Hi guys. My name is Abby, and we're going to go through a case study about breast cancer together. Let's get started. In this scenario, our patient is Natasha. She's 32 years old and an African American patient that arrives at the surgical oncology unit after a left breast mastectomy and lymph node excision. She arrives from the PACU, the post anesthesia care unit, by hospital bed with her spouse, Angelica, at the bedside. They explained that a self exam revealed a lump and, after mammography and biopsy, that surgery was the next step in cancer treatment and they have found an oncologist that they trust. Natasha says, “I wonder how I will look after surgery since I want reconstruction?” Let's take a look at our critical thinking checks number one and number two below.
Great job after screening and assessing the patient, the nurse finds that she is alert and oriented to date, place, person, and situation. The PACU staff gave her ice due to dry mouth and the patient self-administered and tolerated very well. She has a 20 gauge IV in her right hand and states that her pain is two out of 10 on a scale of one to 10, with 10 being the worst. Her wife asks when the patient can eat and also about visiting hours. Natasha asks about a bedside commode for urination and why she does not have a pain medicine button. Another call light goes off and the nurse's clinical communicator rings. The nurse heard in report about a Jackson Pratt drain, but there are no dressing change instructions, so she does not further assess the post-op dressing situation in order to deal with the call lights and everything else going on. She sits down to document that patient medications were ordered in the EHR or the electronic health record, but have not been administered.
Take a look below for those pain medicines. She has Tramadol that she can have 50 milligrams, every six hours, oxycodone, and fentanyl. She's got some good choices. She also has lactated ringers, or LR, at 125 milliliters an hour via IV infusion, and she should be getting two liters of that. There's also Naloxone. Just in case.
Let's take a look at her vital signs: her blood pressure is 110/70 mmHg, her oxygen saturation on room air is 98%, her respiratory rate is 14, her heart rate is 68 beats/minute with a regular rhythm and her temperature is 36.5 degrees Celsius. Her CBC looked good. Everything was within normal limits on her BMP. However, the potassium came back at 5.4. Now that we have this information, let's go ahead and take a look at our critical thinking checks.
Excellent. Natasha sleeps through the night with no complaints of pain. The lab comes to draw the ordered labs and the CNA takes vital signs. Let's look at these things below: Her CBC results and her hemoglobin with 7.2, hematocrit 21.6. Her BMP, the Na, or her sodium, came back at 130, potassium at 6.0 and a BUN, or blood urine nitrogen, at 5. We also got a new set of vitals from our aid: The blood pressure, 84, over 46 and a heart rate of 109. She has a respiratory rate of 22 and she's saturating on room air at 91%. Things have changed a little bit. In light of these results, let's take a look at our critical thinking check number five below.
Good job. The dressing is saturated with bright red blood. There is evidence of bleeding through the dressing and in the bed as well. Plus, when the nurse sees the CNA has emptied the drain at least eight times in the shift, the nurse knows this is unusual. The nurse calls the surgeon to advise of the bleeding, the labs, and the vital signs that were irregular. Natasha asks for her phone so that she can call her wife. She's tearful in the phone call. She says, “I look so disgusting right now. No one will ever love me, but that does not matter. I'm going to die of cancer. Anyways, I should have kept going to church with my parents at the kingdom hall.” She was pretty upset. Now that we have this information, let's take a look at our critical thinking checks number six and number seven below.
Well done. The surgeon orders one unit of packed red blood cells to be infused. The nurse then goes to the patient to ask about religious affiliation and to discuss the doctor's orders. After verifying that Natasha is not a practicing Jehovah's Witness, the nurse proceeds to prepare the transfusion. Now with all of this in mind, let's take a look at our critical thinking check number eight below.
Great job after receiving that unit of packed red blood cells, Natasha rests quietly, but she still appears upset. The nurse asks if she needs anything and Natasha states, “Yes. What happens when I get out of here? I'm so worried about what is next.” In order to address this development, Let's take a look at our critical thinking check number nine below.
Fantastic job everyone! This wraps up our case study on Breast Cancer. Please take a look at the attached study tools and test your knowledge with a practice quiz. We love you all, now go out and be your best self today, and as always, happy nursing!
References:
For condition from uptodate.com Overview of the treatment of newly diagnosed, invasive, non-metastatic breast cancer
Authors:Alphonse Taghian, MD, PhDSofia D Merajver, MD, PhDSection Editors:Daniel F Hayes, MDGary J Whitman, MD (last updated June, 2021) AND Clinical features, diagnosis, and staging of newly diagnosed breast cancer
Author:Bonnie N Joe, MD, PhDSection Editor:Harold J Burstein, MD, PhD (last updated Nov, 2021)
