J G COLLEGE OF NURSING AHMEDABAD SUB-MEDICAL SURGICAL NURSING TOPIC-BREAST CARCINOMA
IDENTIFICATION DATA• PATIENT’S NAME: Jubedabivi Bharubhai Kakar• IPD . NO: F 45314• AGE:54 years• SEX:Female• DATE OF ADMISSION`: 2-1-2012• DR’S UNIT: Unit-2 Dr.prakash patel• WARD: cancer female medical ward• MARRITAL STATUS: married
• RELIGIO: Muslim• EDUCATION: 5th std.• OCCUPATION: House wife• ADDRESS: Sendava Taluko-Badwana, District- Badwada, State-Madhya Pradesh• DIAGNOSIS: Breast carcinoma Stage-3.• OPERATION: Total Mastectomy• OPERATION DATE:4 -1-2012• HEIGHT: 146Cm• WEIGHT: 6 Kg
PRESENTING COMPLAINS• Patient having complained of following:• -Fever• -Pain in left breast• -heavyness in left breast• -Lump in left breast• -Anorexia• -Weight loss• -Undigesion•
PRESENT HISTORY:• Jubedabivi was asymptomatic before 1year than she develop pain in left breast and heaviness in the breast, this time she was admit for total mastectomy for breast carcinoma stage -3.
PAST HISTORY:• PAST MEDICAL HISTORY:• Jubedabivi was asymptomatic before 1 year than develop pain in the left breast and heaviness in the breast thus she went to privet hospital for tacking treatment but symptoms not relived finally she refered in v.s.hospital for further treatment and no any major history of major treatmemt.
• PAST SURGICAL HISTORY:• Before five month she had done biopsy for the breast lump in the v.s.hospital and finally diagnose the carcinoma breast .
DIET HISTORY:Jubedabivi’s family isnon vegetarian so her family eats nonvegetarian diet. He cooked all type of nonvegetarian diet .
PERSONAL HISTORY• Diet : Non vegetarian & taking all type of small amount diet• Appetite : Decreased• Sleep :disturb• Micturation : No burning micturation• Bowel habit: Abnormal habits• Smoking : No• Alcohol : No• Drugs : No• Tobacco : No• No any other habits
FAMILY HISTORY• In her family no any family members have history of any Hypertension, Diabetes mellitus, Ischemic heart disease, Epilepsy, Asthma, Storks, Arthritis, Cancer or any other disease. Her father suffering from the tuberculosis and expired with this disease.
Relations Name of hip Age in OccupatioSr.No. Family Education Year With n Members patient 1 Bhurabhai 6oYrs. Husband Old S S C Retired kakar Railwayma n 2 Jubedabivi 54Yrs Patient 3rd pass Housewife Kakar 3 Musabhai 40Yrs Son 12th pass Raiway Kakar driver 4 Naseembiv .37Yrs Son’s wife 7th pass Housewife i Kakar 5 Raja Kakar 10Yrs Grand son 5th std - 6 Rafic Yrs Grand son - -
SOCIOECONOMIC HISTORYIn her family her husband isretired person and her son is working inrailwayHer family earn around24,000 thousand rupeesin the month and savingabout the 2500 rupees permonth .
Date Temp ( F) Pulse Respirati BP (mm (/min) on(/min) of Hg)4-1-2012 100 F 100/min 24/min 116/745-1-2012 99 F 126/min 26 min 116/646-1-2012 99 F 120/min 26 min 114/787-1-2012 98.6F 116/min 24 min 118/748-1-2012 98.4 F 110/min 24 min 110/70
GENERAL OBSERVATION:• Sensorium: She is conscious and well oriented• Foul body odour: no any bad odour from her body• Foul breath : no• Posture : normal• Hair: Brown hair, clean no any dandruff.
• Body image: normal• Health: Unhealthy• Activity: less active• MENTAL STATUS:• Consciousness: conscious• Look: weakness, fatigue due to her disease.• Posture• Body curves: normal• Movement: Full movement(if given deep pain than small reflection was done by patient)•• Height: 146cm Weight: 67kg
EYES:•Eyebrow: normal•Eye lashes: no infection, not open by patient•Eyelids: no any injury or oedema is present•Eye balls: not sunken•Conjunctiva: pale•Sclera: no jaundiced•Pupils: constricted•Vision: react to light
• ECG:• wnl• Ultrasound-• 4.5*3.9cm lesion seen in the left breast.• MRI Breast-• 5*4*3cm lesion seen in the left breast.• MEMOGRAPHY DONE-• There is Lesion spread in to ipsilateral mammary lymph nodes and tumor sie is more than 5cm.
MEDICATION• CHEMOTHERAPY GIVEN AFTER SURGERY• -Injection Adriamycin and cyclophosphamide regimen every 3week for four cycle.• -Injection amikasine 500gm i/v 12hourly.• -Injection dynapar 1 ampoule i/v 12hourly.• - Injection Pentoprajol 1 vial i/v 12 hourly.• - Injection Glucose 5% 1 litre i/v slowly.
• Maintain intake and output chart daily• Contineus observation of the patient on monitor for any abnormal symptoms.• TPR chart 1 hourly Monitoring continuously for blood pressure, respiration rate, pulse, and for oxygen saturation.• Care taken of catheter daily• Care taken of all tubes which are inserted• Watched for respiratory failure .• Changed the dressing and adhesive tap at the site of intracath
DISEASE CONDITIONKnowing the various parts of the breast, what they doand why theyre important is critical to identifyingany abnormalities that might appear in your breasts.Understanding female breast anatomy can helpyou understand which changes are normal andhealthy, and which may signal disease.
Female Breast Anatomy• Although the human breasts are located over the pectoral muscles of the chest wall, the human breast doesnt actually contain any muscle tissue. Your breasts, which are made up of glandular, fatty and fibrous tissues, have a number of different functional parts:• Areola (colored area around the nipple)• Blood vessels and lymph vessels• Ducts (milk passages)• Fatty tissue• Fibrous tissue that surrounds the lobules and ducts• Lobes• Lobules (milk glands)• Nipple.• A layer of fatty tissue surrounds the breast glands and runs throughout the entire breast. This layer of tissue gives the female breast its soft consistency.
Female Breast Milk Production• Each breast has 15 to 20 sections (or "lobes") beneath the nipple and areola, arranged in a circular pattern that resembles a daisy. Lobes are part of the milk production system; each lobe contains many smaller milk-producing glands called "lobules." Each lobule has tiny bulbs, called "alveoli." When a woman is lactating, the alveoli produce milk in response to hormonal signals.• When milk is produced, the ducts transport it from the lobules to the nipple. As each duct gets closer to the nipple, it widens to form a sac called an "ampulla." The spaces between the lobules and the ducts are filled with fatty tissue, connective tissue and ligaments. As the milk production system is roughly the same size in all women, breast size and shape depend on the amount of fat in the breasts.
• Arteries and capillaries carry oxygen- and nutrient- rich blood to the breasts. The axillary artery, which extends from the armpit, supplies blood to the outer half of the breast. The internal mammary artery, which extends down from the neck, supplies blood to the inner part of the breast.• The human breast also contains lymph vessels. The lymphatic system is part of your immune system and contains blood vessels, lymph ducts and lymph nodes. These work to fight off harmful or infectious substances within your body. Clusters of lymph nodes are located under your arm, above your collarbone, behind your breastbone and in various other parts of your body.••
DEFINITION:• Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Cancer is a disease in which abnormal cells grow in an uncontrolled way. Breast cancer is the most common cancer in women, but it can also appear in men. In the U.S., it affects one in eight women.
CAUSES:In Book In Patient Hormonal yes imbalanceChanges in DNA May bebond of cellGenetic abnormality noany
PATHOPHYSIOLOGY:• Breast cancer, like other cancers, occurs because of an interaction between the environment and a defective gene.• Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues.• Cells become cancerous when mutations destroy their ability to stop dividing, to attach to other cells and to stay where they belong.
• When cells divide, their DNA is normally copied with many mistakes. The mutations known to cause cancer.• These mutations are either inherited or acquired after birth. Presumably, they allow the other mutations, which allow uncontrolled division, lack of attachment, and metastasis to distant organs.• Mutations that can lead to breast cancer have been experimentally linked to estrogen exposure.
• Failure of immune surveillance, the removal of malignant cells throughout ones life by the immune system.• Abnormal growth factor signaling in the interaction between stromal cells and epithelial cells can facilitate malignant cell growth.• In breast adipose tissue, overexpression of leptin leads to increased cell proliferation and cancer.
CLINICAL MENIFESTATION:In Book In Patient Lump in breast Present Thickening in the breast Present Change the size and Presentshape of the breast Nipple discharge Present Change size and Present shape of the nipple Chang color of the Present nipple and the areola Raches seen on the Present skin
ASSESSMENT & DIAGNOSTIC FINDINGS:IN BOOK IN PATIENT- Taking a thorough - Done history including family history- Physical examination - Done (note BP & weight)- Laboratory work - Done (cholesterol levels, glucose ) -Ultrasound - Done
MANAGEMENT:• MEDICAL MANAGEMENT:• Chemotherapy in four cycle with Adreamycine and cyclophosphemide.• Analgesics• Antibiotics• SURGICAL MANAGEMENT:• Prepare for Total mastectomy of the patient.• Preoperative advice given to the parents signature taken for operation, nil by mouth after 10pm before operation day.
NURSING MANAGEMENT• Identify at risk patients, & teach lifestyle modifications to prevent development any complication.• Teach patient to control cholesterol levels through dietary reduction of cholesterol intake, exercise, smoking cessation.• Note & report findings from history, physical examination, & laboratory results that indicate hypertension or diabetes, & teach to control blood pressure by taking treatment in the nearest hospital.•
NURSING DIAGNOSIS:• Altered skin integrity related to bed ridden condition as evidence by redness on back side.• Risk for infection related to presence of dressing at suture site.• Altered body temperature due to presence of infection.
• Imbalance nutritional level less than body requirement related to loss of appetite.• Activity intolerance related to surgery done.• Impaired body image due o surgeory.• Altered self image and confidence due to fegure.
HEALTH TEACHING:• Arrange specific services for patient(e.g. respiratory therapy education, physical therapy for exercise & breathing)• Explain patient’s reletives about discharge planning.• Give advice about regular medication as per timing.• Explain and demonstrate about chest physiotherapy by doing deep breathing exercise .
• Explain and demonstrate about coughing and how to remove cough.• Advice given about good nutritive .• Advide given for prevention of infection management.• Explain about follow up care.
BIBLIOGRAPHY:• Bennette and Plum; “TEXTBOOK OF MEDITION ; 10thedition, 1996;• W.B. Saunders Company, New York : 1996. PP : 789-794• Black J.M; “MEDICAL SURGICAL NURSING; 5th edition, 1999• ; W.B. Saunders Company, Philadelphia. PP: 1217-1242
• Brunners & Suddarth’s; “TEXT BOOK OF MEDICAL SURGICAL• NURSING VOL-_1”;10th edition, 2004; Elsevier Publishers, New Delhi,• India. PP: 684-740•• B T Basavanthappa;”TEXT BOOK OF NURSING THEORIES”,Jaypee brothers Medical Publishers ,New Delhi.• PP: 40-• WEBSITES: • http://www.wikipedia.com. • http://www.patho.coronaryarterydisease.org/.com.in • http://www.google.com. • http://www.medicine.com.•