HESI Case Study – Breast Cancer

NUR 2065 WEEK 12 CASE STUDY BREAST CANCER. Breast Cancer/Complications of Chemotherapy Jan Leisner, 50 years old Primary Concept Perfusion Interrelated Concepts (In order of emphasis) 1. Infection 2. Pain 3. Fluid and Electrolyte Balance 4. Thermoregulation 5. Immunity 6. Cellular Regulation 7. Clinical Judgment 8. Patient Education 9. Communication 10. Collaboration © 2016 Keith Rischer/www.KeithRN.com Unfolding Clinical Reasoning Case Study: STUDENT Breast Cancer History of Present Problem: Jan Leisner is a 50-year-old Caucasian woman who has been healthy with no previous medical history. One year ago, she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy, she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her mammogram confirmed a 5 cm mass. An ultrasound biopsy confirmed the presence of cancer cells in the tumor as well as in three of her lymph nodes most proximal to the tumor. An MRI scan that followed revealed a 1 cm tumor on her lumbar spine. She is not a surgical candidate at this time, so an implanted venous access device (VAD) will be placed later this afternoon so that chemotherapy can be started as soon as possible. You are the nurse responsible for her care on the oncology unit of a community hospital. Personal/Social History: Jan has four children under the age of 17. She has no personal or family history of breast cancer. She has never smoked and lives with her husband in a suburban community. She works part-time as a substitute teacher. Jan is a devout Christian who has a strong faith and trust in God. She also believes in the power of prayer and believes that God can heal her. She chose to have a mammogram just before her husband’s insurance plan expired because he just lost his job. What data from the histories are RELEVANT and has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: No previous medical history Noted small palpable lump in her right breast, sizeof an almond Lump is increasing in size Ultrasound confirmed cancer cells in the tumor as well as three of her lymph nodes most proximal to the tumor MRI revealed a 1 cm tumor on her lumbar spine VAD will be placed later this afternoon so that chemotherapy can be started as soon as possible Finding a lump is usually the first sign of breast cancer The lump is getting bigger so the cancer is spreading Now with it in the lymph nodes it will be harder to stop It is still spreading This is an attempt to stop the spread without surgery RELEVANT Data from Social History: Clinical Significance: 4 kids under the age of 17 No personal or family history of breast cancer Never smoked This is showing her kids need her to help take care of them There isn’t any history so she wasn’t constantly worried about getting it