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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- Breast Surgery. The removal of breast cancer cells through operation can vary depending on the size, grade, and extent of the tumor and disease.
- Lumpectomy – to remove small tumors and a margin of surrounding healthy breast tissues; also known as wide local excision or breast-conserving surgery
- Mastectomy – to remove the entire breast
- Sentinel node biopsy – to remove a limited number of lymph nodes and determine cancer spread in these areas
- Axillary lymph node dissection – to remove additional lymph nodes if the sentinel nodes show signs of cancer
- Medications. Several pharmacologic therapies have been used to treat breast cancer, such as:
- 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.
- Hormone Therapy – used to treat breast cancers that are sensitive to hormones estrogen and/or progesterone
- 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)
- Immunotherapy – utilizes the immune system to attack the breast cancer cells; examples include immune system modulators and checkpoint inhibitors
- 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.
- External beam radiation – aims the energy beams at the affected body area
- Brachytherapy – places radioactive material inside the body in order to perform radiation therapy
Nursing Diagnosis for Breast Cancer
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.
| Nursing Interventions for Breast Cancer | Rationales |
| 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. |
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.
| Nursing Interventions for Breast Cancer | Rationale |
| 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. |
Breast Cancer 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.
| Nursing Interventions for Breast Cancer | Rationales |
| 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. |
Breast Cancer Nursing Care Plan 4
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to fatigue, emotional distress, and poorly controlled pain due to chemotherapy secondary to breast cancer, as evidenced by expressions of inadequate food intake, loss of interest in food, inability to ingest food, reduced subcutaneous fat, body weight 20 percent below optimum for height and frame, stomach cramps and constipation.
Desired Outcomes:
- The patient will be able to demonstrate a stable weight gain toward the goal with normal laboratory values.
- The patient will not show any indicators of malnutrition.
- The patient will be able to participate in specific interventions to gain appetite and increase dietary intake.
| Nursing Interventions for Breast Cancer | Rationale |
| Observe the patient’s daily food consumption and advise them to keep a food diary as directed. | This helps to determine the nutritional status, particularly the deficiencies of the patient. |
| Measure the patient’s height, weight, and the thickness of triceps or other anthropometric measurements as appropriate. Find out how much weight has recently been lost. Weigh the patient daily, or as directed. | The patient’s main reserve of stored energy on fat tissue is exhausted if these measurements don’t meet minimum requirements. |
| Observe the patient for pallor, slow wound healing, and swollen parotid glands in the skin and mucosal membranes. | Especially when weight and other anthropometric parameters are below average, this aids in the detection of protein-calorie malnutrition. |
| Encourage the patient to have a calorie-dense, nutrient-rich diet while also getting enough fluids. Promote frequent or smaller meals spaced throughout the day and the use of supplements. | Both fluid and metabolic tissue requirements rise to eliminate waste products. Maintaining a sufficient protein and calorie intake might benefit from supplements. |
| Encourage the patient to eat with family and friends by creating a pleasant dining environment. | Increases the joy of eating, which can increase proper food intake. |
| Encourage the patient and carer / significant other to share thoughts about the effects of chemotherapy on the patient’s food intake. | Frequently a source of nausea, GI upset, diarrhea/ constipation, and even emotional pain, going through chemotherapy can affect the patient’s food intake. It is also important for the significant other to be included in the discussion about nutrition and food intake because they usually desire regular feedings of the patient. When the patient declines to eat in ideal amounts, the significant other or carer could feel that they are not helpful to the patient which puts them at risk for caregiver role strain. |
| Adjust the patient’s diet before and after chemotherapy treatment as needed. Give clear and cool liquids, offer light or bland foods, as well as candied ginger, dry crackers, toast, carbonated drinks. Consider fluid restriction during meals. | The effectiveness of food modification in reducing nausea following medication varies greatly from person to person. To identify the optimal treatment or combination, patients must experiment. Fluid restriction during meals reduces feeling “full” too soon. |
| Refrain the patient from eating overly fatty, sweet, or spicy foods. | These foods can cause an episode of nausea and vomiting. |
| Encourage the patient to do meditation, guided imagery, visualization, and light exercise before meals. | This may delay the onset of nausea or lessen its intensity, lessening anorexia. This intervenion may allow the patient to increase oral intake. |
| Determine which patient is experiencing anticipatory nausea and vomiting, and take the necessary action. | Antiemetic medications typically do not relieve psychogenic nausea and vomiting that occurs prior to chemotherapy. On the day of treatment, a change in the patient’s routine or the treatment environment may be beneficial. |
| Administer antiemetics regularly, either before or after the administration of antineoplastic agents, depending on the situation. | The most incapacitating and mentally taxing side effects of chemotherapy are typically nausea and vomiting. |
| Monitor the antiemetic’s effectiveness. | All drugs have varied effects on various people. First-line antiemetics could not be effective, necessitating a change in medication therapy or the use of combination drugs. |
| Subject the patient’s gastric secretions and stool to lab tests as indicated by the physician, | Antimetabolites used in some treatments prevent the GI tract’s epithelial cells from renewing, which can result in alterations ranging from minor erythema to severe ulceration and bleeding. |
| Review the patient’s relevant laboratory studies including total lymphocyte count, serum transferrin, and albumin or prealbumin. | Determines the degree of malnutrition and metabolic imbalance, and it affects the choice of nutritional therapies. Note: Because anticancer medications might affect nutrition studies as well, all findings must be compared to the patient’s clinical condition. |
| Refer the patient to the nutritional support team or dietitian. | Gives instructions for a unique diet to satisfy individual demands and lessen issues with protein, calorie, and vitamin deficits. |
| Insert and maintain a central line for total parenteral nutrition (TPN) if necessary, or an NG or feeding tube for enteric feedings. | Tube feeding or TPN may be required to meet nutritional needs if there is severe malnutrition (loss of 25% to 30% of body weight in 2 months) present or if the patient has been NPO for 5 days and is unlikely to be able to eat for another week. |
Breast Cancer Nursing Care Plan 5
Nursing Diagnosis: Risk for Infection related to insufficient secondary defenses, immunosuppression, and chronic disease process secondary to breast cancer, as evidenced by damaged epidermal tissue, skin irritation on injection site, shortness of breath, presence of mucus in the saliva, nasal drainage, fever of 100.5 °F, sore throat and chills.
Desired Outcomes:
- The patent will be able to stay afebrile and achieve timely healing as appropriate.
- The patient will be able to identify and participate in interventions to prevent or minimize the risk of infection.
| Nursing Interventions for Breast Cancer | Rationale |
| Encourage the patient’s visitors and other staff to wash their hands properly. Visitors who may be infected should be screened and limited. As specified, place the patient in reverse isolation. | Safeguards the patient from infection sources, such as guests and personnel who might have an upper respiratory illness (URI). |
| Reinforce good personal hygiene for the patient. | Reduces the risk of infection and uncontrolled bacterial growth. |
| Monitor the patient’s temperature. | If anti-inflammatory medications aren’t used to mask it, temperature increase may happen for a variety of reasons including chemotherapy side effects, disease process, or infection. Early detection of infectious processes enables timely initiation of the necessary therapy. |
| Assess the patient for signs and symptoms of infection in various systems such as the skin, respiratory, and genitourinary on a regular basis. | Early detection and treatment may stop the development of sepsis or a more catastrophic scenario. |
| Encourage the patient to move frequently and to maintain sheets wrinkle-free and dry. | Decreases tissue pressure, discomfort, and possible skin deterioration, as it may be a potential site for bacterial growth. |
| Encourage the patient to have regular periods of relaxation and exercise. | Reduces fatigue while promoting enough mobility to avoid complications from stasis such as pneumonia, decubitus, and thrombus formation. |
| Emphasize the need for good oral hygiene. | Risk of infection and subsequent overgrowth rises with the development of stomatitis. |
| Limit performing invasive procedures on the patient. If the invasive procedure is required, always follow aseptic technique. | Reduces the access points for pathogenic pathogens and lowers the chance of contamination. |
| Check the patient’s complete blood count (CBC), differential WBC and granulocyte counts, and platelets as needed | Chemotherapy side effects, the disease condition, or radiation therapy can all decrease bone marrow activity. In order to schedule medicine supply and avoid subsequent problems such as infection, anemia, or hemorrhage, myelosuppression must be closely monitored. |
| Obtain samples for cultures as needed. | Determines the responsible organism(s) and the best treatment. |
| Ensure that dietary requirements are met. | Skin deterioration and sluggish wound healing can be brought on by altered diet. Work together with the nutritionist to make sure the patient is getting enough nutrition and is aware of its significance. |
| Assess the patient’s skin during radiation therapy. | Every time a patient receives radiation, the area should be checked for redness, skin peeling or blistering, and other irritation. These are frequent with radiation, but needs to be monitored. Additionally, the patient needs to be told to carefully examine the skin after the procedure. |
| Educate the patient about the proper skin care after radiotherapy. | Inform the patient about the potential effects of radiation on their skin integrity if the patient is having radiation therapy for breast cancer. Emphasize how important it is to stay away from lotions, deodorants, and other items that can cause irritation. |
| Encourage the patient to adhere to limb restrictions. | Following the excision or radiotherapy of the axillary lymph nodes, lymphedema is a problem. By avoiding blood pressure checks and lab draws in the affected arm, the complication can be reduced. |
| Encourage the patient to wear loose clothing. | During the months the patient is having chemotherapy or radiation therapy, remind patients to dress comfortably and loosely to prevent having an impaired skin integrity which may cause pathogens to enter the body. Educate the patient about the significance of avoiding clothing-related friction, tightness, or constriction. |
Breast Cancer Nursing Care Plan 6
Nursing Interventions: Anticipatory Grieving related to expected decline in physiological health and perceived risk of dying secondary to breast cancer, as evidenced by alterations in eating habits, changes in sleeping patterns, activity levels, and communication patterns, shortness of breath, acute panic, expressions of fear and crying.
Desired Outcomes:
- The patient will be able to recognize their own emotions and convey them effectively.
- The patient will be able to maintain the normal daily routine while planning for the future and looking ahead one day at a time.
- The patient will be able to express awareness of the dying process.
- The patient will demonstrate ways to identify anxiety to prevent going into a panic state.
| Nursing Interventions for Breast Cancer | Rationale |
| Prepare the patient for initial shock and disbelief following a cancer diagnosis and undergoing traumatic procedure such as a disfiguring surgery. | Few patients are truly ready for the alterations that may actually take place. |
| Determine the patient’s and significant other’s current stage of grief, describe the process as necessary. | Understanding the grief process helps patients deal with feelings and reactions more effectively and confirms that they are normal. |
| Utilize active listening, acknowledgment, and other therapeutic communication techniques with the patient and create a welcoming, uncritical environment. | Welcomes and supports frank discussion of feelings and worries. |
| Encourage the patient to have a verbal expression of ideas or worries, and welcome tears of sadness, rage, or rejection. Recognize that these feelings are normal. | Knowing intense, frequently conflicting emotions are common in this trying situation and are experienced by all people, whether they are sick with cancer or not. This may encourage the patient to communicate their sentiments. |
| Monitor the patient for erratic behavior, aggression, and other acting-out traits. Limit incorrect actions and refocus the patient’s thoughts. | Signs of inadequate coping and the need for further therapies. The patient can keep control and the sense of self-worth by avoiding destructive behavior. |
| Monitor the patient for possible debilitating depression. Directly probe the patient’s mental condition. Numerous breast cancer patients are at a significant risk of suicide, according to studies. When just diagnosed and released from the hospital, they are particularly vulnerable. | |
| Encourage the patient’s caretaker and support person to remain with them as needed. Depending on the situation, either make regular phone calls or frequent visits to provide physical contact. | Reduces feelings of abandonment and solitude. |
| Provide information about dying and reinforce instruction about disease processes and remedies. Be truthful and avoid inspiring false hope when offering emotional support to the patient. | Factual information is beneficial to the patient and significant others. Direct questions regarding death are acceptable, and honest responses encourage trust and give assurance that the right information will be provided. |
| Review past events, changes in roles, and coping mechanisms. Talk about topics that the patient is interested in. | Possibility to uncover abilities that could aid the patient in more effectively coping with the current grief. |
| Identify and inform the patient about the positive aspects of the current condition. | Future prospects may be improved by the likelihood of remission, a slowing of disease progression, and new treatments. |
| Discuss how the patient and significant others can make future plans together. Encourage both to set attainable goals. | Participating in planning and problem-solving might give one a feeling of control over upcoming occurrences. |
| If necessary, arrange for a visiting nurse, a home health provider, or a hospice program for the patient. | Supports the patient and significant others in fulfilling the physical and emotional requirements and can support the care that the patient’s family and friends can provide. |
| Provide the patient with a warm and comforting environment. | An environment that is chaotic or stimulating can make the patient feel more anxious. When speaking with the patient, keep the voice soothing and encouraging. |
| Encourage the patient to practice alternative relaxation techniques including guided imagery, talk therapy, deep breathing exercises, yoga, and meditation. | A patient’s fear may be reduced by using a range of relaxation techniques. Encourage the patient to experiment with various methods to find the one that suits them the best. |
| Educate and help the patient in understanding the diagnosis. | A lack of knowledge about the diagnosis may contribute to the grief of the patient. Assess the patient’s comprehension of the diagnosis, course of therapy, and outlook. Fear and anxiety can be reduced by providing factual information and clearing up common misconceptions. |
More Breast Cancer Nursing Diagnosis
- Acute Pain
- Fear/ Anxiety
- Risk for Altered Oral Mucous Membranes
- Risk for Impaired Skin Integrity
- Risk for Disturbed Body Image
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. (2022). 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. (2020). 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
