CASE STUDY

ON
BREAST CANCER

SUBMITTED BY

Purnima Sahay

M.Sc. NURSING 1st YEAR

(Medical Surgical Nursing)

 INTRODUCTION

As the part of my M.Sc. Nursing Programme I got my specialty posting

Medical Surgical Nursing posting in ‘Prem hospital’ Panipat and I selected a
patient with ‘Breast cancer’ for Case Study through providing of nursing
care. It was an excellent opportunity to learn the holistic nursing care in
“Breast cancer.It is the malignant cell growth in the breast. If left untreated,
the cancer spreads to other areas of the body.
OBJECTIVES OF CASE STUDY

 To get through knowledge aboutBreast cancer.

 To learn how to give nursing care to patient with disorder like my topic on
Breast cancer.
 To provide knowledge to the patient about his disease.
 To clarify the doubts of the patient.
 To improved theoretical skills.
 To increase knowledge of peer group, students and teachers.
 To give effectiveness nursing care to the patient.
 To prevent spread of disease by preventing method.
HISTORY

IDENTIFICATION DATA
Patient’s Name Mrs. Kanika

Age 40years

Sex Female

Marital Status Married

Education 10th Pass

Occupation House wife

Religion Hindu

Address Panipat

Hospital Prem Hospital

Name of ward surgicalward

Diagnosis Breast Cancer

Doctor Dr. Abinav

CHIEF COMPLAINT

Patient admitting with the following chief complaints breast pain, lump in the left breast, bloody
discharge from the left breast and ulcer on the breast.

PRESENT HISTORY:

 Antenatal – Patient have no antenatal history of the patient..

 Intranatal: Patient have no intranatal history of the patient.
 Postnatal - Patient have no any postnatal history.

 Gynecological history- Patient have diagnosed with the breast cancer. The patient have the
complaints is the pain in the left breast and lump in the affected breast.
 Medical- surgical history- Patient have the complaints of hypertension diseases since 1 yr.
 Marital history- Patient have the marital duration is 8 yr.
 Contraceptive history- The couple use the condom and safe period method.
 Menstrual history- Patient have the menarche age is 13yr .And the patient menstrual cycle
is regular. The duration of menstrual cycle is 28 days.
 FAMILY TREE

Grandfather89yearGrandmother Male

85year Female

Father PatientPatient

42year 35year

Son Daughter

20year 18year

PERSONAL HISTORY

 Diet She is pure vegetarian.

 Sleep Normal

SOCIO –ECONOMIC STATUS

Living locality Village

Housing Pucca

Number of rooms 3

Toilet Facility Own-Latrine

Electricity Yes

Drinking water source Tap (muncipality)

PERSONAL HYGIENE

Oral Hygiene: Good Frequency: Twice a day Agent used: Tooth- paste

Bath : Per day Frequency: Twice Agent used: Soap

Diet : Vegetarian

No. of meals per day: Two Food preference: Vegetarian

Water intake : 4-6 glass per day, Tea - 4 Cups / day

Sleep and rest 8-10 hour / day

ELIMINATION

Bowel movement per day: Regular Frequency : Twice a day

Urine frequency: During day : Three times Night :Twice

MOBILITY& EXERCISE

Exercise/ Activity: Moderate

SEXUAL & MARITAL HISTORY

Spouse Health Good

Spouse Occupation Working

Relationship Satisfactory

Staying Together Yes

No. of children Male: One Female: One

PHYSICAL EXAMINATION

VITAL SIGNS:

Date Patient value

Temperature 98.6°F

Pulse (beat/min.) 92beats/min.

Respiration 24breaths/min.
(breath/min.)

Blood Pressure (mm

of Hg) 130/80mmHg

Height: 5Ft 5 inches/167cm Weight: 50kg

BMI: 17.9

HEAD TO FOOT EXAMINATION

Skin colour Normal

Posture Normal

Gait Normal

Bleeding Nil

Discharge No

HEAD:
 Scalp Normal
 Hair distribution characteristics Brownish in colour
 Any Abnormalities No
EYES:

 Eye Brows Thick, black colored

 Eyelides Normal
 Eyelashes Normal
 Sclera Pink in color, slightily hyperemic
 Conjuctiva Black in colour
 Pupil Brown in color, normal reaction to
light
 Vision Right eye 6/6, Left eye : 6/6
 Any abnormality No

EARS:
 Hearing Normal both the ears
 Discharge No
 Pain No
 Cerumen Slight present both the ear
 Any abnormality No
NOSE:
 Nasal septum Straight
 Nasal polyps No
 Discharge / Epistaxis No
 Any abnormality Decrease sense of smell
MOUTH:
 Lips Cracked, dry
 Gums Swollen

 Teeth Whitish in colour

  Tongue White Coated
 Oral mucosa Sore

THROAT:
 Inflammation No
 Pus No
 Any other observation No
NECK:
 Inspection No abnormality seen
 Palpation Normal. No Abnormality detected
 Any other observation None
CHEST:
 Shape Abnormal
 Breast Abnormal and pain
Inspection:
 Symmetry Unilateral symmetrical
 Skin Abnormal and irritation
 Nipple Abnormal and discharge
Palpation:
 Mass Mass palpable
 Axillary lymphosis Palpable
 Discharge from nipple Present
ABDOMEN:
Inspection
 Color Brown
 Distention Mild distended
 Visible movement Normal with respiration
 Scare present No
Palpation
 Hernia No
 Organomegaly No
 Any abnormalities No
BACK:
Inspection
 Color Brown
 Lesions None
 Shape of vertebral column Normal, Straight
 Any other observation Nil
 Curvature and growth Normal curvature
Palpation

 Tenderness No

EXTREMITIES:
 Symmetry Symmetrical
 Color Brown
 Muscle strength Good and equal
 Any other abnormality No
SKIN

Hydrated

REVIEW OF PHYSIOLOGICAL SYSTEM /SYSTEMIC EXAMINATION

1. NEUROLOGICAL / SYSTEM

Level of consciousness : Eye movement, verbal command, motor response

Memory

 Recent No memory loss

 Remote No memory loss

Oriented

Insight or Judgment Good

General Intelligence Good

Speech correct. No slurring or irrelevant speech

Behavior Good. No signs of abnormal behavior

Signs of Meningial Irritation

 Neck pain No
 Kerning’s sign No
 Brudzinki’s sign No

CO-ORDINATION

a) Finger to Nose Good, Normal

b) Pronation Supination Good, Normal
c) Heel-Knee Test Good, Normal
d) Gait Normal
 e) Postural Adjustment Normal

BALANCE

a) Rombering Test
b) Tandem Walking
c) REFLEX
 Deep Tendon Reflexes(Muscle Stretch Reflex)

Biceps Triceps Brachioradialis Patella Achilles

r

Right Normal Normal Normal Normal Normal

Left Normal Normal Normal Normal Normal

 Superficial Reflexes Normal

 Abdominal Reflexes Normal

MOTOR FUNCTIONS Normal

SENSORY FUNCTIONS Normal

2. RESPIRATORY SYSTEM:
Inspection
 Symmetry Movement of the chest wall is equal on
both the sides
 Chest Movement Equal on both the side

 Respiratory Rate 24b/min, regular, comfortable

Auscultation
 Breath Sounds Equal on both the sides
 Percussion
 Resonance
3. CARDIO-VASCULAR SYSTEM:
  Heart Sounds S1 & S2 audible
 Heart rate 92b/min.
 Blood Pressure 130/ 90 mmHg, right upper limb
4. GASTRO-INTESTINAL SYSTEM:
Inspection
 Colour Fair
 Skin Texture Smooth &elastic
 Distention Mild distention
 Abdominal Girth 52 inches
 Visible movement None
Auscultation
 Bowel Movements Normal
Percussion
 Resonance
Palpation
 Mass None
 Tenderness None

5. GENITO-URINARY SYSTEM:
Inspection & Palpation (External Genitalia)
 Redness No redness
 Swelling No swelling
 Discharges No discharge

6. MUSCULO-SKELETAL SYSTEM:
Inspection
 Symmetry Symmetrical & good with
no restrictions & difficulty
 Muscle Strength 6/6, good
 Range of Motion Complete
 Any Abnormalities None
7. INTEGUMENTARY SYSTEM:
Inspection & Palpation
 Colour Fair
 Moisture Hydrated
 Vascularity Good, Normal
 Skin Turgor Dry
 Skin Texture Fair
 Any Lesions or Breaks in Skin Integrity No
  Examination of nails Normal, no clubbing seen
 ColourNormal
 Shape Normal
 Strength Good
INVESTIGATION

Hb Blood Blood Urine Bowel Bladder Any other

Grouping sugar Screening
$ Rh type Mammography:
11.2gm/dl No albumin indigestion Urinary shows lump in
A+ No sugar retention the breast.
98mg/dl

DISCRIPTION OF THE DISEASE

BREAST CANCER

Introduction

It is the malignant cell growth in the breast. If left untreated, the cancer spreads to other areas of
the body. Excluding skin cancer is the most common type of cancer in the women.

Definition

Breast cancer is an uncontrolled growth of breast cells. It refers to a malignant tumor that has
developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules,
which are the milk producing glands or ducts , the passage that drain milk from the lobules to
thenipples.

ANATOMY AND PHYSIOLOGY

The breast is a mass of glandular, fatty and fibrous tissues positioned over the pectoral muscles
of the chest wall and attached to the chest wall by fibrous strands. A layer of fatty issue
surrounds the breast glands and extends throughout the breast.The fatty tissues give a soft
consistency to the breast.The glandular tissues of the breast house the lobules and ducts.Towards
the nipple, each duct widens to form a sac(ampulla).

FORMS OF BREAST CANCER

 1. Invasive Ductal Carcinoma:This type of breast cancer develops in the milk ducts and
accounts for about 79% of cases. It can break through the duct wall and invade the
breast’s fatty tissue, then metastasize to other parts of the body through the bloodstream
or lymphatic system.
2. Invasive Lobular Carcinoma: This type of breast cancer accounts for about 10% of
cases and originates in the breast’s milk producing lobules. It also can spread to the
breast’s fatty tissue and other places in the body.
3. Medullary, Mucinous and Tabular Carcinomas: These are three slow growing types
of breast cancer. Together they present about 10% of all breast cancers.
4. Paget’s disease: This type represents about 1% of breast cancers. It starts in the milk
ducts of the nipple and can spread to the areola.
5. Inflammatory Carcinoma:This type accounts for about 1% of all cases.Of all breast
cancers, inflammatory carcinoma is the most aggressive and difficult to treat, because it
spread to quickly.
6. Lobular Carcinoma in Situ: It is less common and less of a threat than ductal
carcinoma in situ. It develops in breast’s milk producing lobules. Lobular carcinoma in
situ does not require treatment , but it does increase a women’s risk of developing breast
cancer.

CAUSES/RISK FACTORS

1. Family history of breast cancer

2. Alcoholism or smoking
3. BRCA1 and BRCA2 gene
4. Non-lactating mother
5. Radiation therapy to the breast
6. Oral contraceptive use
7. Overweight
8. Certain breast changes
9. Lack of physical activity
10. Reproductive and menstrual history

PATHOPHYSIOLOGY

Lymph system contains lymph nodes, lymph vessels and lymph fluid.

Breast cancer cells can enter lymph vessels and begin to grow in lymph nodes.

The cancer cells metastasis to the lymph nodes under the arm (Axillary nodes).
 Then the cancer cells goes to the lymph nodes around the collar bone.

And spread inside the chest near the breast bone (internal mammary lymph nodes).

BREAST CANCER

CLINICAL MANIFESTATIONS

SIGN AND SYMPTOMS BOOK PICTURE PATIENT PICTURE

 Breast pain Present Present
 Skin irritation Present Present
 Nipple pain Present Present
 Redness and swelling Present Present
 Discharge from nipple Present Present
 Nipple turned inward into
Present Present
the breast
 Enlarged axillary
Present Present
 Change in breast shape
Present Present

TREATMENT

S.NO DRUG NAME DOSE ROUTE ACTION

1. Inj.Cefotaxim 250 mg I/V Anti –biotic
2. Inj.Tamoxifen 50 mg I/V Anti-estrogen
3. Inj. Lupron 2 ml I/V GnRH
agonist
4. Inj. Mitomycin 5 ml I/V Anti-tumour
 NURSING MANAGEMENT

ASSESSMENT

1. History taking
2. Physical examination
 Palpation
3. Assess the skin of breast, areola
4. Assess the symmetry of breast
5. Assess the nipple size and any dicharge
6. Check the vital signs
7. Health record and health reviewed
8. Consulted with other team members

DIAGNOSIS

1. Severe Pain related to muscle spasm and tenderness of uterus as evidence by malaise
and restlessness.
2. Fluid and electrolyte imbalance related to lack of fluid intake as evidenced by the dry
and cracked lips.
3. Anticipated grieving related to loss of physiological well being as evidenced by
changing eating pattern and alteration in sleep pattern.
4. Anxiety related to diseases condition as evidenced by discomfort and restlessness.
5. Knowledge deficit related to lack of information about the treatment of breast cancer as
evidenced by asking frequently questions.
6.

ASSESSMENT NSG.DIAGNOSI GOAL PLANNING IMPLEMENTAT EVALUA

 S ION TION
Subjective Fluid and To maintain 1.To assesses the -Assessed the Fluid
data: electrolyte the fluid intake –output intake-output volume
Patient saysthat imbalance related volume of chart. chart of the maintained
to lack of fluid patient.
“I am suffered the patient .
intake as
from dizziness evidenced by the 2.To assess the
and fainting”. dry and cracked dehydrated level -Assessed the
Objective data: lips. of the patient. dehydrated level
of the patient.
I observe that 3.To give the
intake output intravenous fluid
chart. prescribed by Dr. -Given the
intravenous fluid
4.Togive the prescribed by dr.
medication
prescribed by the
-Given the
Doctor. medication
prescribed by the
5.To give the oral Doctor.
fluid and fruit
juices.
-Given the oral
fluid and fruit
juices

Subjective Data: 1. Anxiety To 1.Toassess the  Levels of Decreased

Patient says that related to decrease level of anxiety the
“I am tense about diseases the anxiety of the assessed. anxiety
disease condition as anxiety patient. level up to
condition.” evidenced by level of some
discomfort the 2.To Provide  Psychological extent.
Objective Data: and patient. psychological support
I Observe that the restlessness. support to the provided.
facial expression patient.
of the patient,
anxiety, behavior. 3. To Explain  Procedure
the diseases explained to the
causes and patient.
pathophysiolo
gy to the
patient.
 4. To Provide  Recreational
recreational therapy
therapy to the provided.
patient.

5. To Explain  About the

the patient treatment the
about the information is
treatment and provided.
care.

ASSESSMENT NSG.DIAGNOSIS GOAL PLANNING IMPLEMENTA EVALUATIO

TION N
Subjective Data: 2. Anticipated To reduce To assess  Assessed Grieving
grieving the the patient the reduced up to
Patient says that “ related to loss grieving for stage of patient some extent.
I am feeling sad .” of of the grieiving for stage
physiological patient. being of
well being as experienced. grieiving
Objective data: evidenced by being
changing To provide experienc
I observe that the eating pattern the non- ed.
verbal behavior of and alteration judgemental
the patient, daily in sleep environment  Provided
activity of the
patient. pattern the non-
To judgeme
encourage ntal
verbalizatio environm
n of ent.
concerns
and feelings
of sadness  Encourag
and anger. ed
verbaliza
tion of
concerns
To reinforce and
teaching feelings
regarding of
diseases sadness
process. and
anger.

 Reinforc
ed the
teaching
regarding
diseases
process.

SUBJECTIVE 3. Knowledge To improve 1.To assess  Level of Improve

DATA: deficit related the the knowledg d the
Patient says that “ to lack of knowledge of knowledge of e knowled
I have no information the patient level of the assessed. ge of the
knowledge about about the related to patient. patient.
diseases treatment of treatment of
condition.” diseases diseases.
condition as 2. To Provide  Health
OBJECTIVE evidenced by health education
DATA: asking education provided
I Observe that the frequently about the with the
verbal behavior question. benefits of help of
of patient, medicines. charts and
knowledge level diagrams.
of the patient.
3. To share  Shared the
the doubts of doubts of
the patient. the
patient.

4.To give the  Given the

information informatio
about the n about
diseases the
causes and diseases
sign and causes
symptoms and sign
with the help and
of diagrams symptoms
and charts. with the
help of
diagrams
and
charts.

DIETARY MANAGEMENT

Dietary modification if any: None

Restrictions if any: None

Food items that can be taken: All food items as per choice

DIET PLANS:

MENU CARBOHYDRATES PROTEIN FAT TOTAL

CALORIES
Breakfast:
Juice, Sandwich 150 100 50 300 calorie
and fruits
Lunch:
2 Chapati,
1Katori dal, 1 400 150 150 700 calorie
Katori mix veg
Evening: Tea, 100 50 50 200 calorie
Biscuits
Dinner:
2Chapati,
1Katori 300 200 100 600 calorie
panner,1 Katori
dal, Salad

HEALTH EDUCATION:

1. To give the health education abouttaking oral fluids in rich amount.

2. To give the advices about taking the balanced diet.
3. To advice for themaintain regular personal hygiene.
4. To provide the psychological support o the patient.
5. To advice for the taking regular medication and follow up.

CONCLUSION:

Kanika have diagnosed with the breast cancer.Her chief complaintsis the breast pain, lump in the
breast and bloody discharge from breast. She taking treatment from civil hospital and the
medications are thecefotaxim, methotrexate and anti-neoplastic drugs.I have educated about
taking the regular medication and follow up.

BIBLIOGRAPHY

 Brunner and Siddhartha’s, Text Book of Medical Surgical Nursing, Wolters Kluwer
Publisher, Twelfth edition, Page No.1481-1500.
 Jacob Annamma, a comprehensive textbook of midwifery and gynaecological nursing,3rd
edition, Jaypeebrothers, Page.no.178-182.