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Ductal Breast Cancer By: Guerrero, Justin Angelo A. Ignacio, Vincent Paul C. Lopez, Jenny Ann V.

Ductal Breast Cancer

By:

Guerrero, Justin Angelo A. Ignacio, Vincent Paul C.

Lopez, Jenny Ann V. Iman, Quia Rose L.

Igot, Marygrace D.

Lim, Angelica A.

ACKNOWLEDGEMENT The completion of this case study would not be possible if not because of the

ACKNOWLEDGEMENT

The completion of this case study would not be possible if not because of the kind and generous people who helped and encouraged the presenters. And with this, they would like to extend their gratitude to these people.

To the station 3 staff nurses of Mindanao Medical Center Hospital, who had accommodated the students, and for guiding them in

every step of the exposure.

To Client ESA and her family, for the cooperation, hospitality and being responsive whenever the students have inquiries. With deep

gratitude they thank you for trusting them with confidential

information regarding her condition.

To the case presenters’ families for their munificent support to the students not just financially but

To the case presenters’ families for their munificent support to

the students not just financially but also in the emotional aspect

as well, thank you for giving them the comfort and inspiration

that they needed in completing this Case Study.

And above all, to our gracious and heavenly Father, for always keeping the students safe in this undertaking, guiding

them in every decision-making and being the source of Divine

wisdom, knowledge and strength. Thank you for keeping the case presenters strong and positive all the times.

  • Case Presenters



OBJECTIVES

General objectives

At the end of the study, the client and the family, and the readers, will be able to understand the nature & possible

factors responsible for the development and progression of

Ductal Breast Cancer. The study is also directed to enhance knowledge of possible treatment/management options.

Specific Objectives  Readers will be able to understand the nature of ideal versus evidenced-based development
Specific Objectives
Readers will be able to understand the nature of ideal versus
evidenced-based development of Ductal Breast Cancer.
Readers will be able to understand the possible factors that will
lead to the development of the said illness.
Educate the readers about the importance of prompt and ideal
management and referral of their illnesses to prevent
development of further complications.
Help the readers become aware of their potentials to help
reduce risks of developing of the said illness.
Encourage the readers to involve themselves in the promotion of
health and increase their commitment to develop skills and
knowledge in the management of this illness through health
education.
Introduction  Jenny Ann V. Lopez

Introduction

Jenny Ann V. Lopez

Ductal Carcinoma sometimes called infiltrating ductal carcinoma, is the most common type of breast cancer. About

Ductal Carcinoma 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 (breastcancer.org).

The incidence of Ductal carcinoma markedly increased from 5.8 per 100,000 wome in the 1970’s to 32.5 per 100,000 women in 2004 and then reach plateau. Approximately 25% of breast cancers diagnosed in the United States are Ductal carcinoma and over 60,000 women will be diagnosed in the US alone in 2015 (uptodate.com).

The Philippines has the highest incidence of breast cancer in Southeast Asia, and the ninth highest

The Philippines has the highest incidence of breast cancer in Southeast Asia, and the ninth highest in the world with 1 in every 13 Filipino women at risk of getting it in her lifetime. While the cause has yet to be pinpointed, medical experts have attributed this to several factors including the decision of many Filipino women not to have children or to delay marriage and having kids until they are

in their 30’s (inquirer.net).

With about 10,000 new cases discovered every year, the disease is already the most common form of cancer among Filipinos. Breast cancer is curable, but only if detected and treated

at an early age, i.e., stage 0 or stage 1, when the tumor is smaller

than the size of a peanut (12 cm’s or smaller). Currently, the 10-year

survival rate among Filipinas with breast cancer is only 40%, very

much lower than 80 to 98% in developed countries (lifestyle.mb.com).

Data Base  Quia Rose L. Iman

Data Base

Quia Rose L. Iman

 Name  Age  Gender  Address General  Santos City  Birth date 
Name
Age
Gender
Address
General
Santos City
Birth date
Birthplace
Health Insurance
Religion
Citizenship

ESA

77 yrs old

FEMALE

PRK. 8 Mirabueno Village Mabuhay,

May 8, 1941

Pampanga

Senior Citiz

Catholic

Filipino

 Educational Attainment  Dialect Spoken  Civil Status  Date/Time of confinement  Attending Physician
Educational Attainment
Dialect Spoken
Civil Status
Date/Time of confinement
Attending Physician
Admitting Diagnosis

Elementary Graduate

Tagalog, Bisaya Widowed July 24, 2018/09:52am

Dr. Cyril Banas

Anemia Secondary to Malignant Breast Cancer

(Ductal CA w/ Lung Metastasis) TC Pneumonia

Health History  Angelica A. Lim

Health History

Angelica A. Lim

Past Health History Patient ESA was born on May 08, 1941 at Purok 08 Mirabueno Village

Past Health History

Patient ESA was born on May 08, 1941 at Purok 08 Mirabueno Village Mabuhay General Santos City. She had twelve children and she gave birth to all of them in their home. Patients ESA gave birth to her first child when she was 18 years old. Patient ESA started to smoke when she was 17 years old and stopped when she was already 50 years old. Patient ESA verbalized that she loves to eat sinugbang karneand she also really likes to eat kinilaw.

Patient ESA had perceived herself as healthy, she was

physically active as she was fond of walking around visiting and making casual conversation with their relatives and people around them that lived nearby.

She is very kind and sweet mother and very friendly person, as all of the children

She is very kind and sweet mother and very friendly person, as all of the children we’re very close to them according to patient ESA’s daughter. Patient ESA’s left breast begin to swollen and tender as she is experiencing this signs and symptoms patient ESA decided to have a checkup at Mindanao Medical Center last February and as a result, she already knows that there is something wrong with her health.

Her daughter recommended her to take a MX3 and they

believe these are just simple illness and she says as well, that the signs and symptoms primarily relieved.

Present Health History Last July 24, 2018 she decided to have check-up because she frequently experience

Present Health History

Last July 24, 2018 she decided to have check-up because she frequently experience difficulty of breathing, back pain and feeling of

tiredness all the time but she can manage it. She was been admitted

immediately in Mindanao Medical Center (MMC) due to her

complaints. As verbalized “Gidala namo siya diri kay naglisod na gud siya ug hinga” (We brought her here because she really felt difficulty of breathing.)

Upon assessment, received patient lying on bed with IVF ongoing.

Awake, responsive, and she was very accommodating nodding and answering our questions. Her vital signs; blood pressure 140/90 mm/Hg, pulse rate 130bpm, respiratory rate 30cpm, temperature 37.5 degree

Celsius, oxygen saturation 97% and O2 via nasal cannula.

God.).
God.).

She lost appetite while in the hospital due to DOB as verbalized by the

patient. She was on moderate high back rest with strict aspiration precaution when eating. She verbalized “Bisan naa ko sakit dili man ko mawalaan ug paglaom ampo lang ko permi sa Ginoo mao wala ko nag guol kung maunsa ko kay wala man impossible sa Ginoo.” (Even if

I have an illness, I don’t lose hope, I always pray to God, I am not

worried of what may happen to me because nothing is impossible to

Family Health History According to Patient ESA’s daughter, her mother’s family had history of hypertension. She

Family Health History

According to Patient ESA’s daughter, her mother’s family had

history of hypertension. She stated that her older brother was diagnosed with kidney problem in 2016 and her older sister had

pneumonia earlier this year, other than that there were no other health

problems within the family in the past six months except from flu,

common cough and colds. Both parents of patient ESA have no history of Breast cancer. They believe in folk killer and prefer to consult manghihilot” if they got sick they just did self-medication. There were no surgical procedure done within their family.

Nursing Assessment  Gordon’s Assessment and Diagnostic Table  Physical Assessment

Nursing Assessment

Gordon’s Assessment and Diagnostic Table

Physical Assessment

Gordon’s Assessment and Diagnostic Table  Marygrace D. Igot

Gordon’s Assessment

and Diagnostic Table

Marygrace D. Igot

Health – Perception – Health - Management Pattern

Health Perception Health - Management Pattern

Problem Cues Inference Nursing Diagnosis Priority Rationale Subjective Cues: Pattern of regulating and integrating into family
Problem Cues
Inference Nursing
Diagnosis
Priority
Rationale
Subjective Cues:
Pattern of regulating
and integrating into
family process a
program for treatment
of illness and the
High 2
This is considered as a
Ineffective
“nagburot naman na last year iyang
totoy”.
“Gi inuman lang ug mx3 ma’am nag
gamay man pod sya.
High
2 priority
as
the
Family
patient’s
recovery
Therapeutic
depends
on
her
treatment
which
will
Regimen
“kay tigulang naman sya ma’am dli sequelae of illness that
be
decided
by
her
Management
napod kaya sa iyang lawas kung
operahan”.(because she’s already old
is unsatisfactory for
family.
meeting specific health
related to
ma’am and her body cannot handle it if goals.
family’s belief.
she will undergo an operation.)
“kay naglisod naman gud siya ug
hinga”. (because she really
experienced difficulty of breathing)
Reference:
Nurse’s pocket Guide
by:
Marilynn E. Doenges
Mary
Frances
Objective Cues:
Moorhouse
Hesitant to follow doctor’s order
Nutritional – Metabolic Pattern

Nutritional Metabolic Pattern

Subjective Cues: una kumpara before unlike now) eats less now) Objective Cues: -2 spoon full rice
Subjective Cues:
una
kumpara
before unlike now)
eats less now)
Objective Cues:
-2
spoon
full
rice

intake during lunch

Problem Cues

Inference

Nursing Diagnosis

Priority

Rationale

nutrients Imbalanced Nutrition: less Medium 1

body

requirements

decrease

This is considered as

a medium 1 priority

because client has

lost her appetite due to her condition. According to Diet health club if a single micronutrient is missing or is in short supply, it can cause

serious implications for the functioning of the entire body.

Intake of

insufficient to meet than

Dako gyud ko sa metabolic needs.

related

to

appetite

karon.(I was big Reference:

Nurse’s

pocket

gamay na lang Guide by:

gyud iyahang Marilynn E. Doenges kaon karon”(she Mary Frances

Moorhouse

Elimination Pattern

Elimination Pattern

Problem Cues Inference Nursing Diagnosis Priority Rationale Subjective Cues: No Problem Identified “nakaihi man ko normal
Problem Cues
Inference
Nursing Diagnosis
Priority
Rationale
Subjective Cues:
No
Problem
Identified
“nakaihi man ko normal
pareha kagahapon, karon sa
buntag naka duha nako ihi”.(I
urinate normally, I urinated two
times in the morning.)
“nakabawas man siya
kagahapon sa gabii kaisa”
(she defecates once yesterday
in the evening)
Objective Cues:
-
Urinates 3 times within 8
hours of duty.
-
Defecates once
Activity – Exercise Pattern

Activity Exercise Pattern

Problem Cues Inference Nursing Diagnosis Priority Rationale Subjective Cue: “Gidala namo siya diri kay naglisod na
Problem Cues
Inference
Nursing Diagnosis
Priority
Rationale
Subjective Cue:
“Gidala namo siya diri kay
naglisod na gud siya ug hinga”
(We brought her here because
Inspiration
and
or
Ineffective breathing
High 1
expiration
that
pattern
related
to
does
not
provide
difficulty
of
This is considered as a high
1 priority. It is a life
threatening condition that
requires immediate
she really
felt
difficulty
of
adequate
breathing
medical attention and
breathing.)
ventilation.
sometimes may lead to
death.
Objective Cue:
Reference:
- difficulty of breathing
Nanda
12t h editon
-elevated blood pressure of
by:
Doenges,
140/90mmHg
Moorhouse, Murr
-RR: 38cpm
- body weakness observed
-nasal cannula attached
Sleep – Rest Pattern

Sleep Rest Pattern

Problem Cues Inference Nursing Priority Rationale Diagnosis Subjective Cue: Sleeping promotes “ wala ko katarong tulog
Problem Cues
Inference
Nursing
Priority
Rationale
Diagnosis
Subjective Cue:
Sleeping promotes
“ wala ko katarong tulog kay
naglisod kog hinga”
(I can’t sleep well because
it’s difficult to breath)
Time-limited interruptions
Disturbed
sleep
Medium
healing
and
of
sleep
amount and
pattern
related
2
repairs
in
your
quality due to external
to
difficulty
of
body.
Sleep
factors.
breathing.
deficiency is linked
to an increase risk
Objective Cues:
of
high blood
--sleepy
Reference:
pressure, diabetes
-frequently sleeping
-fatigue
-weak
Nurse’s pocket Guide
by:
and
stroke
(nhlbi
2017)
Marilynn E. Doenges
Mary
Frances
Moorhouse
Cognitive – Perceptual Pattern

Cognitive Perceptual Pattern

Problem Cues Inference Nursing Priority Rationale Diagnosis Subjective Cues: A pattern of ease, relief Readiness to
Problem Cues
Inference
Nursing
Priority
Rationale
Diagnosis
Subjective Cues:
A pattern of ease, relief Readiness to
Low 1
Patient
ESA
“tong naglisod ko ug hinga nagpa admit ko and transcendence in enhance
participate and
kauban akoang anak”.(When I experienced
physical, psychospiritual, comfort
cooperate
to
difficulty of breathing I admitted here with my environmental, and/or
treatments
to
daughter).
social dimensions that
alleviate
her
“Kung magtindog ko ga patabang ko sa akoang can be strengthen.
anak ug kung mag ihi pod ko pauban ko
niya.”(When I stand I ask for help to my daughter
discomforts.
and when I urinate I also ask her for help.)
Reference:
Objective Cues:
Nurse’s pocket Guide
by:
-Relax and calm
-participates in comfort measure of choice
-allowing others to performed Tsb.
Marilynn E. Doenges
Mary
Frances
Moorhouse
Self – Perception – Self – Concept Pattern

Self Perception Self Concept Pattern

Problem Cues Inference Nursing Priority Rationale Diagnosis Subjective Cues: No Problem Identified Bisan naa ko sakit
Problem Cues
Inference
Nursing
Priority
Rationale
Diagnosis
Subjective Cues:
No
Problem
Identified
Bisan naa ko sakit dili man ko mawalaan
ug paglaom ampo lang ko permi sa Ginoo
mao wala ko nag guol kung maunsa ko
kay wala man impossible sa Ginoo. (Even if
I have an illness, I don’t lose hope, I always
pray to God, I am not worried of what may
happen to me because nothing is
impossible to God.)
Objective Cues:
Smiling
Accomodating
Role – Relationship Pattern Problem Cues Inference Nursing Priority Rationale Diagnosis ”paborito na siya sa iyang
Role – Relationship Pattern
Problem Cues
Inference
Nursing
Priority
Rationale
Diagnosis
”paborito na siya sa iyang
mga apo, mangdasok sila
No
Problem
Identified
sa iyaha kung naa
sya”(She is the favorite of
her grandchildren, they
would snuggle around her
if she’s with them)
Sexuality – Reproductive Pattern Problem Cues Inference Nursing Priority Rationale Diagnosis Subjective: No Problem Identified “Dugay
Sexuality – Reproductive Pattern
Problem Cues
Inference
Nursing
Priority
Rationale
Diagnosis
Subjective:
No
Problem
Identified
“Dugay na man namatay ang
among papa”(My husband
died long ago).
“Wala na sya nag.isip ana, sige
na lang man siya laag”(She
does not think about it [being in
a relationship], she enjoys
traveling).
Coping – Stress Tolerance Pattern Problem Cues Inference Nursing Diagnosis Priority Rationale Subjective: No Problem Identifie
Coping – Stress Tolerance Pattern
Problem Cues
Inference
Nursing Diagnosis Priority
Rationale
Subjective:
No
Problem
Identifie
The patient
“Bisan naa ko sakit dili man ko
mawalaan ug paglaom ampo lang
d
already knows
and accepted her
ko permi sa Ginoo mao wala ko
situation.
nag guol kung maunsa ko kay
wala man impossible sa Ginoo.”
(Even if
I
have
an
illness, I don’t
lose hope, I always pray to God, I
am not worried of what may
happen to me because nothing is
impossible to God.)
Value – Belief Pattern Problem Cues Inference Nursing Priority Rationale Diagnosis No Problem Identified No problem
Value – Belief Pattern
Problem Cues
Inference
Nursing
Priority
Rationale
Diagnosis
No
Problem
Identified
No problem
identified since
the client is
already devoted
to her beliefs and
religion
Physical Assessment  Jenny Ann V. Lopez

Physical Assessment

Jenny Ann V. Lopez

B. PHYSICAL ASSESSMENT Date/Time of assessment: July 25, 2018/1:30 PM SYSTEM ASSESSED INSPECTION PALPATION PERCUSSION AUSCULTATION
B. PHYSICAL ASSESSMENT
Date/Time of assessment: July 25, 2018/1:30 PM
SYSTEM ASSESSED
INSPECTION
PALPATION
PERCUSSION
AUSCULTATION
NEUROLOGIC SYSTEM
HEENT
 Conscious and talkative
HEAD
 Symmetrical
normocephalic
No abnormalities and
lesions palpated
EYES
 Rounded shape
Symmetrical
EARS
 Symmetrical
Non tender
Unable to hear clearly from 2 feet
away
NOSE
 Unable to identify scents of perfume
and alcohol
THROAT AND MOUTH
Dark
colored lips noted
Dark colored gingiva noted
SYSTEM ASSESSED INTEGUMENTARY SYSTEM INSPECTION PALPATION PERCUSSION AUSCULTAION SKIN  Temperature:  Skin is dry to
SYSTEM ASSESSED
INTEGUMENTARY
SYSTEM
INSPECTION
PALPATION
PERCUSSION
AUSCULTAION
SKIN
 Temperature:
Skin is dry to
37.9°c
touch
Dark colored skin
Loose skin
Small dark scars
noted at both arms
HAIR
 Hair is dull/dry
Burgundy colored
NAILS
 Nails of both hands
and feet are untidy
Capillary refill is 2
seconds
REPIRATORY SYSTEM
 Respiratory rate:
Non tender
 Dull sound noted
 Wheezing and
38cpm
crackles sound
Dysneic
noted when
auscultated
CARDIOVASCULAR  Blood pressure:  SYSTEM 140/90 Pulse rate: 109 bpm mmHg MUSKULO-SKELETAL  Symmetrical shoulders
CARDIOVASCULAR
Blood pressure:
SYSTEM
140/90
Pulse rate: 109
bpm
mmHg
MUSKULO-SKELETAL
Symmetrical
shoulders and legs
SYSTEM
Lower lumbar
bone part:
Moderate
osteoporosis
warm and a
little painful
Able to perform
when touched
rotation and
abduction
Verbalized back
pain
GASTRO INTESTINAL
SYSTEM AND
DIGESTIVE TRACT
Round fatty
abdomen
Non tender
 dull
 Borborygmi
sound: 16cpm
Anatomy and Physiology Pathology of the Disease  Justin Angelo A. Guerrero

Anatomy and Physiology

Pathology of the Disease

Justin Angelo A. Guerrero

The breast is the tissue overlying the chest (pectoraal) muscles. Women's breasts are made of specialized

The breast is the tissue overlying the

chest (pectoraal) muscles. Women's

breasts are made of specialized tissue that

produces milk (glandular tissue) as well as fatty tissue. The amount of fat determines

the size of the breast.

The milk-producing part of the breast is organized into 15 to 20 sections, called lobes. Within each lobe are smaller

structures, called lobules, where milk is

produced. The milk travels through a network of tiny tubes called ducts. The ducts connect and come together into larger ducts, which eventually exit the skin in the nipple. The dark area of skin surrounding the nipple is called the areola.

Connective tissue and ligaments provide support to the breast and give it its shape. Nerves provide

Connective tissue and ligaments provide support to the breast and give it its shape. Nerves provide sensation to the breast. The breast also contains blood vessels, lymph

vessels, and lymph nodes. (DerSarkissian,2017)

Medical Management  Justin Angelo A. Guerrero

Medical

Management

Justin Angelo A. Guerrero

Date and Time July 24, 2018 9:52 AM T – 36.4 c RR – 23 cpm
Date and Time
July 24, 2018
9:52 AM
T – 36.4 c
RR – 23 cpm
HR – 102 bpm
BP – 110/80 mmHg
O2 Sat – 93%
HGT – 134 mg/dL
Doctor’s Order
Ideal Management
Significance
Admit to MMC under
Clinical pathways are used
To recognize the
Dr. Espinosa/ Panas
to identify specific outcomes
(Important is the focus of the
outcome-based patient
care) and corresponding
activities diagnosis.
(Obenges et. Al, 2008)
client’s existing health
problem and to
address unusually in his
wellness.
Secure Consent
Consent is secured for the
confirmation or approval of
This serves as a legal
documentation
the client or client’s
confirming their
caregiver about risks and
benefits of the treatment or
examination to be done on
approval to be
admitted and treated.
the patient regarding his
care. (Martilli 2011)
Diet as Tolerated
Date and Time Doctor’s Order Ideal Management Significance VS Monitoring q4h Vital signs are measurements of
Date and Time
Doctor’s Order
Ideal Management
Significance
VS Monitoring q4h
Vital signs are measurements
of the body's most basic
functions these are
measurements of the body's
Patient vital signs must
be monitored every 4
hours to address
anything unusual and
most basic functions and
for close monitoring.
these values are important in
medical care as it is an
evidence-based approach
to care for the patient.
(Hopkins Medicine, 2015)
Labs: CBC/Platelet
A complete blood count
This Lab test is ordered
(CBC) is a blood test used to
evaluate your overall health
by the doctor to assess
the blood of the
and detect a wide range of
patient. This test is a
disorders, including anemia,
infection and leukemia.
(Mayo clinic.com,2017)
routine lab test.
Date and Time Doctor’s Order Ideal Management Urinalysis is a routine examination Significance Urinalysis This Lab
Date and Time
Doctor’s Order
Ideal Management
Urinalysis is a routine examination
Significance
Urinalysis
This Lab test is ordered by the
done to screen the client’s urine for
doctor to determine
renal or urinary tract disease. (Kluwer
2011)
abnormalities in the patient ESA
urine, and this test is a routine
lab test.
HGT
A blood sugar test is a procedure
that measures the amount of sugar,
or glucose, in your blood.
(Prelipcean, MD, 2018)
HGT is ordered by the doctor to
determine the blood sugar
level. This test is a routine lab
test.
ECG
ECG is a non-invasive diagnostic
tool, the 12-lead ECG records the
heart’s electrical activity as
waveforms. (EMTRESOURCE.com,
ECG is ordered by the doctor
to determine abnormalities of
the heart of patient ESA. This
test is routinely done.
2014)
CXR PA
X-ray is an imaging test that uses
small amounts of radiation to
produce pictures of the organs,
tissues, and bones of the body.
Chest X-ray is ordered by the
doctor to determine
abnormalities in the patient
ESA lungs.
(Krans, 2017)
Date and Time Doctor’s Order Ideal Management Significance Blood typing Blood typing is a test that
Date and Time
Doctor’s Order
Ideal Management
Significance
Blood typing
Blood typing is a test that determines a
person’s blood type. (Weatherspoon,
PhD, MSN, RN, CRNA, 2017)
The test is ordered by the
doctor because it is a fastest
way to ensure the right kind
of blood need to receive by
patient ESA.
IVT: D5Nss 1L @
80cc/hr
D5Nss is a sterile, nonpyrogenic
solution for fluid and electrolyte
replenishment and caloric supply.
(RxList, 2008)
This is ordered by the doctor
to rehydrate patient ESA
and to allow IVTT
medications.
D5NM
1L @
80cc/hr
D5NM provides water and electrolyte
for maintenance of daily fluid and
This is IVT is for hydration of
patient ESA.
electrolyte requirements, plus minimal
carbohydrate calories. (Tacio, 2013)
Meds: Multivent
neb 1 neb q6h
Multivent Solution works by relaxing
the muscles in the walls of the small
airways in the lungs; opening air
passages to the lungs.
Multivent is given to patient
ESA to support the airway
because patient has cough.
(tabletwise.com, 2018)
Date and Time Doctor’s Order Silgram 750mg IV q8h ANST Ideal Management Silgram is use for
Date and Time
Doctor’s Order
Silgram 750mg IV q8h
ANST
Ideal Management
Silgram is use for bacterial
infections by inhibiting the
synthesis of bacterial cell
wall. (tabletwise.com, 2018
Significance
Silgram is given to
patient ESA to fight the
bacterial infection in
the lungs.
Paracetamol 500mg 1-
Pain relief may result from
Paracetamol is given to
tab q4h prn for fever
inhibition of prostaglandin
synthesis in CNS, with
subsequent blockage of
pain impulses.
patient ESA to ease the
pain and treat the
fever.
(Lippincott,2011)
O2 @ 1-2LpM in N.C
prn for dyspnea
Nasal Cannulas are used to
deliver oxygen when a low
Oxygen is given to
support the respiration
flow, low or mdium
of patient ESA and
concentration is required,
and the patient is in a
stabled state. (Kelly, 2011)
since she has dyspnea.
Please inform AP
Notify once admitted
Refer accordingly
Diagnostic/Laboratory Study  Vincent Paul C. Ignacio

Diagnostic/Laboratory

Study

Vincent Paul C. Ignacio

Date: July 24, 2018 Time: 10:15am Chemical Chemistry Result Reference Range Significant of the study Interpretation
Date: July 24, 2018
Time: 10:15am
Chemical Chemistry
Result
Reference
Range
Significant of the study Interpretation of the
Result
Hemoglucotest
134
74-106mg/dL A blood sugar test
The result shows that
(Whole
measures the amount
Blood)
of sugar, or glucose, in
the blood. The results
can help doctors
she has high levels of
sugar in her urine which
indicates signs of
diabetes.
diagnose diabetes,
and help people with
diabetes manage
their condition.
(healthline,2016)
Urinalysis Date: July 24, 2018 Color: Dark Yellow Specific Gravity: 1.015 Albumin: Negative Transparency: Clear PH:
Urinalysis
Date: July 24, 2018
Color: Dark Yellow
Specific Gravity: 1.015
Albumin: Negative
Transparency: Clear
PH: 6.5
Glucose: Negative
Result
Significant of the study
Interpretation of the Result
Erythrocyte
0-2 /HPF
This
test helps to diagnose blood
in
urine. In
The result shows that there is
normal conditions red blood cells also called
presence
of
blood
in
the
urine
which may indicates infection.
Pus cells
15-25 /HPF
erythrocytes are not found in urine.
(laboratorytest.net, 2016)
Pus is a whitish or yellowish or slightly green
substance which is thick like glue. Pus in urine
Pyuria can also be an indication of
a sepsis infection or pneumonia in
signifies that the body is fighting an infection in
older adults (BelaMarraHealth.com
the lower or upper urinary tract. Pus contains
dead skin cells, bacteria and white blood cells.
(qoura.com, 2017)
Squamous Epithelial Cell from the skin or from
the outer urethra can appear in urine.
2017)
Squamous
moderate
Bacteria
moderate
Bacteria are common in urine specimen
because of the abundant normal microbial
flora of the vagina or external urethral meatus
and of their ability to rapidly multiply in urine at
room temperature (University of Utah 2018).
Complete Blood Count Date: July 24, 2018 Time: 10;59am Result Reference Significant of the study Range
Complete Blood Count Date: July 24, 2018 Time: 10;59am
Result
Reference
Significant of the study
Range
Interpretation of the
Result
Hemoglobin
118.0 SI g/L
120-140SI g/L Hemoglobin is a protein in
Low hemoglobin count
red blood cells that carries
can be associated with
oxygen. The hemoglobin
a disease or condition
test measures how much
hemoglobin is in your blood.
(Medlineplus,2016)
that causes your body to
produce fewer red
blood cells than normal
includes cancer.
(Mayoclinic.com 2018)
RBC
4.2 x10^12/L
4.5-5.0 x10^12/L
A red blood cell count is a
blood test that your doctor
Within the normal range
uses
to find
out how many
red blood cells
(RBCs) you
have. It's also known as an
erythrocyte count.
(Healthline,2016)
Result Reference Range Significant of the study Interpretation of the Result HCT 0.36 .37-.43 The hematocrit
Result
Reference Range
Significant of the study
Interpretation of the Result
HCT
0.36 .37-.43
The hematocrit test indicates the
percentage of blood by volume that
is composed of red blood cells. The
condition called "anemia" results
When hemoglobin is low,
the hematocrit also
decreases.
from having too few red blood cells.
(Emedicinehealth,2016)
MCV
84U^3
82-92U^3
Mean corpuscular volume (MCV) is
the average volume of red cells.
Within the normal range
(Medscape,2016)
MCH
26.7 pg
27-31pg
This test is performed to know the
average amount of hemoglobin in
the average red cell.
Some medical conditions
can also cause anemia.
(medicalnewstoday.com
(Medicine,2016)
2017)
MCHC
31.7 g/dL
32-36 g/dL
This test is performed
to
know the
average
concentration
of
hemoglobin in the given volume of
Low MCHC can be
caused by anemia and
cancer. (Healthline.com
blood.
2017)
(Medicine,2017)
Result Reference Range Significant of the study Interpretation of the Result Platelet 184 x10^g/L 150-350 x10^g/L
Result
Reference Range Significant of the study
Interpretation of the Result
Platelet
184 x10^g/L
150-350 x10^g/L
A
PLT
blood
test
measures
the
Within the normal range
number of platelets in the blood.
Platelets help blood clot.
(References.com)
WBC
9.61 x10^g/L
5.0-10.0 x10^g/L A WBC count is a test that measures
the number of white blood cells in
your body. This test is often included
with a complete blood count
Within the normal range
(CBC).
(Healthline,2017)
Neutrophils
0.78%
.55-.65%
A blood differential test to measure
the following components of your
blood: white blood cells, which help
stop infections. (Healthline,2016)
An increased percentage
of neutrophils may be due
to acute infection.
(medlineplus.com 2017)
Lymphocyte
0.10%
.35-.50%
s
A blood differential test to measure
the following components of your
blood: white blood cells, which help
stop infections. (Healthline,2016)
An increased percentage
of lymphocytes may be
due to infection.
(medlineplus.com 2017)
Result Reference Range Significant of the study Monocytes 0.12% 0.03-0.06% A blood differential test to measure
Result
Reference Range Significant of the study
Monocytes
0.12%
0.03-0.06%
A blood differential test to
measure the following
Interpretation of the Result
An increased
percentage of
components of your blood:
monocytes may be due
white blood cells, which help
stop infections.
to bacterial infection.
(medlineplus.com 2017)
(Healthline,2016)
Eosinophils
0.00%
0.02-0.04%
A blood differential test to
measure the following
components of your blood:
Decreased
white blood cells, which help
stop infections.
(Healthline,2016)
Basophil
0.00%
0.00-0.01%
A blood differential test to
measure the following
components of your blood:
Within the normal range
white blood cells, which help
stop infections.
(Healthline,2016)
BREAST:
BREAST:

Date: July 02, 2018

Findings/ interpretations:

Global sonogram of both breast done.

The glandular tissue exhibit normal lobulated moderated moderately dense echopattern. However there is a poorly defined, large, oval hypoechoic solid

mass lesion seen in the left outer upper quadrant measuring 2.9 x 2.3cm a cobblestone appearance is likewise noted in the remaining left breast

parenchyma. There are lobulated hypoechoic foci also appreciated in the left

axillary region measuring 1.6 x 1.5cm and 1.2 x 1.2cm. The right breast is unremarkable. Incidental finding of a poorly defined hypoechoic ocus seen at the anterior chest

wall measuring 4.0 x 2.4cm.

IMPRESSION: Poorly defined, large, oval hypoechoic solid mass lesion, left breast as described. Neoplastic process is

IMPRESSION:

Poorly defined, large, oval hypoechoic solid mass lesion, left breast as

described. Neoplastic process is considered. Cellucitis of the left breast also considered. Enlarged lymph nodes, left axilla.

Inicidental finding of poorly defined masslesion anterior chest wall.

Clinical correlation is suggested.

BI-RADS ASSESSMENT CATEGOTIES

0- Needs additional imaging 1- Negative

2- Benign finding

3- Probably benign. Short interval/ allow up or may do excision biopsy for tissue diagnosis 4- Suspicious abnormal biopsy should be considered. 4A: low suspicion for malignancy

4B: moderate suspicion for malignancy

4C: high suspicion for malignancy. 5- Highly suggestive of malignancy- appropriate action should be taken 6- Biopsy proven malignancy

NOTED!!!
NOTED!!!

Surgical Pathology Result

GROSS DISCRIPTION:

Received 4 slides for cytologic examination

HISTOLOPATHOLOGIC IMPRESSION

S/P CNAB, BREAST, LEFT CYTOLOGY Positive for malignant cell, consistent with Ductal Carcinoma

MICROSCOPIC DIAGNOSIS:

Cytologic examination shows pleomorphic atypical cell with marked variation of nuclear size, Nucleoli are frequently seen. There is altered nucleo- cytoplasmic ratio.

Microscopic examination done.

Clinical correlation recommended.

Impression: Date: July 26, 2018 XRAY REPORT Present study when compared with the CXR PA obtained/taken

Impression:

Date: July 26, 2018

XRAY REPORT

Present study when compared with the CXR PA obtained/taken 2/13/17 shows

coarse reticular and small nodular opacities in both hemithoraces. The left hemidiaphragm is elevated by 2 intercostal space relatives to the right hemidiaphragm. Heart is mildly enlarged with a CTR of 0.54 the stomach/splenic

flexure is seen at the lower lung zone. The left breast is markedly enlarged. No

other remarkable finding.

Pulmonary metastasis Inter-current pneumonia

Borderline cardiomegaly

Diaphragmatic hernia, left Tortuous atheromatous aorta

Enlarge left breast

Mild dextroscoliosis, thoracic spine

Degenerative change, thoracic spine

Osteoporosis

Drug Study  Quia Rose L. Iman

Drug Study

Quia Rose L. Iman

Classification   
Classification

Drug Name: Salbutamol + Ipratropium Doctor’s Order: salbutamol + ipratropium 1 neb as PA1 Date/Time: July 24, 2018 QID

Therapeutic: Bronchodilators

Pharmacologic: Adrenergic

Mechanism of Action:

Combivent Inhalation Solution is a combination of the anticholinergic bronchodilator, ipratropium bromide, and the beta2-adrenergic

bronchodilator, salbutamol sulfate. Ipratropium bromide is a quaternary

ammonium derivative of atropine and is an anticholinergic drug which has bronchodilator properties. Salbutamol produces bronchodilation through

stimulation of beta2-adrenergicreceptors in bronchial smooth muscle, thereby causing relaxation of muscle fibers. This action is manifested by an

increase in pulmonary function as demonstrated by spirometry

measurements

 

Indication:

For the management of bronchospasm in patients suffering from chronic

obstructive pulmonary disease (COPD) who requires regular treatment

with both ipratropium and salbutamol

Contraindication:

Patients with cardiac tachyarrhythmias, hypertrophic obstructive

cardiomyopathy and patients with a history of hypersensitivity to any of its components or to atropine or its derivatives.

Adverse Effect:  CNS: lightheadedness, drowsiness, insomnia, dizziness, vertigo, CNS stimulation  CV: hypertension, arrhythmia, hypotension,
Adverse Effect:
CNS: lightheadedness, drowsiness, insomnia, dizziness, vertigo, CNS
stimulation
CV: hypertension, arrhythmia, hypotension, tachycardia, angina
EENT: sinusitis, blurred vision, taste perversion, dry mouth, paradoxical
bronchospasm, bronchitis
GIT: abdominal pain, dyspepsia, gastrointestinal distress, vomiting,
diarrhea, constipation
GUT: dysuria, urinary retention, urinary difficulty
MS: Fatigue,
     

Nursing Responsibility:

Assess lung sounds, PR and BP before drug administration and during peak of medication.

Observe fore paradoxical spasm and withhold medication and

notify physician if condition occurs.

If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication.

Advise the patient to rinse mouth with water after each inhalation to

minimize dry mouth.

Inform the patient that Albuterol may cause an unusual or bad taste.

Rationale:

This drug was given to relax bronchial muscle to improve bronchial function and to facilitate effective breathing.

 

Generic Name: Ampicillin Sulbactam Doctor’s Order: Ampicillin + Sulbactam 750mg IV ANST(-) Date/Time: July 24, 2018 TID

Classification

Therapeutic: antibiotic

Mechanism of Action:

Destroys bacteria by inhibiting bacterial cell-wall synthesis during

microbial multiplication. Addition of sulbactam enhances drug’s

resistance to beta-lactamase, anenzyme that canin activate

ampicillin.

 

Indication:

Treatment of a variety of skin and skin structure infections, soft

tissueinfections including: Otitis media, Sinusitis, Respiratory tract

infections, Genitourinary tract infections, Meningitis, and Septicemia.

Contraindication:

Hypersensitivity to penicillin, cephalosporins, imipenem, of other

beta-lactamase inhibitors

Adverse Effect:  CNS: lethargy, hallucinations, anxiety, confusion, agitation, depression, fatigue, dizziness, seizure  EENT: blured
Adverse Effect:
CNS: lethargy, hallucinations, anxiety, confusion, agitation,
depression, fatigue, dizziness, seizure
EENT: blured vision, itchy eyes
GI: nausea, vomiting, diarrhea, abdominal pain, gastritis, stomatitis
GU: hematuria, hyaline casts in urine, aginitis, nephropathy,
interstitial nephritis
RESPIRATORY: wheezing, dyspnea, hypoxia, apnea
SKIN: rash, urticaria, diaphoresis.
       

Nursing Responsibility:

Assess patient of previous sensitivity reaction to penicillin or cephalosporins

Assess patient for signs and symptoms of infection

Assess for allergic reactions

Monitor electrolytes

Assess bowel pattern daily

Monitor for bleeding

Assess for superinfection

Rationale

This drug was administered to fight and control infection since the

patient has breast cancer, signs of pneumonia and urinary tract

infection (UTI).

  

Drug Name: Paracetamol Doctor’s Order: Paracetamol 500mg 1tab PO for fever Date/Time: July 24, 2018 PRN

Classification

Therapeutic: Antipyretics

Pharmacologic: nonopioid analgesics

Mechanism of Action:

Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. Has no significant anti- inflammatory properties or GI toxicity. Therapeutic Effects: Analgesia. Antipyresis.

Indication:  Mild pain. Fever. Adverse Effect:  GI: HEPATIC FAILURE, HEPATOTOXICITY(OVERDOSE).  GU: renal failure
Indication:
Mild pain. Fever.
Adverse Effect:
GI: HEPATIC FAILURE, HEPATOTOXICITY(OVERDOSE).
GU: renal failure (high doses/chronic use).
Hemat: neutropenia, pancytopenia, leukopenia.
Derm: rash, urticaria.
    

Nursing Responsibility:

Assess patient’s fever; intensity, duration, temperature, and diaphoresis.

Assess allergic reactions: rash, urticaria; if these occur, drug may have to be discontinued.

Teach patient to recognize signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat.

Tell patient to notify prescriber for pain/ fever lasting for more than 3 days.

Rationale:

To treat the fever of Patient ESA, temperature ______________.

Nursing Management  Angelica A. Lim  Marygrace D. Iman

Nursing Management

Angelica A. Lim Marygrace D. Iman



Prognosis

Medical Prognosis

Patient ESA was diagnosed with Malignant Breast Cancer (Ductal CA) with lung metastasis, was admitted to Mindanao Medical Center on July 24, 2018. According to National Cancer

Institute statistics for 2012, the five year survival rate for women

diagnosed with metastatic cancer or stage IV breast cancer was 22% raised to 26% in 2016. With these, the prognosis of the patient is poor and because of other factors like her age and

family support. The medication and other treatment may help

relieve and comfort her but will not cure her condition.



b. Nursing prognosis:

The recovery of the patient depends on the support

of her family since her family is the one deciding for

her treatment. The nursing prognosis for her recovery is poor. The family believes that she cannot bear anymore to undergo to any treatment especially

surgery because of her age. They only want to make

her comfortable and be relieved from symptoms and complication.

PRIORITIZATION PROBLEM LIST PRIORITY PROBLEM PRIORITY RATIONALE Ineffective breathing pattern High 1 related to difficulty of
PRIORITIZATION PROBLEM LIST
PRIORITY PROBLEM PRIORITY RATIONALE
Ineffective breathing pattern High 1
related to difficulty of breathing
This is considered as a high 1 priority. It is a life
threatening condition that requires immediate
medical attention and sometimes may lead to
death.
Ineffective Family Therapeutic
Regimen Management related to
familys’ belief.
This is considered as a High 2 priority as the patient’s
High 2
recovery depends on her treatment which will be
decided by her family.
Disturbed sleep pattern related to
difficulty of breathing
Medium 1
This is considered as a medium 1 priority because
client has lost her appetite due to her condition.
According to Diet health club if a single
micronutrient is missing or is in short supply, it can
cause serious implications for the functioning of the
entire body.
Nursing Care Plan

Nursing Care Plan

ASSESSMENT NEED BACKGROUND OF THE STUDY DESIRED OUTCOMES INTERVENTION RATIONALE EVALUATION Subjective Cue: P Ineffective breathing
ASSESSMENT
NEED
BACKGROUND OF THE STUDY
DESIRED OUTCOMES
INTERVENTION
RATIONALE
EVALUATION
Subjective Cue:
P
Ineffective
breathing
pattern
General:
Independent:
“Gidala namo siya diri kay
H
related
to
difficulty
of
-After 8 hours shift
GOAL PARTIALLY
MET
naglisod na gud siya ug
Y
breathing
is
defined
as
client will be able to
-Encouraged deep
breathing exercises
-Promote chest
expansion
After 8 hours shift
hinga”
S
Inspiration
and
or
expiration
improve normal
-
Monitored
the patient exhibits
(We brought her here
because she really felt
difficulty of breathing.)
I
that
does
not
provide
breathing pattern
O
adequate ventilation.
L
-Assesses the
condition of the
client
improved normal
breathing pattern
as manifested by
O
Reference:
Specific:
respiratory
patterns, including
rate, depth, and
effort
Objective Cue:
G
Nanda 12t h editon by:
-That the client will
low RR: 28cpm, the
patient was able to
- difficulty of breathing
I
Doenges, Moorhouse, Murr
manifest improved
-
Encouraged
-To provide relieve
sleep after
-elevated
blood
pressure
C
of 140/90mmHg
-RR: 38cpm
N
In relation to the client,
ineffective breathing was
diagnosed.
position of comfort
of causative factor
intervention.
-
body
weakness
E
observed
-nasal cannula attached
E
normal breathing
pattern.
Exhibit improved
normal rate and
depth respirations.
D
Dependent
-Give supplemental
oxygen as ordered
via nasal cannula.
-Helps giving
adequate oxygen
to the client
-
Administer
medication as
ordered.
-To stimulate
bronchodilation.