A patient with a history of triple negative breast cancer presents with increasing fatigue, shortness of breath, and a persistent cough. Diagnostic tests reveal bilateral pleural effusions, several small nodules in the lungs, and elevated CA 15-3 levels. Which nursing intervention is a priority to address the patient's current respiratory symptoms?

D) Prepare the patient for thoracentesis to relieve pleural effusion.

A) Administer supplemental oxygen and elevate the head of the bed to ease breathing.

B) Encourage increased fluid intake to thin secretions and improve comfort.

C) Provide education about breathing exercises to enhance lung capacity.

D) Prepare the patient for thoracentesis to relieve pleural effusion.

A patient with a history of triple-negative breast cancer presents with fatigue, shortness of breath, and a persistent cough. Diagnostic imaging reveals bilateral pleural effusions and lung nodules suggestive of metastatic spread. Her lab results show mild anemia and elevated CA 15-3 levels. Which nursing intervention is most appropriate to prioritize for managing this patient's respiratory symptoms?

D) Position the patient in a high Fowler's position to ease breathing.

A) Administer supplemental oxygen to improve oxygenation.

B) Encourage increased fluid intake to help reduce pleural effusions.

C) Perform chest physiotherapy to mobilize secretions.

D) Position the patient in a high Fowler's position to ease breathing.

A 60-year-old female patient with triple-negative breast cancer presents with worsening respiratory status and increased fatigue. Her vital signs include a respiratory rate of 28 breaths per minute, oxygen saturation of 88% on room air, heart rate of 110 beats per minute, and blood pressure of 145/90 mmHg. Auscultation reveals diminished breath sounds bilaterally and dullness to percussion on the left side. Considering her condition, which nursing intervention should be prioritized to address her current symptoms?

D) Prepare the patient for thoracentesis to relieve pleural effusion.

A) Increase the oxygen flow rate to 4 liters per minute.

B) Administer a bronchodilator to improve lung function.

C) Encourage deep breathing exercises to enhance oxygenation.

D) Prepare the patient for thoracentesis to relieve pleural effusion.

A patient with advanced triple-negative breast cancer presents with worsening respiratory status, significant fatigue, and intermittent palpitations. The healthcare team implements supplemental oxygen and considers anticoagulation therapy due to increased thromboembolic risk. As the nurse, which intervention should be prioritized to address the patient's immediate needs?

A) Increase the oxygen flow rate to 4 liters per minute to improve oxygen saturation.

B) Administer prescribed anticoagulation medication to reduce thromboembolic risk.

C) Initiate a blood transfusion to address the patient's low hemoglobin levels.

D) Collaborate with palliative care to manage the patient's symptoms and improve quality of life.

A patient with a significant left-sided pleural effusion and symptomatic anemia is experiencing respiratory distress. Despite increased oxygen therapy and the initiation of anticoagulation for suspected pulmonary embolism, her condition remains critical. Which nursing intervention is the most appropriate to prioritize at this time?

B) Prepare the patient for a thoracentesis to relieve pleural effusion.

A) Increase the oxygen flow rate further to improve saturation.

B) Prepare the patient for a thoracentesis to relieve pleural effusion.

C) Administer the prescribed blood transfusion to address anemia.

D) Initiate continuous positive airway pressure (CPAP) therapy for respiratory support.

A patient with a significant left-sided pleural effusion and suspected pulmonary embolism is experiencing persistent respiratory distress. The healthcare team has initiated anticoagulation therapy and increased oxygen support. What should be the nurse's priority intervention at this time?

A) Prepare the patient for thoracentesis to relieve respiratory distress

B) Increase the oxygen flow rate to further improve oxygen saturation

C) Monitor closely for signs of bleeding due to anticoagulation therapy

D) Initiate patient education on the importance of deep breathing exercises

A patient with a newly diagnosed pulmonary embolism and worsening pleural effusion presents with acute chest pain, dyspnea, and hypotension. The healthcare team is considering escalating anticoagulation therapy and performing a thoracentesis. As the nurse, what is the most immediate priority in managing this patient?

B) Administer supplemental oxygen and monitor respiratory status closely.

A) Prepare the patient for a thoracentesis procedure.

B) Administer supplemental oxygen and monitor respiratory status closely.

C) Start intravenous fluids to address hypotension.

D) Discuss palliative care options with the family.

A patient has developed acute chest pain, worsening dyspnea, and a suspected pulmonary embolism with increased pleural effusion. Her vital signs indicate hemodynamic instability. What is the most appropriate initial nursing action?

C) Increase the patient's oxygen flow rate

A) Prepare the patient for thoracentesis

B) Administer the prescribed anticoagulation therapy

C) Increase the patient's oxygen flow rate

D) Notify the patient's family about the change in condition

A patient with a history of malignancy has undergone thoracentesis to relieve a pleural effusion and is currently on therapeutic anticoagulation. Her vital signs show a heart rate of 115 bpm, respiratory rate of 24 breaths per minute, oxygen saturation of 92% on 4 liters of oxygen, and a slight increase in white blood cell count to 13,000/mm³. Given these clinical findings, what should be the nurse's priority action?

B) Monitor for signs of infection and continue current interventions

A) Increase the oxygen flow rate to improve oxygen saturation

B) Monitor for signs of infection and continue current interventions

C) Assess and manage the patient's pain to reduce heart rate and improve comfort

D) Prepare for possible intubation due to increased respiratory rate

A patient with a history of malignancy and pleural effusion underwent thoracentesis and therapeutic anticoagulation. Post-procedure, she reports reduced chest pain and shows slight improvement in oxygen saturation. However, her white blood cell count has increased to 13,000/mm³. Which nursing intervention is most appropriate to address the potential risk of infection?

A) Increase the frequency of vital signs monitoring and reassess for signs of infection.

B) Discontinue anticoagulation therapy immediately to prevent further complications.

C) Increase the oxygen flow rate to improve oxygen saturation further.

D) Delay the administration of broad-spectrum antibiotics until culture results confirm infection.

triple negative breast cancer - Nursing Case Study

Pathophysiology

• Primary mechanism: Triple negative breast cancer (TNBC) lacks estrogen, progesterone, and HER2 receptors, leading to a more aggressive cancer type with limited targeted therapy options, as these receptors usually guide hormone or HER2-targeted treatments.

• Secondary mechanism: TNBC often exhibits high genetic instability and mutations, such as in the TP53 tumor suppressor gene, resulting in uncontrolled cell proliferation and resistance to standard chemotherapy.

• Key complication: Due to its aggressive nature and lack of targeted treatments, TNBC is associated with a higher risk of metastasis and recurrence, necessitating more intensive monitoring and treatment strategies.

Patient Profile

Demographics:

45-year-old female, high school teacher

History:

• Key past medical history: Diagnosed with triple negative breast cancer six months ago, completed initial chemotherapy regimen.

• Current medications: Paclitaxel, Doxorubicin, supportive care medications including antiemetics and pain management.

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing fatigue and shortness of breath.

• Key symptoms: Persistent cough, chest pain, unexplained weight loss, swelling in the left arm, and occasional night sweats.

• Vital signs: Blood pressure 145/92 mmHg, heart rate 110 bpm, respiratory rate 22 breaths per minute, temperature 100.4°F, oxygen saturation 88% on room air.

Section 1

New Diagnostic Results:

Following the patient's presentation with increasing fatigue, shortness of breath, and persistent cough, a series of diagnostic tests were conducted to evaluate her current status. A chest X-ray revealed bilateral pleural effusions, more pronounced on the left side, which could account for her respiratory symptoms. A subsequent CT scan of the chest confirmed the presence of these effusions and identified several small nodules suggestive of metastatic spread to the lungs. Blood tests indicated elevated levels of cancer antigen 15-3 (CA 15-3), a marker often used in monitoring breast cancer, reinforcing concerns about possible disease progression.

Additionally, a complete blood count (CBC) showed mild anemia, with hemoglobin levels at 10.2 g/dL, which may contribute to her fatigue. Her platelet count was slightly elevated at 450,000/mm³, potentially indicating an inflammatory response or paraneoplastic syndrome. Liver function tests returned normal, but renal function tests showed a slight increase in creatinine levels at 1.4 mg/dL, warranting close monitoring, especially considering the nephrotoxic potential of her current chemotherapy regimen.

These findings suggest a progression of the disease, with new metastatic involvement and complications arising from treatment. The healthcare team must now consider adjusting her therapeutic approach, potentially incorporating palliative measures to manage symptoms and improve quality of life. Further discussions with the oncology team are necessary to explore additional systemic therapies or clinical trials that might be suitable given the limited options available for triple negative breast cancer. This new development marks a critical point in the patient's journey, requiring thoughtful coordination of care and close monitoring for further changes in her condition.

Section 2

Change in Patient Status:

As the healthcare team reconvened to assess the patient's evolving condition, it became evident that her respiratory status had deteriorated further. During the initial assessment, the patient appeared visibly fatigued, with labored breathing and an increased respiratory rate of 28 breaths per minute. Oxygen saturation was measured at 88% on room air, prompting the initiation of supplemental oxygen via nasal cannula at 2 liters per minute to maintain adequate saturation. Auscultation of her lungs revealed diminished breath sounds bilaterally, with pronounced dullness to percussion on the left side, consistent with the pleural effusions noted on imaging.

In addition to respiratory symptoms, the patient reported a significant increase in fatigue and intermittent episodes of palpitations. Her heart rate was recorded at 110 beats per minute, and blood pressure was slightly elevated at 145/90 mmHg. These cardiovascular changes, along with her elevated platelet count, raised concerns about potential thromboembolic events, a risk exacerbated by both her cancer status and recent immobilization due to increased fatigue. To address these risks, the team considered starting anticoagulation therapy, weighing the benefits against potential bleeding complications, especially in the context of her mild anemia.

The patient's laboratory results also showed a further decline in hemoglobin levels to 9.8 g/dL, necessitating a discussion about the need for possible blood transfusion to alleviate symptoms of anemia and improve her overall functional status. Given her deteriorating condition and the limited treatment options available for triple-negative breast cancer, the oncology team initiated discussions about potential enrollment in clinical trials, aiming to provide access to novel therapies that could stabilize her disease. Meanwhile, palliative care was brought in to focus on symptom management, emphasizing the importance of maintaining quality of life as the patient navigates this challenging phase of her illness.

Section 3

Following the initiation of supplemental oxygen therapy, the healthcare team closely monitored the patient's response to this intervention. Despite the increased oxygenation support, her respiratory status showed minimal improvement, with oxygen saturation stabilizing at 90% on 2 liters per minute via nasal cannula. The team decided to increase oxygen delivery to 4 liters per minute, resulting in a slight improvement of oxygen saturation to 92%. However, the patient's respiratory rate remained elevated at 26 breaths per minute, indicating persistent respiratory distress. Repeat imaging was ordered, and a chest CT scan confirmed a significant left-sided pleural effusion, now exerting pressure on the mediastinum, further complicating her respiratory mechanics.

In parallel, laboratory tests revealed a worsening of the patient's hematological profile. Her hemoglobin level dropped further to 8.5 g/dL, reinforcing the need for a blood transfusion to address her symptomatic anemia. Additionally, D-dimer levels were markedly elevated, intensifying concerns about thromboembolic events. Given the patient's increased risk profile and recent symptoms of palpitations, the decision was made to initiate anticoagulation therapy with low-molecular-weight heparin while closely monitoring for any signs of bleeding. This was accompanied by an echocardiogram, which showed evidence of right heart strain, raising the suspicion of a possible pulmonary embolism, a complication that could be contributing to her respiratory decline.

As these interventions were put into place, the patient's overall condition remained critical, prompting the multidisciplinary team to reassess her management plan. Discussions about her eligibility for clinical trial enrollment continued, alongside the implementation of more aggressive palliative care measures to manage her symptoms and improve her comfort. The team recognized the need for a delicate balance between aggressive treatment of complications and maintaining the patient's quality of life, as they prepared to navigate the complex decisions that lay ahead in her treatment journey.

Section 4

As the multidisciplinary team continued to manage the patient's complex clinical picture, a new complication emerged that demanded immediate attention. Overnight, the patient developed acute chest pain and worsening dyspnea, prompting a rapid response from the healthcare team. Vital signs revealed a further increase in respiratory rate to 30 breaths per minute, a heart rate of 120 beats per minute, and blood pressure that had dropped to 90/60 mmHg, indicating potential hemodynamic instability. Oxygen saturation, despite being on 4 liters per minute of oxygen, fell to 89%, signaling a possible acute deterioration.

A repeat chest CT scan was urgently performed, revealing an increase in the size of the left-sided pleural effusion, now coupled with findings suggestive of a newly developed pulmonary embolism within the right pulmonary artery. This confirmed the team's suspicion that the patient's respiratory decline was multifactorial, now heavily influenced by thromboembolic events. The decision was made to escalate anticoagulation therapy to therapeutic levels, and considerations for interventional procedures such as thoracentesis to relieve the pleural effusion were discussed.

The team also reevaluated her palliative care needs, emphasizing symptom management and comfort measures. The patient's worsening clinical status necessitated a family meeting to discuss her prognosis and potential shifts in treatment goals, balancing aggressive interventions with her quality of life. As the situation evolved, the team prepared for potential intensive care unit admission, should the patient's condition continue to decline, ensuring that all aspects of her care remained aligned with her previously expressed wishes and overall treatment goals.

Section 5

As the multidisciplinary team gathered to address the patient's worsening condition, they focused on the response to the escalated interventions. Following the initiation of therapeutic anticoagulation, the team closely monitored the patient's clinical status, reassessing her vital signs and overall response. Within several hours, there was a slight improvement in her oxygen saturation, now reading at 92% on 4 liters per minute of oxygen. Despite this modest improvement, she continued to experience significant dyspnea, and her heart rate remained elevated at 115 beats per minute. The patient's blood pressure, however, stabilized at 100/65 mmHg, indicating a positive response to the fluid resuscitation measures that had been implemented alongside anticoagulation therapy.

In conjunction with pharmacological management, a decision was made to proceed with a thoracentesis to address the symptomatic pleural effusion. The procedure was conducted smoothly, and approximately 800 milliliters of serosanguinous fluid were removed, leading to a noticeable alleviation in her respiratory distress. Post-procedure, the patient reported a reduction in chest pain, and her respiratory rate decreased to 24 breaths per minute, suggesting an overall improvement in her breathing mechanics. The pleural fluid was sent for cytological analysis to assess for malignant cells, providing further insight into the progression of her cancer.

As the team continued to evaluate her condition, they remained vigilant for any new complications that could arise. The patient's white blood cell count, however, showed a slight increase to 13,000/mm³, raising concerns about potential infection or inflammatory response related to the underlying malignancy or recent intervention. The team initiated broad-spectrum antibiotics as a precautionary measure while awaiting culture results. This proactive approach was essential to prevent any further decline in her clinical status and underscored the importance of maintaining a dynamic and responsive care plan tailored to her evolving needs. With these interventions in place, the team prepared for the next phase of management, ensuring that all decisions were made in line with the patient's goals of care and her family's expectations.