Reference no: EM133460955
Assignment:
Case Study
BD is a 41 year old woman with four children who works part time as a clerk. She is 5' 8" tall and weighs 135 pounds. She has insurance through her husband's employer. She does not smoke but has a glass of wine with dinner every night. She has no PMH except for the birth of her children.
When she came to her doctor for her annual physical, which she missed last year she was advised to get a mammogram since she is over the age of 40. A lump was discovered in her right breast, which went undetected by herself and her husband. When a biopsy indicated the lump was malignant, she elected to have a lumpectomy and lymph node dissection. The pathology report indicated that 3 of 14 lymph nodes were positive.
You are a staff nurse at the group oncology clinic where she was refereed to have chemotherapy. Admitting diagnosis: Infiltrating ductal carcinoma, Stage T2 N1 M0.
BD wants you to explain to her what T2 N1 M0 means. What will you tell her? What is a biopsy? How is it performed and why was it necessary?
BD will be receiving six cycles of combination chemotherapy consisting of Adriamycin and Cytoxan. She wants to know why she "has to have two types of chemotherapy to get better." How can you explain this to her?
The lumpectomy and lymph node dissection or the surgical excision is considered the primary treatment for breast cancer. Follow-up chemotherapy is called ADJUNCTIVE? How will you explain to the family why the patient needs chemo when they state, "So the lump has been removed, I don't want all that IV medicine in her!"
When you ask BD if she has any questions, she states, "No, I understand it all. I'll be fine." How will you prepare her for the side effects of this therapy she is likely to experience?
She doesn't interrupt what you have to say but you sense she has stopped listening after you address the issue of hair loss. Elaborate on the issues of hair loss.
TWO WEEKS LATER
BD Comes to the clinic and states she feels fine except for some sores in her mouth. Laboratory data includes WBC 1.2 thou/cm, Hct 30%, Hgb10gm/dl, plt 125,000, and chem 14 is WNL. Her four year old has a cough and has been home from school. Where will you focus your discussion?