Case study no 1.

42 years old government employee The name of this disease is dread some and more fearsome than somebody actually getting the disease. The name itself scares you; it causes you more of a mental shock as compared to getting the disease itself. I had never dreamt I could get the disease I felt a very small lump of the size of a gram (1cm) when I pressed it there was no pain. May be 8, 10, 11 months or may be for a year it was there but I had never paid attention that I had a small lump. Although I had heard it should be reported to a doctor in this busy life, one has to go to work and work at home. I still did not pay attention. Then I noticed that the lump had increased to in size and the area around it had become hard then I thought it was serious now and had to talk to someone. Until now, I had not spoken to anyone about it. My mother was already bedridden, she would have got scared then I remembered a friend of mine who had breast cancer but I was not in regular contact with her. She told me that she would take appointment with the same doctor who had treated her but there was no harm in taking another opinion. I thought that was right I should consult 3-4 doctors, as I cannot have this disease. I did not even know which doctor to go whether a gynecologist or some other lady doctor as I could not have gone to just any doctor with this disease....but I never thought I could have breast cancer. My friend convinced me to go with her to her doctor there the doctor examined me and asked for how long it had been there. On hearing my answer he scolded me and told me I had not behaved like an educated family. He wrote CA breast on my slip. I thought CA breast could be breast cancer, then I thought it must be some other medical terminology as breast cancer cannot affect me. But I could not understand that it meant breast cancer. Wherever he sent me everybody helped me on priority basis without asking any questions. I could not understand the reason for this extra helpful behavior and they did not ask for appointment. They said come tomorrow and we will operate very lightly..Doc said arrange for 50,000 pesos for the surgery. The doctor then confides that he thought of breast cancer but FNAB would confirm. Everything changed thereafter. Now I had to tell my family members about it. I think I was the strongest. All others started to cry. The lump was restricted to one breast only and no lymph nodes were involved. The size increased from 1cm to 3 cm and at the time of diagnosis, the lump was 4 by 3 cm. In one year, that I had neglected the lump it increased to be diagnosed in stage II. It was stage IIa. Stage II is also good and bad my doctor told me it was stage II good. The period which

followed was stressful. The doctor told me that this disease was as common as common cold and a person can be treated if detected in time. The doctors sounded me by telling me that they were thinking of breast cancer but FNAC would confirm the diagnosis. Surgery was eventless. Soon I started recovering from the surgery and thought nothing major or serious had happened., then started the painful chemotherapy, it led to a lot of nausea and vomiting and I suffered a lot. Every time I somebody cooked in the kitchen I would vomit because of the smell. Now I thought I would leave the treatment and die, as chemotherapy was too bad to be tolerated by me. My friends had warned me about the side effects of chemotherapy and the doctor had counseled me about them, which helped. Here the counseling really helped me. My biggest problem was I did not know who and where to go. One should talk to ones family and friends. Although I did know that, the breast self-examination had to be performed but I never had enough information. No one should hide, any type of disease be it physical or mental. No one should keep such a problem to herself, which is the mistake I committed. One should talk about it and not hide just because it involves the breast. 1. 2. 3. 4. 5. 6. 7. What are the nursing diagnoses for this case? What can be the crucial health teaching for the client in this case? What is the importance of early detection in this case? Post surgery what can be the possible nursing consideration What should be consider if the client is undergoing chemotherapy? What is the role of the family in the treatment of CA? Make a nursing care plan for this client after the Mastectomy.