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Running head: CASE ANALYSIS 1

Case Study 2

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CASE ANALYSIS 2

Critical analysis

Breast cancer can be described in simple terms as cancer involving breast cells. It is

common among women but can also occur in men. The survival rates have improved especially

with an early diagnosis but missed diagnosis can increase mortalities especially due to metastasis

(Grayson, 2012). The following case analysis involves Mrs. Harriet Weng who has a history of

breast cancer that has metastasized to the bones. She is 56 years old and has undergone mastectomy

of her left breast. She is a married woman to Patrick and together they are blessed with 3 children

Sarah (13), Peter (15), and Susan (17). The diagnosis was made 6 years ago but following poor

prognosis, she opted to undergo mastectomy but unfortunately, cancer had already metastasized.

Her current concerns include pain which keeps on recurring, fevers which can be related to the

infection and inability to take care of herself. Her pulse is reflective of the pain that she is

experiencing as well as the raised systolic blood pressure of 185 but her diastolic blood pressure

remains normal which means she does not require any drug to lower her blood pressure. Her SpO2

is relatively low and may require some intervention to improve her saturation levels though it

might not require oxygen administration. Evaluation of the case using DRABC reveals the

following;

D- danger- This involves the assessment of the caregiver’s safety along with that of the patient. In

attending to the patient, there should be no casualty on either side. One should only proceed to

attend to the patient after safety is assured (Flinders University, 2009). According to this case, the

patient safety is guaranteed as she is lying on her bed and the environment of the ward is safe for

the caregiver to proceed to attend to her.

R- response- This involves checking whether the patient is conscious or unconscious. In this case,

the patient is conscious and thus the caregiver will only respond to address the immediate concern.

CASE ANALYSIS 3

A-airway- this involves ensuring that the airway is clear and patent to facilitate air entry into the

respiratory tract. In this case, a SpO2 of 93 indicates that the patient is not well saturated and may

require something to be done. Elevating the head of being could help ease breathing and improve

saturation. In addition, head-tilt chin-lift maneuver could help ease the entry of air into the lungs.

In our case, Harriet will need to be elevated to improve her circulation owing to the lung secretions

secondary to the infection.

B-breathing- It is aimed at ensuring that signs of breathing are noted and felt. For instance, the

caregiver looks at the chest for chest rising and falling to establish that there are signs of breathing.

He/she also listens for the sounds elicited in breathing (Flinders University, 2009). In this case,

Harriet seems to have no problems when it comes to breathing as chest rise and fall are visible.

C-circulation- This aims at ensuring that there is circulation by checking for pulse especially the

carotid one. Harriet has a pulse of 130 beats/minute which means it is high and will require an

intervention of the aggravating factors. In this case, addressing the pain and probably the anxiety

will help her to stabilize.

Nursing priorities

Nursing priorities are structure based on their urgency or importance. They determine

which activity requires first intervention followed by others in order of their priority (Mariano,

2013). Nursing priorities and goals for Harriet revolves around addressing the immediate concerns

confronting her. The first priority would be focused on relieving her chronic pain. The second

would focus on the gap created by self-care deficit to try and restore some functioning or assist her

in performing the activities of daily living. The third primarily focuses on the disturbed body image

to try and help her cope with the illness. Nursing diagnosis according to priority would be;

CASE ANALYSIS 4

1. Chronic pain related to the inflammatory process of the disease as evidenced by patient

verbalizing pain of scale 9/10.

2. Self-care deficit related to pain and discomfort as evidenced by the inability to perform

activities of daily living.

3. Disturbed body image related to mastectomy as evidenced removed left breast following

surgery.

Nursing interventions

Nursing interventions would be geared towards relieving the concerns raised above. Pain

relief would be the first major nursing goal for Harriet. Nursing interventions will include assessing

patient’s level of pain using the pain scale as well as assessing the expectations of the patient

regarding the desired outcomes of pain management (Hökkä, Kaakinen, & Pölkki, 2014). Based

on the level of pain (9/10), it would be essential to evaluate a pain reliever that would also bring

about the relaxation of the patient. According to pain relief standards, pain management will

require that the caregiver administers strong analgesic such as morphine sulfate or

pethidine(Ripamonti, Bandieri, & Roila, 2011). In this case, pethidine would be appropriate as it

does not cause respiratory depression as is the case with morphine. Harriet has a SpO2 of 93%b

and therefore administration of morphine would further compromise the situation. Harriet also

needs to be taught on non-pharmacologic pain relief interventions such as deep breathing exercises

which are known to reduce pain (Apóstolo et al., 2013). It also includes positioning and she reports

that the pain is relieved upon lying on her back. Evaluation criteria would be based on the patient

verbalizing pain relief and pain scale revealing the absence of pain.

Addressing the issue of self-care deficit requires that the family cooperate with the

caregiver on the issue to help the patient regain some level of functionality. The goal should be to

CASE ANALYSIS 5

help the patient regain some level of functionality (Berbiglia, 2011). Harriet should be assisted by

the family and the nurse in doing the simple tasks that she can manage. The relatives in this case,

such as the husband should be allowed to offer the support and encourage her to do so. It helps in

giving the patient moral support needed to carry on simple tasks with ease. Evaluation criteria

would be based on the level of functionality gained following the interventions and the ability to

perform activities of daily living.

Disturbed body image is common especially with the loss of a body part or deformity. It is

a representation of how one feels about themselves (Paterson, Lengacher, Donovan, Kip, &

Tofthagen, 2015). In this case, primary nursing intervention for this nursing diagnosis will be

geared towards restoring a positive body image. It is important to accept and acknowledge the

feelings of dependency, frustration, grief, anger, and hostility that may be elicited by the patient.

The loss will make one go through the normal stages of grief. As a caregiver allow the patient to

verbalize both positive and negative thoughts and feelings. The expression is deemed to enhance

the coping strategies of the patient. Counseling is also effective in bringing about the acceptance.

Evaluation criteria will be based on patient verbalizing acceptance of the loss and the situation and

changes in self-concept from negativity to positivity (Atkinson, 2015). In addition, Harriet should

be in a position to discuss the changes with her family.

CASE ANALYSIS 6

References

Apóstolo, J., Mendes, A., Bath-Hextall, F., Rodrigues, R., Santos, J., & Cardoso, D. (2013). The

use of non-pharmacological nursing interventions on the comfort of cancer patients: A

comprehensive systematic review protocol. The JBI Database of Systematic Reviews and

Implementation Reports, 11(2), 372–388. Retrieved from

http://www.joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/804/1182

Atkinson, M. (2015). Mindfulness interventions for improving body image: A worthwhile

pursuit? Journal of Aesthetic Nursing, 4(10), 498–500.

https://doi.org/10.12968/joan.2015.4.10.498

Berbiglia, V. A. (2011). The self-care deficit nursing theory as a curriculum conceptual

framework in baccalaureate education. Nursing Science Quarterly, 24(2), 137–145.

https://doi.org/10.1177/0894318411399452

Flinders University. (2009). Primary survey data. Clinical Skill Information Sheet.

Grayson, M. (2012). Breast cancer. Nature, 485(7400), S49. https://doi.org/10.1038/485S49a

Hökkä, M., Kaakinen, P., & Pölkki, T. (2014). A systematic review: Non-pharmacological

interventions in treating pain in patients with advanced cancer. Journal of Advanced

Nursing. https://doi.org/10.1111/jan.12424

Mariano, C. (2013). Holistic Nursing : Scope and Standards of Practice. Holistic Nursing: A

Handbook for Practice, 59–84.

Paterson, C. L., Lengacher, C. A., Donovan, K. A., Kip, K. E., & Tofthagen, C. S. (2015). Body

Image in Younger Breast Cancer Survivors: A Systematic Review. Cancer Nursing, 39(1),

CASE ANALYSIS 7

39–58. https://doi.org/10.1097/NCC.0000000000000251

Ripamonti, C. I., Bandieri, E., & Roila, F. (2011). Management of cancer pain: ESMO clinical

practice guidelines. Annals of Oncology, 22(SUPPL. 6).

https://doi.org/10.1093/annonc/mdr390

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