Breast Cancer Concept Map

Concept maps
1. Many types, variations, layouts
2. Primary diagnosis
  1. Typically in center of maps
  2. Connects to
    1. Contributing factors
    2. Medications
    3. Labwork
    4. Patient education
    5. Nursing diagnoses
      1. Interventions
      2. Evaluations

Nursing Points

General

Nursing diagnosis
1. Anticipatory grieving
  1. Assess patient for current emotional status
    1. Patient’s emotional state is determined
  2. Provide open, non-judgmental environment
    1. Patient speaks openly about feelings
  3. Encourage patient to express feelings
    1. Patient feels supported in expressing feelings
2. Altered nutrition; less than body requirements
  1. Monitor daily food intake
    1. Patient maintains normal weight
  2. Assess skin, mucous membranes
    1. Appropriate skin turgor
    2. Proper healing of wounds
  3. Create pleasant dining experience
    1. Patient increases calories consumed
3. Risk for impaired skin integrity
  1. Assess skin frequently
    1. Skin issues identified quickly
  2. Encourage patient to do not rub/scratch
    1. Decreased skin trauma in patient
  3. Teach patient-bathe with lukewarm water/mild soap
    1. Decreased skin irritation in patient

Assessment

Contributing factors
1. Female
2. Over 55
3. Family/personal history of breast cancer
4. Overweight
5. Smoking
6. Alcohol consumption
7. Lacking exercise
8. Dense breasts
9. Race
  1. Caucasian

Therapeutic Management

Labwork
1. Blood tests
  1. Hormone receptor test
  2. HER2/neu test
2. Other diagnostic testing
  1. Mammogram
  2. Ultrasound
  3. MRI
  4. Biopsy
Medications
1. Estrogen modulator
  1. Tamoxifen (20-40 mg oral)
2. Antineoplastic (chemotherapy) agent
  1. Pertuzumab (loading dose 840 mg IV, 420 mg IV)
3. Hormone-based (chemotherapy) drug
  1. Letrozole (2.5 mg oral)

Nursing Concepts

Clinical judgment
Coping
Grief
Tissue/skin integrity

Patient Education

Patient education
1. Inform patient of all options available
  1. Surgery
    1. Reconstruction
    2. Prosthesis
  2. Chemotherapy/radiation
    1. Side effects
    2. Frequency/duration
2. Treatment goals

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Transcript

Hey guys! Today we’re going to take a look at the concept map for breast cancer!

So in this lesson we will take a look at the components of a concept map including contributing factors, medications, lab work and the significance, patient education, and associated nursing diagnoses with interventions and evaluations!

Ok so here is a basic example of a concept map, guys there are many different variations and this is just one example. First, we start with the primary diagnosis typically in the center of the concept map which leads to nursing diagnoses and interventions and also contributing factors, medications, labwork, and patient education which are associated with the primary diagnosis. Lets jump in! Lets start with contributing factors in the upper corner. Being female is the biggest risk factor, also being over 55, having a family or personal history of breast cancer, being overweight, smoking, lacking exercise, having dense breasts, drinking alcohol and race as caucasian women are more likely than african american women to be diagnosed are all contributing factors to breast cancer.

In this next circle we may see medications that would be associated with a breast cancer diagnosis. Tamoxifen (20-40 mg oral), an estrogen modulator or in other words it acts as an inhibiting agent in the mammary tissue, can treat breast cancer but also prevent it in women who are at high risk. Your patient will most likely receive chemotherapy treatment which might include a drug called Pertuzumab (loading dose 840 mg IV then 420 mg IV after) which is an antineoplastic agent and a humanized monoclonal antibody that binds to the extracellular domain II of HER2. Finally, you may see your patient is on a hormone-based chemotherapy drug like Letrozole (2.5 mg oral) which is used to treat breast cancer in post-menopausal women as a non-steroidal, anti-estrogen medication.

Ok additional information included in a concept map is commonly patient education and significant labwork. So in this circle here lets add important patient education information which should include teaching the patient all of their options with their new diagnosis. The patient should be educated on the location and extent of their tumor, the surgical process if the patient decides to have a surgical intervention. If the patient decides to have a mastectomy, teach them their options regarding reconstruction or the use of a prosthesis after surgery. Finally, help the patient to understand the extent of treatment, be it chemotherapy and/or radiation, the possible side effects, possible reactions after treatment, the frequency and duration of treatment, and finally the treatment goals. A breast cancer diagnosis is typically made with many tests including a mammogram, ultrasound, MRI, and biopsy while labwork including the hormone receptor test and HER2/neu test are commonly completed to determine which type of treatment may be most effective.

Finally, in the three circles that are left we will add nursing diagnoses with interventions and evaluations for breast cancer. One nursing diagnosis that could be utilized is anticipatory grieving due to the anticipated loss of physical well-being or even death by the patient. What interventions can we apply here? We of course would want to assess the patient to determine their current emotional status, provide an open and non-judgemental environment, and encourage the patient to express their feelings of grief and sadness. We will evaluate these interventions by the patient being able to identify and express their feelings appropriately.

Another nursing diagnosis for breast cancer could be altered nutrition; less than body requirements related to hypermetabolic state associated with cancer or due to chemotherapy, radiation, or surgery. Interventions that we can apply here are monitoring daily food intake or asking the patient to keep a food diary. This intervention is evaluated by the patient being able to identify the number of calories being consumed and maintain normal weight. An additional nursing intervention is assessing the patient’s skin and mucous membranes for pallor and delayed wound healing which will be evaluated by appropriate skin turgor and proper healing of mastectomy. Also, you can encourage the patient and their support system to create a pleasant dining experience to make meals times more enjoyable which can increase intake of food which is evaluated by the patient consuming more calories.

There are quite a few nursing diagnoses for breast cancer but lets add one more. Risk for impaired skin integrity related to the affects of chemotherapy or radiation is definitely an appropriate nursing diagnosis. Interventions appropriate include assessing the skin frequently for side effects related to cancer therapy paying attention to skin breakdown or delayed wound healing which is evaluated by quickly identifying skin issues in the patient. Encourage the patient to not scratch or rub the skin which is evaluated by the patient’s skin being free from trauma. Finally, encourage the patient to bathe with lukewarm water and a mild soap to prevent skin irritation but still clean the skin which is evaluated by the patient being free from skin irritation.

Breast Cancer Concept Map

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Outline

Overview

Nursing Points

General

Assessment

Therapeutic Management

Nursing Concepts

Patient Education

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