chapter 48 assessment and management of patients with breast disorders
DESCRIPTION
Chapter 48 Assessment and Management of Patients With Breast Disorders. Breast Disorders. Overview of anatomy of the breast Cultural and psychosocial considerations Breast cancer is a major health problem - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/1.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Chapter 48
Assessment and Management of Patients With Breast Disorders
Chapter 48
Assessment and Management of Patients With Breast Disorders
![Page 2: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/2.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast DisordersBreast Disorders
• Overview of anatomy of the breast
• Cultural and psychosocial considerations
• Breast cancer is a major health problem
• In the U.S., more than 215,000 women and 1,450 men develop breast cancer annually, and more than 40,000 die
![Page 3: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/3.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Anatomy of the BreastAnatomy of the Breast
![Page 4: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/4.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Risk Factors for Breast CancerRisk Factors for Breast Cancer
• Female gender
• Age
• Personal and family history including genetic mutations
• Hormonal factors
• Exposure to radiation
• History of benign breast disease
• Obesity
• High-fat diet (controversial)
• Alcohol intake
![Page 5: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/5.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Guidelines for Early Detection of Breast Cancer
Guidelines for Early Detection of Breast Cancer
• Women in their 20s and 30s: clinical breast exam at least every 3 years, then preferably annually after age 40
• Mammography annually beginning at age 40
• Women at increased risk may have earlier initial screening, shorter screening intervals, or additional screening procedures such as ultrasound and MRI
• Teach women in their 20s the benefits and limitations of breast self-examination (BSE)
![Page 6: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/6.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Self-ExaminationBreast Self-Examination
• Provide instruction to women regarding BSE
• Instructions should be provided to men if there is a family history of breast cancer
• Encourage BSE but do not overemphasize it
• Instructional materials can be obtained from the American Cancer Society and The National Cancer Institute
![Page 7: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/7.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Lymph NodesLymph Nodes
![Page 8: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/8.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Teaching Breast Self-ExaminationTeaching Breast Self-Examination
• Best performed days 5 to 7 days after first day of menses or once monthly for postmenopausal women
• Review the feel of normal breast tissue and ways or identify changes
• Routine BSE helps patients become familiar with their own “normal abnormalities”
• Demonstrate the examination technique
• Encourage the student to perform a BSE demonstration on herself or on a breast model
![Page 9: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/9.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Self-ExaminationBreast Self-Examination
• Stand in front of a mirror
• Check both breasts for anything unusual
• Look for discharge from the nipple and puckering, dimpling, or scaling of the skin
![Page 10: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/10.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Self-Examination (cont.)Breast Self-Examination (cont.)
• Watch closely in the mirror as you clasp your hands, bend your head, and press your hands forward
• Note any change in the contour or your breasts
![Page 11: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/11.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Self-Examination (cont.)Breast Self-Examination (cont.)
• Next, press your hands firmly on your hips and bow slightly toward the mirror as you pull your shoulders and elbows forward
• Note any change in the contour of your breasts
![Page 12: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/12.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Self-Examination (cont.)Breast Self-Examination (cont.)
• Raise your left arm; using 2 or 3 fingers, feel your left breast carefully and thoroughly
• Beginning at the outer edge, press the flat part of your fingers in small circles, moving the circles slowly around the breast
• Gradually work toward the nipple
• Cover the whole breast
![Page 13: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/13.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Self-Examination (cont.)Breast Self-Examination (cont.)
• Feel for any lumps or masses.
• Repeat on the right breast; step 4 should be repeated lying down
• Lie flat on your back with your left arm over you head and a pillow or folded towel under the left shoulder
• Use the same circular motion
• Repeat on the right breast
![Page 14: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/14.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Teaching Breast Self-ExaminationTeaching Breast Self-Examination
• Part of the examination may be done in the shower with soapy hands to glide over the breast and focus on underlying tissue
• Note the importance of including the area between the breast and underarm, and the underarm itself
• Discuss reporting of any changes
• Describe the goals, methods of instruction, and methods of evaluation for a teaching plan for BSE
• List resources for information and materials
![Page 15: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/15.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Diagnostic TestsDiagnostic Tests
• Mammography
• Galactography
• Ultrasonography
• Magnetic resonance imaging (MRI)
• Biopsies
– Percutaneous: fine-needle aspiration and core biopsies
– Surgical biopsies: excision, incision, and wire needle localization
![Page 16: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/16.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
MammographyMammography
![Page 17: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/17.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Surgical Management—Breast CancerSurgical Management—Breast Cancer
• Breast conservation treatment
• Total mastectomy
• Modified radical mastectomy
• Sentinel node biopsy and axillary lymph node dissection
• Breast reconstruction surgery
![Page 18: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/18.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Reconstruction With Tissue Expander
Breast Reconstruction With Tissue Expander
![Page 19: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/19.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Reconstruction With TRAMBreast Reconstruction With TRAM
![Page 20: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/20.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Breast Reconstruction—Latissimus Dorsi Flap
Breast Reconstruction—Latissimus Dorsi Flap
![Page 21: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/21.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Nonsurgical Management of Breast Cancer
Nonsurgical Management of Breast Cancer
• Radiation therapy: external beam, brachytherapy
• Chemotherapy
• Hormonal therapy
– Estrogen and progesterone receptor assay
– Selective estrogen receptor modulators (SERMs): tamoxifen
– Aromatase inhibitors: anastrozole, letrozole, and exemestane
• Targeted therapy
![Page 22: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/22.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Nursing Process—Assessment of the Patient Undergoing Breast Cancer
Surgery
Nursing Process—Assessment of the Patient Undergoing Breast Cancer
Surgery
• How is the patient responding to her diagnosis?
• What coping mechanisms does she find helpful?
• What psychological or emotional supports does she have and use?
• Is there a partner, family member, or friend available to assist in making treatment choices?
• What are her educational needs?
• Is she experiencing any discomfort?
![Page 23: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/23.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Nursing Process—Preoperative Diagnosis of the Patient Undergoing
Breast Cancer Surgery
Nursing Process—Preoperative Diagnosis of the Patient Undergoing
Breast Cancer Surgery
• Deficient knowledge
• Anxiety
• Fear
• Risk for ineffective coping
• Decisional conflict
![Page 24: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/24.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Nursing Process—Postoperative Diagnosis of the Patient Undergoing
Breast Cancer Surgery
Nursing Process—Postoperative Diagnosis of the Patient Undergoing
Breast Cancer Surgery• Pain
• Disturbed sensory perception
• Disturbed body image
• Self-care deficit
• Risk for sexual dysfunction
• Deficient knowledge
– Drain management
– Arm exercises
– Hand and arm care
![Page 25: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/25.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Collaborative Problems/Potential Complications
Collaborative Problems/Potential Complications
• Lymphedema
• Hematoma/seroma formation
• Infection
![Page 26: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/26.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Nursing Process—Planning the Care of the Patient Undergoing Breast Cancer
Surgery
Nursing Process—Planning the Care of the Patient Undergoing Breast Cancer
Surgery
• Major goals may include:
– Increased knowledge about the disease and its treatment
– Reduction of preoperative and postoperative fear, anxiety, and emotional stress
– Improvement of decision-making ability and improvement of coping skills
– Improvement in sexual function
– Absence of complications
![Page 27: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/27.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Preoperative InterventionsPreoperative Interventions• Review and reinforce information on treatment options
• Prepare patient regarding what to expect before, during, and after surgery
• Inform patient regarding surgical drain, arm and shoulder mobility, and range-of-motion exercises
• Maintain open communications
• Provide patient with realistic expectations
• Support coping
• Involve or provide information for supportive services and resources
• Support patient decisions
![Page 28: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/28.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Postoperative InterventionsPostoperative Interventions
• Inform patient regarding common postoperative sensations
• Maintain privacy
• Provide bra with breast form
• Provide information
• Support coping and adjustment
• Provide counseling and referral
• See Table 48-5 and Chart 48-6
• Monitor for potential complications
![Page 29: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/29.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Hand and Arm CareHand and Arm Care• Potential for lymphedema formation after auxiliary lymph
node dissection (ALND)• Patient education• Prevention is vital; follow guidelines for the rest of life• No blood pressure, injections, or blood draws in the
affected arm• Perform exercises 3X a day for 20 minutes to increase
circulation and muscle strength, prevent stiffness and contractures, and restore ROM
• A mild analgesic or a warm shower may be helpful prior to exercise
• Initial limitation of lifting (over 5 to 10 lbs) and activity• See Chart 48-7
![Page 30: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/30.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Exercises After Breast SurgeryExercises After Breast Surgery
Wall climbing
Rope turning
Rod liftingPulley tugging
![Page 31: Chapter 48 Assessment and Management of Patients With Breast Disorders](https://reader035.vdocument.in/reader035/viewer/2022062222/56814f8b550346895dbd46ee/html5/thumbnails/31.jpg)
Copyright © 2008 Lippincott Williams & Wilkins.
Drain ManagementDrain Management
• May need home care referral to assist with drain management
• Drains are usually removed when drainage is less than 30 mL in a 24-hour period; usually occurs in 7 to 10 days
• Drain site and incision care
• See Chart 48-8