Breast Cancer Nursing Care Plan

This assignment focuses on developing a comprehensive nursing care plan for patients diagnosed with breast cancer. It explores various aspects of breast cancer, including its types, symptoms, diagnostic procedures, and treatment options. The care plan addresses the physical, emotional, and psychosocial needs of patients throughout their journey, emphasizing symptom management, education, support, and collaboration with healthcare professionals.

Running Head: PALLIATIVE SYMPTOMS
Palliative symptoms
Name of the Student
Name of the University
Author Note

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Discussion on primary disease
The primary disease is the breast cancer
The types of breast cancer (Bomeisl et al., 2015) are-
 Ductal carcinoma In situ
 Invasive Ductal carcinoma
 Invasive breast cancer
 Lobular carcinoma Insitu
 Medullary Carcinoma,
 Invasive Tubular Carcinoma, and
 Invasive Mucinous Carcinoma
The signs and symptoms of breast cancer (Harmer, 2016) are-
 feeling of lump in breast, armpit, upper chest, unusual thickening of breast,
unusual pain in breast or nipple
 Enlargement of one breast
 Enlarged lymph node in armpit
 change in skin texture- scaling, redness or thickening of breast skin or nipple,
puckering or dimpling of the breast skin
 Change in appearance of nipple- Nipple retraction, rash or crusting of nipple
 Nipple discharge other than breast milk
The diagnostic methods of breast cancer (Vriens et al., 2017) are-

2PALLIATIVE SYMPTOMS
 Breast exam- physician examines the breast for signs and symptoms of breast
cancer
 Mamogram- X-ray of breast from multiple vantage points and is a screening
process for diagnosing breast cancer. This method distinguished between the
benign and malignant mass.
 Ultrasound- scanning of breast tissue using sound waves that do not affect the
tissue but generate images of even deep structures in the area of investigation. It
gives an image of breast tissue
 MRI- scanning of breast tissues by transmitting magnetic energy and radio wave.
It is a non-invasive technique to examine the breast tissue
 Biopsy- removal of fluid or tissue from suspicious area for microscopic
examination to detect for cancer
Metastatic sites of breast cancer (Peart, 2017) are-
 Lymph nodes under the arm or rib cage or collar bone, Muscle fatty tissue and
skin around the area of tumor, Bones, Bone marrow, Liver, Lungs through blood
stream and Brain
Symptom assessment
The two problem symptoms of breast cancer are-
1. Unusual pain in breast with lump- Persistent pain in one of the breast is a
concern. Breast tumors cause pain but in most cases are not reported as harmful.
Presence of a tumor can cause a pain as it is pushed into healthy tissues. It is the
problem encountered during the inflammatory breast cancer. In rare form of

3PALLIATIVE SYMPTOMS
breast cancer called the Paget’s disease of the nipple results in pain, and irritation
in nipple. Unusual pain occurs in case of metastatic breast cancer due to spread of
tumor in different parts of body. Lumps are painless but in some cases lumps are
accompanied with pain particularly in later stages due to involvement in deeper
structures (Harmer, 2016).
2. Nipple discharge- Normal discharge may be due to pregnancy, abscess, birth
control pills, menstruation or excess stimulation. Blood discharge may occur due
to benign conditions without even touching or any irritation to breast. Bloody
discharge from nipple spontaneously from a single duct or from single spot on
nipple is considered a problem. It is the problematic symptom of breast cancer.
The common cause may include fibrocystic breast changes, galactorrhea or non-
cancerous growth in breast ducts (Smania, 2017). (Refer Appendix A).
Symptom management- pharmacological interventions
The medication for pain caused by metastatic breast cancer is pamidronate (Aredia). This
drug is called bisphosphonate (Wilkes & Barton-Burke, 2016). This medicine is selected for
discussion as this medication is useful in preventing the destruction of bone in metastatic cancer,
which is a painful event. Since pain is mainly associated with the metastatic breast cancer and
Aredia is administered for patients at this stage, it is the rationale for pharmacological
intervention. Moreover, this medication is the approved for cancer treatment. These medicines
keep the bone calcium level normal and it alters the cycle of bone formation and breakdown. It is
usually given with chemotherapy medicines and is effective in reducing the bone fractures. It is
given intravenously and decrease pain due to progressive skeletal destructions (Lehne &
Rosenthal, 2014). (Refer Appendix B).

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Symptom management- Non-pharmacological intervention
The non-pharmacological interventions for the symptom addressed above are:
 Cognitive behavioural therapy- This therapy was found to be effective in breast
cancer patients with advanced stage. It includes techniques such as progressive
muscle relaxation, hypnosis, relaxation training, problem solving, distraction an
imagery. The rationale for choice of this non-pharmacological interventions is the
evidence obtained form metaanalysis and randomised control trial, which indicate
lesser pain experienced by breast cancer patients. Further evidence from RCTs
other studies showed that in comparison to control group, the intervention group
showed decrease in pain (Carlson, 2017).
 Yoga: Breast cancer patients when subjected to yoga have shown positive results
in terms of decrease in pain, depression, fatigue, mood and quality of life. The
rationale for choosing these interventions is the evidence from the metaanalysis
that yoga reduces joint pain due to aromatase inhibitors. It was found effective in
a women with metastatic breast cancer (Pirschel et al., 2017).
Complications
The most serious complication after diagnosis of the breast cancer is the psychological
distress. It inlude fear, anxiety, loss of sleep, and depression due to disease and panic attacks.
This can also be the urgent problem in most cases while in some cases it onsets during the
treatment process (Soo & Sherman, 2015).
The psychological issues may be the outcome of the detection of breast cancer in advance
stage. It results in fear of unable to handle the disease or a fear of death. Lack of support and care

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from partner may trigger anxiety and depression. The probable cause of this complication in
advanced stage is the break of tumor and movement to other parts of the body through blood
stream or lymphatic vessels. It leads to invasion of tumor cells in new sites distant from its
origin, resulting in pain. The other probable cause is the failure to adjust with the disease
(Swanson & Koch, 2010).
The complete the assessment of this complication the information required is-
 Demographic characteristics
 Patient history of past medical illnesses such as anxiety disorder, or any chronic
condition
 Physical functioning
 Cultural factors
 Spiritual beliefs of patient
 Social connectedness
 Family support (Groth-Marnat, 2009)
The treatment of this complication (Carlson, 2017) includes referring to –
 Counsellor- counselling services include psychosocial educational
interventions to increase awareness of illness and reduce the
distress in patients. Oncology providers or the psychosocial
professional can provide the positive support and
encouragement. It is the meaningful intervention where erroneous thoughts
are corrected by reframing. Further psychotherapy fixes all the adjustment

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disorders where the patient learns to cope up with the newly diagnosed illness. It
has been found effective in reducing stress
 Social worker- intervenes to help resolve crisis in personal life and offer mental
health services. Crisis intervention may be regards to lack of health insurance or
source of income and promoting self management. It is effective in reducing
stress and anxiety to a great extent.
 Pastoral counsellor can give advice on mental health and provide spiritual support
that relieves stress and provides patients with emotional comfort

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References
Andersen, B. L., DeRubeis, R. J., Berman, B. S., Gruman, J., Champion, V. L., Massie, M. J., ...
& Rowland, J. H. (2014). Screening, assessment, and care of anxiety and depressive
symptoms in adults with cancer: an American Society of Clinical Oncology guideline
adaptation. Journal of Clinical Oncology, 32(15), 1605-1619.
Bomeisl, P. E., Thompson, C. L., Harris, L. N., & Gilmore, H. L. (2015). Comparison of
Oncotype DX Recurrence Score by Histologic Types of Breast Carcinoma. Archives Of
Pathology & Laboratory Medicine, 139(12), 1546-1549. doi:10.5858/arpa.2014-0557-
OA
Carlson, L. (2017). Mindfulness and Cancer Care: Easing Emotional and Physical
Suffering. Alternative & Complementary Therapies, 23(5), 167-170.
doi:10.1089/act.2017.29127.lca
Groth-Marnat, G. (2009). Handbook of psychological assessment. John Wiley & Sons.
Harmer, V. (2016). Signs and symptoms of breast cancer: The practice nurse role. Practice
Nursing, 27(8), 377-382. doi:10.12968/pnur.2016.27.8.377
Knauer, M., & Thürlimann, B. (2014). Adjuvant Bisphosphonates in Breast Cancer
Treatment. Breast Care, 9(5), 319-322. doi:10.1159/000368760
Lehne, R. A., & Rosenthal, L. (2014). Pharmacology for Nursing Care-E-Book. Elsevier Health
Sciences.
Peart, O. (2017). Metastatic Breast Cancer. Radiologic Technology, 88(5), 519-541.

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Pirschel, C. (2017). Cancer Prevention Through Community-Based Programs. ONS
Voice, 32(10), 16-20.
Smania, M. A. (2017). Evaluation of common breast complaints in primary care. Nurse
Practitioner, 42(10), 9-15. doi:10.1097/01.NPR.0000524661.93974.e8
Soo, H., & Sherman, K. A. (2015). Rumination, psychological distress and post-traumatic
growth in women diagnosed with breast cancer. Psycho-Oncology, 24(1), 70-79.
doi:10.1002/pon.3596
Swanson, J., & Koch, L. (2010, January). The role of the oncology nurse navigator in distress
management of adult in patients with cancer: a retrospective study. In Oncology Nursing
Forum (Vol. 37, No. 1).
Vriens, I. J., Keymeulen, K., Lobbes, M. B., van Bommel, A. C., Nieuwenhuijzen, G. A., Smidt,
M. L., & ... Tjan-Heijnen, V. C. (2017). Breast magnetic resonance imaging use in
patients undergoing neoadjuvant chemotherapy is associated with less mastectomies in
large ductal cancers but not in lobular cancers. European Journal Of Cancer, 8174-80.
doi:10.1016/j.ejca.2017.05.012
Wilkes, G. M., & Barton-Burke, M. (2016). 2017 Oncology Nursing Drug Handbook. Jones &
bartlett learning.

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Appendix- A
Questions to assess the nipple discharge:
 Discharge is clear or blood stained?
 Blood discharge is from one breast or both breasts?
 Discharge is spontaneous or persistent?
 You feel a unusual lump in breast?
 Do you feel pain in one of the breast? (Harmer, 2016)
Appendix- B
(Knauer & Thürlimann, 2014)
Actions: It prevents the bone complications and help relive from pain in metastatic breast cancer.
Its principal pharmacologic action is the inhibition of bone resorption.
Side effects of are-
 Fever, nausea, vomiting
 Fatigue
 Bone pain at the start of medicines
 Loss of appetite
 Anemia
 Osteonecrois of jaw