Unfolding Clinical Reasoning Case Study Breast Cancer

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Unfolding Clinical Reasoning Case Study Breast Cancer I. Data Collection History of Present Problem Jan Stam is a 50-year-old Caucasian woman who has been healthy with no previous medical history

History of Present Problem:

Jan Leisner is a 50-year-old Caucasian woman who has been healthy with no previous medical history. One year ago, she

noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy, she assumed it

was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her mammogram

confirmed a 5 cm mass. An ultrasound biopsy confirmed the presence of cancer cells in the tumor as well as in three of her

lymph nodes most proximal to the tumor. An MRI scan that followed revealed a 1 cm tumor on her lumbar spine. She is

not a surgical candidate at this time, so an implanted venous access device (VAD) will be placed later this afternoon so

that chemotherapy can be started as soon as possible. You are the nurse responsible for her care on the oncology unit of a

community hospital.

Personal/Social History:

Jan has four children under the age of 17. She has no personal or family history of breast cancer. She has never smoked

and lives with her husband in a suburban community. She works part-time as a substitute teacher. Jan is a devout Christian

who has a strong faith and trust in God. She also believes in the power of prayer and believes that God can heal her. She

chose to have a mammogram just before her husband’s insurance plan expired because he just lost his job.

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