[Solved]: M.R. is a 57-year-old woman whose routine mammogram sho

M.R. is a 57-year-old woman whose routine mammogram showed a 2.3- times 4.5-cm lobulated mass at the 3 o’clock position in her left breast. M.R. underwent a stereotactic needle biopsy and was diagnosed with invasive ductal carcinoma, estrogen and progesterone receptor positive, HER-2 negative. The staging workup was negative for distant metastasis. Her final staging was stage IIB. She had a modified radical mastectomy with axillary lymph node dissection 8 week ago. The sentinel lymph node and 4 of 16 lymph nodes were positive for tumor cells. An implanted port was placed during surgery. 1. What are the common risk factors for breast cancer? 2. Discuss the implications of a positive sentinel node. 3. What factors affect prognosis and treatment for breast cancer? 4. Surgical intervention is the primary treatment for breast cancer. Describe the surgical procedure that M.R. had. 5. Choose the most likely option for the information missing from statement below by selecting from the lists of options provided. M.R.’s tumor is estrogen and progesterone receptor positive, meaning the tumor ____1_____ in the presence of these hormones. Therefore, M.R. ____1_____ a candidate for hormone therapy. Options for 1 Options for 2 dies is grows is not shrinks is possibly 6. Why is M.R. at risk for lymphedema? 7. What actions will be part of M.R.’s care to reduce her risk for developing lymphedema? 8. How would you help M.R. cope with any feelings of distress she may be experiencing? 9. What are some community resources from which she may benefit? CASE STUDY PROGRESS M.R. is beginning a prescribed chemotherapy regimen of 6 cycles of CAF (cyclophosphamide, doxorubicin, fluorouracil). 10. M.R. asks you why she has to have chemotherapy with so many drugs if the surgeon removed all the cancer. How would you respond? 11. Name the common side effects M.R. may experience while receiving CAF. 12. What information would you want to review with M.R. about the signs and symptoms of infection and when to seek treatment? 13. M.D. is ordered doxorubicin at 75 mg/m2. Her height is 5 feet, 7 inches (170 cm), and her weight is 155 pounds. Calculate the dose she will receive. 14. What ongoing assessment will you need to perform since M.R. is receiving doxorubicin? 15. M.R. is prescribed filgrastim (Neupogen) as part of her treatment regimen. You teach her filgrastim is used is to: a. Improve the number and function of neutrophils b. Help CAF be more effective in treating her cancer c. Replace abnormal cells in the bone marrow with normal cells d. Decrease the level of fatigue she will experience during treatment 16. You have finished teaching M.R. about the effects of CAF. You know that she understands instructions about cyclophosphamide when she says: (Select all that apply) a. “This medication should be taken with food.” b. “I will drink 2000 to 3000 mL of fluids each day.” c. “Taking this drug at nighttime will reduce nausea.” d. “I will increase my intake of foods with potassium.” e. “Urinating often will help decrease the risk for cystitis.” 17. However, after reviewing with her how to manage alopecia, you determine further teaching is needed after she says: a. “I should go buy a wig now, before I start losing my hair.” b. “Wearing a scarf or hat when outside will help to protect me.” c. “My hair will begin to return 2 months or so after treatment ends.” d. “I can prevent hair loss if I wash every other day with a gentle shampoo.” CASE STUDY PROGRESS M.R. has now completed 4 cycles of CAF, with her last treatment 8 days ago. She comes to the emergency department with a 1-day history of fever, chills, and shortness of breath. On arrival, she is slightly confused and agitated. Vital signs are 100/60, 119, 26, 103.6deg F (39.8deg C), Spo2 86% on room air. The chest x-ray examination shows diffuse infiltrates in the left lower lung consistent with pneumonia. Her basic metabolic panel is within normal limits, except the blood urea nitrogen (BUN) 28 mg/dL (10.0 mmol/L) and creatinine 1.6 mg/dL (141 mcmol/L). 18. Underline the findings that require your follow up. Chart View Complete Blood Count White blood cells (WBCs) 1200/mm3 (1.2 x 109/L) Neutrophils 34% Segmented (“polys”) 30% Bands 4% Lymphocytes 60% Monocytes 3% Eosinophils and basophils 2% Hematocrit (Hct) 24.9% Hemoglobin (Hgb) 8.7 g/dL (87 g/L) Platelets 85,000/mm3 (85 x 109/L) 19. Interpret M.R.’s CBC results. 20. Calculate M.R.’s absolute neutrophil count (ANC) and describe its significance. 21. Choose the most likely option for the information missing from statement below by selecting from the lists of opti