care modalities after mastectomy ms. ahdab faisal eskandar umm al-qura university applied medical...
TRANSCRIPT
Care modalities after mastectomy
Ms. Ahdab Faisal Eskandar
Umm Al-Qura UniversityApplied Medical Sciences CollageNursing DepartmentMedical & surgical nursing course 2
Objectives:
• Define mastectomy • List types of mastectomy• Describe post operative nursing
interventions• Enumerate possible complication and
its nursing managements• Patient teaching • Demonstrate exercise after
mastectomy
• What is the meaning of mastectomy?It is surgical operation done to remove
malignant breast tissues
Types
• Simple mastectomy(the entire breast is removed, but the lymph
nodes and surrounding muscle are left intact)
• Partial mastectomy(a larger amount of breast tissue and some
skin are removed with the tumor.)• Radical mastectomy(to remove all affected tissues and even the
surrounding one as well ). used in cases of extensive tumors
Post operative nursing interventions
• Reliving pain and discomfortMany patients tolerate the breast surgery
quite well and have minimal pain during the postoperative periods.
N.I : Analgesic medication, warm bath or relaxation and distraction methods .
Post operative nursing interventions
• Managing post operative sensationCommon sensation such as tenderness ,
numbness , tightness , , and pulling.
Phantom sensation( feeling post mastectomy that breast \ and or nipple are still present).May persist for 2 years or longer .
N.I: reassure the patient and these sensations are not indication of problem
Post operative nursing interventions
• Promoting positive body image N.I :Emotional distress patient need
(Conversation treatment)or-Breast reconstructions - Temporary breast form to place in her bra
Post operative nursing interventions
• Promoting positive adjustment and coping
N.I : Identifying supporting system and providing information
-Anxiety related to treatment (e.g. chemotherapy)
Ineffective coping need consultation of mental health practitioner
Monitoring and managing potential complications
Complications post mastectomy are:
• Lymphedma• Hematoma or seroma formation• Infection
complications
Lymphedma:It results if functioning lymphatic channels
are inadequate to ensure a return flow of lymph fluids to general circulation .
-Performing exercises can help reduce transient edema
complications
Hematoma or seroma formation:Hematoma :is collection of blood inside
cavityUsually develops within first 12 hours after
surgery
1. The nurse should assess Sign & symptoms : swelling, tightness, pain
and bruising of skin 2. Patient may take warm shower or apply
warm compressor
complications
Hematoma or seroma formation:Seroma :collection of serous fluid under
mastectomy incision .If drain being removed or obstructed
Sign and Symptoms: swelling , discomfort , heaviness and sloshing of fluid
If large amount doctor manually aspirating fluid with needle and syringe
complications
Infection Risk factor for infection such as:Diabetes , older age, poor hygiene and
immune disorder.
Sign and symptoms :Redness Tenderness Foul smelling drainage Fever and chills
1- Patient should report infection , arm swelling , hematoma or seroma .
2- Hygiene is important to prevent infection( shower can be on 2nd day post operative)
4- The drains usually removed when the output is less than 30 ml in 24 hours
Home care: * Patient can empty and measure fluids from
drainage devices.
*Patient should contact her doctor if ( sudden change in color of drainage or sudden cessation of drainage )
*Patient know how to milk clots through tubing of drainage devices.
1- Avoid blood pressure , injections & blood extraction in affected extremity.
2- Avoid insect bites.
3- Avoid lifting objects greater than 5-10 pounds
4- Use sunscreen for extended exposure to sun.
Exercises after breast surgery
Range of motion exercies are initial on the 2nd day post op.Goals of exercises:
1 -increase circulation and muscles strength2 -Prevent joint stiffness and contractures
3 -Restore full range of motion
Exercise done 3 times a day for 20 minutes at a time (4-6 weeks)
Exercises after breast surgery
Rod broomstick lifting
Rope turning
Wall hand
climbing
Pulley tugging
Rod or broomstick lifting
1. Grasp rod with both hands held about 20 cm apart
2. Keeping arms straight raise the rod over head
3. Bend elbows to lower rod behind the head
4. Reverse maneuver
Wall hand climbing
1. Stand facing wall with feet apart and toes as close as possible
2. Balm slightly bent , place palms of the hand on the wall at shoulders level
3. By flexing fingers works hand up the wall until arm are fully extended
4. Reverse process, working hands down to starting point.
Rope turning
1. Tie light rope to doorknob 2. Stand facing the door3. Take free end of rope in hand on
side of surgery 4. Place other hands on hip
Rope turning
5. With rope holding arm extended and held away from body (nearly parallel with the floor)
6. Turn the rope , making as wide swings as possible
7. Begin slowly at first ; speed up later
Pulley tugging
1. Toss light rope over a shower curtain rod or doorway curtain rod.
2. Stand as nearly under rope as possible.
3. Grasp end in each hand 4. Extend arm straight and away from
body 5. Pull the left arm up by tugging down
with right arm , continue in see- sawing motion.
References
• Medical surgical nursing textbook Brunner's and saudraths
• http://integra-med.com/exercises-after-mastectomy.html
• http://surgery.about.com/od/proceduresaz/ss/Mastectomy_6.htm