Reference no: EM132853076
Task: A Case History with Guided Questions
Aim of assessment
The aim of this assessment is for students to discuss the pathogenesis of breast cancer and lymphoedema and explain the pharmacological effect of morphine during the perioperative period.
Case Study
Mrs Catherine Prakash is a 34-year-old woman who presented to her General Practitioner (GP) for her yearly medical review. During her breast check the doctor found a palpable lump in her right breast. Catherine told her doctor that she noticed the lump about 6 months ago but was not worried as she was still breast feeding her 12-month-old baby and having "lumpy"breasts was normal for her. The GP ordered an urgent breast ultrasound. The ultrasound results show a small solid mass in her right breast. Catherine was referred to a breast surgeon for continued care. After further investigations by Dr. Middleton (breast surgeon) Catherine was diagnosed with Invasive Ductal breast carcinoma stage IIA. Catherine was scheduled for a Right Breast Partial Mastectomy and removal of several axillary lymph nodes the following week.
Catherine's past history includes:
Medical: diagnosed with type 2 diabetes at 28 years old. Catherine weighs 91kg.
Social: Catherine is married and has two children aged four years old and 12 months old. Catherine is a civil engineer working part-time with her local council.
Catherine was admitted to her local private hospital one day prior to her surgery so that the Clinical Nurse Consultatnt (CNC) who specialises in breast care can have a private consultation with her to discuss the surgery, postoperative expectations and ongoing care including the follow-up radiotherapy that will commenced in six weeks' time.
Catherine's surgery went well. Post operatively on return to the ward Catherine's vital signs are: - BP 144/85mmHg, HR 89bpm, HR 16bpm, Sp02 96% on RA (room air)
- BGL (Blood Glucose Level) 5.2mmol/L
- Current pain score 3/10
Catherine has insitu:
- a Haemovac drain with 10mL of bright red blood - an intact dressing on her chest incision
Catherine has been ordered:
- I.V. Sodium Chloride 0,9% 1000mls 8 hourly -Paracetamol 1 gram P.O. 6 hourly
-Morphine 2.5mg I.V. 6 hourly PRN
-Metoclopramide 10mg I.V. 8 hourly PRN
Guided Questions:
Question 1. (suggested word limit 500 words) Explain the pathogenesis of invasive ductal breast carcinoma.
Question 2. (suggested word limit 200 words) Explain how the administration of Morphine alters the conscious perception of pain.
Question 3. (suggested word limit 500 words) Explain the pathogenesis of Lymphoedema that may occur for women who have undergone axillary lymph node removal during breast cancer surgery.
Attachment:- Case History.rar
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