Chapter 48 Management of Clients with Breast Disorders

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Etiology and Risk Factors of Breast Cancer in Women

Age and ethnicity Ovarian and hormonal function Benign breast disease Family history Environmental and dietary factors Health promotion activities

Long-Term Surveillance Chemoprevention Prophylactic Mastectomy

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Pathophysiology of Breast Cancer in Women

Carcinoma in situ

Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS) Infiltrating Ductal Carcinomas Infiltrating Lobular Carcinomas

Invasive Cancer

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Diagnostic Evaluation

Breast Self Exam (BSE) Mammography US and MRI

Procedures For Tissue Analysis

Fine needle aspiration Stereotactic needleguided biopsy Ultrasound core biopsy Open biopsy
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Staging and Prognosis

Tumor node metastasis (TNM) staging Prognosis depends on:

HER-2 gene

Size of the primary tumor Extent of axillary lymph node involvement Extension to the chest wall or skin Presence of distant metastasis

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Benign Conditions of the Breast

Breast Pain Cysts Fibrocystic breast Benign Proliferative Breast Disease Atypical Hyperplasia Lobular Carcinoma in Situ

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Breast-Preserving

Indications

Stages I and II breast cancers

Contraindications

Cannot tolerate radiation Extensive intraductal involvement Presence of two cancers in the same breast

Complications

Infection, cellulitis, hematoma, and/or lymphedema

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Mastectomy

Modified Radical Mastectomy Total (Simple) Mastectomy Breast Conservation Treatment Indications Axillary Dissection

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Nursing Management

Preoperative

Reinforce physicians instructions Encourage client to express feeling

Postoperative

Assess the flap or breast area for color, temperature, and capillary refill Education

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Radiation Therapy

Indications

Stage I or II cancer Poor surgical candidates After mastectomy with positive margins Positive axillary nodes

With chemotherapy for early stage Administration

External beam Brachytherapy Iridium implants

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Side Effects of Radiation Therapy

Temporary skin changes Moist desquamation Fatigue Dry throat Pneumonitis Arm edema Increased susceptibility to rib fracture Dosing issues
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Systemic Chemotherapy

Localized breast cancer

Stages I and II Local surgical intervention Combination therapy Plan is tumor size dependent

Advanced localized breast cancer

Stage III Preoperative chemotherapy Surgery and radiotherapy

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Reconstructive Breast Surgery

Reduction Mammoplasty Augmentation Mammoplasty Mastopexy

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Breast Cancer Self-Care Post-Op

Exercises (1491) Reach for Recovery Breast Prosthesis Quality of Life Gerontology Reconstruction

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Breast Cancer in Men

Etiology and risk factors Symptoms Treatment

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Nursing Diagnosis, Outcomes, and Interventions

Nursing diagnosis

Deficient Knowledge related to inexperience and new information regarding options for treatment Understanding of treatment options Explain options Initiate teaching plan

Outcomes

Interventions

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Nursing Diagnosis, Outcomes, and Interventions

Nursing diagnosis

Ineffective Coping and Compromised Family Coping related to diagnosis of cancer and surgical changes in breast Client will cope with diagnosis and surgical changes in the breast Assess and identify coping mechanisms

Outcomes

Interventions

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Nursing Diagnosis, Outcomes, and Interventions

Nursing diagnosis

Disturbed Body Image related to impending changes in breast and sexuality

Exhibit positive body image Initiate referral Assess coping strategies Explore body image concerns

Outcomes

Interventions

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Nursing Diagnosis, Outcomes, and Interventions

Nursing diagnosis

Risk for Impaired Skin Integrity related to surgery or radiation therapy Client will remain free of impairment in skin integrity Provide and explain dressing and drain care Prevent skin complications

Outcomes

Interventions

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Nursing Diagnosis, Outcomes, and Interventions

Nursing diagnosis

Risk for Injury related to increased risk of infection and lymphedema secondary to axillary node dissection
Client will not experience injury

Outcomes

Interventions

Prevent lymphedema, teach arm exercises Administer antibiotics Promote self-care

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Nursing Diagnosis, Outcomes, and Interventions

Nursing diagnosis

Effective Therapeutic Regimen Management related to chemotherapy and radiation therapy Client will understand the purpose and goals of chemotherapy and radiation therapy Education

Outcomes

Interventions

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Nursing Diagnosis, Outcomes, and Interventions

Nursing diagnosis

Imbalanced Nutrition: Less Than Body Requirements related to nausea, vomiting, and stomatitis, secondary to chemotherapy Client will maintain adequate nutrition Provide oral hygiene Prevent nausea and vomiting

Outcomes

Interventions

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Breast Cancer Self-Care

Lifelong surveillance Promote acceptance of body image Inform of outside resources Knowledge of recurrence

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