Exam 1 Flashcards
(188 cards)
1
Q
What are some significant advances in health care?
A
•AWHONN
2
Q
Healthy People 2020 Goals
A
- Goals that were set to improve health and the quality of life for all Americans
- Maternal, infant and child health have 33 specific goals
3
Q
What are some examples of goals for Healthy People 2020?
A
- Reduce the rate of fetal and infant deaths
- Reduce the rate of maternal mortality
- Reduce preterm births
- Reduce cesarean births among low risk women
4
Q
What are some problems with the U.S. health care system?
A
- Structure of the health care delivery system
- Reducing medical errors
- High cost of health care
- Limited access to care
- Health Literacy
5
Q
Different cultures have different _____ about health care.
A
Beliefs
6
Q
What are some trends in fertility and birth rates?
A
- Low birth weight and preterm births
- Infant mortality in the U.S.
- International infant mortality trends
- Maternal mortality trends
- Maternal morbidity
- Obesity: one third of women in the U.S. are obese
7
Q
How much does a low birth weight baby weigh?
A
Less than 2500 grams
8
Q
What race are most common low birth weight babies?
A
- Non hispanic black babies
* More likely to die within the first year of life
9
Q
How can we prevent low birth weight?
A
- Prenatal care is important
- WIC
- Pregnancy resource center
- Income clinics
10
Q
What are some trends in fertility and birth rates?
A
- Low birth weights and preterm birth
- Infant mortality in the U.S.
- International infant mortality trends
- Maternal mortality trends
- Maternal morbidity
- Obesity: one-third of women in the U.S. are obese
11
Q
*What are some associated common complications with obesity?
A
- Hypertension
- Diabetes
- With both Hypertension and Diabetes we could see infertility, congenital anomolies with the baby, miscarriages, and fetal death
12
Q
With the maternal mortality trend the mom could die from what?
A
Infections
Hemorrages
Hypertension
13
Q
What are some perinatal health care services?
A
Ambulatory care
Community based care:WIC, Income based, home health care
High technology care
14
Q
What are some other issues in women’s health nursing?
A
- Involving consumers and promoting self-management
- International concerns
- Womens health
15
Q
Women are typically healthy when?
A
During child bearing
16
Q
What are we concerned with limiting or accessing for?
A
- Nutrition
- Smoking or second hand smoke
- No alcohol
- Violence prevention: Do you feel safe at home?
- Support system
17
Q
What is an international concern that also happens in the U.S.?
A
Female genital mutilation
•Can cause complications in child birth
•Over 500,000 women
18
Q
What else is an international concern with women and children?
A
Human trafficking
•can experience hard labor, sexual work, organ donation
19
Q
What is the leading cause of death of women?
A
Heart disease
20
Q
What are some other issue in women’s health?
A
•Malignant neoplasms
Breast cancer
Ovarian cancer
Cervical cancer
•Violence-increases in pregnancy
Battery
Rape
21
Q
What is a standard of care?
A
- The level of practice that a reasonably prudent nurse would provide in the same or similar situation.
- Developed based on reporting an evidenced based practice
22
Q
What are legal issues in provision of care?
A
- Risk management
- Sentinel events
- Failure to rescue
- Quality and Safety Education for Nurses (QSEN)
- Evidence Based Practice
23
Q
What is risk management?
A
- Is a system of checks and balances
* Doing everything we can to decrease risk of injury to a patient
24
Q
What is a sentinel event?
Ex: Medication Errors
A
- Could result in temporary harm to a patient, permanent harm, or death
- Was not based on the condition of the patient
25
What is failure to rescue?
* Not recognizing or acting on early signs of distress
| * Assessment skills are super important
26
What is Quality and Safety Education for Nurses (QSEN)?
* They set standards for any specialty
* For nursing students and instructors
* Applicable to every nurse
27
What is evidenced based practice?
Providing care based off evidenced gained through research and clinical trials
28
What is outcomes oriented practice?
Compares current care practices with clinical standards
29
What are ethical issues in Perinatal Nursing and Women's health care?
* Reproductive technology
* Allocation of resources
* Older-age pregnancies: High risk
* Third-party payers
* Induced ovulation and in vitro fertilization
* Multifetal pregnancy reduction
* Intrauterine fetal surgery
* Treatment of very low-birth-weight infants: looking at cost
30
What is a big part of infant maternal health nursing?
Family planning
31
Who do we turn to for our cultural background and our value?
Family
32
What does a nuclear family consist of?
* A husband wife and children (biological or adopted)
* Live as an independent unit
* This kind of family is declining
33
What is a single parent family?
A non traditional family and are most socially vulnerable
| •Can impact health status, school achievement, and promote high risk behaviors
34
What is a married blended family?
A married couple with children from a previous relationship
35
What is an extended family?
Ex: cousins, aunt's, grandparents, uncles
Provide social, emotional, and financial support to one another
36
What plays the most valuable roll in the actions of individuals and families?
Beliefs and values
37
What to assess for with low-risk families?
Promoting and assisting healthy behaviors during pregnancy and a healthy delivery
38
What to assess for with high risk families?
Focus on additional illnesses
| Example: a mom with an alcohol problem
39
What is cultural competence?
* You understand your own culture and you understand that others have different beliefs as well
* This involves the patients culture and not the nurses
40
What is subculture?
This is a culture within a culture (African-American, Asian American, Hispanic American)
41
What is acculturation?
Changes that occur within a group when people from another group come into contact with one another.
Two cultures combined
Some of your own culture is still retained but you adopt practices of the dominant society
42
What is assimilation?
Laws of cultural identity and you become part of the dominant culture
43
What is ethnocentrism?
* Believing that your beliefs and values are the best
| * They are the only right way
44
Time orientation
•In some cultures it is enterprated differently
| •
45
What are family roles?
* Vary among cultures
* In hispanic culture the maternal grandmother is very involved in the labor and delivery process and the care newborn
In european american culture the father of the baby is more likely to participate in the labor and delivery process
In asian american family the father may not be involved in the labor and delivery process
In native american families the entire family attends the birth
46
Within community health what is key?
Assessment
47
Women make up what percentage of the population?
50%
48
What are adolescent girls considered vulnerable?
* Because they're young
* Unexperienced
* More likely to have unprotected sex
* Low self-esteem
49
Women are more at risk for what?
Chronic illnesses
50
Incarcerated women are considered what?
```
A vulnerable population related to lifestyle choices
•Smoking
•Drugs
•Communicable disease
•Drinking
•Unprotected sex
```
51
Why are women in rural areas considered vulnerable?
Limited access to care
52
Why are homeless women vulnerable?
* More at risk for infectious diseases
* Lack of prenatal care
* Anemia
* Substance abuse
* Chronic diseases
53
What are levels of preventive care?
Primary
Secondary
Tertiary
54
What are primary levels of preventive care?
Examples: Vaccinations, car seats, exercising, nutrition
55
What are secondary levels of preventive care?
Examples: screenings
Will target a specific population
Intervention: Contraceptives, STD tests, flu shot
56
What is tertiary level of preventive care?
Treatment to prevent further deterioration
| Example: If someone has a stroke they may go to a rehab to prevent bed sores or muscle weakness
57
Home care for women is what?
* Growing demand for women health specialty
* Birthing alternative
* Cost effective
* Reimbursement by third part payers
* For lactation
58
Care Management of home care
* Assess for safety for
* Infection control
* Climate control
* What is the integrity of the home
* Who lives there?
59
The structures of the female reproductive system develop and grows in response two what hormones?
Estrogen
| Progesterone
60
With age or a decline in hormone production reproductive structures can what?
Atrophy and become less effective
61
What are the internal structures of the female reproductive system?
* Uterus
* Fallopian Tube
* Endometrium
* Cervix
* Ovary
* Vagina
* Vulva: External
62
What is the uterus?
* Is a muscular organ that's positioned in the pelvic cavity
* Responsible for receiving, implanting, and retaining a fertilized egg
* Responsible for menstruation
* If and when the female becomes pregnant it's responsible for housing the fetus and for the expoltion of the fetus
63
What are fallopian tubes?
* Also known as th unterun tubes
| * Where the ovum is fertilized by the sperm
64
What is endometrium?
* The lining of the uterus
* Highly vascular
* During menstruation this layer is shed
65
What is the cervix?
* It is made up connective and elastic tissue
* What stretches during a vaginal birth
* What Dilates
66
What are the ovaries?
* Produce ova (eggs)
| * Responsible for ovulation (releasing of eggs) and hormone production
67
What is the vagina?
* Lies between the bladder and the rectum
| * It is a passage way for the menstrual cycle and for birth
68
The mammary glands are made up of what?
* Lobules
* Physiologic alterations
* Function
* We want the breast to be smooth and no dimpling
* No masses (could be malignant or benign (could be in response to hormonol changes)
69
Dimpling to the breast could indicate what?
Malignancy (Breast cancer)
70
What stimulates the growth in breasts?
Estrogen
71
What are functions of the breast?
* Lactation
* Breast feeding
* Sexual arousal
72
Where are the mammary glands found?
Between the second and the sixth rib
73
What are some physiologic changes with menstruation?
* Menarche: First menstruation (usually around 13 years old)
* Puberty: Transition between childhood and sexual maturity
* Menstrual cycle: prepares the uterus for pregnancy 28 days of a cycle (5 days of bleeding, 50mL of blood lost)
* Prostaglandins
74
What are prostaglandins?
* Oxygenated fatty acids also knows as hormones •Produced in uterus
* Responisible for smooth muscle contractility
* Moderates hormonal activity
* Play a key role in ovulation (when an egg is released)
* Influnce estrogen and progesterone production
* Can be recognized in various body systems (GI upset, cramping, diarrhea, CNS irritability, sleep disturbances)
75
What are the two specific hormones for women?
Estrogen
| Progesterone
76
What is climacteric menopause?
•Transition phase between ovarian function and decrease in hormone production
77
What is perimenopause?
* What happens before a woman stops having her menstrual cycle
* No estrogen being produced by the ovaries
* Occurs over a 4 years span
* Decrease in ovary production
* Less eggs will be released (ova)
78
What is perimenopause?
* What happens before a woman stops having her menstrual cycle
* No estrogen being produced by the ovaries
* Occurs over a 4 years span
* Decrease in ovary production
* Less eggs will be released (ova)
79
What is menopause?
* The last menstrual period
* Noted after one year of no bleeding
* Can occur anytime between 30 and 60 but the average age is 51.4
80
What is menopause?
* The last menstrual period
* Noted after one year of no bleeding
* Can occur anytime between 30 and 60 but the average age is 51.4
81
What is menopause?
* The last menstrual period
* Noted after one year of no bleeding
* Can occur anytime between 30 and 60 but the average age is 51.4
82
What is menopause?
* The last menstrual period
* Noted after one year of no bleeding
* Can occur anytime between 30 and 60 but the average age is 51.4
83
What is menopause?
* The last menstrual period
* Noted after one year of no bleeding
* Can occur anytime between 30 and 60 but the average age is 51.4
84
What is menopause?
* The last menstrual period
* Noted after one year of no bleeding
* Can occur anytime between 30 and 60 but the average age is 51.4
85
What are some barriers for seeking health care?
* Financial Issues
* Cultural Issues
* Gender Issues
86
What are some approaches to healthcare for women?
* Preconception
* Pregnancy
* Family Planning
* Menstrual Problems
* Perimenopause
87
What do young and middle adulthood women need?
* Need contraception
* Pelvic and Breast screenings
* Pregnancy care
88
What care do parenthood after 35 y/o needs and late reproductive age?
* Enhanced age
* May have chronic conditions that worsen with time
* Not just caring for one aspect but all of them
* If pregnant after 35 they are at increased risk for genetic anamolies (Downs Syndrome)
* How they prioritize their life?
* Screenings
89
What are nutritional risk factors to women's health?
* Appropriate intake of calcium (women are at a greater risk for developing osteoporosis)
* 400 mcg of folic acid daily for pregnancy
* Screen for eating disorders
* BMI >30 are more at risk for diabetes, stroke, CAD, hypertension, cancer
90
What are exercise risk factors to women's health?
* Can treat and prevent various diseases like cardio disease, osteoporosis, diabetes
* Encourage 20-30 min of exercise at least 3 times a week
91
What are medical conditions risk factors to women's health?
* Heart disease
* Lung, breast, and colon cancer
* Chronic lung disease
* Diabetes
* Infertility, miscarriage, preterm labor, ovarian cyst, STDs
92
What are lifestyle risk factors to women's health?
* Risky behaviors could have a negative impact on their life and health
* Sexual practices (unprotected)
* Female genital mutilation
* Human trafficking
* Domestic violence
* Environmental and workplace hazards
93
What are mental health factors to women's health?
* Screen for depression and anxiety (EVERYONE)
* Do they feel stressed and/or in control?
* Promote a support system
* Be supportive
* Help with coping skills
* Anticipatory guidance: education so they know if something does arise
94
What are substance abue risk factors to women's health?
* Anything from caffeine to cocaine
* Can have a negative impact on the women's health and on a fetus
* Is mom using prescription drugs inappropriately?
95
What question do you ask when you enter the room for a health assessment?
Hi. My name's "" what bring you to the clinic today?
96
Within an interview for a health history what kind of questions do you ask?
Open ended
97
Who are women with special needs?
Adolescents
Victims of abuse (Screen all women)
Women with disability (hearing or visually impaired)
98
What is physical examination of a health assessment for women?
Head to toe
99
What is a pelvic exam?
* Explain the procedure and always get consent for the exam!
* Prepare and educat the patient
* Have them put on a gown
* Decrease their fears and educate them
* Lethotamy position
* We can assess the outer pelvic exam
100
What are labs and diagnostic procedures for a women's health assessment?
•May need to collect swabs or blood draws to assess for STDs or STIs
***•May also look for candida (yeast infection), bacterial (vaginitis), group b strep (in pregnancy), gaunorrhea and clamodia, HSV (herpes)
•Pap smear (advanced care provider): used to screen for cervical cancer
101
What should nurses promote?
* Nutrition
* Exercise
* Stress management
* Substance use cessation
* Sexual Practices that reduce risks
102
What is Amenorrhea?
•Menstrual disorder
•The absence of menstrual flow
•Abnormal finding
•Noted if menarche and secondary sexual characteristics are not present by age 13
Ex:No menstrual flow or breast development
•Absent of menses by 15 with normal growth and development
•Absent of menses within 5 years of breast development
•If a female experiences her menstrual cycle but goes 6 months plus with out having a menstrual cycle. This is called secondary Amenorrhea
•Could be a sign of a disease
•Influences are: pregnancy, endocrine disorders, diabetes
103
How do we rule our pregnancy with a urine test for the cause of Amenorrhea?
HCG hormone
104
What is included in the assessment for Amenorrhea?
```
Through assessment and physical exam
CBC
Thyroid stimulating hormone
Prolactin
Estridal
HCG
```
105
What is included in the counceling and education for Amenorrhea?
Could have an impact on child bearing
106
What is included in the management for Amenorrhea?
```
Contraceptives
Diet modification
Relaxation
Physical
Emotions
Environmental
```
107
What is included in the female athlete triad?
Amenorrhea
Osteoporosis
Insufficient nutrition
108
What is Dysmenorrhea?
* Pain during or shortly before menstruation
| * Primary or secondary
109
Severe Dysmenorrhea can be associated with
Early menarche
Nulliparity (Never been pregnant)
Lack of physical exercise
110
What is Primary Dysmenorrhea?
* Associated with ovulatory cycles
| * An excessive release of prostaglandins
111
What happens when the prostaglandins are released?
They'll cause the arterioles in the uterus to spasm
112
What are common treatments for primary Dysmenorrhea?
```
Heat (vasodilates)
Exercise
Relaxation techniques
Low sodium diet
Low fat diet
Vitamin E supplement
NSAIDS (primary treatment)
```
113
What is secondary Dysmenorrhea?
* Menstrual pain that occurs later in life (usually after 25 years)
* Could be associated with the pelvic pathology (Endometriosis, fibroids)
114
What do people complain of with secondary Dysmenorrhea?
Bloating
Pelvic fullness
Pain in legs or/and lower back
115
How do we treat Secondary Dysmenorrhea?
* Treat the cause
| * Encourage treatment options that we would recommend for primary Dysmenorrhea
116
What is Premenstrual syndrome and Premenstrual Dysphoric Disorder? (PMS, PMDD)
Cyclic symptoms (not 24/365 complaints)
117
What is PMS?
* A poorly understood condition
* A combination of physical, psychological, and behavioral behaviors
* Fluid retention
* Pelvic fullness
* Breast tenderness
* Weight gain
* Depression
* Irritability
* Cravings
* Headaches
* Fatigue
118
What is PMDD?
•Similar to PMS but more severe
119
What is management of PMS and PMDD?
```
Treat symptoms:
Encourage a well balanced diet
Exercise
Relaxation
Encourage to quit smoking
Supplements (calcium, B6, D3)
```
120
What is Endometriosis?
* The presence and growth of endometrial (lining of the uterus) tissue outside of the uterus
* Adhesions could be present from the endometrial tissue and systemically anywhere (vagina, vulva, perineum, bladder, gall bladder, and heart)
121
***What are symptoms of Endometriosis?
```
Dysmenorrhea
Painful intercourse
Abnormal uterine bleeding
Infertility
•These symptoms can worsen with each cycle or may not have symptoms
•Symptoms can disappear after menopause
```
122
What is management for Endometriosis?
* NSAIDS
* Medications that suppress estrogen (side effects that resemble menopause: hot flashes, vaginal dryness, decreased libido)
* Birth control 6-12 months to decrease adhesions
* Surgical Intervention
* Abdominal Hysterectomy (DEFININENT CURE)
123
What are physiologic characteristics of menopause?
```
Anovulation (eggs aren't released)
Menstrual cycle length (months or years over 4 years
Ovulation is less
Progesterone is not produced
FSH is elevated
```
124
What are physical changes of menopause?
* Bleeding long periods (lighter or heavier)
* Genital changes (decrease in libido, vaginal dryness, incontinence)
* Vasomotor instability (hot flash)(avoid caffeine and alcohol, dress in layers, drink water)
* Moods/behaviors
125
What are health risks of a perimenopausal woman?
•Osteoporosis (progressive loss of bone mass related to decreased levels of estrogen)
-Estrogen converts vitamin D to calcitonin
•Coronary Heart Disease
126
***What are menopausal hormonal therapy for Vasomotor instability?
•We can treat the symptoms of menopause with estrogen or it can be a combination of estrogen and progesterone
* SSRI'S
* Gabapentin
* Clonidine
127
What are the risks with taking estrogen and hormonal supplements?
* Take the lowest effective dose
* It can increase the risk of breast cancer
* The risk is increased for up to 5 years after they stop taking that hormone
* Recurrece of breast cancer can also occur
128
What are common side effects of estrogen or the combo of estrogen and progesterone?
```
Headache
Nausea
Vomiting
Brown spots on skin
Depression
```
129
What are effective alternative therapies do menopausal symptoms?
Soy and vitamin E
130
What is the plan of care for menopausal patients?
* Sexual counceling: sexuality and the capacity of sexual expression declines after menopause; they still have the desire
* Well balanced diet
* Exercising
* Educatiom on Medications w/ risk factors and side effects
* Support groups
131
A women complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:
Endometriosis
132
What is Micromastia?
* Underdevelopment of breast tissue
* It can be congenital
* They can have lower self esteem
133
What is Macromastia?
* Large heavy breasts
* Self esteem issues
* Complaints of back and shoulder pain
134
What are developmental anomalies?
* Noticeable change of size of breast and they are asymmetrical
* Self esteem issue
* Can have a prosthetic
* The smaller breast lacks granular tissue and could have an issue if mom wants to breast feed
135
***What are the two goals of benign breast disease initial evaluation?
* Distinguish what is benign and what is malignant
| * Assess the risk of breast cancer
136
What are fybrocystic breast changes?
* The most common benign problem
* Related to an imbalance of estrogen and progesterone
* Very common in women from 20-50
137
What are some clinical manifestations of fibrocystic?
* Upon assessment there would be lumpiness with or without pain
* Typically around the menstrual cycle is when they would experience the pain
* Occurs one week before menstruation and gone a week after
* Typically women in 20s feel pain
* Lumps are soft and moveable and we'll differentiated
138
How do you diagnose fibrocysts?
* Discovered first from women
* Ultrasound
* If lump is fluid filled they can aspirate the fluid
* If not fluid filled they would need further testing
139
What are therapeutic interventions for fibrocysts?
* Surgical removal of lumps
* Nutrition education: Don't smoke, don't drink alcohol or caffeine
* NSAIDS
* Birth control to treat masses
140
What is breast pain?
* Known as mastalgia
* Common during reproductive years
* Uncommon in breast cancer
* What is the pattern of pain?
* Is it cyclic or noncyclic?
* Is it focal or diffuse?
141
What is treatment for bre
* Diet: no caffeine or Alcohol and don't smoke
* NSAIDS
* Oral contraceptives
142
What are solid masses?
* No fluid component
* Don't Increase a women's chance of developing breast cancer
* Not always malignant
143
What are solid masses called?
Fibroadenoma
144
What are Fibroadenomas?
* Most common and discrete
* Less than 3 cm in diameters
* Develop mostly in teenage years
* Tenderness experienced in menses and will stay the same size except in pregnancy it will increase little in size
* As a woman ages it gets smaller
* Doesn't respond to hormonal therapy or diet changes
145
What is cellulitis?
•Inflammation of skin
146
What are risk factors of cellulitis of the breast?
```
Obesity
Large breasts (Macromastia)
Previous surgery
Radiation
Smoking
Diabetes
Nipple piercings
```
147
What is the most common cause of cellulitis?
•Merca: hard to treat
148
What is cellulitis?
* Skin will be red, warm, thickened
| * If an abscess develops it needs to be drained
149
What is the treatment for cellulitis of the breast?
Antibiotics
150
What is care management of benign conditions of the breast?
* Breast self exam (90% of lumps are discovered by the patient) (malignant or benign)
* Client History and physical exam
151
When should we tell the patient to perform a breast exam?
* 5-7 days after their menstrual cycle
| * In the same pattern every time
152
Who should clinic breast exams be performed by?
Health care provider starting in her 20's and then routine mammagrams after 40
153
What are the three nursing actions for benign conditions of the breast?
* Discuss the intervals for breast screening
* Provide written educational information
* Perform therapeutic communication
154
What is etiology of malignant conditions of the breast?
* Gender
* Age
* Time of menarche
* Time of first live birth
* Personal History
* Geographic differences
* First pregnancy after 40
155
What is the cause of breast cancer?
Unknown
156
What are findings of breast cancer?
* Lumps or dimpling
* Retractions with breast
* Look for unilateral changes
* Early menarche
* Look at family history
* Race Non hispanic, white
* Nulliparity
157
***What are genetic considerations?
* 15% of case are related to a genetic mutation
| * BRCA1 AND BRCA2: Can be drawn as labs to see if it is present: the woman has an 85% chance of developing breast cancer
158
If BRCA1 AND BRCA2 are present what will someone do?
* Bianual exams with imaging
| * Chemoprevention to prevent breast if they have a history of breast cancer w/ genetic mutations
159
What is the 2nd leading cause of death in women?
* Breast cancer
| * 1 in 8 women develop it
160
What is the survival rate for breast cancer?
•83% 10 years after diagnosis
161
What is the percentage of breast cancer in a male?
1%
162
What is the pathophysiology of malignant conditions of the breast?
* Unknown
* Invasive tumors can travel elsewhere in the body
* All tumors behave and act differently
163
What are four different types of tumors?
Ducts tumor
Lobular tumor
Nipple carcinoma
Inflammatory breast cancer
164
What is a ducts tumor?
* found in ducts of breast and invade surrounding tissue
* Solid and non mobile
* Not tender
165
What is a lobular tumor?
* Found in the lobes of the breast
* Not palpable
* Not detected with a self breast exam
* Diagnose with imaging
166
What is a nipple carcinoma?
* Occurs with a ductle carcinoma
* Bleeding and oozing and crusting around nipple
* Common with pajet disease
167
What is inflammatory breast cancer?
* Where the breast are red, rash and misdiagnosed as cellulitis or mastitis
* Very aggressive
* Present as a stage 2
168
What is the most common type of breast cancer?
Invasive ductle carcinoma
169
What effects the rate of breast cancer growth depend on?
Estrogen
Progesterone
Other subtypes of hormones and receptors
170
What are the common places that metastisize malignant cancer spreads to?
Bones
Lungs
Brain
Liver
171
What are clinical manifestations and diagnoses of malignant breast cancer?
Screenings and guidelines:
•Mammography: gold standard for breast cancer but not 100%
•MRI can be used in combo with mammogram and ultrasound. Good for silicone implants or high risk of or history of breast cancer
•Biopsy is what confirms the diagnosis as malignant
172
What is the prognosis for malignant breast cancer?
•Dependent on nodule involvement and tumor size
173
What is surgery care management of malignant breast cancer?
* Lumpectomy
* Masectomy
* Prophalactic mastectomy
174
What is a lumpectomy?
removal of tumor and small margin of healthy tissue around tumor
175
What is a prophalactic mastectomy?
•Removal of patient at high risk for breast cancer •Need a mammogram 90 days prior to removal to ensure the tissue being removed is healthy
176
What is a mastectomy?
* Removal of breast including the nipple and alveoli m
* Most invasive
* Used when other treatments don't work or large tumor or multiple tumors in that breast
177
What is breast reconstruction?
* Done at the same time as a mastectomy
| * Flaps would be breasts that are made from other tissues in body
178
What is radiation therapy?
•Need if diagnosed with breast cancer or if someone has had a mastectomy
•Most conservitive and effective approach
•Watch for skin irritation
Heaviness w/ breasts
Fatigue
179
What is done right after tumor removal?
Adjuvant systemic therapy
•Chemo right after surgical removal of tumor
•Most helpful for women that are premenopausal and cancer has spread to their lymph nodes
180
What is hormonal therapy for malignant breast cancer?
Tamoxifen: oral hormonal therapy
181
What do you need with Tamoxifen?
* Need an annual pap
* Need an annual eye exam
* Liver function test every six months
* Bone density screen every 3 years
182
What are the common adverse effects of Tamoxifen?
* Hot flashes
* Weight gain
* Higher risk for DVTs
* Can cause cataracts
183
What is chemotherapy?
* Most common therapy for node-positive and node-negative tumors
* High dose therapy
* Can be administered IV, sub q or oral
184
What are the side effects of chemotherapy?
* Leukopenia
* Hair loss
* Thrombocytopenia
* Anemia
* Nausea
* Vomiting
185
What are nursing considerations for surgery, radiation, chemotherapy?
* Practice infection control
* Therapeutic communication
* No BP in mastectomy on side of breast cancer
* Dont place IV or take blood on mastectomy side
186
What are special considerations of young women <40?
* 12% diagnosed
* Use same treatment plan
* Sexual activity and child bearing could be compromised
* Help with coping
* Higher recurrence
187
What are the special do considerations with women 65 and over?
* Recurrence is declining
| * Diagnosis increases
188
What are survivorship issue with breast cancer?
* Vasomotor symptoms
* Sexual dysfunction
* Osteoporosis (antiestrogen therapies or chemo)
* Weight gain
* Cognitive changes
* Canver related fatigue
* Cardiotoxicity (antiestrogen therapies or chemo)
* Neuropathies (antiestrogen therapies or chemo)
