Nursing Management Related Treatments Upon her follow-up assessment in the hospital due to her condition, Mrs.

C underwent further physical assessment and numerous laboratory and diagnostic examinations before her physician suggest that she must be confined because she was diagnosed of stage 2 breast cancer. Some of the diagnostic findings in detecting breast cancer include FNAB (fine needle aspiration biopsy), excisional (or open) biopsy, incisional biopsy, needle localization, core biopsy and stereotactic biopsy. Lippincotts Manual of Nursing Practice (2008) defined FNAB or fine needle aspiration biopsy as a diagnostic procedure in detecting breast cancer or other types of cancer. It uses a thin needle and syringe to collect tissue or to drain lump after using a local anesthetic. If it is a cyst, removing the fluid will collapse it; no other treatment may be needed. Ultrasound may be used to locate a nonpalpable cyst. A normal cyst fluid appears straw-colored or greenish. Fluid should be sent from cytology if it appears to be suspicious (clear or bloody). This office procedure uses local anesthesia with results usually within 24 hours. Nursing management for a patient who is undergoing FNAB is to inform her that there is only small risk of hematoma and infection. Also adhesive bandage is applied once after the procedure and usually theres no discomfort due to local anesthesia.. And if theres a solid lesion, it is advice to have excisional biopsy instead of this procedure. Needle biopsy is another procedure wherein it uses local anesthetic and removes a small piece of breast tissue using a needle with a special cutting edge. Indications of needle biopsy are for palpable lesions with a high suspicion of malignancy. Diagnosis can bedone within approximately 24 hours. Nursing considerations include informing the patient that there will be several passes may be necessary to obtain specimen and with minor discomfort. And then pressure dressing is applied after the procedure, then administration of ibuprofen (Advil) or acetaminophen (Tylenol) may be taken as ordered for postprocedure discomfort. Besides FNAB and needle biopsy, Sentinel lymph node biopsy or SLNB is another diagnostic surgical procedure for breat cancer in which it utilizes selective lymph node sampling. As Stated from Lippincotts Manual of Nursing Practice (2008), It is a pathologic study of the first (sentinel) axillary lymph node to recieve drainage from a tumor and it may predict the status of the remainder of the axilla. Localization is done through injection of blue dye and/or radioactive particles around a tumor to identify lymph node with afferent drainage. The status of the sentinel lymph node is used to determine whether to proceed with full axillary dissection and/or determine treatment modalities. If the sentinel lymph node test is negative, no further axillary surgery is indicaded. But if it is positive, further axillary surgery dissection may be needed. Nursing management for SLNB is further education about this diagnostic procedure. SLNB is commonly done in the outpatient department. During her assesment, Mrs. C has a diagnosis of infiltrating ductal cancer of her left breast. Mammography detected her condition. Mammgraphy is a procedure wherein it uses low-dose X-ray of breast is used to screen for breast abnormalities or may be used when a lump is found on physical examination.(Lippincott, 2008) Compression of the breast is used to reduce the amount of radiation absorbed by the breast tissue and separate overlapping tissues. Scoring in mammography assessment ranges from 1 (not benign) to 6 (malignant metastatic) and it is not routinely done for pregnant mothers. Nursing management for a patient undergong mammography to tell about the routine screening of mammography may reduce mortality from breast cancer and the procedure itself is done approximately 15 minutes.

Nursing Management The physician suggested to Mrs. C to undergo lumpectomy. Lumpectomy or incisional bopsy is a surgical procedure wherein the tumor is removed as well as its surrounding tissue (Lippincott, 2008).Indications include diagnosis of an abnormal mammographic finding or palpable breast lump ifneedle biopsy is not performed. After the surgery, Mrs. C undergo chemotherapy and radiation therapy. Her medication that the physician ordered was tamoxifen (Nolvadex). Tamoxifen is a the drug of choice for breast cancer (Lippincott, 2008). Indications of this medication is for metastatic breast cancers. Other uses of tamoxifen according to the website http://www.nlm.nih.gov/medlineplus, tamoxifen is also used sometimes to induce ovulation (egg production) in women who do not produce eggs but wish to become pregnant. Tamoxifen is also sometimes used to treat McCune-Albright syndrome (a condition that may cause bone disease, early sexual development, and dark colored spots on the skin in children). Contraindications for tamoxifen includes pregnancy because it promotes vaginal bleeding (MIMS, 2001) and in patients requiring concomitant coumarin-type anticoagulant therapy. It is also contraindicated in women who are at high risk for--or those with a history of--blood clots (Tamoxifen Adverse Effects, http://www.livestrong.com/article/75489-tamoxifen-adverse-effects-contraindications/#ixzz1mp8vnjU3, 2010) Tamoxifen has been shown to worsen menopausal symptoms, such as hot flashes and vaginal discharge, in 20 percent of users, according to a 2008 review published in the journal "Breast Cancer." Nursing considerations for chemotherapy is to educate the patient about the adverse effects and contraindications of chemotherapeutic drugs, including the dosage and the time of administration. Radiation therapy may be done in conjunction with breast-preserving procedure as an adjuvant (additional) to decrease incidence of local recurrence or invasive breast cancer and DCIS (ducal cancer in situ). It can be used after mastectomy in patients with large tumors that involves in the chest wall (Lippincott, 2008) Conraindications of radiation therapy include two primary tumors in separate quadrants of the breast, histore of previous radiation therapy, pregnancy and positive margins. In nursing management in radiation therapy, individuals may make changes in their lives to help them cope with the presence of illness and facilitate health promotion while receiving active treatment for cancer.This is true especially if they are provided with well-designed and effective supportive care (Wengstrm, Yvonne; Nursing Interventions in Radiation Therapy, 1999) .

Refrences: 1. Breast Conditions, Lippincotts Manual of Nursing Practice 8th ed., Lippincott Williams and Wilkins, 2008 (p.945) 2. Dinh, Tuan Tamoxifen Adverse Effects, http://www.livestrong.com/article/75489-tamoxifenadverse-effects-contraindications/#ixzz1mp8vnjU3, 2010 3. Wengstrm, Yvonne; Nursing Interventions in Radiation Therapy, 1999

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