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NSG 320 (mcp) > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

Breast cancer is the ___ leading cause of death.
What cells are affected?

What is key for increased survival?

A

4th leading cause of death

Epi cells surrounding mammary ducts or lobules

EARLY DETECTION
- increases survival when it’s localized.

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2
Q

Which population tends to have worse outcomes?

A

African American AFABs

  • Diagnosed later
  • Worse outcomes

Multifactorial; health disparities

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3
Q

3 Categories of Breast Cancer:

technically only 2…

A
  1. Noninvasive (20%): w/in duct
  2. Invasive (80%): duct + tissue
  3. Metastasized: bone, liver, lung, brain
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4
Q

5 Types of Breast Cancer:

Which type is non-invasive?

Which isn’t a “true” cancer?

A
  1. Ductal Carcinoma in Situ → non-invasive
  2. Lobular Carcinoma in Situ → not “true” CA
  3. Infiltrating Ductal Carcinoma
  4. Inflammatory Breast cancer
  5. Triple-negative breast cancer
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5
Q

Types of Breast Cancer:

Ductal Carcinoma in Situ

A

Early, non-invasive breast cancer

About 14-50% of these cases will become invasive if left untreated

Lack Biologic capacity to metastasize

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6
Q

Types of Breast Cancer:
Lobular Carcinoma in Situ

Typical age of diagnosis?

A

Rare cancer that begins in the lobules
- Not a “true” cancer → CAN’T spread

Increases the chance that breast cancer will develop later

Typically diagnosed at 40-50

Observation?? (don’t know what she meant..)

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7
Q

Types of Breast Cancer:
Infiltrating Ductal Carcinoma

Presentation?

What defining characteristics occur late in disease?

A

Starts in mammary ducts and epithelial cells lining the ducts then grow into tissue in an irregular pattern.

Presentation:
-Felt as a poorly defined, irregular lump

Late in Disease:

  • Fibrosis will develop around lump (dimpling)
  • Peau D’Orange due to edema can develop later in disease also
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8
Q

Types of Breast Cancer:
Inflammatory Breast cancer

Diagnosis?

Presentation?

A

Invasive; Highly aggressive

Typically diagnosed later in disease
May not show up on a mammogram

Presentation:

  • No palpable lump
  • Redness, Swelling, Pain
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9
Q

Types of Breast Cancer:
Triple-negative breast cancer

What risk factors are associated with this?

What population is at a higher risk of developing this?

A 
Invasive; Highly Aggressive
Lacks receptors typical to Breast Cancer
  - No estrogen receptor
  - No progesterone receptor
  - No human epidermal growth factor 21

Risk factors:
BRCA positive + Pre-menopausal

African American Women are at higher risk compared to other races

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10
Q

What % of breast cancer is associated with males?

Issues?

Presentation?

A

<1%
Diagnosis often delayed → worse outcomes

Presentation:
hard, painless lump; Sub-areolar
With or Without gynecomastia

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11
Q

Breast Cancer + Risk Factors

Non-environmental

A
  1. Gender
    - 99% AFAB
  2. Age
    - 95% of cases >40 yrs
  3. Genetics (BRCA-1 or BRCA-2)
    - 1st Degree relative (sister, mom, daughter)
  4. Bone density
    - Increased bone density increases risk
  5. Early menstruation or Late menopause
  6. Atypical hyperplasia
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12
Q

Breast Cancer + Risk Factors

Environmental

A
  1. Alcohol
  2. Obesity
  3. Hormone Replacement Therapy (HRT)
  4. Oral Contraceptics w/ Estrogen
  5. Null Parity
  6. Radiation exposure
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13
Q

Breast Cancer + Screening
What’s the test?

What age is recommended for screening with no risk factors?

A

Mammogram

AFAB >40 years for AVERAGE RISK

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14
Q

Breast Cancer + Screening

At what age should screening be done annually?

A

AFAB >50 years

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15
Q

Breast Cancer + Screening
At what age should screening be done for people with a 1st degree relative with breast cancer or gene mutation?

How often?

Does testing differ?

A

Screened 10 years before their 1st-degree relative developed breast cancerANNUALLY

Mammogram + MRI (& ultrasound?)

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16
Q

Breast Cancer + Screening

When should Self-Breast exams (SBEs) be done and what’s important to know?

A

Assess at the same time every month

KNOW YOUR NORMAL
- Some lumps are normal
- Report changes
→ schedule a Provider Breast Exam

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17
Q

Breast Cancer + Diagnosis
What tests are used for diagnosis?

What confirmation test is used if a mass is identified?

A

Diagnostic mammogram =
mammogram + ultrasound

Biopsy

18
Q

Breast Cancer + Diagnosis

What other tests are used for Diagnosis?

A
  1. Liver enzymes (ALT, AST, AlkP)
  2. Calcium levels
  3. Breast tomosynthesis
  4. CXR
19
Q

Breast Cancer + Prevention

What type of prevention do we implement for High-risk people? (4)

A

For pts w/ BRCA-1/BRCA-2 gene mutation

Secondary prevention:

  1. Annual mammograms & MRI
  2. Clinical breast exams
  3. Prophylactic mastectomy/oophorectomy
  4. Anti-Estrogen chemotherapeutic agents
20
Q 
Breast Cancer + Assessment
Patient History (3)
A
  1. Identify Risk factors
  2. Identify any Breast mass
  3. Health Maintenance
21
Q

Breast Cancer + Physical Assessment

What technique is used for a Clinical Brest exam performed by an AP?

A

”face of the clock” method for lump location

22
Q

Breast Cancer + Physical Assessment

What 3 broad things are we looking at?

A
  1. Lump characteristics:
  2. Skin changes
  3. Pain
23
Q 
Breast Cancer + Physical Assessment
Lump characteristics (4)
A
  1. Shape
  2. Size
  3. Consistency
  4. fixed or mobile
24
Q 
Breast Cancer + Physical Assessment
Skin Changes (3)
A
  1. Peau D’orange
  2. Nipple changes
  3. Ulceration
25
Q

Breast Cancer + Interventions

What type of interventions are best?

A

CAM

80% of AFABs use some form of complementary alternative medicine.

26
Q

Breast Cancer + CAM Interventions
What’s important to educate our patients about related to CAM?

Name some CAM therapies:

A

Tell the provider about any and all CAM!

  1. Vitamins
  2. Diet
  3. Herbal Therapy
  4. Massage
  5. Meditation
  6. Acupuncture
27
Q

Breast Cancer + Tx Interventions

Plan is based on _____, _____, and _____.

A

Type, Extent, and Location of possible Mets

28
Q

Breast Cancer + Tx Interventions

4 Types of Treatments:

A
  1. Surgery
  2. Radiation
  3. Chemotherapy
  4. Hormonal therapy
29
Q

Breast Cancer + Tx Interventions

6 Types of Surgery:

A
  1. Lumpectomy
  2. Partial Mastectomy
  3. Total Mastectomy
  4. Radical Mastectomy
    - all breast tissue removed + lymph nodes
  5. Neoadjuvant
  6. Reconstruction
30
Q

Breast Cancer + Surgery

Differentiate b/t Total Mastectomy, Radical Mastectomy, & Neoadjuvant

A

Total → removal of all breast tissue

Radical → removal of all breast tissue + Lymph nodes

Neoadjuvant → removal of all breast tissue & Lymph nodes + Chemo/Radiation

31
Q

Breast Cancer + Post-surgical Interventions:
What should we NOT do r/t the side that had a mastectomy? (2)

What if the patient had a double mastectomy?

What could this put the patient at risk for?

A
  1. No BP readings on affected side
  2. NO venipuncture on affected side

Take BP readings on the LEG

RISK FOR LYMPHEDEMA
(if BP done on the affected side)

32
Q

Breast Cancer + Tx Interventions
What Precautions should we employ r/t mastectomy? (1)

BEST PRACTICE?

A
  1. ADD a SIGN OVER the BED!

BEST PRACTICE:
ASK THE PATIENT!!
AND
EDUCATE them to advocate for themselves

33
Q

Breast Cancer + Post-surgical Interventions

How often do we take VS? (review)

What are we monitoring for?

Drains?

Positioning?

Pain?

A
  1. Vital Signs
    - q15 min for 1st hr →
    - q30 min for next hr →
    - q1 hr for next 12 hrs
  2. Bleeding assessments
  3. Drain care
    - Type of drains that’ll be used
    - Want serosanguinous
    - Monitor for sanguineous
  4. Position
    - Semi-fowlers
  5. Pain Management
    - Multimodal (opioids 1st → then switch)
34
Q

Breast Cancer + Post-surgical Interventions
What type of exercises do we employ?

When do they start active ROM & what Key Teaching do we need to prove?

A

Arm exercises
→ Elbow extension & flexion
→ Squeezing a medicine ball

Active Rom → 1 week post-op

Key teaching:
Don’t perform active ROM to the point that it HURTS!!

35
Q

Breast Cancer + Post-surgical Interventions

Home care Patient Teaching

A
  1. Activity restrictions
  2. NO lotion or deodorant (sorry, you gotta stank for awhile)
  3. NO elevating arm above the head!
  4. ENCORE referral (YMCA)
  5. Lymphedema teachings→
36
Q

Breast Cancer + Post-surgical Interventions

Activity nursing considerations (3)

A
  1. Walking :)
  2. Incentive spirometer
  3. CONSULT W/ PT!!
37
Q

Breast Cancer + Post-surgical Interventions

What increases the risk for Lymphedema? (4)

A
  1. Obesity
  2. Extensive Axillary disease
  3. Infection during recovery
  4. Radiation
38
Q

Breast Cancer + Post-surgical Interventions

Lymphedema Education:

A
  1. Instruct pt that they’ll be aiming to prevent this for the rest of their life… :(
  2. Educate on S/S
    - Feeling of heaviness
    - Aching
    - Numbness, paresthesia (Tingling of arm)
    - Swelling in arm or upper chest
  3. Contact Provider ASAP if S/S occur!!
39
Q

Breast Cancer + Radiation
When would Radiation therapy be employed?

Name the 2 types:

A

5-6 weeks post-surgery

Types:

  1. Whole breast
  2. Partial breast
40
Q

Breast Cancer + Chemotherapy
How and when is this given?

Duration?

A

Central IV Access
Combination Regimen

4-6 week cycles (for 2-3 weeks)

Total treatment time is 3-6 months

41
Q

Breast Cancer + Chemotherapy

Nurse’s Role (3)

A
  1. Administer Chemotherapy
  2. Manage Central Line
  3. Manage symptoms
42
Q

Breast Cancer + Hormonal Therapy
Why is this done?

When can we use this?

What can occur?

A
  1. Reduce Hormones (estrogen, progesterone) available to Cancer
  2. Only for cancers with hormone receptors
    (doesn’t work for triple negative)
  3. Menopausal Symptoms

NSG 320 (mcp) (24 decks)

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