Case Study 1: Breast Cancer

Situation: The client is a 50-year-old female teacher who was notified of an abnormal screening mammogram. Diagnosis of infiltrating ductal carcinoma was made following a stereotactic needle biopsy of a 1.5 x 1.5 cm lobulated mass at the 3:00 position in her left breast. The client had a modified radical mastectomy with lymph node dissection. The sentinel lymph node and 11 of 16 lymph nodes were positive for tumor. Estrogen receptors and progesterone receptors were both positive. Further staging work-up was negative for distant metastasis. Her final staging was stage IIB. Her prescribed chemotherapy regimen is 6 cycles of CAF after a single-lumen central line was placed.

1. The client asks you to help her …show more content…

12. What is the single most important nursing intervention for a patient with an AGC less than 500/cmm?

Handwashing is the most important intervention for the prevention of infectious organisms.

13. What is the significance of the lactic acid level?

The Client has pneumonia in her LLL. When O2 is not available, cells are required to manufacture ATP using the anaerobic pathway. The by-product of anaerobic metabolism is increased lactic acid.

CASE STUDY PROGRESS: The client’s oxygen requirements significantly increase. She is admitted into the ICU and requires endotracheal intubation.

14. Differentiate among sepsis, severe sepsis, and septic shock.

• Septic shock occurs along a continuum that begins with an inflammatory process in response to an infectious organism.

• Sepsis occurs when 2 of the following 4 criteria are met:
1. Temperature over 38° C
2. Heart rate over 90 beats/min
3. Respiratory rate over 20 breaths/min or arterial blood CO2 level less than 32 torr
4. WBC over 12 thou/cmm, less than 4 thou/cmm, or containing more than 10% immature forms (bands)

• Severe sepsis occurs when the patient meets the above criteria for sepsis and also has organ dysfunction, hypoperfusion, or hypotension manifested by lactic acidosis, oliguria, or mental status alteration among others.

• Septic shock meets the above criteria for severe sepsis and includes hypotension despite adequate fluid resuscitation.