Case Study Mastectomy Revised

Case Study Of
Breast Cancer
In Partial Fulfillment Of the Requirements

For the Degree of Bachelor Of Science In Nursing
Submitted by:
BSN III- Batch 2017
Borre, Jessa Anne
Gervacio, Jonah Micah
Mangalus, Maribel
Pastrana, Izza Mae
Submitted to:
Ms. Khristine Gay Cunanan
Clinical Instructor
October 22, 2015
Present History of Illness :

As for her present illness, one week prior to admission, the patient felt a mass on her right upper
breast and seek for medical attention.After having an examination on her breast, the physician advance to
have a biopsy on her right upper breast. Without any hesitation the patient agreed to the said operation.
The patient has Stage 2 hypertension and Type 2 Diabetes Mellitus for unknown cause.
Anatomy and Physiology
The breast is a mass of glandular, fatty and connective tissue. The breast is made up of:
lobules glands that produce milk
ducts tubes that carry milk from the lobules to the nipple
fatty and connective tissue surrounds and protects the ducts and lobules and gives shape
to the breast
areola the pink or brown, circular area around the nipple that contains small sweat
glands, which release (secrete) moisture as a lubricant during breast-feeding
nipple the area at the centre of the areola where the milk comes out
Ligaments support the breast. They run from the skin through the breast and attach to muscles on
the chest.
There are several major nerves in the breast area, including nerves in the chest and arm. There
are also sensory nerves in the skin of the chest and axilla.
The breast lymph nodes include:
supraclavicular nodes above the collarbone
infraclavicular (or subclavicular) nodes below the collarbone
axillary nodes in the armpit (axilla)
internal mammary nodes inside the chest around the breastbone (sternum)
Function
The breasts main function is to produce, store and release milk to feed a baby. Milk is
produced in lobules throughout the breast when they are stimulated by hormones in a womans
body after giving birth. The ducts carry the milk to the nipple. Milk passes from the nipple to the
baby during breast-feeding.
Diet
Exercise
- Increase food high

in Protein and Fiber.
- Daily Exercise by
means of
walking(Passive).
Breakfast
- two eggs
- 1/2 cup of mixed
vegetable
- 1 cup of raspberrie
juice.
Lunch :
>Stuffed baked
potato made with:
-1 whole potato
(skin and flesh)
-2 ounces broccoli,
steamed
-1 ounce cheddar
cheese
-2 tablespoons lowfat ranch dressing
-2 slices bacon,
crumbled.
Post Operative
Intervention.
Dependent :
PAIN :
- Assess for facial
-Avoid strenuous
grimace, Irritability.
activity(heavy lifting)
- assess for location
and vigorous
and intensity of
exercise(Jogging,Riding pain.
a bicycle and other out
> Encourage to use
door games like
relaxation
basketball, soccer
techniques (Deep
etc.)until the stitches
breathing exercise
are removed.
and listening in soft
music).
SKIN INTEGRITY
and INFECTION :
- Assess for redness,
Itchiness and
numbness around
the wound.
> Keep the area
clean and dry.
> Use appropriate
wound covering.
( Gauze pad with
saline water).
Independent :
- Give prescribed
medication.
(Mefenamic Acid)
Discharge Plan
Health Teaching.
>Perform Deep
Breathing exercise to
reduce pain.
> -Avoid strenuous
activity(heavy lifting)
and vigorous
exercise(Jogging,Riding
a bicycle and other out
door games like
basketball, soccer
etc.)until the stitches
are removed.
- Early Ambulation.
> Fast recovery.
> Encourage an
increase in protein and
calorie intake.
- To aim time wound
healing.(2-3 weeks)
> Observe aseptic
technique in cleansing
the area.
>Instruct proper
disposal of soiled
dressing.
-To prevent infection.
BLOOD CHEMISTRY
Is defined simply as identifying the numerous chemical substances found in the blood.
The analysis of these substances will provide clues to the functioning of the major body
systems.
Fasting Blood Sugar (FBS)

- is the test most commonly used to diagnose diabetes. It measures blood glucose levels
after a period of fasting, usually at least eight hours without food or liquid (except water).
FBS (Hexokinase)
Creatinine
Sodium
Potassium
Result
5.59 mmol/L
66.00 umol/L
139.20
4.20mmol/L
Normal Values
3.89-5.49 mmol/L
45-84
Interpretation
Increase
Normal
3.50-5.30
Normal
Interpretation:
- When fasting the hormone glucagon is stimulated and this increases plasma glucose
levels in the body. Body produces insulin to rebalance the increased glucose levels.
COMPLETE BLOOD COUNT

is a blood test used to evaluate your overall health and detect a wide range of disorders,
including anemia, infection and leukemia. A complete blood count test measures several
components and features of your blood, including: Red blood cells, which carry oxygen.
Prothrombin Time is a blood test that measures how long it takes blood to clot.
Result
Neutrophils
Lymphocytes
Monocyte
Eosinophils
Basophil
Prothrombin Time
Pt. control
% Activity
INR
Alk. Phosphate
SGOT/AST
SGPT/ALT
42%
43.80%
9.10%
5.30%
0.80%
12.10 sec.
14.10 sec
>150
0.82
83 u/L
28 u/L
46 u/L
Normal Values
34.00-71.00
19.00-52.00
5.00-12.00
1.00-7.50
0.00-1.00
12.60-15.20
Interpretation
Normal
Normal
Normal
Normal
Normal
Decrease
0.80-1.20
35-104
0.0-24.0
0.0-34.0
Normal
Normal
Normal
Normal
Interpretation:
- Blood clots is more quickly than expected because of Vitamin K supplementation and
Fresh frozen plasma transfusion
PLATELET COUNT
Is a lab test to measure how many platelets you have in your blood. Platelets are
parts of the blood that help the blood clot.
Red Blood Cells
The blood cells that carry oxygen. Red cells contain hemoglobin and it is the
hemoglobin which permits them to transport oxygen (and carbon dioxide).
Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the
body's tissues and returns carbon dioxide from the tissues back to the lungs.
Hematocrit is a blood test that measures the percentage of the volume of whole blood that is
made up of red blood cells.
WBC
RBC
Hemoglobin
Hematocrit
Mean Corpuscular Vol
Mean Corpuscular Hb
Mean Corpuscular
HbConc
RBC Distri Width
Platelet
Mean Platelet Vol
Result
5.26x10 g/L
5.72x10 12/L
158.00 g/L
0.46
80-90
27.60%
34.10%
12.50%
Adequate
10.10 L
Hematology
Normal Values
3.98-10.04
3.93-5.22
112.00-157.00
0.34-0.45
79.40-94.80
25.60-32.20
32.20-35.50
Interpretation
Normal
Increase
Increase
Increase
Normal
Normal
Normal
11.60-14.60
Normal
6.50-12.00
Normal
Interpretation:
- red blood cell production increases to compensate for chronically low blood oxygen
levels due to poor heart or lung function.
Interpretation:
- increased demand for the oxygen-carrying capacity of red blood cells at higher altitudes
where there is decreased oxygen concentration in the atmosphere.
ULTRASOUND
-
sound or other vibrations having an ultrasonic frequency, particularly as used in

medical imaging.
ULTRASOUND OF THE BREAST
The breast parenchyma is homogeneous.

The clinically palpable hard mass at the right 9-10 oclock gone B position sonographically
corresponds in a microlobulated, markedly hypoechoic, taller-than-wide, solid focus punctate
calcifications. It measures 2.06 x 1.88 x 2.93 cm. No significant internal vascularity was noted.
A 0.41 x 0.43 cm. small cyst is seen in the right 12 oclock zone A position.
No focal lesions seen in the left.
The right nipple is inverted. The left nipple is unremarkable.
There is a 1.69 x 2.06 x 1.54 cm. ovoid hypoechoic focus in the right axillary region, likely
enlarged lymph node.
The left axilla is unremarkable.
RADIOGRAPHY
Is an imaging technique that uses electromagnetic radiation other than visible light,
especially X-rays, to view the internal structure of a non-uniformly composed and opaque
object such as the human body.
RADIOGRAPHIC REPORT
There are no active lung parenchymal infiltrates.
The heart is enlarged with a cardiothoracic ratio of 0.6.
The trachea is midline.
The costophrenic angles and hemidiaphragms are intact.
The rest of the osseous structures and the soft tissues are unremarkable.
IMPRESSION:
NO SIGNIFICANT CHEST FINDINGS. No abnormal results noted.
MAMMOGRAM
-
An X-ray of the breast that is taken with a device that compresses and flattens the
breast. A mammogram can help a health professional decide whether a lump in the breast
is a gland, a harmless cyst, or a tumor.
MAMMOGRAM REPORT
Craniocaudal and mediolateral oblique views on both were obtained.

These are baseline mammogram.
Report of bilateral breast ultrasound done 10/8/15 was reviewed.
FINDINGS
There is moderately dense fibrograndular tissue with obscured nodularities.
There is a mass density with obscured and speculated borders and internal microcalcification in
the right upper outer quadrant.
The right nipple is retroverted.
An enlarged node is seen in the right. Unenlargednode are also seen bilaterally.
IMPRESSION:
RIGHT UPPER OUTER QUADRANT MASS WITH RIGHT AXILLARY
LYMPHADENOPATHY.
FINDINGS AS NOTED ABOVE, SEE RECOMMENDATION BELOW.
BI-RADS: CATEGORY 5- Highly suggestive of malignancy, appropriate action should be taken
RECOMMENDATION:
Follow-up per established guidelines.
-
ELECTROCARDIOGRAPHIC/ECG
- Is a test that checks for problems with the electrical activity of your heart.
An EKG shows the heart's electrical activity as line tracings on paper. The spikes and
dips in the tracings are called waves. The heart is a muscular pump made up of four
chambers.
Left ventricular hypertrophy is a condition in which the muscle wall of heart's left pumping
chamber becomes thickened
ELECTROCARDIOGRAPHIC REPORT
Rhythm:
SINUS
QRS Axis:
PR Interval:
0.16
QRS
Rate Arterial: 80
Interpretation:
NORMAL SINUS RHYTHYM
NORMAL AXIS
LEFT VENTRICULAR HYPERTROPHY
NON-SPECIFIC WAVE CHANGES
+50
0.08
Ventriculars: 80
QT:
0.40

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Case Study Of

In Partial Fulfillment Of the Requirements

October 22, 2015

Present History of Illness :

Anatomy and Physiology

lobules glands that produce milk

The breast lymph nodes include:

supraclavicular nodes above the collarbone

infraclavicular (or subclavicular) nodes below the collarbone

axillary nodes in the armpit (axilla)

- Increase food high

Fasting Blood Sugar (FBS)

COMPLETE BLOOD COUNT

sound or other vibrations having an ultrasonic frequency, particularly as used in

ULTRASOUND OF THE BREAST

The breast parenchyma is homogeneous.

Craniocaudal and mediolateral oblique views on both were obtained.

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