I.

INTRODUCTION
Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal

carcinoma, is the most common type of breast cancer. About 80% of all
breast cancers are invasive ductal carcinomas.
Invasive means that the cancer has invaded or spread to the surrounding
breast tissues. Ductal means that the cancer began in the milk ducts, which
are the pipes that carry milk from the milk-producing lobules to the nipple.
Carcinoma refers to any cancer that begins in the skin or other tissues that
cover internal organs such as breast tissue. All together, invasive ductal
carcinoma refers to cancer that has broken through the wall of the milk duct
and begun to invade the tissues of the breast. Over time, invasive ductal
carcinoma can spread to the lymph nodes and possibly to other areas of the
body.
Although invasive ductal carcinoma can affect women at any age, it is more
common as women grow older. According to the American Cancer Society,
about two-thirds of women are 55 or older when they are diagnosed with an
invasive breast cancer. Invasive ductal carcinoma also affects men. At first,
invasive ductal carcinoma may not cause any symptoms. Often, an abnormal
area turns up on a screening mammogram (x-ray of the breast), which leads
to further testing.
In some cases, the first sign of invasive ductal carcinoma is a new lump or
mass in the breast that you or your doctor can feel. According to the
American Cancer Society, any of the following unusual changes in the breast
can be a first sign of breast cancer, including invasive ductal carcinoma are
swelling of all or part of the breast, skin irritation or dimpling, breast pain,
nipple pain or the nipple turning inward, redness, scaliness, or thickening of

the nipple or breast skin, nipple discharge other than breast milk, lump in
the underarm area.
The Department of Health and the Philippine Cancer Society, Inc. confirmed the
high prevalence of breast cancer in the country, stating in a report that breast
cancer is the most common cancer in the Philippines, taking at least 16 percent of
the 50,000 cases diagnosed with cancer. (2010 Philippine Cancer Facts and
Estimated).

Breast cancer is the most common cancer in women worldwide,

comprising 16% of all female cancers. It is estimated that 519 000 women
died in 2010 due to breast cancer, and although breast cancer is thought to
be a disease of the developed world, a majority (69%) of all breast cancer
deaths occurs in developing countries (WHO Global Burden of Disease,
2010).Incidence rates vary greatly worldwide, with age standardized rates as
high as 99.4 per 100 000 in North America. Eastern Europe, South America,
Southern Africa, and western Asia have moderate incidence rates, but these
are increasing. The lowest incidence rates are found in most African
countries but here breast cancer incidence rates are also increasing.
Our group chose this case Invasive Ductal Carcinoma as the subject of
our case presentation because the group is concerned about the occurrence
of the disease which is continues to cause significant number or rate of
disease which is very common in women. And to also enhance our
knowledge concerning of its clinical manifestations, possible causes, cure
and prevention, and among others. This pertinent knowledge will eventually
become an indispensable tool that can be shared to others and will never go
out of style. As a future nurses, it is imperative to learn new techniques in
modern science in order to develop skills that would benefit the medical
world. This learning prospective must be conveyed to future generations and
develop innovative techniques, state -of the- art technology that caters the
modern man.

II.

OBJECTIVES

General Objective:
The case study aims to acquire information about Invasive Ductal
Carcinoma and to apply such knowledge and learning for optimum level of
nursing care practice.

Specific Objectives:
Assess the condition of the patient by establishing rapport, gather all
vital information and determine clients past and present health
history. Perform physical assessment on clients condition to attain
baseline data.
Know the different signs and symptoms, manifestations and other
things connected to the condition to help the health care providers to
diagnose the real condition properly.
Plan on how to care patients and plan managements for their condition
regarding to this kind of case.

 Apply different nursing intervention on how to help them lessen their

sufferings about their condition.
Evaluate patients condition after treatment. Noted and evaluated also
the laboratory test that has been done to the patients.

III.

NURSING HISTORY
BIOGRAPHICAL DATA
Name
: Patient X
Age
: 37
Gender
: Female
Address
: Palar, Makati
Nationality
: Filipino
Religion
: Roman Catholic
Birthdate
: February 26, 1976
Hospital

: Ospital ng Makati

Date of Admission
: July 2, 2013
Date of Interview : July 8, 2013
Informant
: Patient
Reliability
: 86%
Source of information
: Patient and Chart
Criteria for reliability
: 86%
A. Extent of data gathered demographics, history habits - 45% =
42%
B. Level of consciousness of interviewee condition, willingness to
disclose info 25%

= 19%

C. Completeness of correlating facts of transpiring events - 30% =

25%

CHIEF COMPLAINT: Mass at the right breast

HISTORY OF PRESENT ILLNESS

One year prior to admission, Patient X felt pain on her right
axilla. She became curious, that is the time when she palpated it, then notice
that there is a mass on her right breast and that was slightly tender, no
associated nipple discharge. The patient did not seek consult because she
just ignored it and it is asymptomatic.
7 months prior to confinement, the patient sought consult at
Ospital ng Makati, OPD because the mass on her right breast grew bigger.
Then, she was undergone by core needle biopsy which revealed breast
malignancy. She was scheduled for mastectomy but due to fear of her
condition, the patient did not comply and was lost to follow up.
A month prior to admission, she consulted a pseudo-medicine to
get a second opinion. The pseudo says that was just milk forming mass. Few
weeks prior to admission, patient noticed that the mass was getting bigger,
tender with associated axillary palpable mass. A day prior to admission the
patient went back to Emergency Room and was subsequently advised for
Modified Radical Mastectomy with Lymph Node Dissection.
PAST MEDICAL HISTORY
According to the patient, she was hospitalized just because of giving
birth of her youngest child by caesarian section.
5

OB History

Patient experienced menarche when she was 12 years old.

Menstruation is regular with 3-4 days of duration, uses 1-3 pads per day
> G7 T7 P0 A0 L6

G7P7
Year

G1
G2

1996
2000

G3

2004

G4

2006

G5

2007

G6

2010

G7

2012
Gyne History

The patient was 18 years old when she had her first coitus , married
and sexually active. She is not taking any contraceptive pills.

FAMILY GENOGRAM
UNKNOWN
HYPERTENSION

HYPERTENSI
ON

INVASIVE
DUCTAL
CARCINOMA
Legend:

PATIEN
T

MOTHER

BROTHER
FATHE
R

DECEAS
ED

IV.

GORDONS FUNCTIONAL HEALTH PATTERN

FUNCTION HEALTH
PATTERN

II

BEFORE
HOSPITALIZATION
According to the patient,
her condition was good
because she doesnt have
any problems to her health
though she has
maintenance because of
Health
having hypertension. Then,
Perception
a year ago, she discovered
and Health
Management that there is a mass on her
right breast. But still, she is
Pattern
performing a normal daily
activity. She is a smoker but
she consumes 1 pack per
year only and that is
occasionally. She is an
occasional drinker.
Nutrition and The patient states that she
Metabolic
consumes 2-3 cups of rice
Pattern
every meal. Before she got
hospitalized, she had a
good appetite and had no
problem swallowing food.
She drinks water at least 35 glasses a day and

DURING
HOSPITALIZATION

According to the patient,

she is not in a good state
because she is post
operated. She wants to go
back to her normal daily life
because she cant stand the
fact that she is staying in
the hospital. She added that
she already stop drinking
and smoking.

During her hospitalization,

she only consumed what
kind of diet the physician
orders. Now that she is post
operated, she can eat the
food she prefers to eat but
in appropriate amount and
nutrition because of her

INTERPRETATION

Readiness for enhanced

self health management
Nurses Pocket Guide
Edition 12

Imbalanced nutrition: less

than body requirements
Nurses Pocket Guide
Edition 12

whenever she wants to

drink. She stated too that
she and her family usually
eat fish, vegetables and
chicken. Specifically, adobo
and ihaw-ihaw. She is not
fond of eating can goods.
She also added that she is
not taking any vitamins.
Weight: 65 kilograms
Before being hospitalized,
she regularly defecates.
Once or twice a day.
-Feces
-Color: Not stated
- Texture: Not stated
III

Elimination
pattern

She doesnt have any

difficulty in defecating and
urinating.
-Urine
- Color: Light Yellow
- Consistency: Clear
-Odor: usually unnoticed by
the patient

IV

Activity and
exercise
pattern

According to the patient,

she regularly finishes her
daily routine. She is also

condition. She stated too

that she only consumes 1
cup of rice and the food
given by the hospital. She
also stated that she is
required to take ascorbic
acid.
Diet : Diet as tolerated
Weight: 61 kilograms

According to the patient,

she defecate already and
she doesnt have any
difficulty in urinating.

Readiness for enhanced

urinary elimination

-Urine
- Color: Yellow
- Consistency: Cloudy
- Odor: usually unnoticed
by the patient

Nurses Pocket Guide

Edition 12

During hospitalization,
according to her, she can
only perform minimal

Impaired physical mobility

Nurses Pocket Guide
Edition 12
9

stretching and exercising

her body by doing
household chores and
taking care of her children.
Before hospitalization, she
can perform her daily
activities; getting up from
bed, sitting, taking a bath,
change of clothes, and any
other movement on her
own.

Cognitiveperceptual
pattern

The patient can hear

clearly. She is not suffering
from any abnormalities of
her senses.

movements because of her

condition.

During hospitalization, there

is no change on her senses.
All of her senses are still
normal. But it is difficult for
her to concentrate because
of the pain she is suffering.
She is uncomfortable too.
She is not assertive all
throughout the interview.
She is not focused on what
we are talking. In addition
to that, she is answering
even if she didnt
understand the question
that we are asking to her.

Impaired comfort
Nurses Pocket Guide
Edition 12

10

VI

VII

Sleep- rest
pattern

According to the patient,

before hospitalization, she
sleeps at least 9 hours.

According to the patient, she

is a not a talkative person.
Most of the time, she is shy
Selfto talk and very silent with
perception,
everything she do. She
Self-concept
stated that she is only
pattern.
talkative and hot tempered
when her children are not
listening to her.

During hospitalization, she

can only sleep with less
than an hour. She also
states that she cant sleep
continuously because of the
noise in the ward and the
health care providers who
are monitoring her.

Sleep deprivation
Nurses Pocket Guide
Edition 12

The patient stated that her

character of being shy is still Disturbed body image
the same. She stated that
she is feeling depressed and Nurses Pocket Guide
loses hope easily because of Edition 12
her loss body part.

11

VIII

IX

Role
relationship
pattern

Sexualityreproductive
pattern.

According to the patient,

she is leaving with her
husband and six children.
She and his husband are
not working regularly. Her
husband has a job before.
She has a good relationship
to her family. She is doing
all her responsibility as a
house wife and mother to
her children.

According to the patient, her

eldest child takes care of
her other children while she
is hospitalized.

According to the patient,

she had her first
menstruation when she is
12 years old. She
According to her, there
menstruates regularly with would be a change because
3-4 days of duration. She
of her condition.
consumes 1-3 pads per day.
She had her first coitus
when she was 18 years old.
She is sexually active.

Ineffective role
performance
Nurses Pocket Guide
Edition 12

Ineffective sexuality
pattern
Nurses Pocket Guide
Edition 12

12

XI

Coping
stress
tolerance
pattern

According to the client,

when she is stressed, she
usually release it her by
watching television and by
releasing it to her children.

According to the patient,

she cant manage stress
properly because she is
thinking of different things.

Ineffective coping

The patient states that she

doesnt believe God
anymore because of her
condition.

Impaired religiosity

Value-belief
pattern

According to the patient,

she is Roman Catholic. She
is not attending mass every
week, she just go to church
when she have time.

Nurses Pocket Guide

Edition 12

Nurses Pocket Guide

Edition 12

13

V.

REVIEW OF SYSTEMS (ROS)

SYSTEMS
Integumentary System
Nervous System

Muscular System
Circulatory System
Respiratory System
Digestive system
Excretory System

VI.

SYMPTOMS
May sugat ako sa bandang
dibdib.
Masakit ang sugat ko.
Hindi ako makatulog ng
maayos dito dahil maingay.
Nahihirapan akong igalaw ang
kanang braso ko.
No significant findings.
No significant findings.
No significant findings.
No significant findings.

PHYSICAL ASSESSMENT

GENERAL:

Date: July 8, 2013

12:30PM
Patient X, 37 years old, Invasive Ductal Carcinoma patient and postoperative. She is conscious but not assertive.
Vital Signs taken as follows:
Blood Pressure = 120/80

Height = 51

Temperature = 37.0

Weight = 61

kilos
Pulse Rate = 93

BMI = 25.4

Respiratory Rate = 16

14

Organ/
System
Head (Facial
features)

Hair

Eyes

Ears

Technique
Inspection

Inspection

Inspection

Inspection

Normal
Findings
>(-) lesion
>(-) areas
deformity
> Symmetric
facial
features
> (+) Moist
skin

Actual
Findings
>(-) lesion
>(-) areas
deformity
> Symmetric
facial
features
> (+) Moist
skin

> Evenly
distributed
>(-)
infestation

> Brown,
evenly
distributed
>(-)
infestation

>Pink
Conjunctivae
>(-)
Periorbital
Puffiness
> White
Sclera
> Normal
visual acuity
>(-)
discharge
>(-) redness
>
Symmetricall
y aligned
>Intact
tympanic
membrane
> Pinna
immediately
Recoil after it

>Pale
Conjunctivae
>(+)
Periorbital
Puffiness
> White
Sclera
> Normal
visual acuity
>(+)
discharge
>(-) redness
>
Symmetricall
y aligned
>Intact
tympanic
membrane

Interpretation
> Normal
> Normal
>Normal
>Normal
>Normal
>Normal
>Lack of
sleep
>Lack of
sleep
>Normal
>Normal

>Poor
Hygiene
>Normal
>Normal
>Normal

>Normal

>Normal

> Pinna
immediately
15

is folded
> Normal
hearing
acuity

Recoil after it
is folded
> Normal
hearing
acuity

16

Neck

Inspection

>(-)
discharge
>Non- Tender
Sinuses

>(-)
discharge
>Non- Tender
Sinuses

Palpation

>Normal
>(-) swelling
and lesion

Breast

Inspection

Palpation

>(-) bleeding
>(-)odor
>(-)
discharge
>(-) dressing
>(-)
contraption

>(-) palpable
masses or
lesion
Thorax and
Lungs

Inspection

Palpation

Percussion

Auscultation

>Normal
>Normal

(+)
symmetrical
expansion
with
respiration
(+) tactile
fremitus
(+) resonant
sound
(+) Normal
vesicular
breathing

>(-) swelling
and lesion
>post>(+)
operative
bleeding
>Normal
>(-) odor
>Normal
>(-)
>postdischarge
operative
>(+) dressing >to drain
>(+)
secretion
Contraption
Jackson
>Normal
Pratt
>(-) palpable
masses or
lesion

> MRM

>Removed
(R) Breast

>Normal

(+)
symmetrical
expansion
with
respiration

>Normal

(+) tactile
fremitus

>Normal

>Normal

(+) resonant
sound
(+) Normal

17

Heart
Auscultation

Upper
Extremities

Inspection

(+) regular
rhythm

(+) regular
rhythm

>Normal

(-) thrills

(-) thrills

>Normal

(-) Murmur

(-) Murmur

>Normal

>(-) lesion
>(-) redness
> Moist skin

>(-) lesion
>(-) redness
> Moist skin

>Normal
>Normal
>Normal

18

Abdomen

Inspection

(-) Scars

(-) Scars

Flat

Flat

>Normal

Auscultation

Bowel Sounds Bowel Sounds >Normal

Percussion

>(-) Bloated

>(-) Bloated

>Normal

Palpation

>No masses

>No masses

>Normal

Genitalia

Inspection

>(-)
discharges

>(-)
discharges

>Normal

Lower
Extremities

Inspection

>Normal
>(-) lesions

>(-) lesions

>(-) redness

>(-) redness

>(-) swelling

>(-) swelling

>(-)
discharge

>(-)
discharge

19

VII.

COURSE IN THE WARD

DATE & SHIFT

July 8, 2013
6AM-2PM

DOCTORS ORDER
Jackson Pratt Drain

NURSING
RESPONSIBILITIES
-Clean the JP drain
site

PT REACTION/
EVALUATION
-The Jackson pratt
drain site is free
from infection.

-Empty the Jackson

pratt drainage bulb
and measure the
amount of fluid
collected and write
the amount of
drainage and the
time collected.

-The Jackson pratt

drainage bulb has
emptied and the
amount of fluid
collected were
documented.

-Assess the
client/family
response to the
drain care
procedure.

-Assess the external

appearance of the
dress drain, site and
bulb.

DATE & SHIFT

July 8,2013
6AM-2PM

DOCTORS ORDER
-Remove heplock/
discontinue IV
medication

-The client and

family verbalized
and demonstrate
understanding
about drain care
procedure.
-The client did not
experience excess
discomfort caused
by drain site
inspection or care.

NURSING
RESPONSIBILITIES
-Check the IV site
for inflammation
and swelling.

PT REACTION/
EVALUATION
-IV site remained
free of swelling and
inflammation.

-Explain the
procedure to the
patient prior to
procedure.

-The patient
understands the
procedure.

-Explain to the client

-The patient
20

that IV medication
will be discontinued.

understands the
instruction given.

-Check the wound of

the patient for the
possible signs of
infection.

-No infection has

noted.

-Daily wound care

-Clean and change

the wound dressing
of the patient
regularly.

DATE & SHIFT

DOCTORS
ORDER

July 8, 2013
6:00AM-2:00PM

-Sultamicillin
750mg/tab/1 tablet
BID to complete 7
days.

NURSING
RESPONSIBILITIE
S
-Assess for the
allergy to the drug
through skin test.
-Observed the 10
rights in giving
medication.
-Monitor for
adverse effect.
-Encourage the
patient to comply
with the
medication
regimen.

-The wound of the

patient has been
cleansed and the
wound dressing has
changed.

PT REACTION/
EVALUATION
-No allergic
reaction was noted.
-10 rights in
medication
administration
have been
observed.
-No adverse effect
was noted.
-The patient
understand the
importance of
taking the
medication.

21

VIII. DIAGNOSTICS
07/05/2013
Test Name

2:19am

Result

Normal
Value

Unit

Interpretat
ion

Ionized
Calcium

1.12

1.12-1.32

Mmol/L

Normal

Total Calcium

2.29

2.15-2.50

Mmol/L

Normal

Magnesium

0.7

0.66-1.07

Mmol/L

Normal

Phosphorus

0.9

0.81-1.45

Mmol/L

Normal

Sodium

139

136-145

Mmol/L

Normal

Potassium

3.5

3.5-5.1

Mmol/L

Normal

Panel 3

22

Date: 07/04/2013
X-RAY REPORT
There are small ovoid calcific apacities in the right upper and lower lobes
which may represent a calcified granuloma.
The pulmonary vascular markings are within limits.
Heart is not enlarged .
Both hemidiaphragms and costrophrenic angle are intact.
Bony thorax is unremarkable.
Consider small calcified granulomas with no active parenchymal infiltrates.

Date: 07/04/2013
Macroscopic Examination
Color:

Straw

Microscopic Examination
WBC:

Transparency:
0-2/HPF

Turbid

Sugar:

Negative

1-2/HPF
RBC:
Epithelial Cells:

MANY

Protein:

Negative

Crystals:

pH:

6.0

Amorphous Urates/Phosphate:

s.g.:

1.015

Casts:

FEW

Others:
Bacteria:

FEW

23

IX.

DIFFERENTIAL DIAGNOSIS

Lump in the
breast
Thickening
of the
Breast Skin
Lump on the
underarm
area
Pain on the
Breast
Nipple
Discharge
Swelling of
the Breast

INVASIVE
DUCTAL
CARCINOMA

DUCT ECTASIA

ACUTE MASTITIS

24

X.

ANATOMY AND PHYSIOLOGY

The breast is an organ which whose structure reflects its special

function: the production of milk for lactation. The epithelial component of the
tissue consists of lobules, where milk is made, which connect to ducts that
lead out to the nipple. Most cancers of the breast arise from the cells which
forming the lobules and terminal ducts. These lobules and ducts are located
spread throughout the background fibrous tissue and adipose tissue (fat)
that makes up the main mass of the breast. The structure of the male breast
is nearly identical to that of the female breast, except that the male breast
tissue lacks the specialized lobules, because there is no physiologic need for
milk production by the male breast.

25

Anatomically, the adult breast sits atop the pectoralis muscle (the
"pec" chest muscle), atop the ribcage. The breast tissue extends from
horizontally (side-to-side) from the edge of the sternum (the firm flat bone in
the middle of the chest) out to the midaxillary line (the center of the axilla,
or under arm). It is important to note that a tail of breast tissue called the
"axillary tail of Spence" does extend into the axilla. This is important because
a mass of breast cancer can develop in this axillary tail, even though it might
not seem to be in the breast proper.
The breast tissue is encircled by a thin layer of connective tissue called
fascia. The deep layer of this fascia sits immediately on top of the pectoralis
muscle, and the superficial layer sits just under the skin. The skin covering
the breast is similar to skin elsewhere on the torso and has similar sweat
glands, hair follicles, and other characteristic features. A clinician will
examine the skin in addition to palpation of the breast tissue itself when
performing a breast exam.
The blood supply from the breast comes primarily from the internal
mammary artery which runs underneath the main breast tissue. The blood
supply provides nutrients such as oxygen for the breast tissue. The lymphatic
vessels of the breast flow in the opposite direction of the blood supply and
drain into lymph nodes. It is through these lymphatic vessels that breast
cancers metastasize to lymph nodes. Most lymphatic vessels flow to the
axillary (under arm) lymph nodes, while a smaller number of lymphatic
26

vessels flow to internal mammary lymph nodes located deep to the breast.
Knowledge of this lymphatic drainage is important, because when a breast
cancer metastasizes, it usually involves the first lymph node in the chain of
lymph nodes. This is called the "sentinel lymph node," and a surgeon may
remove this lymph node to check for metastases in a patient with breast
cancer.
Physiologically, the breast is an organ specialized for milk formation
(lactation). Many additional changes are seen in the breast tissue during
pregnancy and lactation due to the changes in hormones during those times.

27

XI. PATHOPHYSIOLOGY

Predisposing Factors

Precipitating
Factors

Hereditary
Advance Age Female
Early menarche < 12 years
old

Virus

Obesity
Smoking
Radiation
Grilled Foods
Alcohol

Response with
Carcinogen
Damage/Change in genetic
material (DNA)

Hyperplasia
Recurrent Injury
(Metaplasia)
28

Prolonged Injury

Mutatio
n
Loss of Apoptysis
(Dysplasia&
Anaplasia)
Neoplasia

Promotion of
CA

Andio Genesis Growth

Factor

Breast

29

4
Absorb
Surroundings
Nutrients
Cell
Starvation

Expanding
Mass

Anoxi
a

Hypothalam
us

Compressed
Breast Vein

Cell Death

Lypolysis

Hypoxia

Fat Loss

Lactic
Acid

Weakness

Pain

Anore
xia

Weight

Conche

Chief
Complaint:
Mass at
Right
Tumor invades adjacent
Breast
tissues

Lump
Tail of Spence

Orange Peel
Dimpling
Nipple
Inversion

Inflammati

Adjacent lymph
nodes are
affected

30

Tumor Invades and gain

access to the blood stream

Metastasis
EARLY SIGNS of CANCER
C- Change in vowel or bladder
habit
A - A sore does not heal
U Unusual bleeding
T Thickening of Lumps
I Indigestion
O Obvious change in
moles/warts

Reference: PATHOPHYSIOLOGY Concept of Altered Health Stages,

N Nagging cough
U Unusual Anemia

Seventh Edition
Carol Mattson Porth, RN, MSN, PhD (Physiology)

31

XII. SURGICAL MANAGEMENT

PROCEDURE DONE/ TO BE
DONE

NURSING RESPONSIBILITIES

Modified Radical Mastectomy

with lymph node
dissemination
July 4, 2013
(Pre-operative)

Prepare the mother for the

operation.
Remove all the jewelries, nail polish,
dentures, hearing aid and contact
lenses.
Take baseline vital sign before pre
op medication.
Have client void before pre op
medication.
Check NPO.
Prepare all the instruments, supplies
and equipment needed for the
operation.

(Intraoperative)
The nurse is responsible in assisting
the surgeon during the operation.
The nurse Maintaining safest and
aseptic environment
The nurse is also responsible for the
monitoring of the vital signs.
(Post operative)

Immediate Care
The nurse is responsible for taking
32

and recording the blood pressure

every 15 minutes.
Nurses are also responsible for
monitoring and taking the
temperature every 2 hours.
Inspect the wound every 30 minutes
to monitor profuse bleeding and
blood loss.
Client is nursed to recovery position
until she is fully conscious to
prevent aspiration since she had a
general anesthesia.

First 24 hours:
Continue IV fluids
Analgesics may be administered as
required
After 24 hours:
Continue monitoring the blood
pressure, respiratory and pulse
rates every 4 hours
Ambulation is encouraged.
48 hours:
Monitor incision for infection risks.
Make sure that the wound is
properly dressed.
Antibiotics are administered.

33

DRUG

DOSA
GE

CLASSIFICA MECHANI
TION
SM OF
ACTION

INDICATI
ON

SIDE EFFECT

34

Generic
Name:
Sultamicil
lin
Brand
Name:
Unasyn

750mg/t
ab 1tab
OD x 1
week

Pharmacologi
c:
Aminopenicillin
/ betalactamase
inhibitor
Therapeutic:
-used to kill an
infectious
agent and
inhibit from
spreading.

Action:
Inhibits cell
wall
synthesis
during
bacterial
multiplicatio
n

Indication:
Treatment
for intraabdominal
infection
which is
caused by
susceptible
strains.

Sultamicillin
inactivates
bacterial
betalactamase

Inactivates
ampicillin
causing
bacterial
resistance
to it

DRUG

DOSAG
E

CLASSIFICA
TION

MECHANI
SM OF

Adverse Effect:
CNS: lethargy,
hallucinations,
anxiety, confusion,
depression,
dizziness, seizures
CV: vein
irritation,thrombop
hlebitis, heart
failure
EENT: blurred
vision, itchy eyes
GI: nausea,
vomiting, diarrhea,
abdominal
pain,gastritis
GU: hematuria,
interstitial
nephritis,
nephropathy
Muskuloskeletal:
arthritis
exacerbation
Respiratory:
wheezing,
dyspnea, hypoxia,
apnea
Skin: rash,
urticarial,
diaphoresis
Other:
hyperthermia,
fever

INDICATI
ON

SIDE EFFECT
35

ACTION
Generic
Name:
Pantoprazol
e

Brand
Name:
Protonix

40mg, IV,
OD while
on NPO

Pharmacologi
c:
Proton pump
inhibitor

Action:
Gastric Acid
pump
inhibitor

Therapeutic:
-used to
control gastric
acidity ,
regulate
gastrointestinal
motility.

Reduces
gastric acid
secretion

Treatment
for
duodenal
and gastric
ulcer.

Increases
gastric
mucus and
bicarbonate
production
Creating
protective
coating on
gastric
mucosa

Side Effect:
CNS: dizziness,
headache
CV: chest pain
EENT: rhinitis
GI: vomiting,
diarrhea,
abdominal pain,
dyspepsia
Metabolic:
hyperglycemia
Skin: rash,
pruritus
Other: injection
site reactionrug
Contraindicati
on:
Hypersensitivity
to drug

Blocks the
final step of
acid
production.

DRUG

DOSAGE

CLASSIFIC
ATION

MECHANI
SM OF
ACTION

INDICATIO
N

36

SIDE
EFFECT

Generic
Name:
Tramadol

50mg, IV,
q6 x 4
dosed

Brand
Name:
Dolotral

Pharmacologi
c:
Opioid agonist
Therapeutic:
-used to relief
from pain

Action:
Binds to muopioid
receptors.

Inhibits reuptake of
serotonin
and
noripinephri
ne in the
CNS.

Relief of
moderate to
moderately
severe pain.

Adverse
Effect:
CNS: seizures
CV:
vasodilation
EENT: visual
disturbances
GI: nausea,
vomiting,
diarrhea,
constipation,
abdominal
pain,
dyspepsia,
flatulence, dry
mouth,
anorexia
GU: urinary
retention and
frequency,
proteinuria,
menopausal
symptoms
Respiratory:
respiratory
depression
Skin: pruritus,
sweating
Contrainndic
ation:
hypersensitivit
y to drug

DRUG

Generic
Name:
Ketorolac

DOSAGE

30 mg
TIV q8 x
4 dose

CLASSIFIC MECHANIS INDICATIO

ATION
M OF
N
ACTION

Pharmacologi
c:
NSAID

SIDE
EFFECT

Action:
Indication: Side Effect:
Interferes with Moderately CNS: drowsiness,
prostaglandin severe pain headache,
37

biosynthesis
Brand
Name:
Acular

Therapeutic:
-used to treat
inflammation,
mild to
moderate pain,
and fever.

Inhibiting
cyclooxygenas
e pathway of
arachidonic
acid
metabolism

Produces antiinflammatory,
analgesic, and
antipyretic
effects

dizziness
CV: hypertension
EENT: tinnitus
GI: nausea,
vomiting,
diarrhea, ,
constipation,
flatulence,
dyspepsia,
epigastric pain,
stomatitis
Hematologic:
thrombocytopenia
Skin: rash,
pruritus,
diaphoresis
Other: excessive
thirst, edema,
injection site pain

Contraindication
:
hyperrrseeensitivit
y to drug
-peptic ulcer
disease
GI bleeding or
perforation

DRUG

DOSAGE

CLASSIFIC MECHANIS INDICATIO

ATION
M OF
N
ACTION

38

SIDE
EFFECT

Generi
c
Name:
Cefoxiti
n
Brand
Name:
Mefoxin

2mg/IV
q6 x 2
doses

Pharmacologi
c:
Secondgeneration
cephalosporin
Therapeutic:
-used to kill an
infectious agent
and inhibit from
spreading.

Action:
Interferes with
the bacterial
cell wall
synthesis and
division

Active against
gram-negative
and grampositive
bacteria, with
expanded
activity against
gram-negative
bacteria

Exhibits
minimal
immunosuppres
sat activity
.

Indication:
Treatment
for infection

Adverse Effect:
CNS: headache,
lethargy,
seizures
CV: vasodilation,
hypotension,
thrombophlebitis
EENT: hearing
loss
GI: nausea,
vomiting,
diarrhea,
abdominal
cramps,
pseudomembran
ous colitis
GU: vaginal
candidiasis,
nephrotoxicity
Hematologic:
bleeding
tendency,
haemolytic
anemia, bone
marrow
depression,
neutropenia,
thrombocytopeni
a
Hepatic: hepatic
failure,
hepatomegaly

Musculoskeleta
l: arthralgia
Respiratory:
dyspnea
39

Skin: urticarial,
maculopapular or
erythematous
rash
Other: chills,
fever,
superinfection,
pain at IM site,
anaphylaxis,
serum sickness
Contraindicatio
n:
-hypersensitivity
to
cephalosporins

40

Cues
Subjective:
Sumasakit
ang dibdib ko
kapag
gumagalaw
ako

Nursing
Diagnosis
Acute Pain r/t
Post Surgical
Incision

Inference
Invasive
Ductal
Carcinoma

Modified
Radical
Mastectomy

Objective:
Facial
Grimaces
Restlessness
Irritability
Sleep
disturbances
Diaphoresis
P- Right
Breast
Q- Stabbing
Pain
R- non-

Goal
Short term:

After 3 hours of
nursing
intervention,
clients pain scale Monitor vital
will be reduced.
signs

Long term:
Removal of
Breast

Surgical
Incision

Acute Pain

Nursing
Intervention
Independent
:
Establish
rapport

After 1 day of
nursing
intervention,
client will be
relieve from pain
and will appear
more relax.

Assess
verbal/nonverbal reports
of pain, noting
location,
intensity (0-10
scale
Encourage
client to use
relaxation
techniques
e.g., guided
imagery, soft
music,
progressive
relaxation

Rationale

Evaluation

To gain trust of
the patient
For baseline
data

Short term:
After 3 hrs of
nursing
intervention,
clients pain
Useful in
scale was
evaluating pain, reduced to a
choice of
normal range
interventions,
from 6 out of 10
effectiveness of to 3.
therapy
Long term:
After 1 day of
Helps refocus
nursing
attention and
intervention,
assist client to
clients pain was
manage pain
relieved and
more
appear more
effectively
relaxed

41

radiating
S- 6/10
T- when
moving

Dependent:

Reduces pain
and discomfort,
enhances rest

Administer
analgesics as
necessary and
prescribed by
a doctor.
Cues

Nursing
Diagnosis

Inference

Goal

Nursing
Intervention

Rationale

Evaluation

42

Short-Term :
Subjectiv
e:
May tahi
ako sa
dibdib ko.

Impaired skin
integrity r/t post
surgery

Invasive Ductal After 1-2 hrs of

Carcinoma
Nursing
Intervention the
patient will
demonstrate
understanding
of self-care
activities.
Modified
Radical
Carcinoma
Long-Term :

Objective
:

Removal of
Breast

-Disruption
of skin
surface
(epidermis
)
Destructio
n of the

Surgical
Incision Site

The patient will

identify possible
danger signs of
infection to take
note of and
notify the
physician with
before
discharge.

Independent:
Asses for
incision every
shift and
document
findings

Assist the
patient with
general
hygiene,
including handwashing.

Short-Term :
To detect signs
and symptoms
of possible
infection

The patient
demonstrated
understanding
of self-care
activities. Goal
Met.

Proper hand
washing is the
most effective
method of
disease
prevention

Nursing
Interventions
for this goal
were effective
for attainment
of the goal.

Explain danger
sign of infection
severe pain in the
arm, breast, or chest To prevent
area red blotches,
infection.
possible swelling,
heat in the area.
Inform the
patient of the
purpose of selfcare practices

Long-Term :

The patient
was able to
identify
possible
danger signs o
infection to
take note of
and could
43

skin layer
(dermis)
Dependent:

Impaired Skin
Integrity

-Invasion
of body
structure.

state when to
notify the
physician on
the second
post-op day.
Goal Met.

To prevent
infection

Administer
Medication as
prescribed by a
physician.

To prevent
infection and
pain.

Cues

Nursing
Diagnosis

Inference

Goal

Nursing
Intervention

Rationale

Evaluation

44

Subjectiv Disturbed body

e:
image r/t post
Naniniba mastectomy
go ako sa
hitsura ng
dib-dib ko

Objective
:
-Refusal to
discuss or
acknowled
ge change
-Refusal to
look at,
touch, or
care for
altered
body part
-Actual
change in
structure
or function
-Naming
changed
body part
or function

Invasive Ductal
Carcinoma

Modified
Radical
Mastectomy

Removal of
Breast

Disturbed Body
Image

Short term:
After 1-2 hrs. of
nursing
Intervention
Patient
demonstrates
enhanced body
image and
increased selfesteem as
evidenced by
ability to look at,
touch, talk about,
and care for
actual or
perceived altered
body part or
function.
Long term:
After 1 day of
Nursing
Intervention client
will verbalized of
positive or
negative
feelings about
actual or
perceived change.

Independent:
Establish
patients
rapport

To gain trust
and
cooperation

Monitor and
record vital
signs

To obtain
baseline

Observe
emotional
changes

To know if the
nursing
intervention is
effective

Talk to patient
and have client
describe self
what is positive
ways and
negative ways

To express
feelings

Dependent:
Instruct client
to have a
artificial breast
or silicon

Short term:
After 1-2 hrs.
of nursing
Intervention
client is
experiencing
physical style
changes and
emotional
changes.

Long term:
Client
verbalized of
positive or
negative
feelings about
actual or
perceived
change.

This
compensates
for actual
changed body
structure and
45

Teach patient
adaptive behavior
(e.g., use of
adaptive
equipment, silicon
breast)

Cues

Nursing
Diagnosis

Inference

Objective:

Altered
mobility

Goal
Short term:

Risk for Injury

Muscle
weakness

breast.

Invasive Ductal
Carcinoma

Modified
Radical
Mastectomy

After 1-2 hours

of nurse-patient
interaction, the
patient will
verbalize
understanding of

function.

Nursing
Intervention
Independent:
Establish pt.
Rapport

Monitor vital signs

frequently.

Rationale

Evaluation
Short term:

To gain trust
and
cooperation
of the pt.
VS could
indicate

The patient
verbalized
understanding
of individual
factors that
contribute to
46

Limited ROM
Slow
movement

Post surgery

Open wound

individual factors
that contribute to
possibility of
injury and take
steps to correct
situations.
Long Term:

Limited
movement

Risk for injury

After 2-3 days of

nurse-patient
interaction, the
patient will
demonstrate
behaviours ,
lifestyle changes
to reduce risk
factors and
protect self from
injury.

Assess mood,
coping abilities
and personality
styles

possible
bleeding

possibility of
injury and take
steps to
correct
situations.

That may
result in
carelessness
and increased
risk-taking
without
Identify
consequence Long term:
interventions and s.
safety devices
The patient
To promote
demonstrate
safe physical
behaviours ,
environment
lifestyle
Encourage
and individual changes to
participation in
safety
reduce risk
self-help
factors and
programs, such as To enhance
protect self
assertiveness
self-esteem
from injury.
training, positive
and sense of
self-image.
self-worth
Dependent:
Administer
Analgesic as
prescribed by a
physician.

Reduces pain
and
discomfort,
47

enhances
rest.
Cues

Nursing
Diagnosis

Objective:
Weakness
Risk for
With dry
Infection
and intact
dressing on
the excised
area
Swelling
over the
incision
area

Inference

Invasive
Ductal
Carcinoma

Modified
Radical
Mastectomy

Removal of
Breast

Surgical
Incision

Open skin

Risk for

Goal

Nursing
Intervention

Rationale

Short term:

Independent:

After 1-2 hours

of nursing
interventions,
the patient will
be able to
identify and
demonstrate
interventions to
prevent or
reduce risk of
infection.

Establish patients
rapport

To gain trust and

cooperation of the
patient

Monitor and
record vital signs

To obtain baseline
data

Proper hand
washing technique
Instruct on proper
wound care

Long term:
After 1 day of
nursing
interventions,
the patient will
achieve timely
wound healing

Inspect the wound

for swelling,
unusual drainage,
odor redness, or
separation of the
suture lines.

Evaluation

Short term:

To avoid cross
contamination

After 1-2 hrs

of Nursing
Intervention
clients
understand
the
importance
of
interventions
to prevent
infection.

Prevention for
infection

Long term:

Wound infection
are accompanied
by signs of
inflammation and a
delay in healing

After 1 day of
Nursing
Intervention
Clients
wound is free
from signs
48

Infection

Dependent:
and be free from taking antibiotics
signs and
as prescribed by a
symptoms of
physician
infection.

and
symptoms of
infection.
To prevent infection

49

XV. DISCHARGE PLAN

Medicines:
-Instructed the patient to continue medication as ordered by the physician.

Exercise:
-Instructed the patient to have a walk every morning.
-Instructed the patient to continue doing household chores.

Treatment:
-Instructed the client to monitor if pain on the wound site occurs..
-Instructed the client to take the prescribed medications.

Hygiene
-Instructed the client to have a proper hygiene.
-Instructed the client to do hand washing before cleaning the wound site.
-Change the wound dressing regularly.

Out Patient:
-Instructed the client to have a follow-up check-up.
Diet
-Encourage the patient to have a low sodium and low fat diet.
-Encourage patient to take food rich in Vitamin C.
-Encourage to eat foods rich in potassium such as green leafy vegetables,
carrots and potatoes.

Safety and Security

-instructed the patient to avoid lifting heavy objects.
50

XVI. EVALUATION

Through that assessment and data gathering, certain problems and

needs at the client were identified. Nursing care plan was established to
improve clients status and recovery. Information and health teaching not
only to the client who are suffering from this condition but also to the people
who are interested to be aware in different conditions were imparted which
lead to increase clients/ people awareness and knowledge with regards to
her condition. The student nurse gained additional information about
Invasive Ductal Carcinoma including diagnostic examination, medical
management needed and as well as the factors affecting the condition which
may help the group and different people in handling properly this kind of
condition that the student nurse may possible encounter again.

51