Madam Asiah, age 35, was admitted to the ward with generalized abdominal pain, more on the right side and back. She has stage IV bilateral breast cancer and is scheduled for surgery. The doctor wants assessments of nausea/vomiting due to chemotherapy and interventions to improve nutrition. Counseling will also be provided to address changes to her body image and self-esteem from the cancer treatments. Pain management interventions are needed to relieve her discomfort.

2.  Breast cancer are common conditions that primarily
affect women.
 When a women discovers a breast lump, her first
response is often fear, of breast cancer, of losing her
breast and perhaps of losing her life.
 Breast cancer also strikes men although rarely.
 Breast cancer is rarely seen in client under the age
of 40.

3.  fibrocystic breast changes : term used to describe certain
benign changes in the breast, typically associated with
palpable nodularity, lumpiness, swelling, or pain
 lymphedema : chronic swelling of an extremity due to
interrupted lymphatic circulatin, typically from an axillary
lymph node dissection
 mastitis : inflammation or infection of the breast
 paget’s disease : from of breast cancer begins in the ductal
system and involves the nipple, areola, and
surrounding skin
 gynecomastia : overdeveloped breast tissue typically seen in
adolescent boys

4.  Breast cancer is a malignant (cancerous)
growth that begins in the tissue of the
breast.
 Cancer is a disease in which abnormal
cells grow in an uncontrolled way.

5. 1 . DUCTAL CARCINOMA IN SITU ( DCIS )
 increase use of mammography as a screening tool has
contributed to the dramatic.
 characterized by the proliferation of malignant cells
inside the milk ducts without invasion into the
surrounding tissue.
 DCIS is frequently manifested on a mammogram with
the appearance of calcifications , and considered breast
cancer stage 0.
 if untreated, increase likelihood that it will progress to
invasive cancer.

6.  The most traditional treatment is total or
simple mastectomy ( removal of the breast
cancer) .
 The trend today is toward less aggressive
surgery breast conservation treatment (
limited surgery followed by radiation).

7. 2. INVASIVE CANCER
a) infiltrating ductal carcinoma
 accounts for 80% of all cases.
 tumors arise from the duct system and invade the
surrounding tissue.
 they often form a solid irregular mass in the breast.
b) infiltrating lobular carcinoma
 accounts for 10% to 15% of breast cancer.
 tumors arise from the lobular epithelium and
typically occur as an area of ill-defined thickening in
the breast.

8. c) medullary carcinoma
 accounts for about 5% of breast cancer.
 diagnosed more often in women younger than 50 years
of age.
Tumors grow in a capsule inside a duct .
They can become large .
d) mucinous carcinoma
 accounts about 3% of breast cancer.
Often presents in postmenopausal women 75 years of age
and older.
Tumor is slow growing , prognosis is more favorable than
in many other types.

9. e) tubular ductal carcinoma
 accounts for 2 % of breast cancer.
Axillary metastases are uncommon with this
histology.
Prognosis is usually excellent.
f) inflammation carcinoma
 unique symptoms
Characterized by diffuse edema and brawny
erythema of the skin, referred to as peau d’orange.
Can spread to other parts of the body.

10. g) paget’s disease
 accounts for 1% of breast cancer.
Symptoms include a scaly,erythematous , pruritic
lession of the nipple.

11. 1. FEMALE GENDER AGE
 First-degree relative. Such as mother, sister, or
daughter.
2. MENSTRUAL HISTORY
 Early menarche – (under age 12)
( late menopause after age 50 )

12. 3. RADIATION EXPOSURE
 Chest x-ray, fluoroscopic examination, particularly
before age 30.
4. LIFE STYLE
 High fat diet, alcohol intake greater than two drink
daily.
 smoking
 obesity
Breast trauma

13. Stage 0 – noninvasive carcinomas occupy their
locations of origin without spreading beyond this
point
Stage I – the tumor is no larger than two
centimeters, and cancer cells are confined to the
breast
Stage II – a tumor has started to spread to the
lymph nodes or, the tumor has exceeded five
centimeters in size

14. Stage III – the tumor has exceeded five centimeters
and has spread into the lymph nodes in a more
extensive way than in stage II
Stage IV – the cancer has metastasized and
spread to other regions of the body

15.  1. Breast mass or thickening.
 2. unusual lump in the underarm or above
the colarbone.
 3. Abnormal nipple discharge.
 4. Rash around the nipple area.
 5. Change in nipple position.
 6. Burning, stinging or pricking sensation.

16.  PERCUTANEOUS BIOPSY
1) percutaneous biopsy  performed on an outpatient
basis to sample palpable and nonpalpable lesion.
2) is a needle or core bopsy that obtains tissue by
making small punture in the skin.
a) fine-needle aspiration
 1) noninvasive biopsy technique.
 2) need a small gauge needle ( 25 or 22 gauge).
 3) suction is applied to the syringe.

17.  4) fluid is usually discarded.
 5) less expensive than other diagnostic methods
and result are usually available quickly.
b) core needle biopsy
 1) similar to fine-needle aspiration (FNA).
 2) but used large gauge needle (usually 14 gauge).
 3) a local anesthetic is applied, and tisssue cores are
removed.
 4) more definitive diagnosis then FNA.

18. c) stereotactic core biopsy
 1) performed on nonpalpable lesions detected by
mammography.
 2) tissue are taken for pathologic examination.
 3) quite accurate and often allows the patient to
avoid a surgical biopsy.

20. 1. Chemotherapy
* The most common chemotherapy agents act
by killing cells that divide rapidly, one of the
main properties of most cancer cells. This
means that chemotherapy also harms cells that
divide rapidly under normal circumstances

22. 2. Radiation Therapy
* is a highly targeted, highly effective way to
destroy cancer cells in the breast that may stick
around after surgery. Radiation can reduce the
risk of breast cancer recurrence by about 70%.
* Despite what many people fear, radiation
therapy is relatively easy to tolerate and its side
effects are limited to the treated area.

24. 3. Breast lumps
* Less than one-fourth of all breast lumps are found to be
cancerous, but benign breast disease can be difficult to
distinguish from cancer. Consequently, all breast lumps
should be checked by a health care professional.

26. 4. Mammography
* Mammography is a low-powered x-ray technique that
captures a picture of the internal structure of the breast.
* Additional angles and magnified views are taken of
suspicious areas. A mammogram may help in the diagnosis
of breast problems, including cancer.

28. 5. CT scan
* a thin X-ray beam is rotated around the area of the
body to be visualized. Using very complicated
mathematical processes called algorithms, the computer is
able to generate a 3-D image of a section through the body.
* CT scans are very detailed and provide excellent
information for the physician.

30. 6. Open biopsy of the breast
* An open biopsy can be performed under local or
general anesthesia and will leave a small scar. Prior to
surgery, a radiologist often first marks the lump with a
wire, making it easier for the surgeon to find.

32. SURGICAL
1)LUMPECTOMY
A lumpectomy is surgery to remove a small area of breast tissue that is
cancerous.This surgery is carried out only in early breast cancer, if the area of tissue
to be removed is relatively small. Women who choose a lumpectomy will require
radiation therapy to destroy any cancer cells that may remain in the area.
2) MASECTOMY
A mastectomy is the surgical removal of the entire breast that is done in order to
remove a malignant tumour in cases of invasive breast cancer, with or without
removing the lymph nodes in the armpit. Sometimes, if more tissue needs to be
removed, a lumpectomy may be disfiguring and a mastectomy may be recommended
instead.

33. CHEMOTHERAPHY
i. Chemotheraphy tratment 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.
ii. Chemotheraphy is used to treat :
a) 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.
b) Advanced stage-breast cancer to destroy or damage the cancer cells as much as
possible.
iii. Some cases, chemotherapy is given before surgery to shrink the cancer.

34. RADIATION THERAPHY
i. Radiation theraphy is also called radio theraphy is a highly targeted, highly
effective way to destroy cancer cells in the breast that may stick around after
surgery.
ii. Radiation therapy is relatively easy to tolerate and its side effects are limited to
the treated area.
radiation theraphy chemotheraphy

35. MEDICAL
Tamoxifen or aromatase inhibitor is recomanded for estrogen receptor-
positive (ER+) breast cancer. Its stop estrogen from fueling ER+ breast
cancer.
i. TAMOXIFEN
a) Medicine that blocks the effect of estrogen on breast cancer cells and
normal breast cells. But this medicine may also increase other risks, such
as for endometrial cancer, stroke and blood clots in veins and in the lungs.

36. ii. Aromatase Inhibitors
a) Letrozole (Femara)
b) Anastrozole (arimidex)
c) Exemestane (aromasin) are medicine that stop estrogen production in
postmenopausal women.
iii. Trastuzumab ( Herceptin )
a) Is recommended after surgery and chemotherapy for HER2/neu breast cancer.
This medicine is a monoclonal antibody that targets the HER-2 protein. It helps
chemotherapy work better.
iv. Serotonin antagonists, corticosteroids and phenothiazines
a) Treatment of breast cancer can cause nausea and vomitting. Doctor will be
prescribe this medicine to help relieve and prevent nausea and vomitting.

37. Destruction of the breast.
Destruction of the chest wall surrounding of the
breast.
Mastitis
Nipple discharge
Chest pain
Most women will have aches or pains from time to
time in the treated breast even years after treatment.
Hair loss after radiation therapy and chemotherapy.

40.  the breast plays a significant role in a woman’s
sexuality and self –identity.
A breast disoder, wether benign or malignant, can
cause great anxiety and fear of potential
disfigurement, loss of sexual attractiveness, and even
death.
Must have expertise in the assessment and
management of not only the physical symptom but also
the psychosocial symptoms with breast disoders.

41. Madam Asiah age 35 years old admitted to the ward at
9 a.m she complaint of generalized abdominal pain 1/7
more on right sided region to the back. B/P :
110/62,Temperature : 38.5,Pulse : 65,Rate : 14. Doctor
has her’s Bilateral Breast Cancer stage iv and suggest
for the operation.

42. 1. Nursing Diagnosis :
Imbalanced nutrition ,less than body requirement
related to nausea and vomiting.
Goal :
Patient experiences less nausea and vomiting
associated with chemotherapy, weight loss is
minimized.

43. Intervension :
i. Assess the patient previous experiences and
expectation of nausea and vomiting, including cause
and intervension.
ii. Adjust diet before and after drug administration
according to patient preference and tolerance.
iii. Prevent unpleast sight,odor and sound in
environment.
iv. Ensure adequate fluid hydration,before during and
after drug administration ,assess intake and output.
v. Provide pain relief measure, if necessary.
vi. Assess other contribution factor to nausea and
vomiting such as other symptom, radiation
therapy, medication.

44. 2. Nursing Diagnosis :
Disturbed body image and situation low self- esteem
related to change in appearance, function and role.
Goal :
Improved body image and self-esteem.

45. Intervension :
i. Assess patient feeling about body image and level
of self- esteem.
ii. Encouraged continued participation in activities
and decision making.
iii. Assist patient in self- care when
fatigue,nausea,vomiting to prevent independence.
iv. Assist patient in selecting and using cosmetic,hair
pieces and clothing that increase sense of
attractiveness.
v. Individualize care for the patient.

46. 3. Nursing Diagnosis :
Chronic Pain
Goal :
Relief of pain and discomfort.

47. Intervension :
i. Assess pain and discomfort characteristic use pain
scale.
ii. Assess other factor contributing to patient pain :
fear,fatigue.anger.
iii. Administer analgesic to promote optimum pain
relief.
iv. Assess patient behavioral responses to pain and
pain experiences.
v. Teach patient new strategies to relieve pain and
discomfort.

48. WAD PALIATIF CARE UNIT (PCU) HTAA
BRUNNER & SUDDARTH’S,Medical –Sergical Nursing,Twelthh
Edition.
http ://www.webmd.com/breast-cancer/tc/breast-cancer-
medications.