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

FUNDAMENTAL Reasoning: STUDENT

© 2016 Keith Rischer/www.KeithRN.com

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Breast Cancer/Complications of Chemotherapy

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 have clinical significance to the nurse?

RELEVANT Data from Present Problem: Clinical Significance:

No previous medical history

Noted small palpable lump in her right

breast, size of 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

© 2016 Keith Rischer/www.KeithRN.com

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