Breast CancerComplications of Chemotherapy

Breast Cancer/Complications of Chemotherapy

Jan Leisner, 50 years old

Primary Concept Perfusion Interrelated Concepts (In order of emphasis)

• Infection
• Pain
• Fluid and Electrolyte Balance

• Thermoregulation
• Immunity
• Cellular Regulation
• Clinical Judgment

RAPID Reasoning Case Study: STUDENT

History of Present Problem:

Breast Cancer

Jan Leisner is a 50-year-old Caucasian woman who has been healthy with no previous medical history. One year ago, she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy, she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her mammogram confirmed a 5 cm mass. An ultrasound biopsy confirmed the presence of cancer cells in the tumor as well as in three of her lymph nodes most proximal to the tumor. An MRI scan that followed revealed a 1 cm tumor on her lumbar spine. She is not a surgical candidate at this time, so an implanted venous access device (VAD) will be placed later this afternoon so that chemotherapy can be started as soon as possible. You are the nurse responsible for her care on the oncology unit of a community hospital.

Personal/Social History:

Jan has four children under the age of 17. She has no personal or family history of breast cancer. She has never smoked and lives with her husband in a suburban community. She works part-time as a substitute teacher. Jan is a devout Christian who has a strong faith and trust in God. She also believes in the power of prayer and believes that God can heal her. She chose to have a mammogram just before her husband’s insurance plan expired because he just lost his job.

What data from the histories are RELEVANT and has clinical significance to the nurse?RELEVANT Data from Present Problem: Clinical Significance: 50 year old female 5cm mass in right breast

• lymph nodes with cancer cells

1cm tumor in lumbar spine These are all significant signs of cancer.RELEVANT Data from Social History: Clinical Significance:

• teenage/young children

Husband lost hid job Suburban home Part time teacher Patient has the responsibility of taking care of her children.She might have added stress due to her husband losing his job and only working part time as a substitute.Her Christian faith may give her hope but will not heal her cancer

Christian Does not have health insurance

Caring and the “Art” of Nursing

• What is Jan likely experiencing/feeling right now in this situation?

She is most likely stressed and scared, worried about her future and her family.

• What can you do to engage yourself with Jan’s experience, and show that she matters to you as a person?

Comfort her and provide her information on her diagnosis and treatment plans, answer any questions she may have, and line up appropriate referrals and resources for her.

Five Weeks Later… Jan is promptly started on chemotherapy of Cytoxan and Adriamycin every 3 weeks for the next 3 months.Two weeks after her first chemotherapy treatment she experiences persistent nausea and vomiting, and has been unable to keep anything down the past 24 hours. She has fatigue that is so severe she has been unable to move off the couch for the past 3 days, and has experienced night sweats with a fever last night. After contacting her oncologist, he arranges to have Jan admitted directly to the med/surg floor where you will be the nurse responsible for her care.