breast cancer

Breast Cancer Nursing Care Plans Diagnosis and Interventions

Breast Cancer NCLEX Review Care Plans

Nursing Study Guide on Breast Cancer

Breast cancer is a type of cancer that involves the uncontrolled growth and division of breast cancer cells. In the United States, breast cancer is the second most common types of cancer in women, after skin cancer.

Signs and Symptoms of Breast Cancer

  • Breast or underarm lump – usually the first symptom of breast cancer; does not go away; can be seen through a mammogram; may be painful or tender
  • Swelling – may be seen or felt in the breast or in the lymph nodes located in the armpit or collarbone area
  • Indentation or flattened area on a breast
  • Changes in breast size, texture, color, contour, or temperature
  • Unusual nipple discharge – can be bloody, clear, or any other color
  • Other nipple changes such as inward pulling, dimpling, itchiness, soreness, burning sensation

Types of Breast Cancer

  1. Ductal Carcinoma in Situ (DCIS). The most common breast cancer type, ductal carcinoma occurs in 1 out of 5 new cases of breast cancer. DCIS is a local breast tumor that has not spread in nearby lymph nodes and other tissues. Some cases of DCIS are asymptomatic, while others show bloody nipple discharge or a breast lump.
  2. Lobular Carcinoma. This type of breast cancer originates in the lobules, the glands where milk is produced. The most common symptoms of lobular carcinoma include swelling, thickening, and/or feeling of fullness in one region of the breast and inverted or flat nipples.
  3. Infiltrating or Invasive Breast Cancer. When the breast cancer has started spreading from its origin towards the surrounding tissues, it is classified as an invasive breast cancer. The symptoms of infiltrating breast cancer include a rash on the breast skin, dimpling, swelling, pain, and an immovable lump in the breast or armpit.
  4. Metastatic Breast Cancer. Also known as advanced or secondary breast cancer, metastatic breast cancer is the type when the disease has spread to other organs and parts of the body. The symptoms of metastatic breast cancer depend on where the disease has spread, but may involve bone pain, headache, jaundice, double vision, trouble breathing, belly swelling, weight loss, gastrointestinal problems, muscular weakness, confusion, and changes in brain function.
  5. Triple Negative Breast Cancer. This type of breast cancer is detected if the tumor produces only low levels of protein called HER-2 and does not contain receptors for estrogen and progesterone hormones. Triple negative breast cancers can be aggressive, thus the treatment protocol is usually different than other types of breast tumors.
  6. Male Breast Cancer. Breast cancer in males is rare. The symptoms such as lump in the breast or armpit and nipple discharge are the same as that of the females.
  7. Paget’s Disease of the Breast. This type of breast cancer occurs with ductal carcinoma. The symptoms of this disease include eczema-looking skin, scaly or crusty nipple skin, burning or itching breast skin, inverted or flat nipple, and yellowish or bloody nipple discharge.

Causes and Risk Factors of Breast Cancer

The exact cause of breast cancer is still unknown. However, the risk factors that may increase the chance of getting breast cancer are well-studied.

In general, breast cancer tumors develop from the rapid growth and division of abnormal breast cells (hyperplasia and dysplasia). Eventually, the cells accumulate and form a mass or a lump.

These abnormal breast cells may spread (metastasis) in the other parts of the breast, lymph nodes, or organs of the body.

The risk factors of breast cancer include:

  • Gender – being a woman is the biggest risk factor of having breast cancer, although 1% of the cases occur in men.
  • Age – 2 of 3 invasive breast cancer cases are seen in women aged 55 years or above
  • Family History and Genetics– the risk is doubled if a woman has a first-degree female relative that has been diagnosed with breast cancer (mother, sister, or daughter)
  • Past Medical History of Breast Cancer – if the patient has had breast cancer in the past, he/she is 3 to 4 times likely to develop breast cancer in the future; having had benign breast conditions in the past also increase the risk for breast cancer
  • Race and Ethnicity – White women have a slightly higher risk for breast cancer than Hispanic, Black, and Asian women
  • Exposure to Radiation – if the patient had radiotherapy to the face or chest to treat acne or another cancer type such as lymphoma, the risk for developing breast cancer is higher than average
  • Obesity and being overweight
  • History of Pregnancy – women who have had their first child after age 30 or have not had any full term pregnancy have a higher risk than women who have had full term pregnancy and/or gave birth before age 30.
  • Breastfeeding – studies show that breastfeeding, especially for longer than 1 year, lowers the risk of breast cancer
  • Menstrual History – women who had periods younger than age 12 have a higher risk of breast cancer; menopausing older than 55 years old also increases the risk
  • Alcohol use and Smoking
  • Hormone Replacement Therapy – HRT users have a higher risk of breast cancer
  • Sedentary Lifestyle

Complications of Breast Cancer

  • Pulmonary insufficiency
  • Infection
  • Metastasis to other organs or parts of the body
  • Cardiac disease

Diagnosis of Breast Cancer

  • Breast Exam. This can be done daily through self-checking. During a breast exam in the clinic, the doctor will observe and feel/palpate the breasts and the lymph nodes in the armpit for any abnormalities such as lumps.
  • Mammogram. X-ray of the breast or mammogram is the most common screening test for breast cancer. Women with no history of breast cancer are recommended to have a yearly mammogram once they turn 40 years old.
  • Breast Ultrasound. This can determine if a breast lump is a fluid-filled cyst or a solid mass.
  • Breast Magnetic Resonance Imaging (MRI). This is used to visualize the breast by creating pictures. MRI involves injection of a dye to see the interior of the breast.
  • Breast Biopsy. The definitive way to diagnose breast cancer, biopsy involves taking a sample of breast cells to be studied under the microscope.
  • Cancer Staging. After diagnosis, the oncologist will assess the extent or stage of breast cancer, from 0 to IV. Cancer staging depends on the blood test results (complete blood count and tumor markers (i.e., cancer antigen 15-3 or CA 15-3, cancer antigen 27.29 or CA 27.29, and carcinoembryonic antigen or CEA), CT/ PET scan, and other diagnostic results.

Treatment for Breast Cancer

  1. Breast Surgery. The removal of breast cancer cells through operation can vary depending on the size, grade, and extent of the tumor and disease.
  2. Lumpectomy – to remove small tumors and a margin of surrounding healthy breast tissues; also known as wide local excision or breast-conserving surgery
  3. Mastectomy – to remove the entire breast
  4. Sentinel node biopsy – to remove a limited number of lymph nodes and determine cancer spread in these areas
  5. Axillary lymph node dissection – to remove additional lymph nodes if the sentinel nodes show signs of cancer
  6. Medications. Several pharmacologic therapies have been used to treat breast cancer, such as:
  7. Chemotherapy – uses drugs to kill cancer cells. The most common chemotherapy protocols for breast cancer include combinations of anti-tumor antibiotics and alkylating agents, followed by taxanes.
  8. Hormone Therapy – used to treat breast cancers that are sensitive to hormones estrogen and/or progesterone
  9. Targeted Therapy – uses drugs that attack specific abnormalities in the cancer cell, such as human epidermal growth factor receptor 2 (HER2); an example is the use of monoclonal antibodies (MABs)
  10. Immunotherapy – utilizes the immune system to attack the breast cancer cells; examples include immune system modulators and checkpoint inhibitors
  11. Radiotherapy. Radiotherapy uses radiation or high-powered energy beams such as protons and X-rays to kill the cancer cells. This can last from 3 days to 6 weeks.
  12. External beam radiation – aims the energy beams at the affected body area
  13. Brachytherapy – places radioactive material inside the body in order to perform radiation therapy

Nursing Care Plans for Breast Cancer

Nursing Care Plan 1

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of breast cancer as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of breast cancer and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis and to help the patient overcome blocks to learning.
Explain what breast cancer is and its symptoms. Avoid using medical jargons and explain in layman’s terms.To provide information on breast cancer and its pathophysiology in the simplest way possible.
Educate the patient about his/her breast cancer treatment plan.  If patient is for systemic anti-cancer therapy (SACT) and/or radiotherapy, explain the treatment protocol that will be administered, its purpose, risks, and possible side effects. If the patient is for surgery, explain the procedure to the patient.  To give the patient enough information on the treatment plan, so that he/she can provide or deny an informed consent.  
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) for supportive care, such as pain medications, anti-emetics and bowel medications. Explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of breast cancer. Teach the patient on how to modify these risk factors (e.g. smoking, excessive alcohol intake, obesity, unhealthy food choices, sedentary lifestyle, etc).To assist the patient in identifying and managing modifiable risk factors related to breast cancer.

Nursing Care Plan 2

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to consequences of chemotherapy for breast cancer, as evidenced by abdominal cramping, stomach pain, diarrhea or constipation, bloating, weight loss, nausea and vomiting, and loss of appetite

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Explore the patient’s daily nutritional intake and food habits (e.g. meal times, duration of each meal session, snacking, etc.)To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to increase dietary fiber, caloric intake and alcohol and coffee intake.To promote nutrition and healthy food habits, as well as to boost the energy levels of the patient. Dietary fiber can help reduce stool transit time, thus promoting regular bowel movement.
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed breast cancer.  
Symptom control: Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Promote bowel emptying using laxatives as prescribed for constipation. On the other hand, provide advice on taking anti-diarrheal medications for diarrhea.To reduce cramping, relieving the stomach pain and helping the patient to have a better appetite. To treat persistent and/or severe constipation/diarrhea.

Nursing Care Plan 3

Nursing Diagnosis: Fatigue related to consequence of chemotherapy for breast cancer (e.g., immunosuppression and malnutrition) and/or emotional distress due to the diagnosis, as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will establish adequate energy levels and will demonstrate active participation in necessary and desired activities.

InterventionsRationales
Ask the patient to rate fatigue level (mild, moderate, or severe fatigue).     Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.
For patients with grade 3 fatigue (severe fatigue), consider discussing having a treatment break with the oncology team.Anti-cancer therapies such as chemotherapy treatments may increase the fatigue levels in a cancer patient, disabling them to perform even the most basic daily activities such as eating and bathing. Having a treatment break may be needed to allow the patient to recuperate before receiving further doses.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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