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45-year old black American female in the hospital. Married mother of two children, ages 10 and 12 years old.
Mrs. Whitney is a 45-year-old woman who noticed a lump in her left breast during her monthly breast self-exam two weeks ago. She made an appointment with her gynecologist who documents “a fixed round lump with irregular borders palpated in the upper outer quadrant of left breast at 2:00. Left axillary edema noted. There is symmetry of the breasts with no puckering or nipple discharge. The client denies pain.” Mrs. Whitney began having her menstrual period at 10 years of age. She has 2 children, both of whom she breastfed for approximately twelve months. Mrs. Whitney’s oldest sister died of breast cancer. Mrs. Whitney has a diagnostic mammogram and a fine needle
aspiration biopsy. It is determined that she has stage II breast cancer.
Mrs. Whitney will have a lumpectomy with lymph node dissection (partial mastectomy). A Jackson Pratt (JP) drain will be in place postoperatively. Following surgery, tamoxifen is prescribed.
1. Discuss the best time of the month to perform breast self-examination (BSE).
2. What factors placed Mrs. Whitney at greater risk for the development of breast cancer? Discuss the risk factors associated with Mrs. Whitney’s ethnicity.
3. Briefly discuss the relationship between breastfeeding and Mrs. Whitney’s risk of breast cancer.
4. Discuss the priority nursing intervention prior to Mrs. Whitney’s biopsy and immediately following diagnosis.
5. The nurse is teaching Mrs. Whitney how to use an incentive spirometer (IS). How will the nurse tell Mrs. Whitney to use the IS and what will the nurse explain as the rationale for IS use postoperatively?
6. Mrs. Whitney is discharged from the post-anesthesia care unit (PACU) following her lumpectomy and lymph node dissection. Now that she is in your care on the nursing unit, discuss what you will assess.
7. Identify five postoperative nursing diagnoses to consider for
Mrs. Whitney. List the diagnoses in order of priority.
8. The nurse hangs a sign above Mrs. Whitney’s bed to alert other member of the health care team about interventions to maintain Mrs. Whitney’s safety and prevent complications of her surgery. Discuss what the sign should say.
9. The nurse gives Mrs. Whitney contact information of “Reach for Recovery.” Discuss the support services available through this program.
10. Mrs. Whitney is going home today. The nurse is teaching her about possible complications of her surgery. Explain what lymphedema is, the chances of developing lymphedema, and its manifestations. Identify at least two other complications the nurse will include in the discharge teaching.
11. Discuss why tamoxifen is prescribed as part of Mrs. Whitney’s treatment plan.
12. Mrs. Whitney asks about the adverse effects of tamoxifen. Create a list of the possible common and potentially life threatening adverse effects of this medication. What instructions should you include regarding sexual activity.
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