Breast

Question 1

What are risk factors and health promotions for patients with breast cancer?

Answer 1

Risk factors:
— female gender
— older than 65
— genetic factors
— hx of previous breast cancers
— dense breasts
— exposure to radiation
— first child born after age 30
— recent oral contraceptive use

Health promotion:
— annual mammogram age 40+
— MRI should be done with high risk factors
— breast self-awareness/self-examination (1 week after period)
— clinical breast exam

Question 2

Prioritize nursing interventions

Question 3

Imaging assessments:

Answer 3

— mammogram
— ultrasound
— MRI
— chest X-ray (lung metastases)
— CT scans (bone, liver, and brain metastases)

Question 4

What diagnoses breast cancer?

Answer 4

Breast tissue biopsy

Question 5

Interventions:

Answer 5

Decrease anxiety
Offer resources
Assess need for knowledge

*denial is common

Question 6

Ways to decrease risk for metastasis

Answer 6

Nonsurgical management:
— radiation
— chemo
— hormone therapy
— targeted therapy
— promote comfort (palliative) with those with advanced cancer

Question 7

Surgical interventions for breast cancer:

Answer 7

Pre-op care:
— relieve anxiety
— provide information
— include spouse/partner
— address body image issues

Procedures:
— lumpectomy: tumor and small amount of tissue removed
— partial mastectomy: part of breast and normal tissue removed
— total mastectomy: removal of entire breast
— modified radical mastectomy: breast and some lymph nodes removed, part of chest wall and muscle also removed

Question 8

What are some post-op care?

Answer 8

— avoid using affected arm for BP, injections or drawing blood
— observe for swelling and infection
— wound care
— draining tube care
— HOB elevated 30 degrees
— elevate arm of affected side on a pillow
— repositioning
— analgesics

Question 9

Patient teaching for post mastectomy:

Answer 9

— wound care
— drains
— no lotions or ointments
— no use of deodorant until healing complete
— observe for infection
— elevate arm on pillow for 30 mins a day for first 6 months
— numbness in surgery area common
— loose fitting clothes
— active ROM within 1 week after surgery

Question 10

Patient teaching:
Prevention of lymphedema + CM

Answer 10

Lymphedema:
Abnormal accumulation of protein fluid in SQ tissue of affected limb after mastectomy
CM:
— sensation of heaviness
— aching
— fatigue
— numbness
— thinking
— swelling
— swelling in upper chest

Prevention:
— avoid BP, injections, or blood draws in affected side
— wear mitt when using oven
— gloves when gardening
— treat cuts and scrapes
— elevate arm when possible