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Patient Centered Care 3 > Cellular Regulation: Breast Cancer Exemplar > Flashcards

Cellular Regulation: Breast Cancer Exemplar Flashcards

1
Q

What is the tumor usually involved in stage 0 breast cancer?

A

Tis- Carcinoma in situ or Paget disease of the nipple

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2
Q

What node is affected in stage 0 breast cancer?

A

N0- No regional lymph node metastasis

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3
Q

Is there any evidence of metastasis (spreading to other places) in Stage 0 breast cancer?

A

No

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4
Q

What kind of tumor is involved in stage I breast cancer?

A

T1- Tumor no larger than 2 cm

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5
Q

Are there any nodes affected in Stage 1 breast cancer?

A

No

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6
Q

Is there any metastasis in Stage 1 breast cancer?

A

no

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7
Q

What are the tumors usually involved in Stage IIA breast cancer?

A
  1. T0-T1= No evidence of primary tumor

2. T2 tumor no larger than 5 cm

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8
Q

Are there any nodes affected in stage IIA breast cancer?

A

N1- Metastasis to moveable ipsilateral axillary nodes

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9
Q

Is there any metastasis (besides the ipsilateral axillary nodes) with Stage IIA breast cancer?

A

No

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10
Q

What are the tumors usually are involved in Stage IIB breast cancer?

A
  1. T2- tumor no larger than 5 cm

2. T3- Tumor larger than 5 cm

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11
Q

Are there any nodes affected by Stage IIB breast cancer?

A

Yes= N1- Metasis to moveable ipsilateral axillary nodes

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12
Q

Is there any metastasis (besides the ipsilateral axillary nodes) with Stage IIB breast cancer?

A

No

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13
Q

What are the tumors typically associated with Stage IIIA breast cancer?

A

T0, T1 (<2cm), T2(<5cm), T3 (>5cm)

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14
Q

Are there any nodes affected by Stage IIIA breast cancer?

A

Yes= N1 (Metastasis to moveable ipsilateral axillary nodes); N2 (Metastasis to ipsilateral fixed axillary nodes

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15
Q

Is there any metastasis (besides the ipsilateral axillary nodes) with Stage IIIA breast cancer?

A

No

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16
Q

What are the tumors usually associated with Stage IIIB breast cancer?

A

T4- Tumor of any size with direct extension to chest wall or skin
Any tumor

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17
Q

Are there any nodes affected by Stage IIIB breast cancer?

A

Yes= N0-N2; N3 (Metastasis to ipsilateral internal mammary lymph nodes)

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18
Q

Is there any metastasis (besides the ipsilateral axillary nodes) with Stage IIIB breast cancer?

A

No

19
Q

What tumors are usually associated with Stage IV breast cancer?

A

Any T

20
Q

Are there any nodes affected by Stage IV breast cancer?

A

Yes= Any nodes

21
Q

Is there any metastasis with Stage IV breast cancer?

A

Yes= M1 (distant metastasis)

22
Q

What are the two breast cancer genes that put someone at risk for developing breast cancer?

A

BRCA1 on chromosome 17 and BRCA2 on chromosome 13

23
Q

What are the nonmodifiable risk factors for breast cancer?

A
  1. Age and gender (women more than men
  2. Genetics
  3. Family history
  4. Personal history
  5. Previous chest irradiation (getting radiation in the chest for other cancers)
  6. Menstrual history (before the age of 12 or menopause after the age of 55)
24
Q

What are the modifiable risk factors for breast cancer?

A
  1. oral contraceptives
  2. not having children or having them after the age of 30
  3. using hormone replacement therapy for more than 5 years
  4. nonbreastfeeding
  5. drinking alcohol
  6. obesity
  7. high-fat diets
  8. physical inactivity
  9. Possibly environmental pollution
25
Q

What are some ways to potentially prevent breast cancer?

A
  1. Drinking less alcohol (max 1 drink/day)
  2. maintaining body weight within normal limits
  3. engaging in physical activity
  4. avoiding smoking
  5. avoiding exposure to environmental pollution and radiation
  6. limiting hormone therapy
  7. Monthy breast self-examinations 3-5 days after their period starts
26
Q

What are the most common clinical manifestations for breast cancer?

A
  1. nontender lump in the breast
  2. Abnormal nipple discharge
  3. A rash around the nipple area
  4. nipple retraction
  5. dimpling of the skin
  6. a change in the position of the nipple
  7. nipple pain, scaliness, ulceration, skin irritation, or discharge
27
Q

Lymphedema may occur following radical mastectomy secondary to the removal of axillary lymph nodes. What are the clinical manifestations of this lymphedema?

A
  1. Swelling of the arm and hand on the side of the mastectomy
  2. May be acute, temporary, and mild if occurring immediately post-operative
  3. Acute and painful if occurring 4-6 weeks post-operative
  4. Chronic and painless if occurring 18-24 months after surgery
28
Q

What are the clinical therapies for lymphedema due to radical mastectomy secondary to the removal of axillary lymph nodes?

A
  1. Exercise
  2. Customized compression sleeve
  3. Arm pump
  4. Diet and weight control
  5. Elevation of the arm
  6. Prevention of infection
  7. Avoidance of invasive procedures on the affected arm
29
Q

Cachexia occurs in most patients with advanced cancer. What are the clinical manifestations of Cachexia?

A

Weight loss, fatigue, weakness, loss of strength, activity intolerance, and constipation

30
Q

What are the clinical therapies for cachexia?

A
  1. Nutritional counseling
  2. Increased caloric intake
  3. Periods of rest and activity
  4. Monitoring weight
  5. Monitoring intake and output
31
Q

What are the clinical therapies used to treat memory loss and difficulty concentrating that may follow treatment with chemotherapy?

A
  1. Warning patients in advance of possible occurrence, because it can be very frightening to patients
  2. Recommending the use of memory aids (making notes)
  3. Providing emotional support to patients
32
Q

What is a radical mastectomy?

A

Removal of the entire affected breast, the underlying chest muscles, and the lymph nodes under the arms

33
Q

What is a simple mastectomy?

A

The removal of the complete breast only

34
Q

What is a segmental mastectomy?

A

The removal of the tumor and the surrounding margin of breast tissues

35
Q

What is a modified radical mastectomy?

A

The removal of the breast tissue and lymph nodes under the arm, leaving the chest wall muscles intact

36
Q

What is a lumpectomy or breast conservation surgery?

A

The excision of the primary tumor and adjacent breast tissue followed by radiation therapy

37
Q

What pharmacologic treatments are there for breast cancer patients?

A
  1. Hormone therapy (tamoxifen, aromatase inhibitors)
  2. Targeted drugs (Trastuzumab)
  3. Chemotherapy
38
Q

When is radiation therapy usually used for people with breast cancer?

A
  1. If the tumor is unusually large and it needs to be shrunk before surgery
  2. in combination with lumpectomy for early-stage breast cancer
  3. Palliative radiation to treat chest wall recurrences and bone metastases
39
Q

How can a nurse help a patient with breast cancer prevent infection?

A
  1. Tell the patient to avoid deodorants and talcum powder on the affected side until the incision is completely healed
  2. Assess surgical dressings for bleeding, drainage, color, and odor
  3. Observe the incision and IV sites for pain, redness, swelling, and drainage
  4. Change dressings and IV tubing using aseptic technique
  5. Teach the patient how to care for the drainage system, clean the site, empty the device, and records the amount, color, and type of drainage
  6. Teach the patient to watch for and report to the healthcare provider the manifestations of infection
40
Q

How would a nurse promote optimal circulation in someone who has breast cancer?

A
  1. Encourage ROM exercises in the affected arm
  2. Explain that lymphedema massage and an elastic compression bandage may help control the swelling after the patient has recovered from surgery
  3. When obtaining blood pressure and starting IVs, use the nonsurgical side
  4. Elevate the affected arm higher than the shoulder on a pillow and do not abduct it
41
Q

How would a nurse help promote a healthy body image for someone who has breast cancer?

A
  1. Assess the patient’s current body image
  2. Explain that redness and swelling in the scar will fade with time
  3. Encourage the patient to look at the incision when she or he feels ready
  4. Breast reconstruction options are available for women and men. If the patient is interested, provide written material and encourage discussion with a plastic surgeon and others who have had a reconstruction
42
Q

The nurse is conducting a seminar about breast cancer at a community center for women from diverse backgrounds. Which of the following would the nurse include about cultural risks of breast cancer to encourage breast self-exam?

  1. Breast cancer is more prevalent in Caucasian women under 40
  2. Asain, Hispanic, and Native American women have a lower incidence of breast cancer
  3. African American women are more at risk for breast cancer than any other group[
  4. Caucasian women are more likely to die from breast cancer because they are often diagnosed in advanced stages
A

The correct answer is: Asian, Hispanic, and Native American women have a lower incidence of breast cancer.

Asian, Hispanic, and Native American women have a lower risk for developing breast cancer.

Breast cancer is more prevalent in Caucasian women over 40.
Breast cancer is more prevalent in African American women under 40.
African American women are more likely to die from breast cancer because diagnosis often occurs at an advanced stage.

43
Q

A client who has had a mastectomy and her spouse is asking the nurse questions about reconstructive surgery. Which of the following is the best response by the nurse?

  1. Silicone is known to be safe when used as an implant
  2. Reconstructed breasts do not look normal
  3. Reconstructive surgery must be completed within 3 weeks of the mastectomy
  4. Reconstructive surgery may require multiple surgeries
A

The correct answer is: Reconstructive surgery may require multiple surgeries.

Depending on the type of mastectomy, reconstructive surgery may require multiple surgeries, thereby increasing such risks as a reaction to anesthesia and infection.

Controversy still exists about the health risks of silicone use.
Reconstructed breasts do look normal, and the surgery may be performed immediately after mastectomy or later on.

44
Q

The nurse is planning care for a client who has just undergone a radical mastectomy. Which of the following would the nurse include in that plan?

  1. Use warm, moist compresses on the arm to alleviate pain
  2. Start IV lines on the affected side in the antecubital area
  3. Keep the affected arm above the level of the heart
  4. Wait for the fifth postoperative day to start exercises
A

The correct answer is: Keep the affected arm above the level of the heart.

The arm is kept elevated after a mastectomy to reduce edema.

Warm compresses encourage the inflammatory response, causing more edema.
IV lines, lab draws, and blood pressures are performed in the opposite arm because the lymph nodes have been removed.
Gentle range of motion may be started immediately after surgery.

Patient Centered Care 3 (19 decks)

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