Answer:
1. Risk factors that could have predisposed the given client for the development of cancer are:
<u> Life style risk factors-</u>
Smoking: Smoking plays a vital role in the pathogenesis of cancer as the mutagens in the smoke are potentially carcinogenic with 2 to 4 % of increased relative risk in individuals with smoking when compared to non smoking individuals.
Family history: Family history of br_east cancer (first degree relative (mother) as well as grandmother) is also a greatest risk factor in this client as the relative risk of cancer in individuals with positive family history is 4 to 6 % more when compared to individuals with negative cancer history. The proto-oncogenes such as BRCA1, BRCA2 exhibit inheritable pattern and lead to development of cancer
<u>Underlying conditions</u>-
Diabetes and obesity: Underlying co-morbidities such as Diabetes, obesity such as aggravate the carcinogenesis and increase the risk of cancer. The relative risk of breast cancer in individuals with Diabetes and obesity is 1 to 2%
<u>Social risk factors</u>-
Stress: The statements such as "the client being busy with her children" and "haven't had time" and delay in receiving the medical attention despite of the abnormal self examination, no previous mammogram are indicators of stress which is another potential risk factor in the development of cancer
Non compliance to diet and medications: Poor control of diet, diabetes, non compliance to medications can result in micro and macrovascular changes which can further increase the risk of metastasis and cancer development. No previous mammogram even though the risk of individual is high also could have led to delayed identification in the given case
2. Signs and symptoms in the given client which indicate cancer are:
Nipple pain: Pain could be due to obstruction to the areola by the tumor
Lump in the right br_east upon palpation: Development of tumor mass could have led to the presence of lump
Tenderness: Inflammation due to tumor can result in tenderness, warmth in the given individual
Unusual tiredness (fatigue): Increased oxygen demand due to tumor, or metastasis to the lung which can impair gas exchange can result in fatigue as seen in this client
3. Three care strategies to provide quality care and their rationales:
As the client is still in the diagnostic phase of Br_east cancer, following care strategies are indicated to provide quality care:
i. Minimizing uncertainity about the condition by providing correct information, and discussing about the diagnostic procedures and treatment options
Rationale: As the client is already in stress and had a history of non compliance with medications, treatment, providing correct information and minimizing uncertainity helps in promoting patient compliance and reduces uncertainity
ii. Promoting physical and psychological well-being of the individual by instituting care measures that prevent further progression of disease,
Rationale: Promoting physical and psychological well being helps in preparing the individual for the expected outcomes, reduces anxiety, alters perception about the general condition and promotes active participation of the client in the treatment
iii. Facilitating social support and instituting collaborative care
Rationale: Increased burden on the client in the care of her three children can take an additional toll on the treatment modalities of the individual. Thus, facilitating social support and exploring community resources for all round care could help in patient directed care
