You are on page 1of 48

BREAST CANCER

Stage IV
BSN IV Group 1B Feb. 8, 2011

INTRODUCTION
Cancer is a major health problem worldwide and the morbidity and mortality from cancer give rise to much suffering. The risk of developing cancer in an individual's lifetime is about 33%, and the risk of dying of cancer is 25%. Cancer is not only a disease of the elderly although for many cancers the incidence increases with age. Breast cancer in the US and Western Europe is the commonest female cancer, and accounts for the most cancer deaths in women. Eighteen percent of women who develop breast cancer will be under 50 years of age and with an average of 50% mortality this will produce a significant number of deaths in a population of wives and mothers who are making major contributions to the nurture of future generations and the economy.

INTRODUCTION
Loss of life in this age group has very serious consequences both for society in general and for the individual families involved. There are now major health programs throughout the world involved in research and development into prevention, early detection, and new treatments with the aim of reducing the morbidity and mortality from breast cancer. It is of some considerable interest that the East in general has amongst the lowest rates of breast cancer in the world. This is assumed to be a combination of environmental and genetic factors and their interaction.

INTRODUCTION
In the UK 30,000 new cases of breast cancer are diagnosed each year making this the commonest malignancy in women and causing nearly 15,000 deaths per year. Randomized studies of prevention strategies particularly with the antioestrogens Tamoxifen and more recently raloxifene, and retinoids have either been completed or are ongoing. The final analysis is awaited but it is likely that effective preventive measures will be available in the not too distant future.

INTRODUCTION
A national population-based breast-screening program was commenced 6 years ago on the evidence from randomized trials, which demonstrate a reduction in breast cancer mortality from screening. This remains an area of considerable medical debate, which centers on the question of cost-effectiveness. In the not too distant future it should be possible to better define women who are at increased risk of breast cancer, to discover the reasons for their increase in risk, and then to target both specific preventive and early detection strategies at this "at risk" population.

INTRODUCTION
In Asia, the Republic of the Philippines has the highest reported incidence rate of breast cancer. From 43.2 in 2003-2005, the age standardizedincidence rate (ASR) is now 47.7 per 100,000 females, and this figure exceeds the rate reported for several Western countries, including Spain, Italy, and most Eastern European countries.

INTRODUCTION
Many breast cancers are diagnosed among 35 to 50-year-old Filipino women. In terms of breast cancer detection, a local study revealed that the use of breast self-examination (BSE) and aspiration biopsy/open biopsy are the most costeffective strategies in the Philippine setting, incurring savings for the government by almost 3 million Philippine Pesos or US $60,000 (1989 value) per year per 100,000 women. Mammography is neither readily available nor affordable especially in the rural areas.

PATIENTS DATA
Name: Mrs. Hopeful Age: 51 y/o Sex: Female Civil Status: Married Religion: Roman Catholic Address: Naguilian, Isabela Birthday: May 12, 1959 Diagnosis: Pleural Effussion; Breast CA; PTB

CHIEF COMPLAINT

Difficulty of breathing and edema on the left upper extremity.

FAMILY HISTORY

On her father side, her grandmother died due to cancer. No other serious illnesses were noted base from the family health history.

PAST HISTORY
According to the patient, she had measles and chicken pox in her grade school. She didnt recall if she had immunizations. She had coughs and colds once in a while and managed it with OTC (over the counter) drugs. Furthermore, she does not have any allergy on foods nor on medicines. Aside from that no other illnesses were noted.

PAST HISTORY (Cont.)


She stated that last June of 2006, she palpated a mass on her left upper breast; she was working as a domestic helper in Hongkong at that time. She had her checked up in one of the hospitals in Hongkong and undergone biopsy and was diagnosed to have a breast cancer Stage II. She went home to the Philippines and on October 6, 2006 she had undergone left mastectomy operation at the PGH (Philippine General Hospital). Then, on 2007 at the same hospital she underwent chemotherapy for 6 months. Next, she also had undergone Cobalt therapy at the Jose Reyes Hospital.

PRESENT HISTORY

1 year PTA, the patient had an edema on her left upper extremity, followed with body weakness and difficulty of breathing.

SOCIAL HISTORY
They originally come from an Ilocano background, she and her husband are from Isabela. She doesn't smoke nor drink alcoholic beverages. She had a good relationship with her family, her only daughter was already married and the family lives with them.

GORDONS 11 FUNCTIONAL HEALTH PATTERNS

Health Perception/ Health Management


BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She regards health as a momentous part of life; it is something not to be taken for granted. She take vitamins, brushes her teeth 2x a day.

She realizes that it is a must to take responsibility in our health. Our health reflects the consequences of our actions.

It was her 5th hospital experience, she values health and her health status somehow gave her realization that actions of staying healthy is more important than just merely knowing on how to be healthy.

NUTRITIONAL METABOLIC
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She sometimes skips her meals, she doesnt have too much appetite, however, she usually eats vegetable and meat.

Lesser appetite because of her medication and condition (dysphagia).

Some of her medication suppresses her appetite which aggravates her usual appetite even before hospitalization.

SLEEP REST
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She sleeps 4-6 She only sleeps hours. She usually for 2-3 hours in a goes to bed at day. 10pm and wakes up at about 4am in the morning.

She admits that she cant help thinking about her condition especially at night, she also mentioned that she had a hard time breathing especially when her lips are dry.

ELIMINATION
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She usually defecates not more than two times a day and micturates 3-5 times.

Urinates 1-2 times a day with slightly yellowish urine and defecates every other day with hard formed stool.

Changes in bowel movement is due to decrease mobility or exercise.

ACTIVITY EXERCISE
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She is a very hardworking mother; she helps her daughter in taking good care of their kids. She also do household chores which is the activities that keeps her fit.

Still performs her daily living activities but with an assistance. Confessed that she gets tired easily these past few days.

Her body is still weak brought about prolonged disease process and decline of her body system.

COGNITIVE PERCEPTUAL
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

Her senses are functional. However, she use eyeglasses when reading, other than that she doesnt wear any other aids or prosthesis.

Her senses are still functional, and still wear glasses when reading.

No change, since the operation performed was localized at her breast.

SELF-PERCEPTION/ SELF CONCEPT


BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She is a strong willed and reliable person; she tries her best to help her family especially in taking good care of her grandchildren.

Shes strong enough to accept her illness, however, she admits that there are times when she just lose hopes, but tries her best not to show it to her family.

Her personality as a strong-willed person somehow helps her to accept her condition but nevertheless, as part of a woman it is expected for her to be emotional at times.

ROLE RELATIONSHIP
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She did not mention any specific problems with her family. She admitted that she had a good relationship with her husband and to her daughter.

She gets along well with other patient and to health care providers. She sometimes feels sad and fears that she might not be able to perform her role in the family.

Being an optimist and dependable person, she values relationship with others regardless of her condition, however, she cant help to have fears to the anticipated procedures she have to undergo if her illness will get worse.

SEXUALITY REPRODUCTIVE
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

At the age of 49, she had her menopausal period. She admits that her relationship with her husband are already in platonic level and do not practice coitus.

Her hospitalization caused her to have limited movements. Her husband just stays with her for support and confidant.

At her age, she admits that she rarely had sexual urges (decrease libido) and her husband was contented just to be with her even without coitus.

COPING/ STRESS TOLERANCE


BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She had a very close relationship with her family; they were very supportive on her condition. In addition, she strongly believes in the power of prayer in solving problems and in making decisions in her life.

Her family supports her and she tries her best to stay strong for them. She had a strong faith in God and its one of the reasons that keep her going.

She is a familyoriented person. She values her family and her faith, which influenced her coping mechanism in dealing with lifes unexpected challenges.

VALUE BELIEF
BEFORE HOSPITALIZATION DURING HOSPITALIZATION RATIONALE

She is a Roman Catholic. She values the gift of life, despite the odds and ironies it brings. She bravely faces this obstacle. She have a strong belief in God above all things and attend mass if have the chance.

She became closer with her faith, and admits at times she questions it but her faith is much stronger than her doubts.

The values she had remains with her no matter how difficult things are.

BREAST CANCER
Stage IV

P A T I E N T B A S E D

PATHOPHYSIOLOGY

PREDISPOSING FACTORS: Age (Pt. is 51 y/o) Gender (Pt. Is female) Late Menopausal (Pt. was menopaused at 49) Lifestyle (Stress) Hereditary (Pt.s grandmother died because of cancer)

PRECIPITATING FACTORS: Unknown

Neoplasm formation in the breast

Primary tumor begins in the breast Surgery (Pt. undergone mastectomy)

S/Sx: pain on the left upper breast

Tumor becomes invasive

Travel (metastasize) to other organ systems in the body

Progress beyond breast to regional lymph nodes

It becomes systemic

Primary cancer spreads

Chemotherapy Radiotherapy Interstitial laser thermotherapy

Progress beyond breast to regional lymph nodes

Removal of the breast

Cancer cell spreads into major organs

Cancer cell destroyed/ removed

Some cancer cell remains

LUNGS S/Sx: DOB, Cough, Pleural Efussion

LIVER S/Sx: RLQ pain

NECK S/Sx: Horseness of voice

BONES
S/Sx: Back & bone pain

BRAIN S/Sx: Headache

DRUG STUDY

DOPAMINE HYDROCHLORIDE
BRANDS: Dopastat, Intropin, Revimine CLASSIFICATIONS: Autonomic Nervous System Agent; Alpha- and Beta-adrenergic Agonist (Sympathomimetic) ACTION: Naturally occurring neurotransmitter and immediate precursor of nor-epinephrine. Major cardiovascular effects produced by direct action on alpha- and betaadrenergic receptors and on specific dopaminergic receptors in mesenteric and renal vascular beds.

DOPAMINE HYDROCHLORIDE
INDICATION: To correct hemodynamic imbalance in shock syndrome due to MI (cardiogenic shock), trauma, endotoxic septicemia (septic shock), open heart surgery, and CHF. CONTRA INDICATIONS: Pheochromocytoma; tachyarrhythmias or ventricular fibrillation. Safe use during pregnancy (category C), lactation, or children is not established.

DOPAMINE HYDROCHLORIDE
NURSING RESPONSIBILITIES: Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage. Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of tenderness, pain, numbness, or burning sensation).

DOPAMINE HYDROCHLORIDE
NURSING RESPONSIBILITIES: Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine flow, other indices of adequate dosage and perfusion of vital organs include loss of pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state.

SURGICAL TREATMENT

MASTECTOMY
Mastectomy is an operation in which the entire breast, usually including the nipple and the areola, is removed. Mastectomy is usually performed as a treatment of breast cancer. In general, women with breast cancer can decide whether to be treated with a lumpectomy or a mastectomy. A lumpectomy is the removal of the cancerous breast tissue as well as a surrounding rim of healthy breast tissue. A lumpectomy is a breast-conserving surgery that is usually followed by radiation therapy (high-dose X-rays or other high-energy rays to kill cancer cells).

MASTECTOMY
There are four main types: Total mastectomy - removal of breast tissue and nipple Modified radical mastectomy - removal of the breast, most of the lymph nodes under the arm and often the lining over the chest muscles Lumpectomy - surgery to remove the tumor and a small amount of normal tissue around it Radical mastectomy - the removal of the breast, lymph nodes and chest muscles. This is no longer common Which surgery you have depends on the stage of cancer, size of the tumor, size of the breast and whether the lymph nodes are involved. Many women have breast reconstruction to rebuild the breast after a mastectomy.

MEDICAL TREATMENT

CHEMOTHERAPY
Chemotherapy treatment uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body. Chemotherapy, often shortened to just "chemo," is a systemic therapy, which means it affects the whole body by going through the bloodstream. There are quite a few chemotherapy medicines. In many cases, a combination of two or more medicines will be used as chemotherapy treatment for breast cancer.

CHEMOTHERAPY
Chemotherapy is used to treat: EARLY-STAGE INVASIVE BREAST CANCER to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back ADVANCED-STAGE BREAST CANCER to destroy or damage the cancer cells as much as possible ***In some cases, chemotherapy is given before surgery to shrink the cancer.***

How Is Chemotherapy Given for Breast Cancer?


For breast cancer, chemotherapy drugs are given intravenously (directly into a vein) or orally (by mouth). Once the drugs enter the bloodstream, they travel to all parts of the body in order to reach cancer cells that may have spread beyond the breast -- therefore chemotherapy is considered a "systemic" form of breast cancer treatment. Chemotherapy is given in cycles of treatment followed by a recovery period. The entire chemotherapy treatment generally lasts several months to one year, depending on the type of drugs given.

RADIATION THERAPY
Radiation therapy, sometimes called radiotherapy, x-ray therapy radiation treatment, cobalt therapy, electron beam therapy, or irradiation uses high energy, penetrating waves or particles such as x rays, gamma rays, proton rays, or neutron rays to destroy cancer cells or keep them from reproducing.

RADIATION THERAPY
Purpose The purpose of radiation therapy is to kill or damage cancer cells. Radiation therapy is a common form of cancer therapy. It is used in more than half of all cancer cases. Radiation therapy can be used: alone to kill cancer before surgery to shrink a tumor and make it easier to remove during surgery to kill cancer cells that may remain in surrounding tissue after the surgery (called intraoperative radiation) after surgery to kill cancer cells remaining in the body to shrink an inoperable tumor in order to reduce pain and improve quality of life in combination with chemotherapy

RADIATION THERAPY
How Radiation Therapy Works The protein that carries the code controlling most activities in the cell is called deoxyribonucleic acid or DNA. When a cell divides, its DNA must also double and divide. Highenergy radiation kills cells by damaging their DNA. This blocks their ability to grow and increase in number. One of the characteristics of cancer cells is that they grow and divide faster than normal cells. This makes them particularly vulnerable to radiation. Radiation also damages normal cells, but because normal cells are growing more slowly, they are better able to repair radiation damage than are cancer cells. In order to give normal cells time to heal and reduce side effects, radiation treatments are often given in small doses over a six- or seven-week period.

RADIATION THERAPY
Preparation Before radiation therapy, the size and location of the patient's tumor are determined very precisely using magnetic resonance imaging (MRI) and/or computed tomography scans (CT scans). The correct radiation dose, the number of sessions, the interval between sessions, and the method of application are calculated by a radiation oncologist based on the tumor type, its size, and the sensitivity of the nearby tissues. The patient's skin is marked with a semi-permanent ink to help the radiation technologist achieve correct positioning for each treatment. Molds may be built to hold tissues in exactly the right place each time.

Thank You...

You might also like