what is breast

7/28/2019 What is Breast

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What is breast cancer?

Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant

tumor is a group of cancer cells that can grow into (invade) surrounding tissues or

spread (metastasize) to distant areas of the body. The disease occurs almost entirelyin women, but men can get it, too.

The remainder of this document refers only to breast cancer in women. For

information on breast cancer in men, see our document, Breast Cancer in Men.

The normal breast

To understand breast cancer, it helps to have some basic knowledge about the

normal structure of the breasts, shown in the diagram below.

The female breast is made up mainly oflobules (milk-producing glands), ducts (tinytubes that carry the milk from the lobules to the nipple), andstroma (fatty tissue and

connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic

vessels).

Most breast cancers begin in the cells that line the ducts (ductalcancers). Somebegin in the cells that line the lobules (lobularcancers), while a small number start

in other tissues.

The lymph (lymphatic) system of the breast

The lymph system is important to understand because it is one way breast cancers

can spread. This system has several parts.

Lymph nodes are small, bean-shaped collections of immune system cells (cells that

are important in fighting infections) that are connected by lymphatic vessels.

Lymphatic vessels are like small veins, except that they carry a clear fluid

called lymph(instead of blood) away from the breast. Lymph contains tissue fluid
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and waste products, as well as immune system cells. Breast cancer cells can enter

lymphatic vessels and begin to grow in lymph nodes.

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary

nodes). Some lymphatic vessels connect to lymph nodes inside the chest (internal

mammary nodes) and those either above or below the collarbone(supraclavicularorinfraclavicular nodes).

If the cancer cells have spread to lymph nodes, there is a higher chance that the cells

could have also gotten into the bloodstream and spread (metastasized) to other sites

in the body. The more lymph nodes that have breast cancer, the more likely it is thatthe cancer may be found in other organs as well. Because of this, finding cancer in

one or more lymph nodes often affects the treatment plan. Still, not all women with

cancer cells in their lymph nodes develop metastases, and some women can have no

cancer cells in their lymph nodes and later develop metastases.

Benign breast lumps

Most breast lumps are not cancerous (benign). Still, some may need to be sampled

and viewed under a microscope to prove they are not cancer.

Fibrosis and cysts

Most lumps turn out to be caused by fibrosis and/or cysts, benign changes in the

breast tissue that happen in many women at some time in their lives. (This is

sometimes calledfibrocystic changes and used to be calledfibrocystic disease.)

Fibrosis is the formation of scar-like (fibrous) tissue, and cysts are fluid-filled sacs.

These conditions are most often diagnosed by a doctor based on symptoms, such as

breast lumps, swelling, and tenderness or pain. These symptoms tend to be worse

just before a woman's menstrual period is about to begin. Her breasts may feel

lumpy and, sometimes, she may notice a clear or slightly cloudy nipple discharge.


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S t a g e s o f B r e a s t C a n c e r

Stage Definition

Stage

0

Cancer cells remain inside the breast duct, without invasion into

normal adjacent breast tissue.

Stage ICancer is 2 centimeters or less and is confined to the breast (lymph

nodes are clear).

Stage

IIA

No tumor can be found in the breast, but cancer cells are found in the

axillary lymph nodes (the lymph nodes under the arm)

OR

the tumor measures 2 centimeters or smaller and has spread to the

axillary lymph nodes

OR

the tumor is larger than 2 but no larger than 5 centimeters and has not

spread to the axillary lymph nodes.

Stage

IIB

The tumor is larger than 2 but no larger than 5 centimeters and has

spread to the axillary lymph nodes

OR

the tumor is larger than 5 centimeters but has not spread to the axillary

lymph nodes.

Stage

IIIA

No tumor is found in the breast. Cancer is found in axillary lymph

nodes that are sticking together or to other structures, or cancer maybe found in lymph nodes near the breastbone

OR

the tumor is any size. Cancer has spread to the axillary lymph nodes,

which are sticking together or to other structures, or cancer may be

found in lymph nodes near the breastbone.

Stage

IIIB

The tumor may be any size and has spread to the chest wall and/or skin

of the breast

AND

may have spread to axillary lymph nodes that are clumped together or

sticking to other structures, or cancer may have spread to lymph nodes

near the breastbone.

Inflammatory breast cancer is considered at least stage IIIB.

Stage

IIIC

There may either be no sign of cancer in the breast or a tumor may be

any size and may have spread to the chest wall and/or the skin of the

breast

AND

the cancer has spread to lymph nodes either above or below the

collarbone

AND

the cancer may have spread to axillary lymph nodes or to lymph nodes
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near the breastbone.

Stage

IVThe cancer has spreador metastasizedto other parts of the body.

I . R i s k f a c t o r s y o u c a n c o n t r o l

Weight. Being overweight is associated with increased risk of breast cancer,

especially for women after menopause. Fat tissue is the bodys main source of

estrogen after menopause, when the ovaries stop producing the hormone. Having

more fat tissue means having higher estrogen levels, which can increase breast

cancer risk.

Diet. Diet is a suspected risk factor for many types of cancer, including breast

cancer, but studies have yet to show for sure which types of foods increase risk. Its

a good idea to restrict sources of red meat and other animal fats (including dairy fat

in cheese, milk, and ice cream), because they may contain hormones, other growth

factors, antibiotics, and pesticides. Some researchers believe that eating too much

cholesterol and other fats are risk factors for cancer, and studies show that eating a

lot of red and/or processed meats is associated with a higher risk of breast cancer. A

low-fat diet rich in fruits and vegetables is generally recommended. For more

information, visit our page on healthy eating to reduce cancer risk in the Nutrition

section.

Exercise. Evidence is growing that exercise can reduce breast cancer risk. The

American Cancer Society recommends engaging in 45-60 minutes of physicalexercise 5 or more days a week.

Alcohol consumption. Studies have shown that breast cancer risk increases with

the amount of alcohol a woman drinks. Alcohol can limit your livers ability to

control blood levels of the hormone estrogen, which in turn can increase risk.

Smoking. Smoking is associated with a small increase in breast cancer risk.

Exposure to estrogen. Because the female hormone estrogen stimulates breast cell

growth, exposure to estrogen over long periods of time, without any breaks, can

increase the risk of breast cancer. Some of these risk factors are under your control,

such as:

taking combined hormone replacement therapy (estrogen and progesterone;HRT) for several years or more, or taking estrogen alone for more than 10

years

being overweight regularly drinking alcohol
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Recent oral contraceptive use. Using oral contraceptives (birth control pills)

appears to slightly increase a womans risk for breast cancer, but only for a limited

period of time. Women who stopped using oral contraceptives more than 10 years

ago do not appear to have any increased breast cancer risk.

Stress and anxiety. There is no clear proof that stress and anxiety can increase

breast cancer risk. However, anything you can do to reduce your stress and to

enhance your comfort, joy, and satisfaction can have a major effect on your quality

of life. So-called mindful measures (such as meditation, yoga, visualization

exercises, and prayer) may be valuable additions to your daily or weekly routine.

Some research suggests that these practices can strengthen the immune system.

I I . R i s k f a c t o r s y o u c a n tc o n t r o l

Gender. Being a woman is the most significant risk factor for developing breast

cancer. Although men can get breast cancer, too, womens breast cells are

constantly changing and growing, mainly due to the activity of the female hormones

estrogen and progesterone. This activity puts them at much greater risk for breast

cancer.

Age. Simply growing older is the second biggest risk factor for breast cancer. From

age 30 to 39, the risk is 1 in 233, or .43%. That jumps to 1 in 27, or almost 4%, by

the time you are in your 60s.

Family history of breast cancer. If you have a first-degree relative (mother,

daughter, sister) who has had breast cancer, or you have multiple relatives affected

by breast or ovarian cancer (especially before they turned age 50), you could be at

higher risk of getting breast cancer.

Personal history of breast cancer. If you have already been diagnosed with breast

cancer, your risk of developing it again, either in the same breast or the other breast,

is higher than if you never had the disease.

Race. White women are slightly more likely to develop breast cancer than areAfrican American women. Asian, Hispanic, and Native American women have a

lower risk of developing and dying from breast cancer.

Radiation therapy to the chest. Having radiation therapy to the chest area as a

child or young adult as treatment for another cancer significantly increases breast

cancer risk. The increase in risk seems to be highest if the radiation was given while

the breasts were still developing (during the teen years).

Breast cellular changes. Unusual changes in breast cells found during a breast

biopsy (removal of suspicious tissue for examination under a microscope) can be a


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risk factor for developing breast cancer. These changes include overgrowth of cells

(called hyperplasia) or abnormal (atypical) appearance.

Exposure to estrogen. Because the female hormone estrogen stimulates breast cell

growth, exposure to estrogen over long periods of time, without any breaks, canincrease the risk of breast cancer. Some of these risk factors are not under your

control, such as:

starting menstruation (monthly periods) at a young age (before age 12) going through menopause (end of monthly cycles) at a late age (after 55) exposure to estrogens in the environment (such as hormones in meat or

pesticides such as DDT, which produce estrogen-like substances when

broken down by the body)

Pregnancy and breastfeeding. Pregnancy and breastfeeding reduce the overallnumber of menstrual cycles in a womans lifetime, and this appears to reduce future

breast cancer risk. Women who have never had a full-term pregnancy, or had their

first full-term pregnancy after age 30, have an increased risk of breast cancer. For

women who do have children, breastfeeding may slightly lower their breast cancer

risk, especially if they continue breastfeeding for 1 1/2 to 2 years. For many women,

however, breastfeeding for this long is neither possible nor practical.

DES exposure. Women who took a medication called diethylstilbestrol (DES),

used to prevent miscarriage from the 1940s through the 1960s, have a slightly

increased risk of breast cancer. Women whose mothers took DES during pregnancymay have a higher risk of breast cancer as well.

For more detailed information about risk factors for breast cancer, visit our Lower

Your Risksection.

C h e m o t h e r a p y

Chemotherapy is treatment with cancer-killing drugs that may be givenintravenously (injected into a vein) or by mouth. The drugs travel through the

bloodstream to reach cancer cells in most parts of the body. The chemotherapy is

given in cycles, with each period of treatment followed by a recovery period.

Treatment usually lasts for several months.

W h e n i s c h e m o t h e r a p y u s e d ?

There are several situations in which chemotherapy may be recommended.
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Adjuvant chemotherapy: Systemic therapy given to patients after surgery who

have no evidence of cancer spread is called adjuvant therapy. When used as

adjuvant therapy after

breast-conserving surgery or mastectomy, chemotherapy reduces the risk of breast

cancer coming back. Even in the early stages of the disease, cancer cells may breakaway from the primary breast tumor and spread through the bloodstream. These

cells don't cause symptoms, they don't show up on imaging tests, and they can't be

felt during a physical exam. But if they are allowed to grow, they can establish new

tumors in other places in the body. The goal of adjuvant chemotherapy is to kill

undetected cells that have traveled from the breast.

Neoadjuvant chemotherapy: Chemotherapy given before surgery is called

neoadjuvant therapy. The major benefit of neoadjuvant chemotherapy is that it can

shrink large cancers so that they are small enough to be removed by lumpectomy

instead of mastectomy. Another possible advantage of neoadjuvant chemotherapy isthat doctors can see how the cancer responds to chemotherapy. If the tumor does not

shrink, your doctor may try different chemotherapy drugs.

So far, it's not clear that neoadjuvant chemotherapy improves survival, but it seems

to be at least as effective as adjuvant therapy after surgery.

Chemotherapy for advanced breast cancer: Chemotherapy can also be used as

the main treatment for women whose cancer has already spread outside the breast

and underarm area at the time it is diagnosed, or if it spreads after initial treatments.

The length of treatment depends on whether the cancer shrinks, how much it

shrinks, and how a woman tolerates length of treatment. Some of the most commonpossible side effects include:

hair loss

mouth sores

loss of appetite

nausea and vomiting

increased chance of infections (due to low white blood cell counts)

easy bruising or bleeding (due to low blood platelet counts)

fatigue (due to low red blood cell counts and other reasons)


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PATIENTS PROFILE

B i o g r a p h i c a l D a t a

Patient is 53 y/o, female, currently residing at Urdaneta City, Pangasinan was born

on May 28, 1956 at Tuba, Benguet. She is married and was blessed with four

children. She is currently living with her sister and her daughter here in Baguio due

to her chemotherapy sessions at Baguio General Hospital and Medical Center.

She is currently a housewife, managing the family and her only daughter. At

present, source of income comes from her husband working as a ComputerTechnician on a company.

She was admitted last August 2012 at Baguio General Hospital and Medical Center

(BGHMC) for MRM (modified Radical Mastectomy) with complaints of having

pain in her right breast last May 2012.

She attained a High school degree having the knowledge and ability to read and

write. As for hobbies and interests, she certainly entertains herself by reading,

cleaning and doing household chores and taking care of her family. She verbalizedthat the greatest gift from her is her only children.

Diagnosis: Breast Cancer SI , IV l eft / s/p MRM

P r e s e n t I l l n e s s

2 months Prior to Admission, patient complained, patient noted a mass

before the incision area of the right breast. There was associated tenderness but no

discharged. Consultation was sought and surgery was scheduled, hence admission.


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P a s t M e d i c a l H i s t o r y

Patient has no previous history of allergies. She had stated that she had previousrecords of hospitalization and operations. Last Operations were performed on

August 2012. She underwent MRM (Modified Radical Mastectomy) and Status post

a 6 cycle of Chemotherapy because of presence of tumor on her right breast. She

has also a history of Hypertension.

F a m i l y M e d i c a l H i s t o r y

Patient verbalized that she is the only one in their nuclear family has cancer. Shehas stated that there were Family Medical Diseases known in their neither family

nor hereditary sickness such as hypertension and most commonly in cancer. She

declared that she had cancer due to an unhealthy lifestyle established during her

younger years. Her aunt had breast cancer and survived and her cousin died due to

cancer.

I.Social/Environmental History

Patient is married and with four children. They are living in a bungalow type of

house made of cement and wood just. Purchase of mineral water is their source of

drinking water in the area. Their Garbage is collected on their area daily. She also

stated that she had been a smoker for the last 20 years and an occasional alcohol

drinker.

II. Mental and Emotional Status

Mental Status

The patient is conscious and coherent, and responds to verbal stimuli, noise,

light and touch sensations. She is oriented to place, person and time. The patient has

the ability to comprehend and follow instructions but with limited movements. She

can comprehend instructions well when given and responds with limited appropriate

actions.


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III.Sensory Status.

V i s u a l

H e r e y e l i d s a r e s y m m e t r i c a l i n s h a p e a n d s h e h a s a n i c

t e r i c sclera. Opaque lenses and equally sized pupils are observed whenexposed to

light. Pupils react briskly to light and accommodation. Sheis farsighted and has intact

peripheral vision.

Auditory

She h a s s y m m e t r i c a l e a r s w i t h o u t a n y r e p

o r t s o f p a i n o r tenderness upon palpation. There are no dischargesobserved uponinspection of the external canal. Her gross hearing is symmetrical.

Olfactory

Her nasolabial fold and septum are along the vertical midline of h e r

f a c e . H e r n a s a l m u c o s a i s p i n k i s h i n

c o l o r . T h e r e a r e n o discharges noted upon inspection of

nostrils. Both nostrils are patentwith symmetrical gross smelling. No pain or

tenderness is reportedupon palpation of sinuses.

Gustatory

Her lips are colored pink to dark pink. Her mucosa is coloredpink and is well

lubricated with saliva. The tongue is along the verticalmidline of her face and she

has missing teeth which are replaced byfalse teeth. Her speech is intact.

VI. Motor Status

Patient is restricted to strenuous activities. Patient is ambulatory but has body

weakness and easy fatigability. She is usually seen in semi-fowlers position to

promote breathing. The patient is semi independent in performing activities of daily

living. She is weak in appearance.


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Muscle strength

3/5 3/5

4/5 4/5

A figure was used to represent her and assess her muscle strength . The scales are

used as follows:

5- Full range of motion against gravity and resistance

4- Full range of motion against gravity and moderate amount of assistance

3- Full range of motion against gravity only

2-Full range of motion when gravity is eliminate

1- weak muscle contraction when muscle dispalpated, but no movement

0- complete paralysis

V. Nutritional Status

She is fond of eating vegetables and fruits, less meat, and fish, and very

selective on food. She dislikes and avoids eating salty foods; she is not very fond of

eating sweets. She also stated that promotes drinking water, hydrating herself bydrinking lots of water approximately 8-10 glasses a day, as she knows that it would

be a benefit to her health

At present,Patient usually relies and finishes the food served by the

hospital. There was no food seen at her bedside table but a mug, water and packs of

instant coffee.


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VI. Elimination Status

Before admission the patient usually urinates 3-6 times a day. She statedthat she is sometimes constipated. A urinalysis result was taken from BGH-

MC indicating dark yellow urine and slightly turbid in appearance.

Chemical examination shows that her urine is acidic with a specific gravity

of 1,015 and pH of 6.0.

A. UrinalysisDate: September 3,2012

Taken at: Baguio General Hospital and Medical Center

Color: Dark Yellow

Apperance: Slightly turbid

p.H.: 6.0

Epithelial cells: many

Mucuos Threads: occasional

VII. Fluid and Electrolyte Status

Patient X s usual intake of fluids is 8-10 glasses of water daily as she stated.

Patient was given post operative intravenous fluid D5LRS X 1L with oxytocin.

There is evidence of edema or swelling on extremities and face. Edema assessed at

less than 5 seconds.

VIII. Circulatory Status

Upon assessment, the average cardiac pulse rate ranged from 90-100 beats per

minute. The carotid artery was palpated as weak. Her blood pressure was ranging

from 150-160 over 90-100 mmHg. Capillary refill 3-4 seconds on the thumb of both

hands. Oxygen saturation was noted to be 94% using pulse oximeter. Complete

Blood Count was done and found out that her blood type is B. And in the


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defferential count all except for WBC is on the normal range which is 11.97 and

normal range is 4.00-10.00.

A. Hematology Result:

Date: September 3, 2012

Taken at: Baguio General Hospital and Medical Center

SI UNIT Reference

Hemoglobin 104g/L 110-160 g/L

Hematocrit 0.412 0.37-0.47

RBC 4.21 4.00-4.50x10L

WBC 11.97 5.00-10.00x 10g/L

Neurophil

Platelet Count 160 150.00-400.00x10g

MCV 97.9 80.00-97.00fl

MCHC 332 310.00-360.00g/L

RDW 0.119 0.110-0.160

RDW-SD 4.91 35.0-56.0 fL

IX. Respiratory Status

Upon assessment her respiratory status rate is about 20-25 breaths per minute. The

patient was also given inhalation per nasal cannula at 2-3 Liters per minute.

Minimal chest movement was observed and her ribs were prominent upon

inspection. Patient has reports of difficulty of breathing.

X. Temperature Status

Upon taking the patients temperature using a digital thermometer, its range is from

36.2 to 37.1 degrees celcius.


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XI. Integumentary Status

Upon assessment, Patient is observed to have slightly dark skin complexion. Dry

skin was noted specially on extremities. Facial area was oily. Several scars were

noted on her arms and legs which she acquired during farming.

XII. Comfort and Rest Status

Before admission patient had regular sleep intervals of about 8-9 hours and a few

naps in the afternoon. Their means of relaxation are divertional activities such as

watching and listening to radio dramas.

During her hospital stay, Patient has short intervals of sleep. She easily wakes bythe sounds created in the ward like voices. She has an easy fatigability when she

does something or a simple activity.

X I I I . G y n e c o l o g i c a l H i s t o r y

The patient was pregnant four times and delivered a four healthy children viaNormal Spontaneous Delivery. During her pregnancy, she has a regular pre-natal

check-up every month. She has a normal menstrual cycle (ranging from 3 to 4 days

every month). She has not undergone any abortion. She has no history of

reproductive abnormalities.


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Primary

cancer cells

spreads


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N U R S I N G C A R E P L A N S

FATIGUE

ASSESSME

NT

EXPLANA

TION OF

THEPROBLEM

PLANN

ING

IMPLEMENATION RATIONALE EVALUA

TION

S> Medyonanghihina

pa ako asverbalized

O Slow

Mov

emen

tsnoted

Muscle

Strenth of3/5

onthe

upperextre

mityand

4/5on

lowerextremitynoted

Needsassist

ancein

performingADLs

Weak inapper

eanc

e

The lengthof

Chemotherapy treatment

depends onwhether thecancershrinks, howmuch it

shrinks, and

how awomantolerateslength of

treatment.Some of themost

commonpossible side

effect isfatigue (dueto low red

blood cellcounts and

otherreasons)

STO>After 8

hours ofNursing

Intervention the

patientwill beable to

identify

techniques toenhanceactivity

tolerancesuch as:- gradual

increasein

activitylevel astolerated

- rest inbetween

activities

LTO>After 8days of

NursingIntervent

ion, thepatientwill be

able toreport an

increaseinactivityintolerance.

DX Monitor Vital Signs

and Record

Assess Ability toambulate

TX Promote Adequate

Rest

Assisted withactivities

Help the patient engagein increasing levelsof physical activityandexercise.

Minimizeenvironmentalstimuli especiallyduring planned timesfor rest and sleep.Bright lighting,

noise,visitors, frequent

Assist patient todevelop a schedulefor daily activity andrest

Forbaselinedata.

Todetermineactivity

intolera

nce

Toenhanceability

toparticip

ate withactivities

Toprotectclient

frominjury

Exercisecan

reducefatigue andhelp

the patient build

endurancefor

physicalactivity

distractions andclutter

in the

patientsphysical environme

nt caninhibit relaxation,interrupt r

est/sleepandcontributeto fatigue

A plan

STO> Goalis met if the

patient willbe able to

identifytechniquesto enhanceactivitytolerance

such as:

- gradualincrease inactivitylevel as

tolerated- rest in

between

activities

LTO> Goalis met if the

patient will

be able toreport an

increase inactivity

intolerance.


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EDX

Teach energyconservation

principles

Stress the importance offrequent rest

periods.

Provide recommendation for nutritionalintake for adequateenergy sourcesandmetabolicrequirements

that

balancesperiodsof

activitywith peri

ods ofrest canhelpthe

patientcompletedesiredactivities

withoutadding tolevels offatigue

Patientsandcaregivers mayneed tolearn

skills fordelegating tasks toothers,

settingpriorities andclusteringcare touse

available energy

tocomplete

desired

activities

Energyreservesmay be

depletedunless

the patient respectsthebody

s need for

increasedrest

Thepatient

willneed adequate,

properlybalanced

intake

of carbohydrates,


19/28

fats, prot

ein,vitamins

and minerals to

provideenergyresources.


20/28

Disturbed Body Image related to illness treatment.

ASSESSME

NT

EXPLANAT

ION OF

THE

PROBLEM

PLANNI

NG

IMPLEMENATI

ON

RATIONALE EVALUATI

ON

S>Nakakahiyamakakalboakoasverbalized

O>

>Refusal tolook at,touch, orcare foraltered body

part

>Compensatory use ofconcealingclothing or

otherdevices

*DisturbedBody Imagerealted to

illnesstreatment.

The length ofChemotherapy treatmentdepends onwhether the

cancershrinks, howmuch it

shrinks, andhow a woman

tolerates

length oftreatment.Some of themost common

possible sideeffect is hair

loss.

STO>After 8hours of

NursingInterventio

n thepatientwill be

able toverbalize

understand

ing ofbodychanges

LTO>After 1

day ofNursingIntervention, the

patient

will beable toverbalizeacceptanceof self in

situation inthe effectsof

therapeuticregimen.

DX> Monitor vitalsigns and record

Determinepatients

perceptionof cancerand cancer

treatments.

Assessperception

of changein

structureor

function of bodypart

TX Ask for

patient for

verbalfeedback,and

correctmisconcep

tion aboutindividuals type of

cancer andtreatment.

Provideanticipatory guidancewith

patientregarding

treatmentProtocol,length of

therapyand

possiblesideeffects

EDX Encouragd

tocommunity

resourcesthat may

help

Encourage

For baselinedata

Aids inidentificationof ideas,attitudes and

fears,misconceptio

n

The extent ofthe responseis more

related to thevalue orimportancethe patient

places on the

partor functionthan theactual valueor importance

Misconceptions about

cancer maybe more

disturbingthan facts andcan interfere

withtreatments/delay healing.

Accurate andconcise

informationhelps dispelfears and

anxiety, helpsclarify the

expectedroutine.

Promotescompetentself-care and

optimal

independence.

STO> Goalis met if

patient willbe able toverbalize

understanding of bodychanges.

LTO> Goal

is met if

patient willbe able toverbalizeacceptanceof self insituation in

the effects oftherapeuticregimen.


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d to

Reviewspecificmedicatio

n regimenand use of

OTCdrugs.

Enhancesability to

manage self-care and

avoidpotentialcomplications

, drugreactions.


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DRUG STUDY

Drug name Mechanism of Action Indication Side Effects: Nursing

Intervention

s

Oxycodone

OxyContin,OxyNorm,

Targinact,(containsoxycodone with

naloxone)

Type of

medicine:

Opioidanalgesic

Mechanism of Action

Central Nervous SystemThe precise mechanism of

the analgesic action isunknown. However,specific CNS opioid

receptorsforendogenous compound

s with opioid-like activityhave been identifiedthroughout the brain

and spinal cord and are

thought to play a role in

the analgesic effects of thisdrug.

Moderateto sever

pain

Therapeutic Effects:

Decreasepain

Common oxycodone

side-effects - theseaffect less than 1 in

10 people who take

this medicine

Feeling or being sick,abdominal pain

Drowsiness, tiredness,

difficulties with vision

Constipation

Diarrhoea

Dizziness, particularlywhen getting up froma sitting or lying

position

Dry mouth

Other side-effects

include: musclestiffness, shallow

breathing,palpitations, swollenlegs or ankles, mood

changes, confusion,anxiety, sleep

disturbances,headache, sexualdifficulties, difficulty

passing urine,indigestion, sweating,

flushing, rash, anditching

>Instructpatient on

how andwhen to ask

for painmedication.Caution

patient not toincrease the

dose ofcontrolled-release

oxycodonewithout

causinghealth care

professional.>Caution

patient that

cotrolled-releaseoxycodone isa potentialdrug of abuse.

Medicationshould be

protectedfrom theftand never

given toanyone other

than forwhom it was

prescribed

>Advisepatients

takingoxycodone

that tabletsmay appear nstool

Drug Name Mechanism of

Action

Indication Side Effects Nursing

Interventions

Nalbuphine

Nubain

OPIOD

ANALGESICS

>binds to opiatereceptors in the

CNS. Alters theperception of andresponse to

painful stimuliwhile producinggeneralized CNSdepression.In addition, has

partial antagonistproperties, whichmay result inopioid withdrawal

in physicallydependent

patients.

Moderate to severpain. Also

provides :Analgesia duringlabor , sedation

before surgery ,Supplement to

balancedanesthesia

This medication may

cause withdrawal

reactions, especially if

it has been used

regularly for a long

time or in high doses.

In such cases,withdrawal symptoms

(such as restlessness,

runny nose, watering

eyes, trouble sleeping,

severe

abdominal/muscle

pain, nausea,

vomiting, rapid

breathing, fast

heartbeat) may occur

if you suddenly stop

using this medication.

>Assess previousanalgesic history.

Antagonisticproperties mayinduce withdrawl

symptoms> Instruct patienton how and whento ask for painmedication

>Caution patientthat frequentmouth rinses, goodoral hygiene, and

sugarless gum orcandy maydecrease

>Advise patient toavoid concurrent
http://www.rxlist.com/script/main/art.asp?articlekey=3239http://www.rxlist.com/script/main/art.asp?articlekey=17889http://www.rxlist.com/script/main/art.asp?articlekey=17889http://www.rxlist.com/script/main/art.asp?articlekey=3239


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use of alcohol or

other CNSdepressants withthis medication


24/28

JOURNALS

Healthy lifestyle changes can reduce breast cancer risk

By Marilyn Linton, QMI AgencySunday, October 21, 2012 2:00:00 EDT AM

Can you prevent breast cancer? Prevention has been a big hurdle for this disease, which has doubledworldwide since 1940.

But according to the Centres for Disease Control and Prevention, which works with North American

cancer experts, survivors and advocates to control breast cancer, doing the following three things couldhelp reduce the risk of this cancer which now strikes one in nine Canadian women and accounts forapproximately 15% of all cancer deaths in Canadian women.

1. Exercise regularly and often. More than 100 studies show breast cancer risk can be decreased if you arephysically activebut how active? A recent University of North Carolina study of 3,000 women

demonstrated that those who walked, danced or ran 10 to 14 hours per week had a risk 30% lower than

inactive women.Ongoing work by the University of Albertas Dr. Christine Friedenreich has shown that an hou r ofexercise five times a week reduces breast cancer risk by 25 to 30%. But her current study, the BreastCancer and Exercise Trial in Alberta (www.beta-trial.com), has enrolled 400 post-menopausal women in

Calgary and Edmonton to see if less exercise, 30 minutes five days per week, can impact prevention thesame as more exercise. She told me the results will be released in 2014.

Calgarys Donna deMan, one participant, has lost 15 pounds and now considers herself a jogger. On herblog, she says she found the five-day regimen difficult at first: I had a hard time maintaining balance inmy life and learning to fit in the fitness I committed to. Now however, she feels the BETA trial changed

my life.

2. Keep a healthy weight. A 2004 Canadian study published in the American Journal of Epidemiology

noted excess body mass accounted for 5.9% of all cancers in women, including post-menopausal breastcancer. Compared with people with a body mass index of less than 25, those with a BMI higher than 30had an overall increased risk of cancer.According to the Canadian Breast Cancer Foundation (www.cbcf.org), excess weight gained duringadulthood increases the risk of breast cancer later in life. The link is believed to be estrogen, which, post-

menopause, is produced in fat tissue. Carry more weight and youre exposed more to the hormone, whichincreases your risk of breast cancer.

Body shape is also an indicator of risk: Carrying excess weight around the waist is associated with greaterhealth risks including heart disease and breast cancer, according to Harvard University research. Aim fora waist circumference of 88 cm or 35 inches or less.

3. Drink less alcohol. A pooled analysis of studies conducted in four countries including Canada, in whicha total of 322,647 women were evaluated for up to 11 years, showed that alcohol consumption is

associated with a linear increase in breast cancer incidence.Why does as little as three to six glasses of wine a week raise breast cancer risk by 15%? According toMexican researchers, a protein present in breast cells breaks down alcohol and that process produces free

radicals, which damage breast cells causing them to proliferate.

A survey done by the Canadian Breast Cancer Foundation found 7% of women were aware of the

association between alcohol and breast cancer risk.

CAN'T HELP ITThere are some factors that increase the risk of developing breast cancer, but cant be prevented,

including being a woman, early menstruation, later than average menopause, dense breast tissue, being
http://www.saultstar.com/author/marilyn-lintonhttp://www.saultstar.com/author/marilyn-linton


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over the age of 50, and a family history of breast cancer or a mutation on the BRCA1 or BRCA2 genes.Check out www.phac-aspc.gc.ca for more on risk.

WE JUST DON'T KNOWScience doesnt have all the answers yet, particularly about the impact of environmental chemicals on

breast cancer. Women should use the precautionary principle to evaluate risk: When scientific evidence

is inconclusive, put your health first and err on the side of caution, explains the Canadian Breast CancerFoundation.

JUST DO ITDr. Christine Friedenreichs previous studies have shown that sedentary postmenopausal women who

adhere to a moderate-to-vigorous intensity exercise program experience a change in various mechanismsincluding circulating estradiol, sex hormone and body fat levels, thus decreasing risk.

NO CHEERS!Alcohol tends to increase the circulating levels of estrogen in the body. Studies have consistently shownthe risk of breast cancer, while moderate with three to six drinks a week, increases to 50% in women who

averaged more than 30 drinks a week or were binge drinkers.

http://www.saultstar.com/2012/10/19/healthy-lifestyle-changes-can-reduce-breast-cancer-risk

Breast cancer cases in older women set to quadrupleNumber of women aged 65 or older with breast cancer projected to rise to 1.2 million by 2040, researchfinds

Denis Campbell, health correspondent The Guardian, Tuesday 16 October 2012

Macmillan Cancer Support said the NHS needed to ensure every older woman with breast cancer got the

best possible care. Photograph: Burger/Phanie/Rex Features

The number of older women with breast cancerwill almost quadruple by 2040, according to new research

in the British Journal ofCancer.Currently 340,000 of the 570,000 women of all ages in the UK with the disease are 65 or older. That is setto increase to 1.2 million out of a projected 1.68 million total number of women with the disease by 2040.

That represents a rise in the proportion of all breast cancers among older women from 59% now to 73%then. The rate of increase among younger women will be much less steep: cases among those aged 44 orunder are expected to almost double, and those among 45- to 64-year-olds will exactly double.

"The NHS needs to take heed of these figures. It is already struggling to provide adequate care for older

breast cancer patients," said Ciaran Devane, chief executive of Macmillan Cancer Support, which fundedthe research, which was carried out by academics from King's College London.

Britain's ageing population is the main reason for the projected rise. According to other recent research inthe same journal, the number of older people with any form of cancer is set to more than treble by 2040,

from 1.3m to 4.1m.

"The NHS needs to ensure that every older woman with breast cancer gets the best possible care," addedDevane. "Too many cancer doctors are making assumptions based on age, which often results in olderwomen receiving inadequate care for their breast cancer," he said.

http://www.guardian.co.uk/society/2012/oct/16/breast-cancer-cancer?newsfeed=true
http://www.saultstar.com/2012/10/19/healthy-lifestyle-changes-can-reduce-breast-cancer-riskhttp://www.guardian.co.uk/profile/deniscampbellhttp://www.guardian.co.uk/profile/deniscampbellhttp://www.guardian.co.uk/theguardianhttp://www.guardian.co.uk/society/breast-cancerhttp://www.guardian.co.uk/society/cancerhttp://www.guardian.co.uk/society/nhshttp://www.guardian.co.uk/society/nhshttp://www.guardian.co.uk/society/cancerhttp://www.guardian.co.uk/society/breast-cancerhttp://www.guardian.co.uk/theguardianhttp://www.guardian.co.uk/profile/deniscampbellhttp://www.saultstar.com/2012/10/19/healthy-lifestyle-changes-can-reduce-breast-cancer-risk


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Antiperspirant Use and the Risk of Breast

Cancer1. Dana K. Mirick,2. Scott Davisand3. David B. Thomas

Received March 13, 2002.Revision received July 15, 2002.

Accepted August 2, 2002.Abstract

The rumor that antiperspirant use causes breast cancer continues to circulate the Internet. Althoughunfounded, there have been no published epidemiologic studies to support or refute this claim. This

population-based casecontrol study investigated a possible relationship between use of products appliedfor underarm perspiration and the risk for breast cancer in women aged 2074 years. Case patients (n =813) were diagnosed between November 1992 and March 1995; control subjects (n = 793) were identified

by random digit dialing and were frequency-matched by 5-year age groups. Product use information was

obtained during an in-person interview. Odds ratios (ORs) and 95% confidence intervals were estimatedby the use of conditional logistic regression.Pvalues were determined with the Wald

2test. All statistical

tests were two-sided. The risk for breast cancer did not increase with any of the following activities: 1)

antiperspirant (OR = 0.9;P= .23) or deodorant (OR = 1.2;P= .19) use; 2) product use among subjectswho shaved with a blade razor; or 3) application of products within 1 hour of shaving (for antiperspirant,OR = 0.9 andP= .40; for deodorant, OR = 1.2 andP= .16). These findings do not support the hypothesis

that antiperspirant use increases the risk for breast cancer.In the last decade, the public has been faced with a seemingly endless number of reports that claim

another agent in the modern environment is associated with the risk of developing cancer. A news itemappearing in the September 20, 2000 issue of the Journal (1) highlighted the increasing prevalence of such

reports and their widespread circulation on the Internet. One rumor in particular, that antiperspirant usecauses breast cancer, received such intense interest that a number of cancer research and information

organizations were forced to post statements denying the link between breast cancer and the use ofantiperspirants (1). Although there are no published reports in the scientific literature to suggest a biologic

mechanism by which the use of antiperspirants could cause breast cancer and no epidemiologic study of

this question has been reported, public concern has persisted.We conducted a population-based casecontrol study of breast cancer in western Washington State,described more fully elsewhere (2,3). Eligible case patients were women aged 2074 years who were first

diagnosed with breast cancer from November 1992 through March 1995. Control subjects were womenwithout breast cancer, identified by random-digit dialing from the same population as the case patients,who were frequency-matched to the case patients by 5-year age groups. An in-person interview was usedto gather information on a large number of past exposures of interest. During the development of thequestionnaire, we became aware of a concern that the use of products for underarm perspiration might be

related to the risk for breast cancer. Specifically, there was concern that such products might contain

harmful substances that could be absorbed via small nicks or abrasions caused by hair removal.Consequently, we included a question to ascertain whether the respondent regularly shaved under herarms. For those who responded affirmatively, we asked whether she applied anything for underarm

perspiration and, if so, which products she used, and whether any of the products were applied within 1

hour of shaving. The Fred Hutchinson Cancer Research Center Institutional Review Board approved allprocedures for contacting potential participants, obtaining informed consent, and collecting all data. Allparticipants provided written informed consent before participation.Several measures of antiperspirant use were constructed to evaluate a possible relationship to breastcancer, including ever regular antiperspirant use, exclusive use of antiperspirant (versus deodorant or talc

products), and application typically within 1 hour of shaving. Because many subjects reported the use ofdeodorants, the three measures of product use listed above were also evaluated for deodorants. Additionalanalyses were conducted by stratifying on the use of a blade (i.e., nonelectric) razor to evaluate whether

the relationship between antiperspirant use and the risk for breast cancer differed according to this methodof underarm hair removal. This analysis was prompted by a concern that small nicks in the skin from theuse of a blade might facilitate the absorption of harmful substances in the products. Odds ratios and 95%confidence intervals were used to estimate relative risks with conditional logistic regression (4) (SAS

procedure PHREG, SAS/STAT release 6.11; SAS Institute, Inc., Cary, NC). All models were conditionalon 5-year age strata, with adjustment for a number of factors associated with the risk for breast cancer

previously identified in this study (3). Statistical significance of the odds ratios was evaluated with the

Wald 2 test. All statistical tests were two-sided.Approximately 78% (n = 813) of the eligible case patients and 75% (n = 793) of the eligible control

subjects agreed to participate and were interviewed for this study (2,3). A total of 810 case patients and793 control subjects provided complete information on underarm hair removal. Nearly all case patientsand control subjects had at some point in their lifetime regularly used at least one method of underarm

hair removal (94% of case patients and 93% of control subjects), with the most common method reportedas shaving with a blade razor. Of the subjects who reported the use of at least one method of underarm
http://jnci.oxfordjournals.org/search?author1=Dana+K.+Mirick&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/search?author1=Dana+K.+Mirick&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/search?author1=Scott+Davis&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/search?author1=Scott+Davis&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/search?author1=David+B.+Thomas&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/search?author1=David+B.+Thomas&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-2http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-2http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-4http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-4http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-4http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-2http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-2http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-2http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-4http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-3http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-2http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/content/94/20/1578.full#ref-1http://jnci.oxfordjournals.org/search?author1=David+B.+Thomas&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/search?author1=Scott+Davis&sortspec=date&submit=Submithttp://jnci.oxfordjournals.org/search?author1=Dana+K.+Mirick&sortspec=date&submit=Submit


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hair removal, case patients were less likely than control subjects to have used antiperspirant regularly(50% of case patients versus 56% of control subjects), to have used antiperspirant exclusively (24% of

case patients versus 30% of control subjects), or to report application of antiperspirant within 1 hour of

shaving (36% of case patients versus 40% of control subjects). Table 1displays the results from the

regression analyses of product use and the risk for breast cancer. There was no evidence of an associationbetween the risk of breast cancer and any of the three measures of antiperspirant use. Compared with

subjects who did not use antiperspirant, there was no evidence that subjects who reported the use of ablade razor for underarm hair removal were at an increased risk for breast cancer from antiperspirant use,or that subjects who reported applying antiperspirant within 1 hour of shaving with a blade razor were at

an increased risk for breast cancer (data not shown).Deodorant use was more prevalent than antiperspirant use: among subjects who used at least one method

of underarm hair removal, 71% of case patients and 65% of control subjects reported having useddeodorant regularly. Case patients were more likely to report the use of deodorant exclusively comparedwith control subjects (43% of case patients versus 38% of control subjects) and were more likely to report

applying deodorant within 1 hour of shaving (49% of case patients versus 43% of control subjects).Similar to the results for antiperspirant use, there was no evidence of an association between the risk for

breast cancer and any of the three measures of deodorant use (Table 1). There was also no evidencethat subjects who reported using a blade razor were at an increased risk for breast cancer from deodorant

use, or that subjects who reported applying deodorant within 1 hour of shaving with a blade razor were atan increased risk (data not shown).To our knowledge, this is the only epidemiologic evidence pertaining to a possible association of the risk

for breast cancer with use of underarm antiperspirants or deodorants, and our results provide no indicationthat such a relationship exists. The strength of these results may be limited somewhat by the lack of moredetailed information on specific patterns of product use and by the self-reported nature of the data.

However, the comprehensive assessment of both antiperspirant and deodorant use helps to address thepossibility that subjects may have reported the use of an antiperspirant when, in fact, the product applied

was actually a deodorant (or vice versa) or the combination of an antiperspirant and a deodorant. Thesefindings are based on data collected from a large population-based study of rigorous design, and as such,the absence of any observed associations may help alleviate the concern of many that use of underarmantiperspirants or deodorants could alter their risk for breast cancer.


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Breast Cancer

Case Analysis

NCM 106

Submitted by:

Nadeene B. Corpuz

BSN

Submitted to :

Sir Jim Montemayor

DATE:

October 20,2012

what is breast

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