Breast Cancer Concept Map

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Cultural considerations, ethnicity, occupation, religion,

family support, insurance. (1) (14)

Socioeconomic/Cultural/Spiritual Orientation &

Psychosocial Considerations/Concerns, to include

the following Social Determinants of Health

The patient is a high school math teacher. She enjoys

teaching students and is always a pleasure for her to go to

work. She is married for the last 24 years and has two

children. Economically she admits that they never faced

any financial problems

History of Present Illness (HPI), Pathophysiology of Admitting Dx

(Cite References) Medical, Surgical, Social History (1).

After the patient showered she palpated her breasts because she knew that

her mother also had breast cancer and was diagnosed at an advanced

stage because she didn't go to the physician. While doing so she felt at the

left breast in the upper and outer quadrant a mass. The mass felt solid and

was around 4 to 5 centimeter. It didn't hurt at all. She also palpated her

axilla to look for any swollen lymph nodes but everything seemed

normal. The next day she made an appointment with her physician which

took a biopsy from the nodule. A week later the result came and informed

the patient that it is a ductal carcinoma. The patient underwent a

mastectomy procedure in order to fully reduce the risk of progression.

Pathophysiology of admitting dx: In this situation environmental factors,

hormone modifications or inherited mutation damage the DNA which is

incapable of repairing correctly. As a result of this mutation at the level

of the genome is formed which leads to the inactivation of the tumoral

suppressor genes and the activation of the oncogenes. As a result of this,

there will an unregulated cell proliferation with decreased apoptosis

which will progress and will lead to the malignant neoplasm. Signs of

breast cancer include new lumps in the breast, possible pain in one of the

armpit, changes or shape or size in the breasts, discharges for the nipple,

swelling in the armpit or nipple modifications.

(Shah,Rosso,Nathanson,2014)

Medical History

Thrombophilia: the patient suffers from an inherited form of

thrombophilia which the mutation at the level of the V Leiden factor.

This is a pathological condition in which the genes which have the role of

keeping the blood viscosity in balance are mutated. As a result of this, the

patient has a tendency to form blood clots.

(Stevens,Woller,Bauer,Kashturi,Cushman,Streiff,2016)

-> Previously this patient was admitted twice for deep vein thrombosis

both of them at the inferior limbs. She is currently undergoing blood

thinning treatment and most likely will have to do so for the rest of her

life. Before her mastectomy, her therapy was stopped in order to avoid

massive bleeding during the surgery.

Surgical History

Because of one of her thrombosis was a really severe one she had to

undergo thrombectomy procedure. During this intervention, the surgeons

will use a device which will either absorb the blood clot or break it up.

The intervention consists of navigating a stent through the arteries of the

patient until it reaches the thrombus. With the help of advanced

imagining guidance, the stent will encase the clot and will remove it.

(Yoo,Andersson,2017)

Social History

The patient used to smoke for 15 years but admits she not longers smoke

for the last 5 years. She lives with her husband and her two daughters.

She denies alcohol and drugs consumption but admits she has a sedentary

lifestyle.

Chief Complaint

The patient felt a mass in her upper outer

quadrant, which was approximately 4

centimeter and it was painless. Because she had

cases of breast cancer in her family she went to

the physician,

Admitting Diagnosis

Breast Cancer/ Stage II

Patient Information

(1)

Name: D.A

Age: 44 years

Gender: Female

Code Status:Full Status

DPOA: N/A

Living Will: N/A

Patient Education (In Pt.) & Discharge Planning (home needs)

The patient went a mastectomy surgery in order to remove the tumor

from her breast. The following are considerations that she should

follow once she is discharged:

-Avoid any heavy lifting or vigorous exercises until the stitches will be

removed.

- Avoid driving and doing housework until the drain will be removed.

- Don't avoid using your arm but don't overwork it.

- Bruisings and swelling can be common in case of this surgery.

- It is normal to face a low-grade fever ( under 100 degrees Fahrenheit).

-Empty your drain when it is needed.

- Take medication are instructed by the physician.

-Use a towel to dry your incision after the shower but make sure you

won't remove the suture or the strips.

Concept Map

Student Name:

Instructor:

Diagnostic Test/ Lab Results with dates

and Normal Ranges (3)

Test

Norms

Date

Current

Value

ESR

< 15

mm/h

8/30.20

C Reactive

Protein

< 1

mg/l

8/30.20

8 mg/l

CA 15-31

< 30

U/ml

8/30.20

U/ML

CA 125

0-35

units/

8/30.20

CEA

< 3

ng/ml

8/30.20

1 ng/ml

ECG - Normal ECG, sinus rhythm.

Mammography Results:

Pleomorphic microcalcification

which is associated with the

palpable mass. The features are

suspicious of malignancy and

biopsy is adviced.

Biopsy: Stage 2 A Breast Cancer,

T2N0M0.

Medical Management/ Orders/ Medications & Allergies (2)

Name

Dose

Freq.

MOA

Considerations

Onset/Peak

/Duration

(Insulin)

Xarelto (

Rivaroxab

an)

(Preston,O

'Neal,Tala

ga,2017)

milig

rams

O.d

It is a factor

Xa inhibitor

with a rapid

onset.Intrinsec

and extrinsic

pathway are

interrupted.

Monitor for

possible side

effects for this

medication.

Monitor for any

signs of

excessive

bleeding

Aspirin

(Preston,O'

Neal,Talag

a,2017)

milig

rams

O.D

Platelet

Aggregation

inhibitor

-Measure the

IRN of the

patient

Erickson’s Developmental Stage Related to pt. & Cite

References (1)

Taking into consideration our patients age which is 44 years

old, based on Erickson's Development scale she would classify

in the seventh group which is the middle adulthood and lats until

65 years old. The basic conflict during this stage is represented

by generativity vs stagnation and the most prominent event is

being a parent. It is that period during which people are afraid of

being meaningless. Children and grandchildren are priorities and

they try to offer all their support. In case they fail they might

feel like they are stagnating and not productive to the society.

Our patient is married and has 2 children. Both of them just

graduated high school and she is very proud of them. Until this

point, we can conclude that she is doing well based on Erikson's

stages. (Malone,Liu,Vaillant,2016)

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