NUR 2065 WEEK 12 CASE STUDY BREAST CANCER.
Breast Cancer/Complications
of Chemotherapy
, Jan Leisner, 50 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Infection
2. Pain
3. Fluid and Electrolyte Balance
4. Thermoregulation
5. Immunity
6. Cellular Regulation
7. Clinical Judgment
8. Patient Education
9. Communication
10. Collaboration
© 2016 Keith Rischer/www.KeithRN.com
, Unfolding Clinical Reasoning Case Study: STUDENT
Breast Cancer
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 has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
No previous medical history Finding a lump is usually the first sign of breast cancer
Noted small palpable lump in her right
breast, sizeof an almond
Lump is increasing in size The lump is getting bigger so the cancer is spreading
Ultrasound confirmed cancer cells in the
tumor as well as three of her lymph nodes Now with it in the lymph nodes it will be harder to stop
most proximal to the tumor
MRI revealed a 1 cm tumor on her lumbar It is still spreading
spine
VAD will be placed later this afternoon so This is an attempt to stop the spread without surgery
that chemotherapy can be started as soon
as possible
RELEVANT Data from Social History: Clinical Significance:
4 kids under the age of 17 This is showing her kids need her to help take care of them
No personal or family history of breast There isn’t any history so she wasn’t constantly worried about
cancer getting it
Never smoked
Breast Cancer/Complications
of Chemotherapy
, Jan Leisner, 50 years old
Primary Concept
Perfusion
Interrelated Concepts (In order of emphasis)
1. Infection
2. Pain
3. Fluid and Electrolyte Balance
4. Thermoregulation
5. Immunity
6. Cellular Regulation
7. Clinical Judgment
8. Patient Education
9. Communication
10. Collaboration
© 2016 Keith Rischer/www.KeithRN.com
, Unfolding Clinical Reasoning Case Study: STUDENT
Breast Cancer
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 has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
No previous medical history Finding a lump is usually the first sign of breast cancer
Noted small palpable lump in her right
breast, sizeof an almond
Lump is increasing in size The lump is getting bigger so the cancer is spreading
Ultrasound confirmed cancer cells in the
tumor as well as three of her lymph nodes Now with it in the lymph nodes it will be harder to stop
most proximal to the tumor
MRI revealed a 1 cm tumor on her lumbar It is still spreading
spine
VAD will be placed later this afternoon so This is an attempt to stop the spread without surgery
that chemotherapy can be started as soon
as possible
RELEVANT Data from Social History: Clinical Significance:
4 kids under the age of 17 This is showing her kids need her to help take care of them
No personal or family history of breast There isn’t any history so she wasn’t constantly worried about
cancer getting it
Never smoked
