Far Eastern University

CASE STUDY
Rizal Provincial Hospital

Submitted By:

Head Nurse:

Agbannawag, Jan Derick

Staff Nurses:

Acio, Eliza Anne

Agustin, Jericson

Alumisin, Shamira Monique

Bareng, Czenen

BSN103
 Submitted To:

Ma’am AnnalizaRabo RN,MAN

MALIGNANT BREAST NEOPLASM

(Breast Cancer)
INTRODUCTION

Breast cancer (malignant breast neoplasm) is cancer originating from breast tissue,
most commonly from the inner lining of milk ducts or the lobules that supply the
ducts with milk. Cancers originating from ducts are known as ductal carcinomas;
those originating from lobules are known as lobular carcinomas.
Prognosis and survival rate varies greatly depending on cancer type and staging.
Computerized models are available to predict survival. With best treatment and
dependent on staging, 10-year disease-free survival varies from 98% to 10%.
Treatment includes surgery, drugs(hormonal therapy and chemotherapy),
and radiation.
Worldwide, breast cancer comprises 10.4% of all cancer incidence among women,
making it the most common type of non-skin cancer in women and the fifth most
common cause of cancer death. In 2004, breast cancer caused 519,000 deaths
worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100
times more common in women than in men, although males tend to have poorer
outcomes due to delays in diagnosis.
Some breast cancers are sensitive to hormones such as estrogen and/or progesterone,
which makes it possible to treat them by blocking the effects of these hormones in the
target tissues. Estrogen and progesterone receptor positive tumors have better
prognosis and require less aggressive treatment than hormone negative cancers.
Breast cancers without hormone receptors, or which have spread to the lymph nodes
in the armpits, or which express certain genetic characteristics, are higher-risk, and
are treated more aggressively. One standard regimen, popular in the U.S.,
is cyclophosphamide plus doxorubicin (Adriamycin), known as CA; these drugs
damage DNA in the cancer, but also in fast-growing normal cells where they cause
serious side effects. Sometimes a taxane drug, such as docetaxel, is added, and the
regime is then known as CAT; taxane attacks the microtubules in cancer cells.
Radiation is usually added to the surgical bed to control cancer cells that were missed
by the surgery, which usually extends survival, although radiation exposure to the
heart may cause damage and heart failure in the following years.

Clinical Abstract

This is the case of a 55 year old, female, single, Filipino, Roman Catholic
from Cardona,Rizal who was admitted for the first time at Rizal Provincial Hospital in
Morong, Rizal last January 2, 2011 at 6:25PM due to Extreme pain on her left breast
with visible masses and discharge. Her condition started 1 year prior to admission
when she found out lump masses on her left breast located under the nipple. On the
first time she noticed those lump, she disregard it and doesn’t consult any physician.
As time goes by, she noticed that her lumps is getting bigger, her nipple changed in
appearance, and noted a discharge,this was also accompanied by breast pain which
she came in to the point to tell her condition to her brother and sister. No one knows
her condition because she’s keeping it by herself.

Last January 2 at 6:25PM they arrived at Rizal Provincial Hospital. Hence, she
was subsequently admitted under Dr. Aran’s service. A Breast physical assessment
was done and Laboratory work ups such as Chest X-ray, Hematology, and Urinalysis.

On January 3,2011 at 10:53 AM, she undergone a surgical intervention for her
neoplasmic breast condition, A modified Radical Mastectomy removing the entire left
breast, its surrounding tissues and nearby lymph nodes affected by the cancer cells.
No other complications happened from the procedure. Through then, she was on her
time of recovery in room10 Bed A and with indwelling foley catheter and improvised
wound drainage and in a good recovery process.
I. BIOGRAPHIC DATA

Name: GTF

Address: Cardona, Rizal

Age: 55 Gender: Female Religious Affiliation: Roman Catholic

Birthday: February 28, 1955

Marital Status: Single Occupation: none

Room and Bed #: Room 10 Bed A

Chief Complaint: Visible enlarged mass on her LEFT breast accompanied by pain.

Provisional Diagnosis: Malignant Breast Neoplasm on left breast

Attending Physician: Dr. Aran

Date of Admission: January 2, 2011; 6:25 PM

II. NURSING HISTORY

A. Past Health History

The client has complete childhood immunizations but she cannot recall what
those immunizations she received. Her Childhood illnesses are chicken pox, measles
and mumps only. No known allergies.

Last October 2007 she undergone surgical procedure, A Cataract surgery with
intraocular lens and last 2010 she was also hospitalized due to an accident, she was hit
by a jeep. Fortunately, she only had minor injuries and was discharge thereafter. The
client was also diagnosed before with Cardiomegaly (enlargement of the heart) and
Atheromatous aorta. However, she denies any medication at home and instead she
was advised to eat a low salt and low fat diet at home.

She has no history of any foreign travel.

B. History of Present Illness

1 year prior to admission, the client found a mass on her left breast that
continuously grown until her 1st check-up last January 2, 2011. She never consulted a
physician until she experienced Extreme pain in her left breast wherein she consulted
medical attention at Rizal Provincial hospital. Several Laboratory Tests was done
revealing a malignant breast neoplasm on her left breast. Also, in her chest X-ray, she
was diagnosed to have an enlarged heart and an atheromatous aorta.
 Moreover, as an intervention for underlying condition, she undergone a STAT
MRM (Modified Radical Mastectomy) surgery last January 3 under Dr.Aran’s
service. The surgery went successful, so now she is having her complete recovery at
Room 10 Bed A at RPH.

C. Family History

The client has a heredofamilial disease of Diabetes, but she doesn’t acquired
the disease. Among the 7 siblings, comprising of 3 male and 4 female, 1male and 2
female are affected by the disease. It is also because their mother is the carrier of the
diabetes. On the other hand, her father died because of colon cancer and no one has
acquired the heredofamiliality of the colon cancer.

The client’s parents had already passed away because of the said diseases
while 2 of her siblings also died because of diabetes. Among the 7 of them, 5 of them
are still alive.

GENOGRAM OF FLORES FAMILY

81

9
79
79

41 44 45 49 55 57 60

Legends:

------------------- Mother with diabetes

------------------- Sister

------------------- Sister with diabetes

------------------- Father with colon cancer

 ------------------- Brother

------------------- Brother with diabetes

------------------- Deceased

D. Obstetric History

The client’s obstetric history is G0P0, no pregnancy since she was single in
status. Her 1st menarche was on her 11 years of age with a regular monthly
menstruation. She was menopaused at the age of 53.

III. PATTERNS OF FUNCTIONING

A. Psychological Health

1. Cognitive Pattern
The client is very open with her family. Especially when in times of problems.
She solves problems together with her family, they talks about the problem and prays
to God. She even said “sa oras ng problema kelangan may karamay ka, mas madali ka
makakapagisip pag ganon” she even believed that to cope up from the problems, there
should be someone who can counsel her and help her to solve the problems. she don’t
treat problems seriously but rather she just believed that it will just pass and will be
solved soon.

Interpretation:
The client's coping pattern shows how a normal person reacts in different situations.
Coping strategy is a natural or learned way on how a person responds to a changing
environment or in a specific problem or situation.

Analysis:
Can reflect on the past and current experiences and can imagine, anticipate, plan and
hope. (Medical and Surgical Nursing by Udan 2009)
Coping may be described as dealing with problems and situations or contending with
them successfully. It also varies among individuals and is often related to the
individual’s perception of the stressful events. Successful coping requires the person
to deal effectively with stressful events and minimize distress associated with them
those results in adaptation. (Kozier et. Al FON 7th ed. P. 1020).

2. Interaction Pattern
The client interacts most often with her family, they have good relationship at
home, and they are open to each other and can express their feelings. She also
socialize with her neighbors, and make some happy times with them, As she said
“mas masarap mabuhay ng maraming kasundo, madami kang malalapitan sa oras ng
problema”. She is very open with to everyone.

Intepretation:
The client is able to mingle with the people around her. she has no difficulty in
interacting with people from her family and possesses a good attitude in interacting
with everyone.

Analysis:
Socialization can be defined simply as the process by which people learn
to become members of the groups and society and learn the social rules, defining
relationships into which they will enter. Socialization involves learning to behave,
feel,and see the world in a manner similar to other person occupying the same role as
oneself. (Fundamentals of Nursing by Kozier and Erbs 8th edition, p17)

Adherence is the extent to which an individual’s behavior (for example taking

medications, following diets or making lifestyle changes) coincides with medical or
health advice. (Fundamentals of Nursing 8th edition Vol. 1 by Kozier and Erb, p.304)

3. Cognitive Pattern
The client doesn’t have any problem in hearing but has a visionproblem,she
cannot read newspaper without eyeglasses and admit that sometimes she experiences
cloudy visions. She had her eye surgery last October 2007 on her left eye but now she
is experiencing right eye cloudiness of vision. Moreover as she gets old she is
experiencing memory problem as she quoted “nagiging makakalimutin na yata ako,
dahil narin siguro ito sa katandaan ko”. She doesn’t consult any physician regarding
her memory condition. Although she sometimes experience memory problems, still
she is in good cognition and able to understand things well.

Interpretation:
The client has no problem in terms of her cognition except for some memory
problems as related with aging.
Analysis:
An individual’s senses are essential for growth, development and survival. Sensory
stimuli give meaning to events in the environment. Any alteration in people’s
functions can affect their ability to function within

4. Self-Concept Pattern
The client perceives a healthy person as somebody who can function well and
do her job. Someone who is not only disease free but also spiritually healthy.
According to her, she was in a very good condition when she was taking care of her
apo’s and nephew at home, she even rated her health status before as 8 out of 10 it is
because she can work well and fulfill her responsibilities in the family. But when she
was hospitalized she said that she will not be as functional anymore because she
knows that her activities will be limited because of her post op condition.
When in times of sickness, the client practices self treatment. she do not seek
medical attention from any institutions. When the client becomes sick she just take
self-prescribed medications such as paracetamol for fever, neozep for colds and
solmux for cough. She cannot recall the dosages but he said “effective rin naman
kahit ako na ang gumamot sa sarili ko, mas makakamura pa ko”. She also drinks 8-10
glasses a day and believes in herbal medications, she sometime uses Oregano and
Lagundi for treating her cough. Moreover, if these herbal medicines are not available,
it is the time he will take some medicines.
The client doesn’t have any form vices.

Interpretation:
The client has a positive self-concept in life. She wants to be a person who helps most
especially her family and relatives.

Analysis:
Self-concept is one's mental image of oneself. A positive self-concept is essential to a
person's mental and physical health. Individuals with a positive self-concept are better
able to develop and maintain interpersonal relationship and resist psychological and
physical illness. (Fundamentals of Nursing 7th edition Volume 1 Kozier and Erb, p.
957)

5. Emotional Pattern
The client sometimes becomes emotional every time she thinks on her
condition especially on the time she was informed about her breast cancer, she really
felt grieving but she didn’t lose hope She just trust everything to God and believed
that she will be fine. She even added “matanda narin ako at sandal nalang rin ako sa
mundo, sa tuwing naiisip ko ang kalagayan ko ay nalulungkot ako”. Her family stayed
on her side and counselled her for everything which really relieved her grieving
process. And now, after her operation, she was starting to accept the fact that there
will be more changes in her previous life and less activity will only be allowed for
her.

Interpretation:
The client experiences sadness because of his current condition. Despite of that, he
remains calm and accepts any posible scenario that may occur.

Analysis:
Acceptanceis when a person agrees to experience a situation, to follow a process or
condition (often a negative or uncomfortable situation) without attempting to change
it, protest, or exit. (Fundamentals of Nursing 6th edition by Potter and Perry p. 357)

6. Sexuality Pattern
The client has no regret when it comes to her feminity. She is a typical woman
who socialize with female friends, a woman who planned to have a family but she live
in 55years as single. She said “Ewan ko ba kung bakit wala pa kong asawa”. She also
had previous love when she was in high school and college days but she do not know
why still she doesn’t have her Mr.RIGHT.

Interpretation:
The client accepts the fact that right now, in her 55 years of existence, she doesn’t
find her perfect partner.

Analysis:
Sexual health is an individual and constantly changing phenomenon falling
within the wide range of human sexual thoughts, feelings, needs, and desires. For
most people, sexual health is not considered until its absence or impairment is
noticed. (Fundamentals Of Nursing by; Kozier and Erbs, 8th edition, page 1023)

7. Family Coping Pattern

The client builds a good relationship with her family, they solve problems
together and they also spend time together. Sometimes after going to church they also
go to malls and eat in a restaurant. Her family is also god fearing, when in times of
problem they can cope up and trust everything to God. As she said “si Bro na ang
bahala, basta ginagawa mo ang tama nandyan sya at tutulungan ka nya.
Intepretation:
The patient is very much connected to her family. she doesn’t have any
problem in terms of family bonding. Their family is able to manage or to solve their
problems by having an open communication.

Analysis:
The late adult becomes more altruistic and concept of service to others and love and
compassion gain prominence.
B. Socio-Cultural Patterns

1. Cultural Pattern
The client also practices some cultural events and beliefs. Together with her
relatives, they also spend fiestas yearly. They prepare foods during fiestas and invite
everyone to eat at their home. Everyone who is related to their family is invited. Also,
he believes to some cultural practices during holy days.

Interpretation: The client exercises or demonstrates the culture they grew up with.
They are also engage into fiestas which are a traditional Filipino culture.

Analysis: Different people have different outlooks in life and vary greatly upon
geographical domain. (Introduction to Psychology by Atkinson et. al.)

2. Significant Relationship
The client spends most of the time with her family; she is the one who always
prepare the food at home and takes care of her nephews. She doesn’t have any work
but she also spend most of her spare time in church activities wherein she is a member
of a Charismatic group and prayer warrior. She doesn’t have a husband nor a
boyfriend so she spend her time most with her family and serving God.

Interpretation:
The client, even if she’s single, does have significant others that she can lean on to.
Also, her relationship with the Almighty is tight since she is part of the Charismatic
group and a Prayer warrior

Analysis:
Relationship-based theories stress courage, generosity, commitment, and the need to
nurture and maintain relationships. (caring) --(Fundamentals Of Nursing by; Kozier
and Erbs, 8th edition, page 84 )

3. Recreation Pattern
The client doesn’t have any recreational activities. She considered her
recreation as exercising during mornings. As she said “wala na rin naman akong
pinagkakaabalahang ibang bagay, malimit kasama ko ang pamilya ko at sa simbahan
lang ako. She stays with her family and fulfils her responsibility as a caretaker of their
house.

Interpretation:
The client spends most of her time at work and considers exercise as a form of her
recreational activity.

Analysis: Recreation is any activity performed during one's leisure or free time.
Recreational activities are often done for amusement, enjoyment or pleasure and are
considered to be fun. Recreational activities serve as a preventive measures againts
deep depression of certain individual that may affect his/her emotional and mental
health.

4. Economic
The client doesn’t have any form of income. Her money was always given by
her brother and younger sisters. Since she didn’t finished High school level, she
considered that this is the reason why she wasn’t able to find work and be the one
who also sustain for the family’s needs. She only stays at home doing the house hold
chores and considered herself as substitute mother of the family.

Interpretation:
The client doesn’t have work at this time. That’s why she said that she wasn’t able to
have a regular check up regarding her disease because she doesn’t have any resources,
especially money.

Analysis
Physical or mental effort or activity directed toward the production or
accomplishment of something. It may be a job, a trade or a profession.
(http://www.answers.com/topic/work)

C. Spiritual Patterns
1. Religious Beliefs and Practices
The client has a good relationship with God, she believes of having a high
level of faith in God and she trusts God for everything she has. Even though she has a
serious disease condition, she still believes that God will make a way to recover her.
In spite of her acceptance that soon she might die, she still believe to God because for
her “Hindi nya tayo bibigyan ng problemang hindi natin makakayanan”. She has a
good fighting spirit and trusts everything to her own creator.
Interpretation:
The client believes in God and that she entrusts everything in him.
Analysis: The late-aged adult person tends to be less dogmatic about religious belief
as religion may offer more comfortable than before
Spiritual development of Fowlers at Paradoxical Consolidative wherein awareness of
truths varies from a variety of viewpoint.
 IV. ACTIVITIES OF DAILY LIVING
ACTIVITIES OF
BEFORE HOSPITALIZATION
DAILY LIVING
The client’s diet is monitored, despite The client is in low salt
the fact of having a cardiomegaly and low fat diet.
athermatous aorta, she was advised to
eat foods that are only low in salted
and fat.
She is fond of eating veggies and
fishes after being diagnosed of
cardiomegaly and atheromatou aorta.
Before she was diagnosed with
cardiomegaly, she is fond of eating
meaty foods.
NUTRITION
URINE
- Voids 5 times a day
- Straw in color
- Faint aromatic
-No pain in urination
STOOL
-Defecates once a day
ELIMINATION
-formed
-brown
EXERCISE She considers doing household chores The client is advised to
as a form of her exercise. She also
tells that she walks when she goes to because of her condition.
church or the market.
DURING INTERPRETATION &
HOSPITALIZATION ANALYSIS
Interpretation:
The client's diet mostly
composed of fatty and
salty foods. She seldom
eats vegetable. During
hospitalization, she was
given a low salt low fat
diet.
Analysis:
An adult should continue
to eat a healthy diet,
following the
recommended portions of
the food groups with
special attention to
protein, calcium and
limiting cholesterol and
caloric intake. Two or
three liters of fluid should
also be included in the
daily diet. (Fundamentals
of Nursing 8th edition vol
2 by Kozier and Erbs p.
1243)
URINE Interpretation:
- on IFC There is no problem
- Draining to yellowish regarding her elimination.
urine
Analysis:
STOOL People's pattern of
-none urination and defecation
is highly individual most
people void 5 to 6 times a
day and defecates several
times per day to two or
three times per week.
(Fundamentals of
Nursing 8th edition by
Kozier and Erbs p. 1290
& 1324)
Interpretation:
stay on bed and rest The client's physical
activity is getting a little
bit inactive since she does

Client takes a bath twice a day.
Cuts her nails whenever needed.
Brushes her teeth twice a day.
HYGIENE
The client is not engaged in any form The client is not engaged Interpretation:
of vices. in any form of vices.
SUBSTANCE ABUSE
SLEEP and REST Client usually sleeps 7-9 hours a day.
She watches tv, take a bath before she
goes to bed. The client said that she
feels satisfied and refreshed when she
wakes up.
not have a routine
exercise not like before
her hospitalization.
Analysis:
People often define their
health and physical
fitness by their activity
because mental well-
being and the
effectiveness of body
functioning depend
largely on their mobility
status. The ability to
move without pain also
influences self-esteem
and body image.
(Fundamentals of
Nursing 8th edition by
Kozier and Erbs p. 1106)
Bed bath is being done Interpretation:
because of her condition. The client is in good
hygiene.
Analysis:
Measure for personal
cleanliness and grooming
called personal hygiene,
promote physicaland
psychologicalwell-being.
Variousstudieshave
confirmedthatimproved
personalhygiene
practicesreduce
illnessrates. (Larson and
Aiello, 2001).
The client is not engaged
in any form of vices.
Client said that she sleeps Interpretation:
for around 6 hours and The client has been
sometimes it is experiencing disturbance
interrupted whenever she in sleeping during
needs to take medications episodes of pain and
or when they take her interruptions.
vital signs. Sometimes
 her sleep is disturbed by Analysis:
the pain in her operation Sleepingcanbe altered if
site. theclient feels pain in
her body. Adultsneed 7 to
9 hoursof sleep at
night(National
SleepFoundation, n.d.b).

• However, there is
individual variation
as some adultsmay be
able tofunction well with
6 hours of sleepand
others mayneed 10 hours
tofunction optimally.

(Fundamentalsof
Nursing 8th edition
Vol. 2 by Kozier and
Erb, p.1168)

The client is single so she is not
sexually active.
The client is not engaged Interpretation:
in any sexual activity. The client is happy being
single and has no
problem regarding not
having sexual activity.

Analysis:
According toSigmund
SEXUAL ACTIVITY Freud’spsychosexual
development. The
genital Stage is
characterized byenergy
directedtoward full
sexualmaturityand
function anddevelopment
of skills needed tocope
withtheenvironment.

V. PHYSICAL ASSESSMENT
(The client doesn’t want her inner part to be assessed, her chest, breast, abdomen
wasn’t assessed it is because the client has contraption, an improvised wound
drainage so she decided not to move any part of her body especially the chest part.
She is afraid that her wound drainage might accidentally be pulled out.)
Measurements
Findings Norms Interpretation
36.5-37.4o
Temperature 36.6 Celsius Normal
Celsius
Pulse rate 94 bpm 60-100 beats/min Normal
Respiratory rate 28 cpm 14-20 cpm Tachypnea
Blood pressure 120/80 mmHg 90-120/60-90 Normal
Pain Scale 6-tolerable No Pain

Body Parts
Has thick black
and gray hair
Clean scalp
equally distributed,
without any
thin, clean and
presence of
smooth scalp
dandruff,
Head without any Normal
normocephalic,
presence of
symmetrical, no
dandruff and lice.
lesions
No presence of
tenderness.
any depression and
tenderness
A restless
Looks slightly
behaviour is
uncomfortable Has
caused by some
guarding behavior
No signs of alterations in
in her chest
Face distress and human body
relaxed. functions. Which
Skin is moist, no
this can be a sign
superficial blood
of a health
vessels, no lesions,
condition.
Uniform in
Varies from light
temperature
to deep brown; Presence of big
from ruddy pink scars can be
Normal skin folds
to light pink; caused by serious
Generally uniform injury causing a
No tenderness,
Skin except in areas break in
masses
exposed to the continuity of the
sun; no abrasions skin that healed
Presence of big
or other lesions, and turned into a
scar in her ankle
uniform in scar.
(caused by Jeep
temperature
accident)
Nails are pink,
smooth, no
Nails are pink in
lesions, and with
color, smooth in
normal nail folds.
Nails texture, and has a normal
capillary refill of
2.3 seconds of
2-3 seconds.
capillary refill.

No presence of lies No presence of

in the head, with lies in the head,
Scalp Normal
lesions and clean, without any
wounds lesion
Eyes No presence of Sclera is white, Presence of white
 jaundice in the
sclera, With pink
conjunctiva, Pupils
are equally round
reactive to light
spots in the iris is
accommodation. Pink conjunctiva
a possible cataract
(Palpebral and
it is also because
Vision of 150/180 bulbar), PERRLA
it is accompanied
And sometimes pupils,
by dim and
experience dim
cloudy vision.
and cloudy vision.

Presence of White
spot in the client’s
Iris
Can hear sounds Sound is heard in
in both ears. both ears or is
Symmetrical on localized at the
both sides, same center of the head,
Ears size and shape, symmetry in Normal
patent ear holes shape and
and no presence of position, patent,
any swellings and no swelling and
discharge. discharge.

no nasal flaring, No discharge,

symmetrical in distinct borders,
Nose Normal
shape with distinct no nasal discharge
borders, no and nasal flaring
presence of lesions
No resistance of
extremities can be
caused by
Can move her
weakness or any
upper extremities
complications in
freely (on right
human skeletal
hand only)but her
system.
left arm cannot be
moved because of
Also, A limited
the surgery Able to move the
range of motion
Range of Motions certain part of the
may be caused by
cannot stay strong body
impaired
upon resistance, no
movement of
gross deformities,
extremity whether
(+) loss of range of
loss of resistance
motion in lower
or a post
extremities
operatively
patient.
VI. LABORATORY FINDINGS
VI. LABORATORY AND DIAGNOSTIC EXAM RESULTS
Chest X-Ray
Date: November 9, 2010

Findings:
Both lungs are clear
Heart is enlarged
Aorta is calcified
Diaphragm and sinuses are intact

Impression:
Cardiomegaly
Atheromatous Aorta

FNAB
Date: December 3, 2010

Pathologic Diagnosis:
Final Needle Aspiration Biopsy, Breast Mass, Left:
CELL FINDINGS CONSISTENT WITH DUCTAL CARCINOMA

Cross-Matching
Date: January 3, 2011
Patient's blood type: AB

Component: WB
Amount: 450cc
Blood type: AB
Rh: +

Type of Cross-Matching requested: Routine

Result of Cross-Matching:
MINOR
 Compatible
 No Hemolysis

MAJOR
 Compatible
 No Hemolysis

Hematology Test
Date: January 2, 2011

Hemoglobin: 120 -150g/L

122g/L
NORMAL

Hematocrit: 0.39-0.50 vol.%

.36 vol.%
NORMAL
WBC: 5-10x10/L
7.50x10/L
NORMAL

Differential Count
Segments: 0.40 - 0.60
0.67
ABNORMAL

Lymphocytes: 0.20 - 0.10

0.33
ABNORMAL

Hematology Test
Date: January 4, 2011

Hemoglobin: 120-150g/L
122g/L
NORMAL

Hematocrit: 0.39-0.50 vol.%

.37 vol.%
ABNORMAL

Urinalysis
Color: Yellow
Transparency: Clear
Reaction: Acidic
Sp. Gr. : 1.005
Albumin -
Sugar -

Microscopic
Epithelial cells: Few
Pus Cells: 0-1
RBC: 0-1

X-RAY; Chest (January 2, 2010)

Findings:
Both lungs cleared
Heart enlarged
Aorta calcified
Diaphragm & sinuses intact

Impression:
CARDIOMEGALY
ATHEROMATOUS AORTA
HEMATOLOGY (January 2, 2011)
WBC – 7.6 (5-10)
NEUTROPHILS- .65 (.40-0.70)
LYMPHOCYTES- .35 (.20-.40)
RBC- 5.0 (4-6 X 10)
HEMOGLOBIN - 143 (120-150)
HEMATOCRIT- .43 (.33-.48)
PLATELET- Adequate (150-350)
BLOOD GROUP- “AB” Rh+

HEMATOLOGY (POST-OP)(Jan.4,2011)
HEMOGLOBIN- 126
HEMATOCRIT- .37

VIII. PATHOPHYSIOLOGY(sham)

IX. ECOLOGIC MODEL

A. Hypothesis

In the case of our client, the host factors of the patient have a significant effect
on the client's predisposition for possible malignant carcinoma of the left breast.

B. Predisposing Factors

Host
-age- the client is 55 years old
-female
-family history of cancer
-the client is single
-the client is fond of eating meat products

Environment
The client is exposed to pollutants, personal habits like lack of exercise.
Stress regarding to personal problems

C. Ecologic Model
D. Analysis

We chose the wheel model because our problem focuses on the multiple factors that
predispose the client to have possible left breast carcinoma which are mainly possible
due to host factors based on the assessment and that the real cause still unknown.

Predisposing Factors

Host
Age- Cancer are age related because our cells change with time, becoming more
susceptible to genetic damage and less xapable of dealing with the damage when it
occurs. This is due to the reduction in the ability of our immune system to track down
and destroy abnormal cells as they appear. The body's diminished immune response
gives those cells time to evolve into a potentially lethal cancer (Cancer, The Role of
Genes, Lifestyle and Environment, Panno, p.38)

Family History of Cancer- Genetic predisposition with a familial tendency, are the
common factors of breast cancer. (Medical Surgical Nursing by Black p. 1710)

Stress- Can threaten a person's physiologic homeostasis. (Fundamentals of Nursing

by Kozier and Erbs p. 829)

Pollutants- Avoidance of industrial or chemical substance by working well-ventilated

aread and taking other safety measures decrease the risk from toxins. (Medical
Surgical Nursing by Black p. 1710)
 E. Conclusion
After analyzing the client's predisposing factors that affects her condition, we
conclude that familial history made a big contribution in the development of the
disease.

F. Recommendations

Educate and encourage the client the importance of eating a variety of nutritious
foods like fruits and vegetables and to adhere to the low salt low fat diet.

Inform the patient that follow-up check-up is important to have continuous

monitoring and care even after attainment of the course medical therapy. Through
constant visits as outpatient, the physician would still monitor the progress of the
therapeutic intervention availed by the patient.

Instruct the family to report any unusual signs and symptoms experienced by the
patient. This will help detect early signs and symptoms of recurrence of the disease.

X. PRIORITIZED LIST OF NURSING PROBLEMS

RANK NURSING PROBLEM JUSTIFICATION
ACUTE PAIN related to trauma
as manifested by chest to arm pain
• This problem is health threatening.

1
Subjective: It needs immediate action because the
> Pain scale of 6 out of 10 (1 being patient may experience infection (pain as a
the lowest and 10 being the highest) sign of infection).
• Resources are available to the client
Objective: and the nurse. The patient needs
> positive facial grimace appropriate care.
> guarding behavior on the affected
site
IMPAIRED SKIN INTEGRITY

2
related to surgical removal of
tissue as manifested by destruction
of skin layers

Subjective:
>
 “nagulatnalangakonawalanapalayu • This problem is health threatening.
ngisangdibdibko” It needs immediate action because the
patient may develop complications such as
Objective: infection.
• Resources are available to the client
> January 3, 2011 at 10:53 AM, she and the nurse.
undergone a surgical intervention for
her neoplasmic breast condition, A
modified Radical Mastectomy
removing the entire left breast, its
surrounding tissues and nearby
lymph nodes affected by the cancer
cells.

> positive that her left breast was

then removed (as seen in physical
assessment)
IMPAIRED PHYSICAL
MOBILITY related to • This problem needs immediate
neuromuscular impairment as action because the patient may feel that she
manifested by limited range of cannot perform activities by her own (or

3
motion. inability to perform self-care activities).
• Resources are available to the client
Subjective: and the nurse.
>“minsanpaggumagalawakomasakit
eh.”

Objective:
> The client is advised to stay on bed
and rest because of her condition.
DISCHARGE PLAN

DISCHARGE GOALS

 Dealing realistically with situation.

 Complications prevented/minimized.
 Exercise regimen initiated.
 Disease process, surgical procedure, prognosis, and therapeutic regimen.
 Plan in place to meet needs after discharge.

MEDICATIONS
 Keep a list of your medicines dosage and when to take them.
 Do not take any medicines that are over the counter or are not prescribed by
your physician.
 With regards to vitamins or food supplements you need to consult your
physician first.
  Antibiotics were given to fight or prevent an infection.
 Always take exactly as ordered by your health care provider.
 You must finish the course of antibiotic treatment.

EXERCISE

Rest is essential after surgery. Slowly start to do more each day. Rest with your arm
up on a pillow to decrease pain and swelling. You may start early ambulation little by
little.

TREATMENTS/THERAPY

Treatments are usually in the form of medications. Your health care provider might
also tell you to undergo radiation therapy. Radiation may help kill cancer cells that
were left and keep these cancer cells from spreading.

HEALTH TEACHING

 When you are allowed to bathe or shower, carefully wash your stitches with
soap and water. Afterwards, put on a clean bandage. Change your bandage
anytime it gets wet or dirty.

 You may ask other's assistance if you cannot do it by yourself.

 Do a monthly breast exam on your other breast.

 You may also have your mammogram taken regularly.

OUT PATIENT FOLLOW-UP

Keep all appointments with your health care provider. Ask your caregiver when you
should return to have your wound checked, drain taken out and stitches removed.

Contact your health care provider if:

• Your skin is swollen, itchy or has rash.

• Your bandage becomes soaked in blood.
• You have discharge or pain in the area where the drain was inserted.
• You have trouble breathing.
• Your arms feel warm, tender, and painful. It may look swollen and red.

DIET
Eat foods that are high in fiber and that are low in calories and cholesterol. Also drink
plenty of water and fruit juices.

SPIRITUAL ACTIVITIES
Encourage patient to continue her faith (her being a prayer warrior) and to remember
that God is always with us.