EBA NUR 201 Breast cancer

Age and Associated Fibrocystic Changes are Prognostically Significant in Patients with Small Node-Negative (T1a,bN0) Invasive Breast Cancer

http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=64e5c2ea-ced8-406d-95e6-52f225700724%40sessionmgr103&vid=16&hid=125

There are many types of breast cancers and other benign breast diseases that affect men and women. This article is specific to small node-negative invasive breast cancer. This long name means the tumor is small(<1cm), there is no metastasis to the lymph nodes and it is invasive, in that the cancer started in the milk ducts or lobules and has broken through to the nearby breast tissue. There are many different factors that contribute to a good prognosis of breast cancer such as low-grade tumor (highly differentiated from surrounding cells), has not metastasized to other areas of the body, your age, and whether it responds to hormones or not, as this determines what drug therapy can be used.

Fibrocystic breast disease is common and simply means that the person’s breasts are either more fibrous/dense or they have fluid filled cysts. Fibrocystic breast disease does not increase a person’s risk of developing breast cancer. However, a person with invasive breast cancer that has fibrocystic changes that occur has a higher chance of recurrence of breast cancer than someone with no fibrocystic changes. A fibrocystic change that can occur in the breast is proliferation, or the increase in size of a lesion/tumor in the breast. The article stated that there was a correlation with non-proliferating and proliferation without atypia and the overall survival of the patient. This means that the tumor either did not grow in size or that it stayed symmetrical and the patient lived longer than that of a similar person who had proliferation and atypia where the tumor changed shape. Further research needs to be done involving fibrocystic changes in invasive breast cancer as it is not usually monitored, because there may be a relation between the benign lesion and the way the cancer reacts to treatment and behaves. Invasive breast cancer that arises in patients that had fibrocystic breast disease may be biologically different and act or react differently than that of one that arises with relation to fibrocystic disease.

The article stated that this type of cancer has been diagnosed at varying ages and was split into two different categories of <40 and >40 years old. The category of <40 years old had a poorer prognosis of recurrence and length of overall survival than that of the >40 years old group. The article also stated that the younger group showed that this cancer was more aggressive in terms of treatment. Patients with higher grade tumors, younger than age 50 at diagnosis, and negative estrogen and progesterone receptor status had an increased rate of death specifically related to breast cancer.

If a person notices changes in their breast they need to see their health care provider to rule out any possible chance of breast cancer no matter what their age is, as invasive breast cancer is more aggressive with younger age. The change may be fibrocystic related and completely benign or it could be worse. If a younger person is treated for invasive breast cancer and they have fibrocystic changes that are not monitored closely and later in life they have a recurrence, what is to say they are not related? For a best case scenario, I feel that all changes should be closely evaluated and monitored. With detection being difficult in dense breast tissue it may be at a later stage and grade that causes an even bigger hurdle to pass in treatment. For younger patients adjuvant therapy consisting of surgery, chemotherapy and/or radiation should be an absolute must with how aggressive this form of cancer is.

Istan Reflective Journal

#1: 1:Completed blood draw  2:partial assessment, got him hooked up to all of the leads and BP cuff    3: recognized he was having decreased oxygen saturation and tried to correct it with help of O2 and a nasal cannula  4: then switched him to a non-rebreather mask for better O2 administration, though it was the wrong size.

#2: the mask that we used was a pediatric mask and that there is a correct adult size one that fits Stan. His sats never came back up out of the 80's because it was an incorrect size and we did not have the O2 set high enough for the non-rebreather. The bag attached to the mask will in fact inflate in simulation if the O2 is high enough (all the way up).

#3: Ensure his O2 mask is the correct size and fit for his face since all people are different. Recognize that his pedal pulse and tibial pulses were not palpable due to his disease process and not a malfunction in Stan's system. The cyanosis of the hands and feet is why his nails would not blanch and that he was just showing toxcicity, need to call the Dr. about this next time. Write the time on the label so that the labs do not have to be redone, correct the first time is the best way to go and the pt will be happier with not having to be re-stuck.

#4: 1:Not everyone reacts the same way to the same situation and to not get frustrated with people on the phone and to delegate to your team when needed, or at least ask them to help you with what you need. 
2: Some people have a better way of talking to and with the pts and sometimes it just takes sitting down and talking to them and not being so "by the book". 
3: Not everything goes how you planned, take a second look at what you are doing or have done so that you will not have to redo it just because of a missed time on a label or location of a culture missing from a label.

#5: 1: The need to humidify O2 for higher quantity of O2, however i forgot you do not humidify a non-rebreather. 
2: Check everything on the pt during assessment, including wrapped wounds. Cleansing isn't necessary right then, but knowing what is there when you first assess is key to helping the pt heal. 
3: Sit the pt up to help them breathe and allow opening of the airway. Orthopneic would have been best but Istan doenst really sit that high up it seems.