KASTURBA GANDHI NURSING COLLEGE

MEDICAL SURGICAL NURSING

LESSON PLAN
ON
BREAST CANCER
 LESSON PLAN

NAME OF THE TEACHER : MS. M. MALARMATHI

SUBJECT : MEDICAL SURGICAL NURSING

TOPIC : BREAST CANCER

LEVEL OF THE STUDENTS : B.Sc. NURSING

PLACE : CLASSROOM

NO. OF STUDENTS : 100

DURATION : ONE HOUR

DATE :

METHOD : LECTURE CUM DISCUSSION.

A.V.AIDS : CHARTS, HANDOUTS, OHP, PAMPLETS, PPT.

GENERAL OBJECTIVE:

At the end of the session, the learner will be able to acquire knowledge regarding breast cancer and develop desirable attitudes and skills in caring for
patient with breast cancer at all settings.

SPECIFIC OBJECTIVE:

At the end of the session, the learner will be able to

 describe the anatomy and physiology of breast

 define breast cancer

 list out the etiology of breast cancer

 discuss the pathophysiology of breast cancer

 describe the clinical features of breast cancer

 enumerate the diagnostic evaluation of breast cancer

 explain the collaborate management of breast cancer

 describe the nursing management of patient with breast cancer

S.NO TIM SPECIFIC CONTENT TEACHERS LEARNER A.V AIDS EVALUATION
E OJECTIVES ACTIVITY ACTIVITY USED

1. 5min describe ANATOMY AND PHYSIOLOGY Teaching Students Chart What you know
the anatomy and activity taken actively about the
Parts, Shape & position of the Gland
physiology of class listening anatomy and
breast • It is conical in shape. and clarifies and asking physiology of
the doubts doubts breast
• It lies in superficial fascia of the front of chest.

• It has a base, apex and tail.

• Its base extends from 2nd to 6th ribs.

• It extends from the sternum to the midaxillary

line laterally.

• It has no capsule.

SHAPE AND POSITION OF FEMALE

BREAST

• 2/3 of its base lies on the pectoralis major

muscle, while its inferolateral 1/3 lies on:

• Serratus anterior
• External oblique muscles.

• Its superolateral part sends a process into the

axilla called the axillary tail or axillary process.

Nipple:

• It is a conical eminence that projects forwards

from the anterior surface of the breast.

• The nipple lies opposite 4th intercostal space.

• It carries 15-20 narrow pores of the lactiferous

ducts.

Areola :

• It is a dark pink brownish circular area of skin

that surrounds the nipple.

• The subcutaneous tissues of nipple & areola are

devoid of devoid of fat.

SHAPE AND POSITION OF FEMALE

BREAST

• It is non capsulated gland.

• It consists of lobes and lobules which are

embedded in the subcutaneous fatty tissue of
superficial fascia.

• It has fibrous strands (ligaments of cooper) which

connect the skin with deep fascia of pectoralis
major.

• It is separated from the deep fascia covering the

underlying muscles by a layer of loose areolar
tissue which forms the retromammary space.
STRUCTURE OF MAMMARY GLAND

• It is formed of 15-20 lobes.

• Each lobe is formed of a number of lobules.

• The lobes and lobules are separated by interlobar

and interlobular fibrous & fatty tissue, called
ligaments of Cooper. (Importance)?These
ligaments give the breasts support by connecting
the skin of the breasts to the pectoralis muscles
below them.

• It has from 15-20 lactiferous ducts which open by

the same number of openings on the summit of the
nipple.
 ARTERIAL SUPPLY

• Perforating branches of internal thoracic (internal

mammary) artery.

• Mammary branches of lateral thoracic artery.

• Mammary branches of Intercostal arteries.

VENOUS SUPPLY

• Veins are corresponding to the arteries.

• Circular venous plexus are found at the base of

nipple.

• Finally, veins of this plexus drain into axillary &

internal thoracic veins.

2. 5 Define DEFINITION Teaching Students Roller What do you

min Breast cancer It refers to a group of malignant diseases that activity taken actively board know about
commonly occur in the female breast and class listening breast cancer?
infrequently in the male breast. It originates from and clarifies and asking
breast tissue,most commonly from the inner lining the doubts doubts
of milk ducts or the lobules that supplies the ducts
with milk.
3. 5min List out ETIOLOGY Teaching Students Handouts
What are the
the etiology activity taken actively
 Gender (female) and increasing age. causative
of class listening
factors ?
Breast cancer  Previous breast cancer: The risk of developing and clarifies and asking
cancer in the same or opposite breast is the doubts doubts
significantly increased.

 Family history: Having first-degree relative

with breast cancer (mother, sister, daughter)
increases the risk twofold; having two first-
degree relatives increases the risk fivefold.

 Genetic mutations (BRCA1 or BRCA2)

account for majority of inherited breast
cancers.

 Hormonal factors: early menarche (before 12

years of age), nulliparity, first birth after 30
years of age, late menopause (after 55 years of
age), and hormone therapy (formerly referred
to as hormone replacement therapy).

 Other factors may include exposure to

ionizing radiation during adolescence and
early adulthood obesity, alcohol intake (beer,
 wine, or liquor), high-fat diet (controversial,
more research needed).

5. 10 Discuss PATHOPHYSIOLOGY Teaching Listening OHP

How the body
mins the Due to etiological factors activity taken
gets affected?
pathophysiology class
of and clarifies
PTEN protein turns off the PI3K/AKT
hyperthyroidism the doubts
pathway

Protective pathways like PI3K/AKT,

RAS/MEK/ERK are mutated that turns the
cells permanently on

Loss of apoptosis

Accumulation of unwanted cells in the

breast tissue

Development of breast cancer

6. 10 Describe the CLINICAL FEATURES Teaching Students ppt What are the sign
mins clinical features activity taken actively and symptoms of
 Generally, lesions are non tender, fixed, and
of breast cancer class listening breast
hard with irregular borders; most occur in the cancer and its
and its stages and clarifies and asking
upper outer quadrant. stages?
the doubts doubts
 Some women have no symptoms and no
palpable lump but have an abnormal
mammogram.
 Advanced signs may include skin dimpling,
nipple retraction, or skin
ulceration.

Stage 0: non-invasive carcinoma or carcinoma in

situ
 • Stages I and II: early
• Stage III: advanced; tumor > 2 cm across and
spread to underarm LNs or is extensive in
underarm LNs or spread to LNs near breastbone or
other tissue near breast
• Stage IV: spread beyond breast and underarm
LNs to other body parts

7. 10 Enumerate DIAGNOSTIC EVALUATION Teaching Students Flannel What are the

min the activity taken actively board diagnostic
History collection
diagnostic class listening evaluation
evaluation of Gender (female) and increasing age, Previous and clarifies and asking Of
Breast cancer breast cancer: The risk of developing cancer in the the doubts doubts breast cancer
same or opposite breast is significantly increased,
Family history: Having first-degree relative with
breast cancer (mother, sister, daughter) increases .

the risk twofold; having two first-degree relatives

increases the risk fivefold these history conclude
that breast cancer

Physical examination
skin dimpling, nipple retraction, or skin ulceration.
finding assessed that breast cancer
Breast exam
 BSE is an option for women starting in their
20s.
 Any changes detected should be reported to a
medical expert.
Mammograms
A technologist will position your breast for the
test. The breast is pressed between 2 plates to
flatten and spread the tissue.The pressure lasts only
a few seconds while the picture is taken. The
breast and plates are repositioned and then another
picture is taken. The whole process takes about 20
minutes.
Breast ultrasound
Uses sound waves to outline a part of the body.
The sound wave echoes are picked up by a
computer to create a picture on a computer screen.
Used to investigate areas of concerns found by a
mammogram.
Biopsy
 A biopsy is done when other tests show that
you might have breast cancer.
 It confirms if a mass is cancerous or not. Mass
is removed and studied.
8. 10 Explain the COLLABRATIVE MANAGEMENT Teaching Students Leaflet What are the
min collaborate activity taken actively treatment
Medical management:
management of class listening modalities of

Breast cancer Radiation therapy and clarifies and asking breast cancer

the doubts doubts

It can be administered through an external
beam and via iridium implants. External beam
radiation is administered 5 days a week by a cobalt
machine or linear accelerator with use of
approximately 5000 rad over 5 weeks.

Chemotherapy

 CA(cyclophosphomide+adriamycin)

 CAT(cyclophosphomide+adriamycin+taxane)

Hormonal therapy

Eg: Tab.Tamoxifen(Nolvadex)

SURGICAL MANAGEMENT

 .Breast conservation surgery(Lumpectomy)

Tumor and surronding breast tissue are removed.
Muscles,skin and lymp nodes left intact.
  Simple mastectomy : removing the lobules,
ducts, fatty tissue, nipple, areola, and some
skin.
 Modified radical mastectomy: simple
mastectomy combined with the removal of the
axillary lymph nodes.
 Radical mastectomy: a simple mastectomy
combined with removing the lymph nodes and
muscles of the chest wall.

NURSING MANAGEMENT:-
9.
5min Enlist  Assess the patient previous experiences and Teaching Students ppt What are the
s expectation of nausea and vomiting, including activity taken actively nursing
the
cause and intervension. class listening management of
nursing  Adjust diet before and after drug and clarifies and asking breast cancer
management of administration according to patient preference the doubts doubts
breast cancer and tolerance.
 Prevent unpleast sight,odor and sound in
environment.
 Ensure adequate fluid hydration,before during
and after drug administration ,assess intake
.
and output.
 Provide pain relief measure, if necessary.
 Assess other contribution factor to nausea and
vomiting such as other symptom, radiation
therapy, medication.
 Assess pain and discomfort characteristic use
pain scale.
 Assess other factor contributing to patient
pain : fear,fatigue.anger.. Administer analgesic
to promote optimum pain relief.
 Assess patient behavioral responses to pain
and pain experiences.Teach patient new
strategies to relieve pain and discomfort.
SUMMARY AND CONCLUSION

We had discussed about breast cancer, etiology, risk factors and pathophysiology, clinical manifestation and its collaborative management.
Students can able to assess the patient with hyperthyroidism and able to provide nursing care and can prevent the complications.

BIBLIOGRAPHY

1. Student’s bibliography

1. Lewis(2018) . Textbook of medical surgical nursing, Elsiever publication, Pg.no : 1141 to 1152
2. Brunner & Suddarth’s, (2008). Textbook of medical surgical nursing, 11 th edition, volume II, Lippincott Williams & William publication,
Pg.No:386 to 390
3. Kathryn L. Mc Cance, a guide to physical assessment, 3 rd edition, New Delhi, Elsevier publication 2015, pg.no :82 to 89
4. BT Basvanthappa, medical surgical nursing, 2nd edition, jaypee publication new Delhi, pg.no 436 to 443
5. Long & Phipps -Medical Surgical Nursing, (2017), Elseivier publication, New Delhi. 588-589

2. Teachers bibliography

1. Brunner & Suddarth’s, Textbook of medical surgical nursing, 11 th edition, volume II, Lippincott Williams & William publication 2008,
Pg.No:386 to 390
2. Lewis(2018) . Textbook of medical surgical nursing, Elsiever publication, Pg.no : 1141 to 1152
3. BT Basvanthappa, medical surgical nursing, 2nd edition, jaypee publication new Delhi, pg.no 436 to 443