INFILTRATING DUCTAL

CARCINOMA

Nursing Management of a Female Surgical Ward

Patient with Infiltrating Ductal Carcinoma in Right Breast

Presented by: Puyo, Shurop Jaynen P. Zinampan, Alizza J. Our Lady of Fatima University, Quezon City

INFILTRATING DUCTAL CARCINOMA

PATHOPHYSIOLOGY

HISTORY OF THE PATIENT

Past Medical History : ( + ) Hypertension and ( + ) Bronchi asthma Diagnosed with Stage IIA clear carcinoma of the right breast. Surgery: Undergo in the year January of 2012.

Present condition started about 10months

Prior to admission: Palpated a ( + ) Mongo sized mass on right breast. Characteristics: Movable and Non-tender 5months Prior to admission: Gradual increase in size of breast mass now measuring 2cm in diameter, soft, non tender, movable. ( - ) Nipple discharge, ( - ) Dimpling, ( - ) Changes in skin characteristic.

4 months Prior to Admission:

Increase mass with 2cc in size. Mammogram revealed an ovoid density with speculated margin on the upper quadrant of her (right) breast. Breast Imaging Reporting and Data Systems(BIRADS), Chromaffin Granule Amine Transporter (microbiology) C/GAT 4c. Infiltrating Ductal Carcinoma revealed by excision biopsy.

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NURSING PHYSICAL ASSESSMENT

Nursing Physical Assessment to A.M.Cs

Alert and Oriented person, place and time. Height: 51 feet Weight: 65 kg. Ambulatory Incapable of performing independent activities of daily living. Vital Signs: Temperature: 36.5 adegrees centigrade, Pulse rate: 75 beats per minute Respiration: 21 cycles per minute Blood pressure 130/80.

 Head

: Symmetrical Chest assessment: lungs are clear, heart is not enlarged. Aorta is not dilated, to test visualized chest structure are remarkable the impression was no significant chest findings Gag reflex or Swallowing: Normal Surgical incision in inguinal area: Intact and ( - ) Erythema

Diet: DAT - high protein and high caloric diet.

Physical Appearance: Thin, Dry skin, Pale Capillary level- Normal Urine output- 600 ml

Hygiene can take a self bath and dress

Bowel sound: ( - )

( + ) fatigue and ( + ) general weakness.

Full range of motion activity level: Sedentary Muscle strength-Normal

RELATED TREATMENTS

RELATED TREATMENTS

The patient has an allergy in chicken and seafood. The patient was ambulatory and the order of physician on her dietary routine was diet as tolerated (DAT) and to stay on a low cholesterol and low salt foods. The Council on food and nutrition of the American Medical Association Mosby (2008) states that protein helps heal and rebuild tissues. During treatment, eat half a gram of protein for each pound you weigh. So if you weigh 160 pounds, try to get 80 grams of protein in your diet each day. The patient medication from March 6, 2012 was Neobloc 50mg/tab once a day shifted. On March 7, 2012 she had prescribed by the physician on her medication from Metoprolol to Amlodipine 5mg tab once a day to reduce peripheral vascular assistance and blood pressure, restoring blood flow. And she was advised to promptly to report unexplained muscle pain, weakness especially when associated with fever. The patient took also Celecoxib 200mg/cap twice a day. To inhibit prostaglandin synthesis, impeding cyclooxygenase-2 (COX-2), to produce anti-inflammatory, analgesic, and antipyretic effects. The patient undergo an intermediate which surgical procedure with intermediate clinical predictions of developing preoperative pulmonary complications. (2005) special procedure excision mass left inguinal area and special procedure excision of the heart mass right in January 2012 to remove the formed mass in the area. Mosby ( 2008) surgery can disrupt the bodys normal rhythm and can often cause fatigue that lasts longer than you may expect. General anesthesia and after-surgery discomfort, pain medication, and restricted activity can also cause fatigue.

NURSING CARE PLAN

NURSING CARE PLAN

A.M.Cs nursing diagnosis is fatigue related to decrease metabolic energy production, side effects of medication, and radiation therapy as manifested by impaired ability to concentrate, decreased performance and lethargic appearance Davis (2008). Mosby (2008) Radiation is often followed by fatigue that can last a few weeks or months. When you're getting radiation, you may be weak from earlier surgery or chemotherapy. The daily demands of radiation therapy change your schedule and make you feel even less energetic and the result can be fatigue. Radiation therapy to a large area of bone can lower your red blood cell and immune cell counts, especially if you're getting chemo therapy at the same time. low blood cell counts can contribute to fatigue. Patients appearance was trembling, with dry skin. Poor nutrition also may play a role in causing fatigue. Eating less and not getting enough of the nutrients she need because of treatment side effects can cause fatigue. The short term goal after nursing interventions was to improve the sense of energy, identify basis of fatigue, the patient could perform activity of daily living and desired activities at level of the ability. Nursing interventions for the patient include assessing the vital signs to evaluate fluid status and cardiopulmonary response to activity. Determine presence of sleep disturbances. Fatigue can be a consequence of sleep deprivation. Establish realistic activity goals with client and encourage forward movement enhance commitment to promoting optimal outcomes. Assist with self-care needs. Encourage to increase her appetite for the patient is to encourage participation in planned exercise programs. The rationale behind this is to increase the endurance and stamina and to lower the fatigue. Mitchelle(2007) the role of the exercise as a helpful intervention has been supported by several controlled trials. The patient needs adequate caloric and protein to reach the ideal weight. The rationale behind this is that nutrients provide energy source, and regulate metabolic processes. Carpenito(2000) and decreases activity tolerance Brunner/Suddarth (2010).

RECOMMENDATIONS

The patient should follow-up with her physician regarding surgery and post-cancer treatment as scheduled. The patient was also advised having a diet as tolerated to improve her weight gain served at room temperature. NANDA (2008) suggested that limit exposure to high temperature and humidity, which may negatively impact energy level. Encourage client to develop assertiveness skills, to prioritize goals and activities, to learn to delegate duties or tasks. She also advised for a continuous intake of her medications such as amlodipine and celecoxib as ordered by her physician. According to Mosby( 2008) In some cases, fatigue that isn't helped by other medicines or lifestyle changes may respond to stimulant medicines. You may want to ask your doctor about some of these options: caffeine, Ritalin (chemical name: methyphenidate), Dexadrine (chemical name: dextroamphetamine), or Provigil (chemical name: modafinal). Work closely with your doctor to find the best medicine for your situation try a catnap. Beware of long naps, though. You might end up wide awake in the middle of the night. Daytime naps should be no more than 30 minutes so you won't fall into deep sleep. (Waking up groggy usually means you've napped too long.) If you find you need a nap every day, take it at a regularly scheduled time, but try not to nap after 2 p.m. Keep to a routine. Go to bed at the same time each night and get up at the same time each morning. Don't stay in bed after you wake up. Make sure you get enough sleep and that you sleep for the same amount of time each night. Keep a diary of how you feel each day. Keep a daily diary of your fatigue to identify when it's the worst and when it's least troubling. Plan activities during the times you have the most energy. Schedule rest periods when your energy is lowest. Make sure you balance each activity with a rest period if you need it. Organize each day. Figure out what you have to do and when you need to do it. Pacing yourself helps to conserve your energy. Ask for help. Accept the offers of help and goodwill from family and friends. If no one has offered to help and everyone seems too busy, ask for what you need even if asking is one of the hardest things for you to do. Get help with little things: taking out the trash, folding the laundry, or paying bills. Keep a list of things you need done so when people ask what they can do, you can give them the list. Join a support group. Sharing your feelings with others can ease the burden of your fatigue and give you more ideas about how you can cope with the condition. Your nurse or doctor can put you in touch with a support group in your area. For an online support group, visit the Breastcancer.org Discussion Boards. Keep lists and make notes to remind you of important things if your memory and concentration are affected by fatigue. Also, give yourself more time for activities that take concentration. Be kind to yourself. If you're fatigued, don't beat yourself up because you can't do what you're "supposed" to do. That browbeating takes energy you can't afford to waste and can add to depression. Do nice things for yourself and give yourself permission to rest and recover, for as long as it takes.

ACKNOWLEDGEMENT

We would like to thank Armed forces of the Philippines Medical Center for providing us the opportunity to enhance our skill and intellectual ability in order to fulfill our

REFERENCES:

Thibodeau, G., PhD & Patton, K., PhD (2008) The medical-surgical nursing 18th edition Chapter 5 p.183-185. Berman, A., Snyder, S., Kozier, B., & Erb, G. (2008) Fundamentals of Nursing (8th edition) Lippincott, W. & Wilkins (2006) Nursing Drug Handbook (26th edition) Doenges, M., & Moorhouse, M., ( 2010) Nurses Pocket Guide (12th edition) p. 983 and p.351-356 Brunner and Suddarths (2010) Medical-Surgical Nursing (12th edition) Mitchelle (2007) Medical-Surgical Nursing (12th edition) Turnbull and Rahman (2008) Medical-Surgical Nursing (12th edition)