Question

M.D. is a 50-year-old woman whose routine mammogram showed a mass in her left breast. M.D. underwent a stereotactic needle biopsy and was diagnosed with infiltrating ductal carcinoma that was both estrogen and progesterone receptor positive. She had a modified radical mastectomy with lymph node dissection. An implanted port was placed during surgery. She is prescribed a chemotherapy regimen of six cycles. M.D. has a son with Down syndrome that she cares for at home. She expresses concern as to what will happen to her son if she dies before him stating "I don't know who will take care of him when I'm gone."

1. What are the risk factors for breast cancer?
2. Disseminated intravascular coagulation (DIC) is a complication of chemotherapy. What are the manifestations of DIC?
3. Therapeutic communication is an important nursing intervention for all patients. List 2 examples of therapeutic responses (tip: you learned this in mental health) that would be appropriate regarding her concern about her son.
4. Bone metastasis may occur in some cancer patients and this may present as high calcium levels, one of the oncologic emergencies we are learning about this week. What is the treatment for hypercalcemia?

Answer 1

Ans) Risk factors for breast cancer:

* Gender: 99% occur in women
* Increasing age: gradual increase until 60, dramatic increase after 60
* Women under 25 low risk
* First full term pregnancy after age 30
* Nulliparity
* Alcohol consumption
* Sedentary lifestyle

• Disseminated intravascular coagulation (DIC):

- sudden onset of bleeding disorder without prior history of bleeding or blood coagulation abnormalities

- spontaneous bleeding for no reason
- purple toes and gums bleeding
- IV bleeding continuously
- petechea, bruising, echymosis, hematomas
- conjunctival bleeding
- tubes, veins, lines, incisions, wounds
- overt bleeding or oozing
- occult bleeding
- changes in mental status
- infarction of tissues in digits and nose

• Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. While it is appropriate for the nurse to attempt to assess the patient's ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger. The nurse's attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient's feeling, this is non-therapeutic in the one-to-one relationship.

The use of "why" questions may cause defensiveness in the patient and hinder communication. The other options promote communication by encouraging the patient to communicate.

• The mainstay of treatment for cancer-related hypercalcemiais hydration with normal saline and intravenous (IV) bisphosphonates. Hydration alone is not sufficient to achieve and maintain normocalcemia in cancer patients.