Rebekah Shim Azusa Pacific University UNRS 367 Pathophysiology Professor Joy David November 30, 2016 Breast Cancer with Metastasis to the Brain and Lungs
Presented by Rebekah Shim
PATIENTS MEDICAL/SURGICAL HISTORY: Caesarean Section 2008 Tubal Ligation 2008 Breast Cancer with Modified Radical Mastectomy of Left Breast 2011 Name: G. T. Multiple Brain Metastases 2014 Age: 40 Gender: Female Whole Brain Radiotherapy 2014 Ethnicity: Hispanic Metastasis to Brain and Bilateral Reason For Seeking Lungs 2016 Care: Confusion, Weakness Diagnoses: Urinary Tract Infection, Altered Mental Status, Metastatic Breast Cancer PATHOPHYSIOLOGY Pathophysiology: Breast cancer occurs when tumor cells invade local tissue and grow and mutate at rapid rates. Cancer cells can migrate and colonize in distant sites Metastasis Metastasis occurs when tumor cells escape basement membrane of tissue, move across extracellular space, enter into the blood or lymphatic circulation, and then gain access to other organs (Copstead & Banasik, 2013). According to a study, the brain is usually the first site of metastasis in patients with breast cancer (Rostami, Mittal, Rostami, Tavassoli, & Jabbari, 2016). Signs and Symptoms: Headache, behavioral changes, fatigue, altered mental status. Significant Labs: Elevated glucose levels due to use of corticosteroids. Decreased Hemoglobin, Hematocrit, RBC, and Platelets due to bone marrow suppression from chemotherapy. Elevated WBC due to UTI.
Significant Diagnostic Tests:
MRI of brain Metastasis to brain and cerebral edema. CT of brain Bilateral metastases and vasogenic edema. Chest X-Ray Vague pulmonary nodules bilaterally with metastasis in both lobes of the lung. TREATMENT AND DISCHARGE INSTRUCTIONS Care Provided for the Patient: Encouraged adequate hydration due to UTI Administered antibiotics as ordered Kept patients head elevated and in midline to prevent increase in ICP Provided wound care using sterile technique Monitored neurological status frequently Provided patient with spiritual resources (Chaplain)
Patient Education & Discharge Instructions:
Teach patient about possible side effects of corticosteroid use such as weight gain, anxiety, and peptic ulcers. Provide patient with information regarding hospice and palliative care. Refer patient to a social worker that can provide information and support for her children. Teach patient to monitor possible symptoms of brain and lung metastasis such as shortness of breath, wheezing, confusion, visual changes, and seizures. EVIDENCE BASED RESEARCH TOPICS Article 1: Sense of Coherence (SOC) and how it relates to a breast cancer patients quality of life Sense of Coherence 3 Main Categories Comprehensibility is the belief that things happening in life are understandable. Manageability is the belief that people have the ability to take care of things. Meaningfulness is the belief that what happens in life is worthwhile. A questionnaire of 13 items is used and patients indicate whether they agree or disagree. Evidence shows that a higher SOC serves as a protective factor for patients who are diagnosed with breast cancer How can this evidence help patients? Help the patient discuss the things in life that are important and meaningful Physicians and nurses can use the SOC questionnaire to determine the patients level of SOC and use that to determine how patients are coping, and what specific needs they may have. Health care workers can help reduce patients stress and focus on interventions to strengthen the patients degree of SOC.
(Rohani, Abedi, Sundberg, & Langius-Eklof, 2015).
EVIDENCE BASED RESEARCH TOPICS Article 2: Retrospective Evaluation of Palliative Care and Hospice Utilization in Hospitalized Patients with Metastatic Breast Cancer Only a minority of patients with metastatic breast cancer receive outpatient palliative care or are referred to hospice during their last hospitalization prior to death. Clinicians should recognize hospitalization as a trigger to discuss end-of-life care goals and preferences with their patients and a signal to consider whether a patient and family may benefit from a palliative care referral or hospice services. Patients with cancer who die in the hospital experience more physical and emotional distress and lower quality of life at the end of life compared to patients who die at home under hospice. Caregivers experience high rates of PTSD and prolonged grief disorder when their loved ones die in the hospital. Why arent more patients with metastatic breast cancer referred to hospice? Most patients who are hospitalized are seen by physicians they have never met who are unfamiliar with their personal values and wishes. This evidence can encourage clinicians to bring up conversations about EOL preferences before the patient is discharged during any acute hospitalization.
(Shin et. al, 2016)
REFERENCES Copstead, L. C., & Banasik, J. L. (2013). Pathophysiology (5th ed.). St. Louis, MO: Elsevier. Rohani, C., Heidar-Ali, A., Sundberg, K., & Langius-Eklof, A. (2015). Sense of coherence as a mediator of health-related quality of life dimensions in patients with breast cancer: A longitudinal study with prospective design. Health and Quality of Life Outcomes, 1-9. doi: 10.1186/s12955-015-0392-4 Rostami, R., Mittal, S., Rostami, P., Tavassoli, F., & Jabbari, B. (2016). Brain metastasis in breast cancer: A comprehensive literature review. Journal Of Neuro-Oncology, 127(3), 407-414. doi:10.1007/s11060-016-2075-3 Shin, J. A., Parkes, A., El-Jawahri, A., Traeger, L., Knight, H., Gallagher, E. R., & Temel, J. S. (2016). Retrospective evaluation of palliative care and hospice utilization in hospitalized patients with metastatic breast cancer. Palliative Medicine, 30(9), 854-861. doi: 10.1177/0269216316637238 https://youtu.be/q_JDp-VePAs