Modified radical mastectomy

Mrs. V. Reyes, 50-year-old, married and scheduled for a modified radical mastectomy. She was diagnosed with Breast Ca due to abnormality in her left breast accompanied by palpable axillary lymph nodes. In her visit to the MD’s clinic, she reported episodes of deep aching pain awakened her at night. The unexplained weight loss for several weeks accompanied by loss of muscle strength prompted her to seek medical advises, thus consulted. She also had a strong family history of cancer. Due to client’s physical and family history, the MD performed series of breast examinations including mammogram. A primary tumor was found about 5.5 cm in diameter at the upper left corner of her left breast but no evidence of spread to underlying lymph nodes and surrounding organs. Local breast excision followed and biopsy revealed positive with cell carcinoma.

Thorough conversation was done between the surgeon and client in relation to the surgical treatment and medical oncology. Modified radical mastectomy was discussed with the inclusion of healthy tissues around the tumor, called the margin; to make sure that the entire tumor is removed. Adjuvant therapy to be followed such as chemotherapy to lower the risk of recurrent and get rid of remaining cancer cells in the body. Reconstructive surgery was also offered but the patient refused.

Prior to her schedule of MRM, diagnostic studies were done, chest radiograph performed as normal, complete blood count showed decrease level of hemoglobin, hematocrit and monocytes concentrations. Fasting blood sugar – 110mg/dl, no abnormal ECG findings, V/ S within normal. No medications ordered except for Multivitamins to boost immune system.

1. Identify the abnormal breast findings by performing the appropriate breast examination techniques.
2. Formulate atleast 2 nursing diagnosis and design a nursing care plan prior to surgical intervention
3. Formulate another 2 Nursing diagnosis and design a nursing care plan post-surgical intervention
4. Discuss different kinds of chemotherapeutic agents used for clients with breast Ca.
5. Examine the risks and benefits of chemotherapeutic intervention to client with breast Ca
6. If there are nursing procedures to bed one on the client, discuss briefly the important nursing responsibilities in performing such procedure.