Breast Cancer/Complications of Chemotherapy SKINNY Reasoning| ANSWER KEY

Primary Concept Infection Interrelated Concepts (In order of emphasis) • Fluid and Electrolyte Balance • Cellular Regulation • Immunity • Stress • Clinical Judgment NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment □ Management of Care 17-23% • □ Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% • Psychosocial Integrity 6-12% • Physiological Integrity □ Basic Care and Comfort 6-12% • □ Pharmacological and Parenteral Therapies 12-18% • □ Reduction of Risk Potential 9-15% • □ Physiological Adaptation 11-17% • SKINNY Reasoning Part I: Recognizing RELEVANT Clinical Data History of Present Problem: Jan Leisner is a 50-year-old Caucasian woman who has been healthy with no previous medical history. One year ago, she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy, she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her mammogram confirmed a 5 cm mass. An ultrasound biopsy confirmed the presence of cancer cells in the tumor as well as in three of her lymph nodes most proximal to the tumor. An MRI scan that followed revealed a 1 cm tumor on her lumbar spine. She is not a surgical candidate at this time, so an implanted venous access device (VAD) will be placed later this afternoon so that chemotherapy can be started as soon as possible. You are the nurse responsible for her care on the oncology unit of a community hospital. Personal/Social History: Jan has four children under the age of 17. She has no personal or family history of breast cancer. She has never smoked and lives with her husband in a suburban community. She works part-time as a substitute teacher. Jan is a devout Christian who has a strong faith and trust in God. She also believes in the power of prayer and believes that God can heal her. She chose to have a mammogram just before her husband’s insurance plan expired because he just lost his job. What data from the histories are RELEVANT and have clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: One year ago she noted a small palpable lump in her right breast about the size of an almond. Over the last month she has noted that this lump has been increasing in size. Her mammogram confirmed a 5 cm mass. This biopsy confirmed the presence of cancer cells in the tumor as well as in three of her lymph nodes most proximal to the tumor. The MRI scan revealed a 1 cm tumor on her lumbar spine. Any lump in the breast area has the potential to be cancerous and needs to be followed up. The majority of breast masses are benign, 10% are cancerous…Irregular fixed masses are suspicious for malignancy [Epocrates, 2015]. A rapidly growing lump is a clinical RED FLAG, a cause for concern, and must not be ignored! Though denial is a common coping mechanism, in this context it could be deadly! Cancer that has progressed to lymph nodes is a clinical RED FLAG that increases the likelihood of metastasis. Finding cancer cells in the lymph nodes is stage III because of their close proximity to the primary tumor. Metastasis from the primary site to a distant location meets the criteria for stage IV. This is the worst possible staging and makes this a terminal diagnosis.