Case Study - Reproductive System Disorders D. M. is a married, 36-year old woman with 4 children who works part-time as
Posted: Thu Apr 28, 2022 8:10 am
Case Study - Reproductive System Disorders
D. M. is a married, 36-year old woman with 4 children who works
part-time as a clerk. She is 68 inches tall and weighs 135 lbs. She
has insurance through her husband’s employer. She has never smoked
and has an occasional social drink. She has PMH of plastic surgery
for breast implants in August of last year. When she returned for
her breast implant check-up 10 months later, a lump was discovered
in her R breast. When a biopsy indicated the lump was malignant,
she elected to have a lumpectomy and axillary lymph node
dissection. Her CT scan and bone scans were negative. She was
referred to the group oncology clinic where you are a staff nurse
to receive chemotherapy. After she completes chemotherapy, she is
scheduled to receive radiation therapy. Admitting diagnosis:
infiltrating ductal carcinoma, stage T2 N1 M0, premenopausal,
estrogen receptor-positive.
Explain the TNM method of staging
malignancies.
D. M. wants you to explain what stage T2 N1 M0 means.
What will you tell her?
She asks you to explain what her chances of survival
are. How will you explain this to her?
D. M. will be receiving 6 cycle of combination
chemotherapy, consisting of doxorubicin (Adriamycin),
cyclophosphamide (Cytoxan), and 5-fluorouracil (5-FU). What are the
major side effects you want to prepare her for?
What is a major complication in patients receiving a
high amount of Adriamycin?
Explain to D. M. in lay terms what she needs to know
about immunosuppression.
D. M. completes her chemotherapy. She lost most of her hair and
has been wearing a scarf but now her hair is beginning to grow
back. She is being transferred to the radiation therapy department
for treatment and is scheduled to begin radiation
therapy.
What is hair loss called? Which drug was primarily
responsible for the hair loss?
You perform an admission assessment. Findings are: wt. 148 lbs.
VS 104/70, 80, 20, 98oF (oral). Cardiovascular: S1 S2 without
murmurs or rubs. Respiratory: clear to auscultation throughout.
Neuromuscular/skeletal: negative, patient c/o fatigue, no c/o bone
pain. GI: without hepatosplenomegaly or masses. GU: negative.
Integumentary/oral: hair growth ¼ inch over entire head, oral
mucosa reddened and patient c/o soreness. Lymph node: no palpable
adenopathy in the cervical, supraclavicular, axillary, or inguinal
nodes.
What areas of the above assessment concern you?
Explain.
D. M. received 6 weeks of daily (weekdays) radiation therapy
treatments with a total dose of 6400 cGy. She had a terrible time
with fatigue, and at one time, told you, “When I lie down, I can’t
be enough of the bed!” You helped her develop an activity-rest plan
and supported her in obtaining outside help with housework. At her
last visit, she tells you, “Now I hope I can see my kids grow up.”
She is scheduled to return to the oncologist every 3 months for
follow-up care and monitoring.
D. M. comes to her scheduled follow-up appointment. She
appears very anxious. When questioned she tells you, “I’ve been
worried about my daughters. What if they get breast cancer? What
can I do to help them?” What is your response?
You ask her if she has other questions. She tells you
she is worried about the breast cancer coming back and wants to
know if she would have to go through the chemotherapy and radiation
therapy all over again. What can you do, and what will you tell
her?
D. M. seemed to do fine for a while. On her 9-month follow-up
visit, she tells you she has been having headaches for the past few
weeks. Her MRI indicates she has metastases to the brain. She
underwent a bone marrow transplant; unfortunately, it failed to
stop her cancer. She died at the age of 38, leaving behind 4
children aged 4 through 14.
D. M. is a married, 36-year old woman with 4 children who works
part-time as a clerk. She is 68 inches tall and weighs 135 lbs. She
has insurance through her husband’s employer. She has never smoked
and has an occasional social drink. She has PMH of plastic surgery
for breast implants in August of last year. When she returned for
her breast implant check-up 10 months later, a lump was discovered
in her R breast. When a biopsy indicated the lump was malignant,
she elected to have a lumpectomy and axillary lymph node
dissection. Her CT scan and bone scans were negative. She was
referred to the group oncology clinic where you are a staff nurse
to receive chemotherapy. After she completes chemotherapy, she is
scheduled to receive radiation therapy. Admitting diagnosis:
infiltrating ductal carcinoma, stage T2 N1 M0, premenopausal,
estrogen receptor-positive.
Explain the TNM method of staging
malignancies.
D. M. wants you to explain what stage T2 N1 M0 means.
What will you tell her?
She asks you to explain what her chances of survival
are. How will you explain this to her?
D. M. will be receiving 6 cycle of combination
chemotherapy, consisting of doxorubicin (Adriamycin),
cyclophosphamide (Cytoxan), and 5-fluorouracil (5-FU). What are the
major side effects you want to prepare her for?
What is a major complication in patients receiving a
high amount of Adriamycin?
Explain to D. M. in lay terms what she needs to know
about immunosuppression.
D. M. completes her chemotherapy. She lost most of her hair and
has been wearing a scarf but now her hair is beginning to grow
back. She is being transferred to the radiation therapy department
for treatment and is scheduled to begin radiation
therapy.
What is hair loss called? Which drug was primarily
responsible for the hair loss?
You perform an admission assessment. Findings are: wt. 148 lbs.
VS 104/70, 80, 20, 98oF (oral). Cardiovascular: S1 S2 without
murmurs or rubs. Respiratory: clear to auscultation throughout.
Neuromuscular/skeletal: negative, patient c/o fatigue, no c/o bone
pain. GI: without hepatosplenomegaly or masses. GU: negative.
Integumentary/oral: hair growth ¼ inch over entire head, oral
mucosa reddened and patient c/o soreness. Lymph node: no palpable
adenopathy in the cervical, supraclavicular, axillary, or inguinal
nodes.
What areas of the above assessment concern you?
Explain.
D. M. received 6 weeks of daily (weekdays) radiation therapy
treatments with a total dose of 6400 cGy. She had a terrible time
with fatigue, and at one time, told you, “When I lie down, I can’t
be enough of the bed!” You helped her develop an activity-rest plan
and supported her in obtaining outside help with housework. At her
last visit, she tells you, “Now I hope I can see my kids grow up.”
She is scheduled to return to the oncologist every 3 months for
follow-up care and monitoring.
D. M. comes to her scheduled follow-up appointment. She
appears very anxious. When questioned she tells you, “I’ve been
worried about my daughters. What if they get breast cancer? What
can I do to help them?” What is your response?
You ask her if she has other questions. She tells you
she is worried about the breast cancer coming back and wants to
know if she would have to go through the chemotherapy and radiation
therapy all over again. What can you do, and what will you tell
her?
D. M. seemed to do fine for a while. On her 9-month follow-up
visit, she tells you she has been having headaches for the past few
weeks. Her MRI indicates she has metastases to the brain. She
underwent a bone marrow transplant; unfortunately, it failed to
stop her cancer. She died at the age of 38, leaving behind 4
children aged 4 through 14.