Transcript breast cancer - 123SeminarsOnly.com

BREAST CANCER:
NURSING CARE PLAN
NURSING ASSESSMENT:
Risk Factors
 Personal/family histories of breast cancer
 Age @ menarche/Age @ menopause (early menses or
late menopause increase risk)
 Symptoms of menopause
 Age @ first child’s birth
 Number of children (nulliparity/birth of first child after
age 30 increase risk)
History of Breast Mass
 Reveals course of disease, health care-seeking practices.
BSE or accidental discovery? Time interval between
discovery and seeking health care provider
 Review of systems focusing on the most common areas
of metastases
Client’s Health Maintenance Practices
 Knowledge, practice and regularity of BSE
 Mammographic history
 Diet history (High alcohol, fat intake increase risk)
 Medications – hormone supplements, birth control pills
PHYSICAL ASSESSMENT:
Focused Assessment of breast mass
 Shape
 Size
 Consistency
 Fixation to surrounding tissues
 Any skin change (peau d’orange)
 Palpate axillary, superclavicular areas for enlarged lymph
nodes
 Pain, soreness?
 Diagram
A firm lump or thickness in breast, usually painless; 50%
are located in the upper outer quadrant of the breast.
 Spontaneous nipple discharge; may be bloody, clear or
serous.
 Asymmetry of the breast may be noted as the patient
changes positions; compare one breast with the other.
 Nipple retraction or scalliness, especially in Paget’s
disease.
 Enlargement of auxiliary or supraclavicular lymph nodes
may indicate metastasis.

PSYCHOSOCIAL ASSESSMENT:
Fear Threats to body image, intimate relationships and
survival
 Decisions regarding treatment options
 Explore client’s feelings, support system, client’s &
family’s knowledge
 Client’s level of education
 Sexuality – psychologic, physiologic, relational
 Evaluate need for additional resources

NURSING DIAGNOSIS:
Anxiety related to diagnosis of breast cancer
Collaborative Problem: Potential for Metastasis
 Anticipatory Grieving r/t loss and possible or impending
death
 Acute Pain r/t tumour compression on nerve endings
 Disturbed Sleep Pattern r/t pain and anxiety
 Disturbed Body Image r/t loss of a body part
 Sexual Dysfunction r/t body image or self-esteem
disturbance

NURSING OBJECTIVE:
Expected Outcomes
 The client will demonstrate the correct method of breast selfexamination (BSE) and practice BSE on a monthly basis
 The client will comply with the guidelines for mammography
and professional examination
 The client will be able to cope with the diagnosis, as shown by
her use of social support, use of information to deal with
uncertainty, absence of physical signs of anxiety and verbal
confirmation of feeling calm
 The client will state that she feels positive about her selfimage
 The client will regain full range of motion of the affected arm
 The client will remain free from lymphedema or infection
NURSING PLANNING:
Anxiety
 Seek information to reduce anxiety
 Control anxiety responses
 Use effective coping strategies throughout the treatment
period
 Participate in decision making
 Discuss concerns
 Learn self-care measures
2. Potential for Metastasis
 The client with breast cancer is expected to remain free
of metastases or recurrence of cancer
1.
NURSING IMPLEMENTATION:
Anxiety
Anxiety Reduction:
 Allow the client to vent her feelings; listen attentively
 Use calm, reassuring approach
 Provide factual information concerning diagnosis, treatment
and prognosis
 Encourage verbalization of feelings, perceptions and fears
 Identify when level of anxiety changes
 Support the use of appropriate defense mechanisms
 Determine client’s decision-making ability
 Flexibility is the key
 Suggest support groups
1.
Potential for Metastasis
Nonsurgical Management:
 Late-stage breast cancer; may be only treatment
possible.
 Tumour removal with local anaesthetic or resection
 F/U with hormonal therapy, chemotherapy, radiation
2.
Surgical Management:
 Halsted radical mastectomy – breast tissue, nipple,
underlying muscles, lymph nodes (rarely performed)
 Modified radical mastectomy – breast tissue, nipple,
lymph nodes
 Simple mastectomy – breast tissue, nipple (lymph
nodes left intact)
 Lumpectomy – only tumour , small amount of
surrounding tissue removed
The nurse provides:
 Preoperative care – psychologic preparation,
preoperative teaching; assess need for drainage tube,
mobility restrictions, length of hospital stay, possibility
of additional therapy; address body image issues
 Intra-operative care – circulator, scrub
 Postoperative care – avoid using affected side for B/P,
injections, blood draws; care of drainage tubes, comfort
measures, client teaching, ambulation, adls, exercise,
Breast Reconstruction
The nurse:
 Assesses incision, flap sites
 Teaches client to avoid pressure flap, suture lines
 Cares for drainage devices
 Teaches client to avoid sleeping in prone position
 Teaches client to avoid contact sports
 Teaches client to minimize pressure to breast during sexual relations
 Teaches client to refrain from driving
 Reassures client that optimal appearance may not occur for 3-6 months
post – surgery
 Reviews BSE procedure
 Reminds client that mammograms should be scheduled at least yearly
for the rest of her life
 Refers to ACS
 Assesses the client’s attitude toward appearance restoration

Adjuvant Therapy:
 F/U with radiation, chemotherapy, hormone therapy;
stem cell therapy; bone marrow therapy
 The nurse knows the specific agents to be used and their
properties; provides care for client before, during, after
procedures
Community-Based Care:
 Home Care Management
Health Teaching – teaching plan should include:
 Measures to optimize body image
 Information to enhance interpersonal relationships
 Exercises to regain full ROM
 Measures to prevent infection of incision
Health Care Resources:
 The nurse makes referrals to community resources
NURSING INTERVENTION:
Monitor for adverse effects of radiation therapy such as
fatigue, sore throat, dry cough, nausea, anorexia.
 Monitor for adverse effects of chemotherapy; bone
marrow suppression, nausea and vomiting, alopecia,
weight gain or loss, fatigue, stomatitis, anxiety, and
depression.
 Realize that a diagnosis of breast cancer is a devastating
emotional shock to the woman. Provide psychological
support to the patient throughout the diagnostic and
treatment process.
 Involve the patient in planning and treatment.
 Describe surgical procedures to alleviate fear.

Prepare the patient for the effects of chemotherapy, and
plan ahead for alopecia, fatigue.
 Administer antiemetics prophylactically, as directed, for
patients receiving chemotherapy.
 Administer I.V. fluids and hyperalimentation as
indicated.
 Help patient identify and use support persons or family
or community.
 Suggest to the patient the psychological interventions
may be necessary for anxiety, depression, or sexual
problems.
 Teach the recommended cancer-screening procedures.

NURSING EVALUATION:

The nurse evaluates the care of the client with breast
cancer on the basis of the identified nursing diagnoses
and collaborative problems.
THANK YOU
BY: SRY INDAH WULAN SARI