1. J G COLLEGE OF NURSING
AHMEDABAD
SUB-MEDICAL SURGICAL
NURSING
TOPIC-BREAST
CARCINOMA

3. IDENTIFICATION DATA
• PATIENT’S NAME: Jubedabivi Bharubhai Kakar
• IPD . NO: F 45314
• AGE:54 years
• SEX:Female
• DATE OF ADMISSION`: 2-1-2012
• DR’S UNIT: Unit-2 Dr.prakash patel
• WARD: cancer female medical ward
• MARRITAL STATUS: married

4. • RELIGIO: Muslim
• EDUCATION: 5th std.
• OCCUPATION: House wife
• ADDRESS: Sendava Taluko-Badwana, District-
Badwada, State-Madhya Pradesh
• DIAGNOSIS: Breast carcinoma Stage-3.
• OPERATION: Total Mastectomy
• OPERATION DATE:4 -1-2012
• HEIGHT: 146Cm
• WEIGHT: 6 Kg

5. PRESENTING COMPLAINS
• Patient having complained of following:
• -Fever
• -Pain in left breast
• -heavyness in left breast
• -Lump in left breast
• -Anorexia
• -Weight loss
• -Undigesion
•

6. PRESENT HISTORY:
• Jubedabivi was asymptomatic
before 1year than she develop
pain in left breast and
heaviness in the breast, this
time she was admit for total
mastectomy for breast
carcinoma stage -3.

7. PAST HISTORY:
• PAST MEDICAL HISTORY:
• Jubedabivi was asymptomatic before 1
year than develop pain in the left breast
and heaviness in the breast thus she
went to privet hospital for tacking
treatment but symptoms not relived
finally she refered in v.s.hospital for
further treatment and no any major
history of major treatmemt.

8. • PAST SURGICAL HISTORY:
• Before five month she had
done biopsy for the breast
lump in the v.s.hospital and
finally diagnose the carcinoma
breast .

9. DIET HISTORY:
Jubedabivi’s family is
non vegetarian
so her family eats non
vegetarian diet. He
cooked all type of non
vegetarian diet .

10. PERSONAL HISTORY
• Diet : Non vegetarian & taking all type of small amount
diet
• Appetite : Decreased
• Sleep :disturb
• Micturation : No burning micturation
• Bowel habit: Abnormal habits
• Smoking : No
• Alcohol : No
• Drugs : No
• Tobacco : No
• No any other habits

11. FAMILY HISTORY
• In her family no any family members
have history of any Hypertension,
Diabetes mellitus, Ischemic heart
disease, Epilepsy, Asthma, Storks,
Arthritis, Cancer or any other disease.
Her father suffering from the
tuberculosis and expired with this
disease.

12. Relations
Name of hip
Age in Occupatio
Sr.No. Family Education
Year With n
Members
patient
1 Bhurabhai 6oYrs. Husband Old S S C Retired
kakar Railwayma
n
2 Jubedabivi 54Yrs Patient 3rd pass Housewife
Kakar
3 Musabhai 40Yrs Son 12th pass Raiway
Kakar driver
4 Naseembiv .37Yrs Son’s wife 7th pass Housewife
i Kakar
5 Raja Kakar 10Yrs Grand son 5th std -
6 Rafic Yrs Grand son - -

13. SOCIOECONOMIC HISTORY
In her family her husband is
retired person
and her son is working in
railway
Her family earn around
24,000 thousand rupees
in the month and saving
about the 2500 rupees per
month .

14. PHYSICAL EXAMINATION
• VITAL SIGN

15. Date Temp ( F) Pulse Respirati BP (mm
(/min) on(/min) of Hg)
4-1-2012 100 F 100/min 24/min 116/74
5-1-2012 99 F 126/min 26 min 116/64
6-1-2012 99 F 120/min 26 min 114/78
7-1-2012 98.6F 116/min 24 min 118/74
8-1-2012 98.4 F 110/min 24 min 110/70

16. GENERAL OBSERVATION:
• Sensorium: She is conscious and well
oriented
• Foul body odour: no any bad odour
from her body
• Foul breath : no
• Posture : normal
• Hair: Brown hair, clean no any
dandruff.

17. GENERAL APPERANCE:

18. • Body image: normal
• Health: Unhealthy
• Activity: less active
• MENTAL STATUS:
• Consciousness: conscious
• Look: weakness, fatigue due to her disease.
• Posture
• Body curves: normal
• Movement: Full movement(if given deep pain than
small reflection was done by patient)
•
• Height: 146cm Weight: 67kg

19. • SKIN CONDITION:
• Color: pallor
• Texture: Rough skin
• Temperature: warm
• Lesions: no lesions present
• HEAD & FACE:
• Scalp: clean
• Face: pale, fatigue, fear, anxiety

20. EYES:
•Eyebrow: normal
•Eye lashes: no infection, not open by patient
•Eyelids: no any injury or oedema is present
•Eye balls: not sunken
•Conjunctiva: pale
•Sclera: no jaundiced
•Pupils: constricted
•Vision: react to light

21. EAR
•External ear: no
discharge
present
•Hearing:
normal

22. NOSE:
•External nares: Redness present
•Nostrils: normal. keeping face mask
for proper oxygenation

23. MOUTH & PHARYNX:
•Lips: dry
•odour of the mouth: not present
•Teeth: normal
•Mucus membrane: dry
•Tongue: pale and moist

24. NECK:
•Lymph node: Not palpable
•Thyroid gland: normal
•Range of motion: flexion, extension
and rotation when done by someone,
patient able to done by own self.

25. CHEST:
•Thorax: expansion
•Breath sound: No any sound
heard
•Heart: normal

26. ABDOMEN:
•Observation: no skin rashes and scar
•Auscultation: reduced bowel sound
•Palpation: no tenderness present
Percussion: not presence of gas, fluid or
masses

27. EXTREMITIES:
•Lower extremities: fully
movements of lower extremities.
mild oedema present
•Upper extremities: can move both
hands but mild oedema is present

28. Genital and rectum:
•No enlarged inguinal lymph
nodes, No hemorrhoids, no
enlargement of prostate
glands.
•Bladder & Bowel Pattern:
Abnormal.

29. INVESTIGATION:

30. Serum Biochemistry test:
Investigation In patient Normal value
Hemoglobin 12 % gm% 14 – 17 gm %.
RBC 100 mg/dl 153mg/ml
UREA 24mg/dl 15-45mg/dl
WBC 9,200/cumm 4000-11000/cumm
S.creat. 0.59mg/dl 0.7-1.5mg/dl
SGPT 36U/L 0-55U/L
S. phosphate 108 U/L <50-150U/L
S.Billirubin 0.7mg/dl 0.2-1.2mg/dl
BLOOD
CHEMISTERY
FASTING 90.0mg/ dl 70-110mg/dl
CHOLESTROL 174 mg/dl >240.0mg/dl

31. Serum Electrolytes:
Investigation In patient Normal
value
S. Na+ 144.3 meq/L 135145meq/L
S.K+ 4.62 meq/L 3.5-5.5 meq/L
Chloride 105 97-108

32. X-RAY CHEST:
•Olcg in
bothlungs

33. • ECG:
• wnl
• Ultrasound-
• 4.5*3.9cm lesion seen in the left breast.
• MRI Breast-
• 5*4*3cm lesion seen in the left breast.
• MEMOGRAPHY DONE-
• There is Lesion spread in to ipsilateral mammary
lymph nodes and tumor sie is more than 5cm.

34. MEDICATION
• CHEMOTHERAPY GIVEN AFTER SURGERY
• -Injection Adriamycin and cyclophosphamide
regimen every 3week for four cycle.
• -Injection amikasine 500gm i/v 12hourly.
• -Injection dynapar 1 ampoule i/v 12hourly.
• - Injection Pentoprajol 1 vial i/v 12 hourly.
• - Injection Glucose 5% 1 litre i/v slowly.

35. • Maintain intake and output chart daily
• Contineus observation of the patient on monitor for
any abnormal symptoms.
• TPR chart 1 hourly Monitoring continuously for
blood pressure, respiration rate, pulse, and for
oxygen saturation.
• Care taken of catheter daily
• Care taken of all tubes which are inserted
• Watched for respiratory failure .
• Changed the dressing and adhesive tap at the site
of intracath

36. DISEASE CONDITION
Knowing the various parts of the breast, what they do
and why they're important is critical to identifying
any abnormalities that might appear in your breasts.
Understanding female breast anatomy can help
you understand which changes are normal and
healthy, and which may signal disease.

38. Female Breast Anatomy
• Although the human breasts are located over the pectoral muscles
of the chest wall, the human breast doesn't actually contain any
muscle tissue. Your breasts, which are made up of glandular, fatty
and fibrous tissues, have a number of different functional parts:
• Areola (colored area around the nipple)
• Blood vessels and lymph vessels
• Ducts (milk passages)
• Fatty tissue
• Fibrous tissue that surrounds the lobules and ducts
• Lobes
• Lobules (milk glands)
• Nipple.
• A layer of fatty tissue surrounds the breast glands and runs
throughout the entire breast. This layer of tissue gives the female
breast its soft consistency.

39. Female Breast Milk Production
• Each breast has 15 to 20 sections (or "lobes") beneath
the nipple and areola, arranged in a circular pattern
that resembles a daisy. Lobes are part of the milk
production system; each lobe contains many smaller
milk-producing glands called "lobules." Each lobule has
tiny bulbs, called "alveoli." When a woman is lactating,
the alveoli produce milk in response to hormonal
signals.
• When milk is produced, the ducts transport it from the
lobules to the nipple. As each duct gets closer to the
nipple, it widens to form a sac called an "ampulla." The
spaces between the lobules and the ducts are filled
with fatty tissue, connective tissue and ligaments. As
the milk production system is roughly the same size in
all women, breast size and shape depend on the
amount of fat in the breasts.

40. Arterial and Lymphatic Anatomy of
the Breast

41. • Arteries and capillaries carry oxygen- and nutrient-
rich blood to the breasts. The axillary artery, which
extends from the armpit, supplies blood to the
outer half of the breast. The internal mammary
artery, which extends down from the neck, supplies
blood to the inner part of the breast.
• The human breast also contains lymph vessels. The
lymphatic system is part of your immune system
and contains blood vessels, lymph ducts and lymph
nodes. These work to fight off harmful or infectious
substances within your body. Clusters of lymph
nodes are located under your arm, above your
collarbone, behind your breastbone and in various
other parts of your body.
•
•

42. DEFINITION:
• Breast cancer is a malignant (cancerous)
growth that begins in the tissues of the
breast. Cancer is a disease in which
abnormal cells grow in an uncontrolled
way. Breast cancer is the most common
cancer in women, but it can also appear
in men. In the U.S., it affects one in eight
women.

43. CAUSES:
In Book In Patient
Hormonal yes
imbalance
Changes in DNA May be
bond of cell
Genetic abnormality no
any

44. PATHOPHYSIOLOGY:
• Breast cancer, like other cancers, occurs because of
an interaction between the environment and a
defective gene.
• Normal cells divide as many times as needed and
stop. They attach to other cells and stay in place in
tissues.
• Cells become cancerous when mutations destroy
their ability to stop dividing, to attach to other cells
and to stay where they belong.

45. • When cells divide, their DNA is normally copied
with many mistakes. The mutations known to cause
cancer.
• These mutations are either inherited or acquired
after birth. Presumably, they allow the other
mutations, which allow uncontrolled division, lack
of attachment, and metastasis to distant organs.
• Mutations that can lead to breast cancer have been
experimentally linked to estrogen exposure.

46. • Failure of immune surveillance, the removal of
malignant cells throughout one's life by the immune
system.
• Abnormal growth factor signaling in the interaction
between stromal cells and epithelial cells can
facilitate malignant cell growth.
• In breast adipose tissue, overexpression of leptin
leads to increased cell proliferation and cancer.

47. CLINICAL MENIFESTATION:
In Book In Patient
Lump in breast Present
Thickening in the breast Present
Change the size and Present
shape of the breast
Nipple discharge Present
Change size and Present
shape of the nipple
Chang color of the Present
nipple and the areola
Raches seen on the Present
skin

48. ASSESSMENT & DIAGNOSTIC
FINDINGS:
IN BOOK IN PATIENT
- Taking a thorough - Done
history including family
history
- Physical examination - Done
(note BP & weight)
- Laboratory work - Done
(cholesterol levels,
glucose )
-Ultrasound - Done

49. MANAGEMENT:
• MEDICAL MANAGEMENT:
• Chemotherapy in four cycle with Adreamycine and
cyclophosphemide.
• Analgesics
• Antibiotics
• SURGICAL MANAGEMENT:
• Prepare for Total mastectomy of the patient.
• Preoperative advice given to the parents signature
taken for operation, nil by mouth after 10pm before
operation day.

50. NURSING MANAGEMENT
• Identify at risk patients, & teach lifestyle
modifications to prevent development any
complication.
• Teach patient to control cholesterol levels through
dietary reduction of cholesterol intake, exercise,
smoking cessation.
• Note & report findings from history, physical
examination, & laboratory results that indicate
hypertension or diabetes, & teach to control blood
pressure by taking treatment in the nearest
hospital.
•

51. NURSING DIAGNOSIS:
• Altered skin integrity related to bed
ridden condition as evidence by
redness on back side.
• Risk for infection related to presence
of dressing at suture site.
• Altered body temperature due to
presence of infection.

52. • Imbalance nutritional level less than body
requirement related to loss of appetite.
• Activity intolerance related to surgery
done.
• Impaired body image due o surgeory.
• Altered self image and confidence due to
fegure.

53. HEALTH TEACHING:
• Arrange specific services for patient(e.g.
respiratory therapy education, physical
therapy for exercise & breathing)
• Explain patient’s reletives about discharge
planning.
• Give advice about regular medication as per
timing.
• Explain and demonstrate about chest
physiotherapy by doing deep breathing
exercise .

54. • Explain and demonstrate about
coughing and how to remove
cough.
• Advice given about good nutritive
.
• Advide given for prevention of
infection management.
• Explain about follow up care.

55. BIBLIOGRAPHY:
• Bennette and Plum; “TEXTBOOK OF
MEDITION ; 10thedition, 1996;
• W.B. Saunders Company, New York :
1996. PP : 789-794
• Black J.M; “MEDICAL SURGICAL
NURSING; 5th edition, 1999
• ; W.B. Saunders Company,
Philadelphia. PP: 1217-1242

56. • Brunners & Suddarth’s; “TEXT BOOK OF MEDICAL
SURGICAL
• NURSING VOL-_1”;10th edition, 2004; Elsevier
Publishers, New Delhi,
• India. PP: 684-740
•
• B T Basavanthappa;”TEXT BOOK OF NURSING
THEORIES”,Jaypee brothers Medical Publishers ,New
Delhi.
• PP: 40-
• WEBSITES:
• http://www.wikipedia.com.
• http://www.patho.coronaryarterydisease.org/.com.in
• http://www.google.com.
• http://www.medicine.com.
•

57. THANK YOU AND HAVE A NICE DAY