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Breast Cancer Concept Map

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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
18
87
C Reactive
Protein
< 1
mg/l
8/30.20
18
8 mg/l
CA 15-31
< 30
U/ml
8/30.20
18
55
U/ML
CA 125
0-35
units/
ml
8/30.20
18
22
CEA
< 3
ng/ml
8/30.20
18
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
RT
Freq.
MOA
RN
Considerations
Onset/Peak
/Duration
(Insulin)
Xarelto (
Rivaroxab
an)
(Preston,O
'Neal,Tala
ga,2017)
20
milig
rams
PO
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)
75
milig
rams
PO
O.D
Platelet
Aggregation
inhibitor
-Measure the
IRN of the
patient
-

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