappensincancer/Howdohealthycellsbecomecancerous.aspx)

D. Cell Cycle

Use

to navigate.

Cell Cycle. Photo Credit: Image Credit: Darryl Leja, NHGRI

Cell Cycle
The cell cycle is the complex sequence of events by which cells grow and divide. In
eukaryotic cells, this process includes a series of four distinct phases. These phases
consist of theMitosis phase (M), Gap 1 phase (G 1), Synthesis phase (S), and
Gap 2 phase (G 2). The G 1, S, and G 2 phases of the cell cycle are collectively referred
to as interphase. The dividing cell spends most of its time in interphase as it grows in
preparation for cell division.
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Living Cell
Cell Culture
Stem Cell

Mitosis
Host Cell Protein
The mitosis phase of the cell division process involves the separation of
nuclear chromosomes, followed bycytokinesis (division of the cytoplasmforming two
distinct cells). At the end of the mitotic cell cycle, two distinct daughter cells are
produced. Each cell contains identical genetic material.
The time it takes for a cell to complete one cell cycle varies depending on the type of
cell. Some cells, such as blood cells in bone marrow, skin cells, and cells lining the
stomach and intestines, divide rapidly and constantly. Other cells divide when needed
to replaced damaged or dead cells. These cell types include cells of the kidneys, liver,
and lungs. Still other cell types, includingnerve cells, stop dividing once mature.

Phases of the Cell Cycle

The two main divisions of the cell cycle are interphase and mitosis.
Interphase

During this segment of the cell cycle, a cell doubles its cytoplasm and
synthesizes DNA. It is estimated that a dividing cell spends about 90-95 percent of its
time in this phase.
G1 phase: The period prior to the synthesis of DNA. In this phase, the cell
increases in mass and organelle number in preparation for cell division. Animal
cells in this phase arediploid, meaning that they have two sets of chromosomes.
S phase: The period during which DNA is synthesized. In most cells, there is
a narrow window of time during which DNA is synthesized. The chromosome content
is doubled in this phase.
G2 phase: The period after DNA synthesis has occurred but prior to the start
of mitosis. The cell synthesizes additional proteins and continues to increase in size.
Stages of Mitosis
In mitosis and cytokinesis, the contents of the dividing cell are equally distributed
between two daughter cells. Mitosis has four phases: Prophase, Metaphase, Anaphase,
and Telophase.
Prophase: In this stage, changes occur in both the cytoplasm and nucleus of
the dividing cell. The chromatin condenses into discrete chromosomes. The
chromosomes begin to migrate toward the cell center. The nuclear envelope breaks
down and spindle fibers form at opposite poles of the cell.
Metaphase: In this stage, the nuclear membrane disappears completely. The
spindle fully develops and the chromosomes align at the metaphase plate (a plane that
is equally distant from the two poles).
Anaphase: In this stage, paired chromosomes (sister chromatids) separate and
begin moving to opposite ends (poles) of the cell. Spindle fibers not connected to
chromatids lengthen and elongate the cell.
Telophase: In this stage, the chromosomes are cordoned off into distinct new
nuclei and the genetic content of the cell is divided equally into two parts. Cytokinesis
begins prior to the end of mitosis and completes shortly after telophase.

Once a cell has completed the cell cycle, it goes back into the G 1 phase and repeats
the cycle again. Cells in the body can also be placed in a non-dividing state called
theGap 0 phase (G 0)at any point in their life. Cells may remain in this stage for very
long periods of time until they are signaled to progress through the cell cycle as
initiated by the presence of certain growth factors or other signals. Cells that
contain genetic mutations are permanently placed in the G 0 phase to ensure that they
are not replicated. When the cell cycle goes wrong, normal cell growth is lost. Cancer
cells may develop, which gain control of their own growth signals and continue to
multiply unchecked.

Cell Cycle and Meiosis

Not all cells divide through the process of mitosis. Organisms that reproduce
sexually also undergo a type of cell division called meiosis. Meiosis occurs in sex
cells and is similar in process to mitosis. After a complete cell cycle in meiosis
however, four daughter cells are produced. Each cell contains one half the number of
chromosomes as the original parent cell. This means that sex cells are haploid cells.
When haploid male and female gametesunite in a process called fertilization, they
form one diploid cell called a zygote.

E. PATHOPHYSIOLOGIC BASIS OF MALIGNANT

GROWTH
Cell

Genetic Mutation of the Cellular DNA

Genetic Mutation (Inherited / Acquired mutation) leads to abnormal

cell behavior (Egger, 2011)

The initial genetically altered cell forms a clone and begins to

proliferate abnormally

Evading normal intracellular and extracellular growth regulating

processes

Invade surrounding tissue and gain access to lymph and blood

vessels

Carry the cells to other areas of the body

B. Personal Data
1. Present Illness
Two months prior to admission, patient notices mass on her left
breast accompanied by slight pain and nipple retraction. There
was no nipple discharges. Two weeks prior to admission patient
consulted a physician and was referred to ZCMC for admission.
Laboratory test was ordered and surgery was advised which
was left radical mastectomy.
2. Past Illness
In her early years she had experience fever, coughs and colds as
like any normal child. At the age of 2, the patient had chicken pox as

stated by the mother. The patient also experienced having measles and
mumps. It was during her school age years that the family began to
notice that there were some developmental delays with the patient.

3. Familial
There is positive history of cancer in the family of the patient
according to her Step Mother as well as a positive history of
intellectual disability in her biological mother.

IV.

GORDONS

ELEVEN FUNCTIONAL HEALTH CARE PATTERNS

1. Health Perception
The client is compliant with her medication regimen, used of
health-promotion activities such as regular exercise, annual check up in thhealth
center. She was immunized with BCG and DPT as claimed by the mother. She
buys over the counter drugs such as Neozep and Biogesic (paracetamol). She
goes to the health center in their barangay for consultation.
She often complains of chronic pain due to her breast cancer.
2. Nutritional Metabolic Pattern
Eats more of fruits and vegetables, eats her meals 3x a day with snack in
between. She can drink up to 1.5L of water or more than 8 glasses a day. She
claims to have a good appetite.

Pre-operative
Weight =
Height =
Normal Body Mass Index =
Before operation, was infused with an IVF of Dextrose in water hooked at her
left cephalic vein.
Post-operative
Weight =
Height =
Normal Body Mass Index =
After operation, was infused with an IVF of Dextrose hooked at her
right cephalic vein (right hand)
3. Elimination Pattern
She voids 5 times a day with 250-300 ml/urination. Her urine color is
amber yellow and sometimes is dark in color. There is no burning
sensation/pain felt during urination. She usually defecates in the morning
regularly, with brown and well- formed stools. After surgery, a Foley catheter
was used attached to the urine bag draining well with dark yellow urine with an
output.

4. Activities/Exercise
The patient can ambulate within the house. She can perform household
chores. She can do simple exercises on the upper and lower extremities by
means of slow dancing. She can perform activities of daily living (ADL) well
until she undergone breast surgery which hindered her from performing some
activities. Although she is verbally incapacitated, she is often seen socializing
with her neighbors.
5. Sexuality/Reproductive
Client is single, has no history of sexually transmitted disease or any
disease affecting her genitals and female reproductive organ. She has
irregular menstruation after surgery.
6. Cognitive / Perception
She is oriented to people, time and place. She has good judgment and is
aware of her environment although she has mild intellectual disability. As
observed, patient seems to know the presence of malignant disease and is aware
of the concept of death yet she stays positive because of the support of her
family.
7. Roles/ Relationship

Single, well-loved and very close to her mother and family although
she is adopted, she is treated specially because of her condition. She has also
good interpersonal relationship with all the family members. Although she is
unable to speak properly, she is often seen socializing with her neighbours.
8. Self-perception/Self concept
Prior to operation:
Before Surgery
Though weak, she still managed to appear calm and relaxed. Agreed
to undergo surgery and gave her trust to the surgical team, hopeful and
positive to have a successful operation. Before operation, she prayed all the
time, with the desire that no complication will arise, and her major concern is
the recovery. Although she denies the existence of the mass in her breast and
refused surgery at first, due to fear, she agreed eventually for surgery.
Patient was in denial at first according to the mother that
her daughter has a growing mass. Client was furious that her breast had to
be removed, since she believed that it can be cured by the faith healer. But
her mother insisted that a doctor is best for treatment. She had mood swings
from anger, sad and hostile at times due to fear of the growing mass and
impending surgery. After her mass was surgically removed, the biopsy
results showed that she has breast cancer. She did not believed it as true and
was angry asking God why she has cancer. Her mood swings are due to her
condition and surgical removal of her breast.
She feels afraid and sometimes loss of hope if she will be cured
and the cancer be treated. She feels incomplete after mastectomy.
9. Value/Belief
A Roman Catholic, have strong faith in God, always prays at
night especially post-surgery, knowing she has cancer. But at first, she
questioned God why she was given the disease. There are no
restrictions in the surgical procedure brought by her religion.
10. Coping Stress Pattern
She cries whenever under stress. Refused to have surgery and
denied that she had breast mass. But her fear of the growing mass
made her decide for surgery as part of her coping. She got support
from her understanding mother and family. Crying was her way of
expressing her feelings of sadness, fear, anger and disbelief of the
growing mass in her breast.
After months of surgery

Her coping with stress was by performing light household

chores and by taking a nap or sleep as a diversion.
She verbalized that the removal of her breast made her feel that it
should not have been removed at first. She denied she had cancer. She
did not like to have her breast removed because she felt incomplete.
Although the client and the whole family were afraid of surgery, they
were given no choice as surgery is the immediate solution to a breast
mass or tumor.
11. Sleep/ Stress Pattern
She can sleep 8 hours per night at present. Her earliest time in going to
sleep is at 9:30 pm. Latest time in waking up is at 6:30 am. No difficulties in
going to sleep. But when even she thinks of the growing breast mass and the
surgery she had difficulty sleeping. Post operatively, sleep is not a problem but
she sometimes wakes up at night due to pain.

V. PHYSICAL ASSESSMENT

VI. Diagnostic Exams (before mastectomy)

A. Haematology Examination
Result
Hemoglobin
Hematocrit
RBC Count
WBC Count
Neutrophil
Lymphocyte
Eosinophils
Monocyte

0.43 g/L
9.0 x 10^q/L
64%
26%
4%
6%

Normal Value
120.0-160.0
0.370-0.470
4.0-5.5
5.0-10.0
40-70
20-45
0-6
0-10

Basophils

Platelet Count
NRBC
MCH
MCV
Bleeding Time
Clotting Time
Blood Type
ESR
Reticulocyte
Malaria Smear

0-1
Result
219 x 10^3 u/L

Normal Value
150-350 x 10^3 u/L
0-1 /100 WBC
28-33 g/L
82-98 f/L
1-3 mins
2-6 mins
0-20 mm/hr

B.Haematology Examination (2nd admission)

Hemoglobin
Hematocrit
RBC Count
WBC Count
Neutrophil
Lymphocyte
Eosinophils
Monocyte
Basophils

Platelet Count
NRBC
MCH
MCV
Bleeding Time
Clotting Time
Blood Type
ESR
Reticulocyte
Malaria Smear

Result
9mg%
0.27 g/L
15 x 10^q/L
72%
20%
4%
4%

Result
168 x 10^3 u/L

Normal Value
120.0-160.0
0.370-0.470
4.0-5.5
5.0-10.0
40-70
20-45
0-6
0-10
0-1
Normal Value
150-350 x 10^3 u/L
0-1 /100 WBC
28-33 g/L
82-98 f/L
1-5 mins
2-6 mins
0-40 mm/hr

A. Histopathological Results /Biopsy

Specimen:
Breast
Procedure:
Modified radical mastectomy
Histologic Type: Invasive lobular carcinoma

Specimen size:
Tumor size :

18 X19 X 6.5 cm.

4 cm in its widest dimension
Multicentric

(Copy all the results of the patient biopsy)

VII. DRUG STUDY

Drug

Mechanism of
Action

Indication

Contraindication

Generic Name:
Lanzoprazole
Brand Name:
Prevacid
Dosage: 30mg
Frequency: Once a
day
Route: Oral
Classification:
Antisecretory drug,
Proton Pump
Inhibitor

Gastric acid-pump
inhibitors.
Suppresses
gastric acid
secretion by
specific inhibition
of the hydrogen
potassium ATPase
enzyme system at
the secretory
surface of the
gastric parietal
cells; blocks the
final step of acid
production.

Short-term treatment
of active duodenal
ulcer
Short-term treatment
of gastric ulcer
Healing of NSAIDrelated gastric ulcer
Risk reduction for
NSAID- related to
gastric ulcer
Short-term treatment
of GERD; severe
erosive esophagitis;
poorly responsive
Long-term treatment
of pathological
hypersecretory
conditions
Maintenance therapy
for healing of erosive
Eradication of
Helicobacter Pylori
infection in patients
with active or
recurrent duodenal
ulcers in combination
with clarithromycin
and amoxicillin
Short-term treatment
of all grades of
erosive esophagitis
when patient is
unable to take oral
medication

Contraindicated with
hypersensitivity to
Lansoprazole or any
components
Use cautiously with
pregnancy, lactation
Adverse Effects:
CNS: Headache,
dizziness, asthenia ,
vertigo, insomnia,
anxiety, paraesthesia,
dream abnormalities

Dermatologic: Rash,
Inflammation, Urticaria,
pruritus, alopecia, dry
skin, acne

GI: Diarrhea, abdominal

pain, nausea, vomiting,
constipation, dry mouth
Respiratory: URI
symptom, cough,
epistaxis
Others: Gastric Cancer
in preclinical studies
back pain, fever

Drug

Mechanism of
Action

Indication

Contraindication

Generic Name:
Tramadol
hydrochloride

Binds to mu-opioid
receptors and inhibits
the reuptake of
norepinephrine and
serotonin; causes
many effects similar
to the opioids
dizziness,
somnolence, nausea,
constipation but does
not have a respiratory
depressant effect

Relief of
moderate to
moderately
severe pain

Contraindicated with
allergy to tramadol or
opioids or acute
intoxication with
alcohol, opioids or
psychoactive drugs.

Brand Name: Ultram

Dosage: 50 mg
Frequency: Three
times a day
Route: Oral
Classification:
Analgesic, Centrally
Acting

Use cautiously in
pregnancy, lactation;
seizures; concominant
use of CNS depressant,
MAOIs, SSRI, TCAs;
renal impairment,
hepatic impairment
Adverse Effect:
CNS: sedation,
dizziness or vertigo,
headache, confusion,
dreaming, sweating,
anxiety, seizures
CV: Hypotension,
tachycardia,
bradycardia

Dermatology: Sweating,
pruritus, rash, pallor,
urticaria
GI: Nausea, vomiting,
dry mouth,
constipation, flatulence

Others: Potential
forabuse; anaphylactoid
reactions

Drug

Mechanism of
Action

Indication

Contraindication

Generic Name:
Tamoxifencitrate

Unknown. Drug
is selective
estrogen
receptor
modular

Advanced breast
cancer in women
and men

Contraindicated in
patients hypersensitive
to drug

Adjunct treatment
of breast cancer

Contraindicated as
therapy to reduce risk if
breast cancer in high risk
women who also need
anti-coagulants or in
women with history of
deep vein thrombosis or
P.E.

Brand Name: Xifeu,

Nolvodex
Dosage: 10 mg, 20
mg

To reduce cancer
occurrence

Frequency:
Route: Oral
Classification: Anti
Neoplastic

Ductal carcinoma
in situ (DCIS) after
breast surgery and
radiation
Gynecomastia

Use cautiously in
patients with Leukopenia
or Thrombocytopenia

Oligospermia

Adverse Effect:
CNS: Stroke, confusion,
weakness, sleepiness,
headache
CV: Fluid retention, hot
flashes, thromboembolism
EENT: Corneal changes,
cataracts, retinopathy
GI: Nausea, Vomiting,
diarrhea
GU: Amenorrhea,
irregular menses,
vaginal discharges,
endometrial cancer,
uterine sarcoma, vaginal
bleeding
Hematologic:
Leukopedia,
thrombocytopenia
Hepatic: Hepatic
Necrosis, fatty liver,
cholestasis
Metabolic:
Hypercalcemia, weight

gain or loss
Musculoskeletal: brief
worsening of pain from
osseous metastases
Respiratory: Pulmonary
embolism (PE)
Skin: Skin changes, rash,
alopecia
Other: Temporary bone
or tumor pain

Drug

Mechanism of
Action

Indication

Contraindication

Generic Name:
Zoledronic Acid

Inhibits bine
resorption,
probably by
inhibiting
osteoclast activity
and osteoclastic
resorption of
mineralized bone
and cartilage.
Decreases
calcium release
induce by the
stimulatory
factors produced
by tumors

Hypercalcemia
caused by
malignancy

Contraindicated in
patients hypersensitive
to drug; in patients with
hypercalcemia of
malignancy whose
creatinine level is more
than 4.5 mg/dL, in
patients with bone
metastases and
createnine level of more
than 3mg/dL

Brand Name:
Reclast, Zometa
Dosage: 5 mg/
100ml
Injection (Zometa):
4mg/5ml
Frequency:
Route: IV
Classification: Anti
Osteoporotic

Multiple myecoma
and bone metastases
of solid tumors in
conjunction with
standard anti
neoplastics
Paget disease of
bone costeitis
deformans
Treatment of
osteoporosis in men;
to reduce incidence
of fracture in postmenopausal women
with osteoporosis
and a recent low
trauma hip fracture

Reclast is contraindicated
in patients in patients
with hypocalcemia.
Patients must be
adequately
supplemented with
calcium.
Adverse Effects

Osteopenia
secondary to
androgen deprivation
therapy in prostate
cancer

CNS: Headache, anxiety,

somnolence, insomnia,
confusion agitation,
depression, paresthesia,
hypoesthesia, fatigue,
weakness, dizziness,
fever

Osteopenia in
estrogen deprived
breast cancer

CV: hypotension,
hypertension, atrial
fibrillation, leg edema

GI: Nausea, constipation,

diarrhea, abdominal pain
vomiting, anorexia,
dysphagia, increased
appetite
GU: increased creatinine
level, urinary infection,
candidiasis
Hematologic: Anemia,
Granulocytopenia,
neutropenia,
thrombocytopenia
Metabolic: decreased
calcium and magnesium
levels; dehydration,
weight decrease

Musculoskeletal: Skeletal
pain
Respiratory: Dyspnea,
cough, pleural effusion
Skin: Alopecia, rash
Other: progression of
cancer

Drug

Mechanism of
Action

Indication

Contraindication

Generic Name:
Celecoxib

Thought to inhibit
prostaglandin
synthesis, impeding
Cox-2, to produce
anti-inflammatory,
analgesics and antipyretic effects

To relieve signs and

symptoms of
osteoarthritis

Contraindicated for the

treatment of
perioperative pain after
CABG surgery

Brand Name:
Celebrex
Dosage: 50 mg
Frequency:
Route: Oral
*Drug may be given
without regard to
meals but food may
decrease GI upset
Classification:

To relieve sign and

symptoms of
rheumatoid arthritis
To relieve signs and
symptoms of
ankylosing
spondylitis
To relieve signs and
symptoms of
juvenile rheumatoid
arthritis

Contraindicated in
patients hypersensitive
to drug,
sulphonamides, aspirin
or other NSAID
Contraindicated in
thosewith severe
hepatic impairment
Adverse Effect:

NSAID
Adjunctive
treatment for
familial
adenomatous
colarectal polyps
Acute pain and
primary amenorrhea

CNS: Headache,
dizziness, insomnia
CV: Hypertension,
peripheral edema
EENT: Pharyngitis,
rhinitis, sinusitis
GI: Abdominal pain,
diarrhea, dyspnea

VII.

NURSING CARE PLAN

Assessment
Subjective cues-
Malisud gayot
duele el donde ya
opera na mi mama(
pointing on her
breast area;)
frowning face
Objective cues
Pain scale of 5
utilizing the Wong
Baker Faces of pain
scale so patient can
point the level of
pain

Nursing
Diagnosis
Chronic pain
related to
destruction of
nerve tissue,
lymph nodes
and
metastasis to
bones due to
breast cancer

Goal of
care
At the end
of the
health
teaching
the patient
will able
to:
manage
her chronic
breast pain

Nursing Intervention w/
Rationale
Independent:
She will determine pain
history, for example,
location of pain,
frequency, duration, and
intensity using a rating
scale (0-10) or verbal
rating scale-no pain to
excruciating; and relief
measures will be use.
Rationale:
Information provides
baseline data to
evaluate need for, and
effectiveness of,
interventions. Pain of
more than 6 months
duration constitutes
chronic pain, which may
affect therapeutic
choices. Recurrent
episodes of acute pain
can occur within, chronic
pain requiring increase
level of intervention
note: The pain
experience is an
individualized one
composed of both
physical and emotional
responses.

Implementat

Explained to
patient and
mother how
determine th
location, freq
duration and
intensity of p
utilizing the
Baker Faces
rating scale

Discussed w
patient and
the managem
pain based o
pain scale an
medication t
administered
home as pre
by the physi

She can dete

pain history
location of p
frequency, d
and intensity
a rating scal
10).
And also she
using the ve
rating scale.

2. Provide
nonpharmacological
comfort measures such
as, repositioning and
back rub; as well as
diversional activities,
such as music, reading
and TV.
Rationale:
Promotes relaxation and
helps refocus attention.

Assessment

Nursing
Diagnosis

Goal of care

Subjective cues:
ya kita ya mi
mama kay tiene
bukul.
(pointing to her
breast area that
body part
where surgery
was done her
breast was
removed
surgically in a
hospital

Grieving
related to
loss of body
part
( breast was
surgically
removed due
breast mass
due to
breast
cancer)

At the end of
the health
teaching the
client will be
able to
overcome her
grief due to
loss of body
part

Objective cues:
Anger
Sad facial
expression
Tearful and
frowning face
Mood swings
sadness, anger
happy but sad
about her

Nursing
Intervention w/
Rationale
Independent:
Allow patient to
be aware of her
mood swings,
evidence of
conflict
Encourage client
to express her
anger or hostility,
and other actingout behaviour due
to the removal of
her breast due to
cancer.
Allow to set limits
on inappropriate
behaviour
Teach patient to
redirect negative
thinking to
positive
Rationale:

Demonstrate
different com
measures lik
repositioning
back rub

Implementation

She is aware of mood

swings, evidence of
conflict, expression
of anger or hostility,
and other acting-out
behaviour. And able
to set limits on
inappropriate
behaviour and
redirect negative
thinking.

condition

Health
Problem

The clients way

of expressing or
dealing with
feelings or despair
and spiritual
distress, reflecting
ineffective coping
and need for
additional
interventions
preventing
destructive
actions enables
client to maintain
control and sense
of self-esteem.

Family
Nursing
Problem

Goal of
Care

Objectiv
e of
Care

Intervention Plan
Nursing
Interven
tio

VI.

Method
of NurseFamily
Contact

TREATMENT AND NURSING INTERVENTIONS

Resourc
es
Required

VII.

EVALUATION

X.

BIBLIOGRAPHY