Student Nurses’ Community NURSING CARE PLAN- Breast Cancer ASSESSMENT SUBJECTIVE: “May nakakapa akong bukol sa dibdib ko, anong dapat kong gawin?” (I have a lump in my breast what should I do?)
as verbalized by the patient OBJECTIVE: • •
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Verbalization of the problem Statement of misconceptio n
DIAGNOSIS
INFERENCE
PLANNING
INTERVENTION
Deficient knowledge regarding illness, prognosis, treatment, self-care, and discharge needs.
Breast Cancer Is the leading type of cancer in women. Most breast cancer begins in the lining of the milk ducts, sometimes the lobule. The cancer grows through the wall of the duct and into the fatty tissue. Breast cancer metastasizes most commonly to auxiliary nodes, lung, bone, liver, and the brain.
After 8 hours of nursing intervention the patient will verbalize accurate information about diagnosis, prognosis, and potential complications at own level of readiness.
INDEPENDENT • Review with patient understanding of specific diagnosis, treatment alternatives, and future expectations.
RATIONALE •
Validates current level of understanding, identifies learning needs, and provides knowledge base from which patient can make informed decisions.
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Provide clear, accurate information in a factual but sensitive manner. Answer specifically, but do not provide unessential details.
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Helps with adjustment to the diagnosis of cancer by providing needed information along with time to absorb it.
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Provide anticipatory guidance with patient regarding treatment protocol, length of therapy, expected results, possible side effects. Be honest with the patient.
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Patient has the right to know (be informed) and participate in decision making. Accurate and concise information helps dispel fears and anxiety, helps clarify expected routine, and enables patient to maintain some degree of control.
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Review with patient the importance of
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Promotes well being, facilitates
V/S taken as follows T: 37.1 ˚C P: 92 R: 19 BP: 120/ 80
EVALUATION After 8 hours of nursing intervention the patient was able to verbalize accurate information about diagnosis, prognosis, and potential complications at own level of readiness.
Student Nurses’ Community maintaining optimal nutritional status.
recovery, and it’s critical in enabling patient to tolerate treatments.
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Encourage diet variations and experimentation in meal planning and food preparation.
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Creativity may enhance flavor and intake, especially when protein foods taste bitter.
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Recommend increased fluid intake and fiber in diet, as well as routine exercise.
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Improves consistency of stool and stimulates peristalsis.
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Instruct patient to assess oral mucous membranes routinely, noting erythema, ulceration.
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Early recognition of problems early intervention, minimizing complications that may impair oral intake and provide routine avenue for systemic infection.