Nursing+Management+&+Process


 * [[image:breastcancer12.jpg]]

Nursing Management**


 * Assessment**

**Important health Information –**Past health history: Benign breast disease with atypical changes; previous unilateral breast cancer; menstrual history (early menarche with late menopause); pregnancy history (nullparity or first full-term pregnancy after age 30); previous endometrial, ovarian, or colon cancer; hyperestrogenism and testicular atrophy (in men). **Health perception-health management:** Family history of breast cancer (especially mother or sister); positive mammography history; palpable change found on BSE; alcohol us **General:** Auxiliary and supraclavicular lymphadenopathy Pleural infusions (possible indicator of metastasis)
 * Subjective data: **
 * Medications** – Use of hormones, especially as postmenopausal hormone replacement therapy and in oral contraceptives, infertility treatments
 * Surgery or other treatments:** Exposure to excessive radiation (e.g., lymphoma or thyroid radiation)
 * Functional Health Patterns: **
 * Nutritional-metabolic:** Obesity; anorexia (possible indicator of metastasis); dietary habits
 * Cognitive-perceptual;** Headache, back, arm, or bone pain (possible indicators of metastasis)
 * Sexuality-reproductive;** unilateral nipple discharge (lear, milky or bloody); change in breast contour, siz or symmetry
 * Coping-stress tolerance;** Psychologic stress
 * Self-perception-self-concept:** Anxiety regarding threat to self-esteem
 * Physical activity;** Level of usual activity
 * Objective Data: **
 * Integumentary**: Firm, discrete nodules at mastectomy site (possible indicator of local recurrence); peripheral edema (possible indicatory of metastasis)
 * Respiratory:** Pleural effusions (possible indicator of metastasis)
 * Gastrointestinal-**Hepatomegaly, jaundice; ascites (possible indicators of liver metastasis)
 * Reproductive-**Hard, irregular, nonmobile breast lump most often in upper, outer sector, possible fixated to fascia or chest wall; nipple inversion or retraction, erosion; edema (“orange peel”) erythema, induration, infiltration, or dimpling (in later stages)
 * Possible Findings-**Finding of mass or change in tissue on breast examination; positive results of mammography or ultrasonography; positive results of FNA or surgical biopsy or similar results with needle biopsy.
 * Diagnoses **
 * Decisional conflict
 * Fear
 * Distrubed body image
 * Acute pain
 * Anxiety
 * Ineffective therapeutic regimen management
 * Impaired physical mobility
 * Risk for injury

The time between the diagnosis of breast cancer and the selection of a treatment plan is a difficult period for the woman and her family. Although the primary care provider discusses treatment options, the woman often relies on the nurse to clarify and expand on these options. ·  Appropriate nursing interventions during the period include exploring the woman’s usual decision-making patterns, helping the woman accurately evaluate the advantages and disadvantages of the options, providing information relevant to the decision, and supporting the patient once a decision is made. ·  Regardless of the surgery planned, the patient needs to be provided with sufficient information to ensure informed consent. Teaching in the preoperative phase includes instruction in turning and deep breathing, a review of postoperative exercises, and an explanation of the recovery period from the time of surgery until discharge. The woman who has breast conservation surgery usually has an uneventful postoperative course with only a moderate amount of pain. The woman who has had a modified radical mastectomy needs nursing interventions specific to this surgery.  -    Restoring arm function on the affected side after mastectomy and axillary lymph node dissection is an important goal.  -    The woman should be placed in semi-Fowler’s position with the arm on the affected side elevated on a pillow. Flexing and extending the fingers should begin in the recovery room, with progressive increases in activity.  -    Post operative arm and shoulder exercises are instituted gradually at the surgeon’s direction.  -    Postoperative discomfort can be minimized by administering analgesics about 30 minutes before initiating exercises. When showering is appropriate, warm water running over the involved shoulder often has a soothing effect and reduces joint stiffness. Whenever possible, the same nurse should work with the woman so that progress can be monitored. //Lymphedema (//accumulation of lymph in soft tissue) can occur as a result of excision or radiation of the lymph nodes. The patient may experience heaviness, pain, impaired motor function in the arm, and numbness and paresthesia of the fingers. The patient must understand that she is at risk of developing lymphedema for the rest of her life. Measures to prevent or reduce lymphedema must be taught including:  -    The affected arm should never be dependent, even while the person is sleeping.  -    Blood pressure readings, venipunctures, and injections should not be done on the affected arm.  -    The woman must be instructed to protect the arm on the operative side from even minor trauma such as a pinprick or sunburn.  -    If trauma to the arm occurs, the area should be washed thoroughly with soap and water, and a topical antibiotic ointment and bandage should be applied.  -    Frequent and sustained elevation of the arm, regular use of a custom-fitted pressure sleeve, and treatment with an inflatable sleeve may also be helpful. Throughout interactions the nurse must keep in mind the extensive psychologic impact of the disease. All aspects of care must include sensitivity to the woman’s efforts to cope with a life-threatening disease. The nurse can help meet the woman’s psychological needs by doing the following:  -    Assisting her to develop a positive but realistic attitude  -    Helping identify sources of support and strength to her, such as her partner, family, and spiritual practices  -    Encouraging her to verbalize anger and fears about her diagnosis  -    Promoting open communication of thoughts and feelings between the patient and her family  -    Providing accurate and complete answers to questions about the disease, treatment options, and reproductive or lactation issues (if appropriate)  -    Offering information about community resources, such as Reach to Recovery, Y-ME, Can Surmount, Encore, and local support organizations and groups
 * Interventions**

 -     The nurse should emphasize the importance of an annual mammography and breast self-awareness. Future symptoms that should be reported to the clinician include new back pain, weakness, constipation, shortness of breath and confusion. The nurse should stress the importance of wearing a well-fitting prosthesis designed for women who have had a mastectomy. <span style="mso-fareast-font-family: Calibri; mso-ascii-font-family: Calibri; mso-hansi-font-family: Calibri; mso-bidi-font-family: Calibri;"> -    A preoperative sexual assessment provides baseline data that the nurse can use to plan postoperative interventions. Often, the husband, sexual partner, or family members may need assistance in dealing with their emotional reactions to the diagnosis and surgery so that they can act as effective means of support for the patient. <span style="mso-fareast-font-family: Calibri; mso-ascii-font-family: Calibri; mso-hansi-font-family: Calibri; mso-bidi-font-family: Calibri;"> -    Depression may occur with the continued stress of a cancer diagnosis. Special nursing interventions are necessary for both psychological support and self-care teaching if a recurrence is found.
 * Patient and family Teaching **