Present Problem:
Jeanne Mayer is a 62 year old female. Three months ago, following a routine mammogram, she was sent for breast ultrasound followed by a needle biopsy for suspicious legion. Needle biopsy confirmed a diagnosis of breast cancer. Two weeks later Jeanne was sent for a sentinel node biopsy.

Two weeks ago Jeanne had a double mastectomy and did extremely well. Currently has a wound Vac in place and four JP. Drainage is slowing and plastic surgeon anticipates removing JP in 2 days as well as wound vac. Wound vac placed due to her large breast size 44 DD and BMI. Did need to stay an extra night in the hospital due to low O2 sats but, presently doing fine.

PAST MEDICAL HISTORY:
• Asthma, states whenever ‘’ I get sick I have to use nebulizer\, and inhalers” history of pneumonia x two.
• Mild Depression
• C-section x 2
• Hypercholesterolemia
• Surgical repair of fracture wrist several years ago
• A fib
• GERD
• Obstructive sleep apnea
• Osteopenia
• Recent breast cancer
• Vit D deficiency

Personal/Social History:
Jeanne has been in relatively good health. She has been, and currently still is, a special education teacher. This is her 42nd year teaching. Her husband George is retired and is 76 years old with a recent toe amputation, cardioversion for a fib and history of X2 surgery for spinal stenosis. George worked for several years running a food pantry and homeless shelter. He and Jeanne also run a mobile home park in a rural area. Although, George has some serious health issues, he does remarkably well and is very active. Jeanne has been an active, healthy female who enjoys gardening, walking and swimming. Jeanne and George have four children. One daughter lives several states away and works full time and is the mother of two small children. It is difficult for this daughter to get home as often as she would like. Their other daughter lives close by and George and Jeanne recognize that this daughter is very helpful and is a source of support, even though she has three children under the age of four, is working on her PhD, and works full time. Jeanne and George love spending time with the Grandchildren. Their one son has recently bought his first home, works full time and

attends graduate school full time. While he lives close he has a very busy life. Their oldest son who lives with them has some significant health problems. He has diabetes, suffered a back injury, and is blind in one eye due to a hunting accident. Due to his health problems, he often has difficulty keeping a job. Jeanne is a hard working woman who has worked two jobs most of her life and has a strong Christian faith. She recently decided to slow down and gave up her second job as a unit secretary in a busy emergency room. Due to her cancer diagnosis she has decided to stop doing an additional job working with dyslexic students. Jeanne’s father is 87 and she shares in his care with a brother and sister. She denies smoking, alcohol use, and illicit drug use. She has had the covid vaccine, and several covid screenings which have all come back negative.

FAMILY HISTORY:
• Jeanne has a strong family history of breast cancer.
o Her mother died 14 years ago at the age of 72 from breast cancer.
• Father had colon cancer at 52 and is alive with hx of HTN, Myasthenia Gravis, Suprapubic catheter, legally blind, HOH, Dementia.
• Sister had breast cancer triple negative at 36 and had another breast cancer at 49. Developed Sarcoidosis after first cancer. Developed drug dependency after second cancer. Jeanne is very concerned over the possibility of drug dependency.
MEDICATIONS:
• Gabapentin300 mg TID po daily as needed
• Calcium 1000 po mg daily
• D3 100 mcg po daily
• Omeprazole 20 mg cap po daily
• Venlafaxine HCL ER po 75 mg
• Norco Po tab PRN

attends graduate school full time. While he lives close he has a very busy life. Their oldest son who lives with them has some significant health problems. He has diabetes, suffered a back injury, and is blind in one eye due to a hunting accident. Due to his health problems, he often has difficulty keeping a job. Jeanne is a hard working woman who has worked two jobs most of her life and has a strong Christian faith. She recently decided to slow down and gave up her second job as a unit secretary in a busy emergency room. Due to her cancer diagnosis she has decided to stop doing an additional job working with dyslexic students. Jeanne’s father is 87 and she shares in his care with a brother and sister. She denies smoking, alcohol use, and illicit drug use. She has had the covid vaccine, and several covid screenings which have all come back negative.

FAMILY HISTORY:
• Jeanne has a strong family history of breast cancer.
o Her mother died 14 years ago at the age of 72 from breast cancer.
• Father had colon cancer at 52 and is alive with hx of HTN, Myasthenia Gravis, Suprapubic catheter, legally blind, HOH, Dementia.
• Sister had breast cancer triple negative at 36 and had another breast cancer at 49. Developed Sarcoidosis after first cancer. Developed drug dependency after second cancer. Jeanne is very concerned over the possibility of drug dependency.
MEDICATIONS:
• Gabapentin300 mg TID po daily as needed
• Calcium 1000 po mg daily
• D3 100 mcg po daily
• Omeprazole 20 mg cap po daily
• Venlafaxine HCL ER po 75 mg
• Norco Po tab PRN

Primary plastic surgeon removes wound vac and 2 jp’ drains. Order to return in 1 week. Continue to measure output of other two JP drains three times a day
Xeroform wound dressing changes to be done daily with 4 abd dressings over and breast binder worn.

One week later presents for follow up appointment for JP removal.
Low grade fever 99.6
Heart rate 106
BP 106/64
O2 sat 98% room air
Assessment unchanged, except left breast reddened and warm touch. Small dime size postulate noted on left suture line.

Started on Antibiotic- started on zpack
Oncotype recurrence score came back at low risk range of 7.
Bone density reveals pt is osteopenic.