Modified Radical Mastectomy

In a modified radical mastectomy, the entire breast is removed, including the skin, areola and nipple, as well as most of the lymph nodes in the armpit area. Modified radical mastectomy is usually recommended if the tumor is large and cancer has already spread to the lymph nodes.

http://www.mayoclinic.org/breast-cancer/radicalmastectomy.html
MOA: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) chemically related to indomethacin and tolmetin. Ketorolac tromethamine is a racemic mixture of [-]S- and [+]R-enantiomeric forms, with the S-form having analgesic activity. Its antiinflammatory effects are believed to be due to inhibition of both cylooxygenase-1 (COX-1) and cylooxygenase-2 (COX-2) which leads to the inhibition of prostaglandin synthesis leading to decreased formation of precursors of prostaglandins and thromboxanes from arachidonic acid. The resultant reduction in prostaglandin synthesis and activity may be at least partially responsible for many of the adverse, as well as the therapeutic, effects of these medications. Analgesia is probably produced via a peripheral action in which blockade of pain impulse generation results from decreased prostaglandin activity. However, inhibition of the synthesis or actions of other substances that sensitize pain receptors to mechanical or chemical stimulation may also contribute to the analgesic effect. IND: For the short-term (~5 days) management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting.
Cefoxitin Antibiotic, Cephalosporin (Second Generation) I: MOA: Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. NR:Administer around-the-clock rather than 4 times/day, 3 times/day, etc, (ie, 12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum levels; modify dosage in patients with renal insufficiency; can be administered IVP over 3-5 minutes at a maximum concentration of 100 mg/mL or I.V. intermittent infusion over 10-60 minutes at a final concentration for I.V. administration not to exceed 40 mg/mL

http://drugsarea.com/Dets-Drugs/Cefoxitinpd.html Ciproloxacin
I: Treatment of documented or suspected infections Antibiotic, Ophthalmic; Antibiotic, Quinolone

MOA:Inhibits DNA-gyrase in susceptible organisms; inhibits relaxation of supercoiled DNA and

promotes breakage of double-stranded DNA NR: Hold antacids for 2 hours after giving

Ketorolac Nonsteroidal Anti-Inflammatory Agent (NSAID) I:Short-term (<5 days) management of pain; first parenteral NSAID for analgesia; 30 mg provides the analgesia comparable to 12 mg of morphine or 100 mg of meperidine MOA:Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclo-oxygenase, which results in decreased formation of prostaglandin precursors

Nursing Implications Monitor for signs of pain relief, such as an increased appetite and activity
Nubain Analgesic, Narcotic I:Relief of moderate to severe pain; preoperative analgesia, postoperative and surgical anesthesia, and obstetrical analgesia during labor and delivery

Observe patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation; observe for narcotic withdrawal
NR:

MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the
perception of and response to pain; produces generalized CNS depression Metoclopramide Gastrointestinal Agent, Prokinetic

Dopaminergic blocking agent gastrointestinal emptying (delayed) adjunct peristaltic stimulant antiemetic
I: Symptomatic treatment of diabetic gastric stasis, gastroesophageal reflux; prevention of nausea associated with chemotherapy or postsurgery and facilitates intubation of the small intestine MOA: Dopaminergic blocking agentsGastrointestinal emptying (delayed) adjunct; peristaltic

stimulant: Exact mechanism of action is unknown; however, it is believed that metoclopramide inhibits gastric smooth muscle relaxation produced by dopamine, thus enhancing cholinergic responses of the gastrointestinal smooth muscle. Accelerates intestinal transit and gastric emptying by preventing relaxation of gastric body and increasing the phasic activity of antrum. At the same time, this action is accompanied by relaxation of the upper small intestine, resulting in an improved coordination between the body and antrum of the stomach and the upper small intestine. Decreases

reflux into the esophagus by increasing the resting pressure of the lower esophageal sphincter and improves acid clearance from the esophagus by increasing amplitude of esophageal peristaltic contractions AntiemeticDopamine antagonist action raises the threshold of activity in the chemoreceptor trigger zone and decreases the input from afferent visceral nerves. {01} High doses of metoclopramide have been found to antagonize 5-hydroxytryptamine (5-HT) receptors in the peripheral nervous system in animals. {61} {62}

Sunday, October 05, 2008

Philippines breast-cancer incidence rate Asias highest

Breast cancer is the leading killer of women ages 35 to 54 worldwide. More than a million develop the disease without knowing it, and almost 500,000 women die from it every year. In Asia, the Philippines has the highest incidence rate of breast cancer and is considered to have the ninth highest incidence rate in the world today. These alarming statistics, obtained from reports of the International Agency for Research on Cancer, were cited by the World Health Organization (WHO) in a statement over the weekend. According to the WHO, approximately 70 percent of breast cancers occur in women with none of the known risk factors. Only about 5 percent of breast cancer are inherited. In the 1940s, the risk for breast cancer was 1 in 22. Today, it is 1 in 18. With the prevalence of breast cancer consistently rising for the past 30 years, particularly in developing countries, the organization said, supposed authorities in the field are baffled why. It also cited a study by Cancer Research UK that had found a significant explanation. Using detailed analysis of 47 published studies with nearly 150,000 participants from 30 countries, researchers found that the increase in incidence rate of the disease in Western countries is caused by women having fewer children and breastfeeding for shorter periods of time. This conclusion, the WHO said, reinforces the long held view that hormonal and reproductive factors are vital in the development of breast cancer.

http://archives.manilatimes.net/national/2008/oct/05/yehey/metro/20081005met6.html

What is Breast Cancer?

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It is considered a heterogeneous diseasediffering by individual, age group, and even the kinds of cells within the tumors themselves. Obviously no woman wants to receive this diagnosis, but hearing the words breast cancer doesnt always mean an end. It can be the beginning of learning how to fight, getting the facts, and finding hope. Women in the United States get breast cancer more than any other type of cancer except for skin cancer. It is second only to lung cancer as a cause of cancer death in women. Each year it is estimated that nearly 200,000 women will be diagnosed with breast cancer and more than 40,000 will die. Approximately 1,700 men will also be diagnosed with breast cancer and 450 will die each year. The evaluation of men with breast masses is similar to that in women, including mammography.

TYPES OF BREAST CANCER

Types of Breast Cancer

Breast cancer type is categorized by whether it begins in the ducts or lobules, the organs responsible for breast milk production. Understanding the specific type of breast cancer can help you ask better questions and work with your physicians to get the best breast cancer treatments.

Ductal Carcinoma In-Situ (DCIS) DCIS is a type of early breast cancer confined to the inside of the ductal system. Infiltrating Ductal Carcinoma (IDC) IDC is the most common type of breast cancer representing 78% of all malignancies. These lesions appear as stellate (star like) or well-circumscribed (rounded) areas on mammograms. The stellate lesions generally have a poorer prognosis. Medullary Carcinoma Medullary carcinoma accounts for 15% of all breast cancer types. It most frequently occurs in women in their late 40s and 50s, presenting with cells that resemble the medulla (gray matter) of the brain. Infiltrating Lobular Carcinoma (ILC) Infiltrating lobular carcinoma is a type of breast cancer that usually appears as a subtle thickening in the upper-outer quadrant of the breast. This breast cancer type represents 5% of all diagnosis. Often positive for estrogen and progesterone receptors, these tumors respond well to hormone therapy. Tubular Carcinoma Making up about 2% of all breast cancer diagnosis, tubular carcinoma cells have a distinctive tubular structure when viewed under a microscope. Typically this type of breast cancer is found in women aged 50 and above. It has an excellent 10-year survival rate of 95%.

Mucinous Carcinoma (Colloid) Mucinous carcinoma represents approximately 1% to 2% of all breast carcinoma. This type of breast cancer's main differentiating features are mucus production and cells that are poorly defined. It also has a favorable prognosis in most cases.

Inflammatory Breast Cancer (IBC)

Inflammatory breast cancer is a rare and very aggressive type of breast cancer that causes the lymph vessels in the skin of the breast to become blocked. This type of breast cancer is called "inflammatory" because the breast often looks swollen and red, or "inflamed". IBC accounts for 1% to 5% of all breast

http://www.nationalbreastcancer.org/About-Breast-Cancer/Types.aspx

Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal carcinomas. Invasive means that the cancer has invaded or spread to the surrounding breast tissues. Ductal means that the cancer began in the milk ducts, which are the pipes that carry milk from the milk-producing lobules to the nipple. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs such as breast tissue. All together, invasive ductal carcinoma refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body. According to the American Cancer Society, more than 180,000 women in the United States find out they have invasive breast cancer each year. Most of them are diagnosed with invasive ductal carcinoma. Although invasive ductal carcinoma can affect women at any age, it is more common as women grow older. According to the American Cancer Society, about two-thirds of women are 55 or older when they are diagnosed with an invasive breast cancer. Invasive ductal carcinoma also affects men.
http://www.breastcancer.org/symptoms/types/idc/
NR: Parenteral doses of up to 10 mg should be administered I.V. push over 1-2 minutes; rapid boluses cause transient anxiety and restlessness followed by drowsiness; higher doses to be administered IVPB; dilute to 0.2 mg/mL (maximum concentration: 5 mg/mL) and infuse over 15-30 minutes (maximum rate of

infusion: 5 mg/minute); rapid I.V. administration is associated with a transient but intense feeling of anxiety and restlessness, followed by drowsiness Monitor periodic renal function test

Tramadol

Analgesic, Non-narcotic

I: Relief of moderate to moderately severe medical pain MOA: Binds to -opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of norepinephrine and serotonin, which also modifies the ascending pain pathway

NR: Avoid driving or operating machinery until the effect of drug wears off; tramadol has not been fully
evaluated for its abuse potential, report cravings to your physician immediately

Arcoxia is used for the following:

acute and chronic treatment of the signs and symptoms of osteoarthritis and rheumatoid arthritis management of ankylosing spondylitis relief of chronic musculoskeletal pain relief of acute pain to treat acute gouty arthritis

Your doctor will prescribe Arcoxia for you only after you have used other medicines for your condition and they have not been suitable for you Arcoxia belongs to a group of medicines called cyclooxygenase-2 (COX-2) specific inhibitors (also known as coxibs). The body produces two similar enzymes called COX-1 and COX-2. COX-1, among other functions, is involved with protecting the stomach, while COX-2 plays a role in joint inflammation and pain. Arcoxia reduces pain and inflammation by blocking COX-2, an enzyme in the body. Arcoxia does not block COX-1, the enzyme involved in protecting the stomach from ulcers. If any of the following symptoms: shortness of breath, chest pains or ankle swelling appear or worsen, stop your treatment with Arcoxia and consult a doctor, as soon as is practical.

Ineffective Role Performance | Nursing Care Plan (NCP) Rheumatoid Arthritis)

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Nursing diagnosis: ineffective Role Performance related to changes in ability to perform usual tasks; increased energy expenditure, impaired mobility Possibly evidenced by Change in structure or function of affected parts Negative self-talk, focus on past strength and function, appearance Change in lifestyle, physical ability to resume roles; loss of employment, dependence on significant other (SO) for assistance Change in social involvement; sense of isolation Feelings of helplessness, hopelessness Desired Outcomes/Evaluation CriteriaClient Will Psychosocial Adjustment: Life Change Verbalize increased confidence in ability to deal with illness, changes in lifestyle, and possible limitations. Formulate realistic goals and plans for future.

Nursing intervention with rationale: 1. Encourage verbalization about concerns of disease process and future expectations. Rationale: Provides opportunity to identify fears or misconceptions and deal with them directly. 2. Discuss meaning of loss or change to client and SO. Ascertain how client views self in usual lifestyle functioning, including sexual aspects.

Rationale: Identifying how illness affects perception of self and interactions with others will determine need for further intervention or counseling. 3. Discuss clients perception of how SO perceives limitations. Rationale: Verbal and nonverbal cues from SO may have a major impact on how client views self. 4. Acknowledge and accept feelings of grief, hostility, and dependency. Rationale: Constant pain is wearing, and feelings of anger and hostility are common. Acceptance provides feedback that feelings are normal. 5. Note withdrawn behavior, use of denial, or overconcern with body and changes. Rationale: May suggest emotional exhaustion or maladaptive coping methods, requiring more in-depth intervention and psychological support. 6. Set limits on maladaptive behavior. Assist client to identify positive behaviors that will aid in coping. Rationale: Helps client maintain self-control, enhancing self-esteem. 7. Involve client in planning care and scheduling activities. Rationale: Enhances feelings of competency and self-worth and encourages independence and participation in therapy. 8. Assist with grooming needs, as necessary. Rationale: Maintaining appearance enhances self-image. 9. Give positive reinforcement for accomplishments. Rationale: Allows client to feel good about self. Reinforces positive behavior. Enhances confidence. 10. Refer to psychiatric counseling, such as psychiatric clinical nurse specialist, psychiatrist/psychologist, and social worker. Rationale: Client/SO may require ongoing support to deal with long-term debilitating process.