A patient with newly diagnosed ER+ and PR+ invasive ductal carcinoma is scheduled to begin treatment with Anastrozole. Which nursing action is most important to perform prior to initiating this hormone therapy?

C) Check the patient's baseline bone mineral density.

A) Review the patient's liver function test results.

B) Educate the patient about potential gastrointestinal side effects.

C) Check the patient's baseline bone mineral density.

D) Ensure the patient has discontinued any calcium supplements.

A patient with newly diagnosed invasive ductal carcinoma, ER+, PR+, HER2-, and regional lymph node involvement is being prepared to start Anastrozole therapy. As a nurse, which patient education point is most important to emphasize to ensure safe and effective treatment?

B) Advise the patient to report any new onset of bone pain or fractures immediately.

A) Ensure the patient understands the importance of daily weight monitoring.

B) Advise the patient to report any new onset of bone pain or fractures immediately.

C) Encourage the patient to limit fluid intake to prevent potential fluid overload.

D) Instruct the patient to avoid exposure to sunlight to prevent skin reactions.

A patient undergoing hormone therapy with Anastrozole for breast cancer begins to experience joint pain, stiffness, and fatigue. Her glucose levels are elevated at 160 mg/dL, and her hemoglobin is slightly low at 10.7 g/dL. Which nursing intervention is the most appropriate to address the patient's joint discomfort while considering her comorbid conditions?

C) Initiate a referral to a physical therapist for tailored exercises to alleviate joint symptoms.

A) Encourage increased physical activity to reduce stiffness and improve cardiovascular health.

B) Recommend the use of over-the-counter NSAIDs regularly to manage joint pain and stiffness.

C) Initiate a referral to a physical therapist for tailored exercises to alleviate joint symptoms.

D) Advise the patient to increase dietary iron intake immediately to address anemia-related fatigue.

A patient undergoing hormone therapy with Anastrozole for breast cancer reports experiencing morning joint stiffness and persistent fatigue. Given her current condition, which nursing intervention is most appropriate to address her joint symptoms while supporting her overall treatment plan?

A) Encourage the patient to perform daily stretching exercises and provide information on maintaining joint mobility.

B) Advise the patient to discontinue Anastrozole until the joint pain subsides.

C) Increase the patient's medication dosage to manage joint pain more effectively.

D) Recommend the use of a daily over-the-counter pain reliever without consulting the healthcare team.

A patient undergoing breast cancer treatment with Anastrozole presents with worsening anemia and elevated glucose levels. As part of her care plan, which nursing intervention should take priority to address these findings effectively?

C) Monitor blood glucose levels and report significant changes to the healthcare provider.

A) Administer prescribed iron supplements to improve hemoglobin levels.

B) Educate the patient on incorporating iron-rich foods and vitamin C into her diet.

C) Monitor blood glucose levels and report significant changes to the healthcare provider.

D) Schedule regular physical therapy sessions to manage joint pain and improve mobility.

A patient undergoing breast cancer treatment with Anastrozole presents with increased fatigue, dizziness, and a hemoglobin level of 9.8 g/dL. Her glucose level is 180 mg/dL. Which nursing intervention should be prioritized to address these findings?

B) Monitor blood glucose levels before and after meals to optimize glycemic control.

A) Educate the patient about iron-rich foods to improve anemia.

B) Monitor blood glucose levels before and after meals to optimize glycemic control.

C) Encourage the patient to rest frequently to manage fatigue.

D) Coordinate with the physical therapist to develop a tailored exercise program.

A patient with iron deficiency anemia is receiving intravenous iron therapy. Which nursing intervention should be prioritized to enhance the effectiveness of the treatment?

C) Schedule iron doses apart from meals that contain high-fiber foods

A) Administer vitamin B12 supplements concurrently

B) Encourage the patient to eat high-calcium foods with meals

C) Schedule iron doses apart from meals that contain high-fiber foods

D) Increase the patient's daily fluid intake to promote hydration

A patient with iron deficiency anemia has been started on intravenous iron therapy. What nursing intervention should the nurse prioritize to ensure the effectiveness of the treatment, considering the patient's overall condition?

C) Monitor the patient's hemoglobin levels and energy levels regularly.

A) Encourage the patient to increase physical activity levels to enhance circulation.

B) Educate the patient on the importance of adhering to oral iron supplementation.

C) Monitor the patient's hemoglobin levels and energy levels regularly.

D) Restrict vitamin C intake to reduce potential gastrointestinal side effects.

A patient receiving intravenous iron therapy reports occasional palpitations and a feeling of fullness in the abdomen. Vital signs indicate a heart rate of 108 beats per minute and stable blood pressure. An ultrasound reveals mild splenomegaly, and lab results show a hemoglobin level of 9.5 g/dL and a platelet count of 140,000/µL. What is the most appropriate nursing action to address the patient's current symptoms?

C) Monitor the patient's cardiovascular status closely and prepare for possible collaboration with a hematologist.

A) Encourage the patient to increase fluid intake to aid in circulation.

B) Educate the patient about the potential side effects of iron therapy, including gastrointestinal discomfort.

C) Monitor the patient's cardiovascular status closely and prepare for possible collaboration with a hematologist.

D) Advise the patient to limit physical activity until the symptoms resolve.

A patient undergoing intravenous iron therapy reports occasional palpitations and abdominal fullness. Her vital signs show a slight increase in heart rate to 108 bpm, and an abdominal ultrasound reveals mild splenomegaly. Her hemoglobin level has improved to 9.5 g/dL, but her platelet count is at the lower end of normal at 140,000/µL. What should the nurse prioritize when considering the patient's current condition and treatment plan?

B) Monitor the patient for signs of hypersplenism and potential hematologic disorders

A) Reassess the patient's dietary intake of iron and vitamin C

B) Monitor the patient for signs of hypersplenism and potential hematologic disorders

C) Educate the patient on increasing fluid intake to manage abdominal fullness

D) Advise the patient to engage in moderate exercise to improve cardiovascular health

Breast cancer - Nursing Case Study

Pathophysiology

• Primary mechanism: Genetic Mutations - Breast cancer often arises from genetic mutations in key genes such as BRCA1 and BRCA2, leading to dysfunctional DNA repair processes. This results in accumulation of further mutations, promoting uncontrolled cellular proliferation.

• Secondary mechanism: Hormonal Influence - Estrogen and progesterone can promote the growth of hormone receptor-positive breast cancer cells. Overexpression of estrogen receptors (ER) can enhance cell division and survival, contributing to tumor development.

• Key complication: Metastasis - Cancerous cells can invade surrounding tissues and spread via lymphatic and blood vessels to distant organs, complicating treatment and significantly impacting prognosis.

Patient Profile

Demographics:

54-year-old female, school teacher

History:

• Key past medical history: Hypertension, type 2 diabetes

• Current medications: Metformin, Lisinopril, Anastrozole

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent breast lump with recent changes

• Key symptoms: Breast pain, skin dimpling, fatigue, mild shortness of breath

• Vital signs: Blood pressure 145/90 mmHg, heart rate 98 bpm, respiratory rate 20 breaths per minute, temperature 37.8°C, oxygen saturation 94% on room air

Section 1

As the case progresses, new diagnostic results reveal significant findings. The patient underwent a mammogram and breast ultrasound, which indicated a suspicious mass with irregular borders in the left breast. A biopsy confirmed the presence of invasive ductal carcinoma, estrogen receptor-positive (ER+), progesterone receptor-positive (PR+), and human epidermal growth factor receptor 2 negative (HER2-). Additionally, a PET scan was conducted to assess for metastasis, revealing hypermetabolic activity in the axillary lymph nodes, suggesting regional lymph node involvement but no distant metastasis at this stage.

The laboratory results further provide insights into the patient's condition. Her complete blood count (CBC) shows a mild anemia with hemoglobin at 10.9 g/dL, potentially contributing to her reported fatigue. Liver function tests are within normal limits, which is critical for assessing potential metastasis and treatment planning. Tumor marker levels, such as CA 15-3, are elevated, consistent with active breast cancer. These results necessitate a tailored treatment approach focusing on hormone therapy, given the ER+ and PR+ status, alongside careful monitoring for any signs of systemic involvement.

These findings guide the clinical team in devising a comprehensive treatment plan. The focus will be on hormone therapy with Anastrozole, and discussions about potential surgical interventions, such as a lumpectomy or mastectomy, followed by radiation therapy will be initiated. Given the lymph node involvement, adjuvant chemotherapy may also be considered. The multidisciplinary team will closely monitor the patient’s response to treatment, with regular follow-ups to assess for any progression or new complications. The patient's hypertension and diabetes will require careful management to optimize overall treatment efficacy and minimize potential side effects.

Section 2

As the treatment plan begins, the patient undergoes her first cycle of hormone therapy with Anastrozole. Initially, she tolerates the medication well, but within a few weeks, she begins to experience joint pain and stiffness, particularly in the mornings. During a follow-up visit, the clinical team conducts a detailed assessment to evaluate her symptoms and overall condition. Her vital signs are stable with a blood pressure of 135/85 mmHg and a heart rate of 78 beats per minute. However, her glucose levels are slightly elevated at 160 mg/dL, necessitating adjustments in her diabetes management plan to prevent further complications.

Despite the side effects, the patient’s cancer markers show a promising decrease, with CA 15-3 levels dropping moderately, indicating a positive initial response to the hormone therapy. However, the fatigue persists, and her hemoglobin remains slightly low at 10.7 g/dL. The clinical team considers these findings, weighing the benefits of continuing Anastrozole against the need to manage the joint discomfort and persistent anemia. They initiate a consultation with a rheumatologist to address the joint symptoms, suspecting an exacerbation of arthralgia commonly associated with aromatase inhibitors.

In light of these developments, the team emphasizes the importance of comprehensive supportive care, including physical therapy to alleviate joint stiffness and nutritional support to address anemia and fatigue. The patient is encouraged to maintain regular physical activity within her limits and adhere to a balanced diet rich in iron. As the team monitors her progress, they remain vigilant for any signs of treatment resistance or disease progression, ready to adjust the treatment strategy should new complications arise. This careful balancing act of managing comorbid conditions while treating the breast cancer sets the stage for ongoing evaluation and potential adjustments in her therapeutic regimen.

Section 3

As the patient continues her treatment journey, a follow-up assessment reveals new developments. The patient reports increased fatigue and intermittent bouts of dizziness, prompting the clinical team to conduct a comprehensive evaluation. Her latest blood work shows a further decline in hemoglobin levels to 9.8 g/dL, indicating worsening anemia. Additionally, her recent glucose reading is 180 mg/dL, suggesting her diabetes control requires further intervention. The patient's liver function tests remain within normal limits, alleviating concerns about potential hepatic side effects from Anastrozole.

Given these findings, the clinical team prioritizes addressing the anemia and glucose management. They initiate a referral to a hematologist to explore underlying causes of the anemia and consider the potential need for iron supplementation or other interventions. Concurrently, the endocrinologist adjusts her diabetes medication regimen, emphasizing the importance of glycemic control in mitigating fatigue and preventing further complications.

In response to the patient's joint pain, physical therapy sessions are intensified, focusing on low-impact exercises to improve mobility without exacerbating her fatigue. The team also reassesses her nutritional plan, incorporating more iron-rich foods and vitamin C to enhance absorption. As the patient adheres to these personalized interventions, the team closely monitors her overall response, ready to modify her treatment strategy based on her evolving needs and ensuring any emerging complications are swiftly addressed. This vigilant approach underscores the complexity of managing comorbid conditions in the context of breast cancer treatment, highlighting the need for ongoing clinical reasoning and patient-centered care.

Section 4

As the clinical team continues to monitor the patient, a follow-up appointment reveals a change in her status that merits further attention. The patient reports experiencing increased shortness of breath, especially during physical activity, and notes that her fatigue has become more pronounced despite adherence to the treatment plan. Vital signs indicate a slight increase in heart rate, now at 102 beats per minute, and her blood pressure is recorded at 128/84 mmHg. These changes prompt the healthcare team to conduct additional diagnostic testing to uncover any underlying issues contributing to her symptoms.

New diagnostic results reveal a further decline in her hemoglobin level, now at 8.9 g/dL, suggesting worsening anemia that may be contributing to her increased fatigue and shortness of breath. A peripheral blood smear is performed, showing microcytic and hypochromic red blood cells, pointing towards iron deficiency anemia. Additionally, her ferritin level is found to be low at 12 ng/mL, confirming the need for targeted iron supplementation. The team collaborates with the hematologist to initiate intravenous iron therapy to address the anemia more aggressively.

In light of these findings, the clinical team revises the patient's care plan to include more frequent monitoring of her hemoglobin levels and symptoms. They also adjust her physical therapy regimen to accommodate her current energy levels, ensuring that exercise remains beneficial without exacerbating her fatigue. The patient's nutritional plan is further refined to include high-iron foods and vitamin C-rich options, supporting the effectiveness of the iron therapy. The team remains vigilant, ready to reassess and adapt her treatment strategy as needed, demonstrating the importance of ongoing clinical reasoning in managing complex cases with multiple comorbid conditions.

Section 5

As the healthcare team continues to monitor the patient following the initiation of intravenous iron therapy, her condition is closely assessed during subsequent visits. Approximately two weeks into the revised treatment plan, the patient reports a slight improvement in her energy levels and a modest reduction in her shortness of breath. Her compliance with the nutritional plan appears to be beneficial, as indicated by her improved dietary log, which reflects increased intake of iron-rich foods and vitamin C. Despite these positive signs, she mentions experiencing occasional palpitations and a feeling of fullness in her abdomen, prompting further investigation.

During this assessment, her vital signs reveal a heart rate that has increased slightly to 108 beats per minute, while her blood pressure remains stable at 130/82 mmHg. Given these findings, the team decides to conduct an abdominal ultrasound to explore the cause of her abdominal discomfort. The ultrasound reveals mild splenomegaly, suggesting an underlying hematologic issue that may be contributing to her symptoms. Additionally, her most recent lab results show a slight improvement in hemoglobin levels, now at 9.5 g/dL, indicating a positive response to the iron therapy, yet her platelet count is noted to be on the lower end of normal at 140,000/µL.

These findings prompt the clinical team to engage in further clinical reasoning. The presence of splenomegaly and the borderline platelet count raise concerns about potential underlying conditions such as hypersplenism or an emerging hematologic disorder. The team collaborates with a hematologist to determine the next steps, which may include additional testing to assess bone marrow function or to explore other possible causes of her symptoms. This careful consideration and integration of new data into her care plan demonstrate the dynamic nature of managing complex cases, emphasizing the need for continual reassessment and adaptation of treatment strategies.