Assignment
Breast Cancer Case Study
Mary, 37 years, was diagnosed with Ductal Carcinoma and underwent a left modified radical mastectomy and axillary lymph node dissection four weeks ago. The primary tumor was 3 cm in size, and two (2) of 20 nodes sampled were positive for cancer. No distant metastasis has been found. The biopsy revealed that the mass was estrogen and progesterone receptor positive, HER-2 negative.
The medical notes indicate Mary has a history of hypertension for the past two years. She has no known allergies. Mary weighs 63 kilograms, and is 162 cm tall.
Family/Social history: Mary is a housewife and mother to four children. She is an active volunteer in her children's schools. Her husband owns his own business, which is doing well. Mary's family history is positive with a maternal aunt and a cousin who have had breast cancer.
Mary will be receiving standard dosage therapy of Adriamycin, Cyclophosphamide, and 5-FU IV. Premedication include:
• Zofran (ondansetron) 32 mg as IV
• Decadron (dexamethasone) 20 mg IV
In addition, Mary will receive Neupogen (filgrastim) 300 mcg subcut daily for 10 days, to begin 24 hours after each chemotherapy treatment.
Consolidation radiation therapy is being considered.
Mary's friend Beth has accompanied Mary to her first chemotherapy treatment. Mary appears anxious as you begin your assessment.
Task
I. What is the difference between Invasive Ductal Carcinoma and Ductal Carcinoma in-situ? Which one does Mary have?
II. What diagnostic tests would have been used to confirm the diagnosis? What is the benefit/rationale for the use of each test?
III. Discuss the implications of a positive sentinel node.
IV. Surgical intervention is the primary treatment for breast cancer. Describe the priority nursing care required for the surgical procedure Mary underwent.
V. What is the goal of adjuvant chemotherapy?
VI. What factors affect prognosis and treatment of breast cancer?
VII. What key therapeutic question would you ask Mary after you give her a tour of the chemotherapy ambulatory unit and review her treatment plan for today?
VIII. What is the rationale for Mary receiving Zofran AND Decadron as premedication before chemotherapy?
IX. What are the indications for receiving filgrastim?
Mary reports that her left arm is stiff, and expresses concern that she may be developing lymphedema.
X. What patient teaching will you provide Mary? Include both prevention strategies and treatment options.
XI. Which statement indicates that Mary requires further teaching about how to manage alopecia?
a. "I should go buy a wig now, before I start losing my hair."
b. Wearing a scarf or hat when outside will help to protect me."
c. "My hair should begin to return 2 months or so after treatment ends."
d. "I can prevent hair loss if I wash every other day with a gentle shampoo.
During Mary's 2nd chemotherapy appointment, Mary and Beth have been discussing tamoxifen and Herceptin (trastuzumab) treatment and Mary asks if she would be a candidate for these therapies
XII. How will you respond?
XIII. What kind of safety precautions should the nurse use in the administration of chemotherapy?
XIV. Briefly discuss the information you would provide Mary regarding specific side effects of the medication she is to receive.
Mary arrives for her third cycle of chemotherapy, and reports a decrease in weight to 57 kg. She had her routine pre-chemo bloodwork done 90 minutes ago.
XV. Throughout the course of chemotherapy, you monitor Mary's nutritional status. What type of nutritional concerns are you monitoring for? Explain why each problem is common in patients being treated for cancer.
XVI. What priority assessments would you carry out, in regard to Mary's most recent weight?
XVII. What priority interventions would you carry out?
Mary reports anorexia and metallic taste which she finds bothersome.
XVIII. What strategies would you recommend?
The blood tests results are in. You calculate Mary's ANC (1.6 X 109/L) and discuss the result with Mary's physician. When you return, Mary asks, "I overheard you discussing my result. What does ANC mean?"
XIX. What client education will you provide? Include the implications for self-care and nursing care.