Care of Patients with Breast Disorders

Question 1

Excluding skin cancers, breast cancer is one of the most commonly diagnosed cancer in women - one most common cancer deaths in woman; great long-term outcomes/survival outcomes if diagnose and treat early - why imp screen and if issue to take care it
Early detection is the key to effective treatment and survival and very imp for this pat pop

Answer 1

Overview

Question 2

second only to lung cancer as a cause of female cancer deaths

Answer 2

Excluding skin cancers, breast cancer is one of the most commonly diagnosed cancer in women - one most common cancer deaths in woman; great long-term outcomes/survival outcomes if diagnose and treat early - why imp screen and if issue to take care it

Question 3

In young women
In men

Answer 3

Categories of breast cancer

Question 4

4.6% occur in women younger than 40
Number one risk factor is being over age 40; not as likely if younger
If have Genetic predisposition is a stronger risk factor for younger women than older women - occur in younger pop
Frequently present with more aggressive forms of the disease, and the number of cases is increasing
Screening tools are less effective because the breasts are denser because tend have denser breasts when younger

Answer 4

In young women

Question 5

Rare, occurring in fewer than 1% of all cases
Average onset 68 - older
Symptoms: hard, painless, subareolar mass
Gynecomastia (enlarged breast tissue) may be present
Diagnosis frequently delayed - diff diagnose because not thought of in men

Answer 5

In men

Question 6

No known single cause
High increased risk
Modifiable risk factors

Answer 6

Etiology

Question 7

Female gender
Older than 65 - including age 40 but especially 65
Genetic factors
History of a previous breast cancer
Dense breasts
Atypical hyperplasia - if had in past
Exposure to radiation
First child born after age 30 (later in life) or nulliparity
Recent oral contraceptive use/birth control or hormone replacement therapy
Highest risk: age, genetics, prior breast cancer, and density of breasts

Answer 7

High increased risk

Question 8

inherited gene mutations of BRCA1 and/or BRCA 2 - much higher risk for breast cancer

Answer 8

Genetic factors

Question 9

contain more glandular and connective tissue

Answer 9

Dense breasts

Question 10

Avoid weight gain and obesity
Engage in regular physical activity
Minimize alcohol intake
If at high risk try modify if can do this and do screening

Answer 10

Modifiable risk factors

Question 11

Mammography
Breast self-awareness/self-examination
Clinical breast exam
Options for high-risk women

Answer 11

Health promotion and maintenance

Question 12

Common health screening
Annually for women ages 40 and older (can do 1-2 years up to age 50)
MRI should be done in women who have known genetic mutations and/or other high-risk factors - if have high risk factor but typ mammogram is sufficient but if showed anything can do these further scans
Ultrasound is sometimes used - if have high risk factor but typ mammogram is sufficient but if showed anything can do these further scans
Increase risk of surviving breast cancer after diagnose; not decrease risk of it if can catch it early

Answer 12

Mammography

Question 13

Should be done in premenopausal women 1 week after their period
For others, should be done the same day each month
Need to get up in tail of spence where may have tumor/mass; not do instead of CBE and mammogram

Answer 13

Breast self-awareness/self-examination

Question 14

Done by HCP annually
Performed by advanced practice nurses and other health care providers annually

Answer 14

Clinical breast exam

Question 15

Positive for BRCA gene
Prophylactic mastectomy (preventive surgical removal of one or both breasts) - prevent breast cancer; not completely eliminate it because sometimes some breast tissue left
Prophylactic oophorectomy (removal of the ovaries)
Anti-estrogen chemopreventive drugs - counteract estrogen and increased risk can have

Answer 15

Options for high-risk women

Question 16

History
Physical assessment/clinical manifestations
Psychosocial
Lab assessment
Imaging assessment - also used for diagnoste
Breast tissue biopsy is the only definitive way to diagnose breast cancer

Answer 16

Assessment

Question 17

Breast mass
Note any skin changes around the mass
Nipple retraction or ulceration - breast mass present
Assess the adjacent lymph nodes for swelling - in axillary, supraclavicular - most likely metastasis first and see if swelling/inflammation
Pain or soreness - mass will cause this

Answer 17

Physical assessment/clinical manifestations

Question 18

Identify the location by using the “face of the clock” method to identify where mass is
Notices it should Describe the shape, size, and consistency
Breast cancer Mass will be hard and fixed (adhere to surrounding tissue) versus mobile
Big CM

Answer 18

Breast mass

Question 19

Dimpling - pulling on tissue; peau d’orange: invasive breast cancers and adv
Redness and warmth

Answer 19

Note any skin changes around the mass

Question 20

Biopsies:

Answer 20

Lab assessment

Question 21

Pathologic examination of tissue from the breast mass
Diagnostic tool to determine if have breast cancer; biopsy breast tissue and often lymph nodes
Pathologic study of the lymph nodes

Answer 21

Biopsies:

Question 22

Mammography - see if have mass and go to US/MRI
Ultrasonography
MRI
Chest x-ray - eval for metastasis
CT scans - eval for metastasis

Answer 22

Imaging assessment - also used for diagnoste

Question 23

Screen for lung metastases

Answer 23

Chest x-ray - eval for metastasis

Question 24

Screen for bone, liver, and brain metastases and

Answer 24

CT scans - eval for metastasis

Question 25

Ineffective coping related to unanticipated breast cancer diagnosis
Potential for metastasis of cancer to other parts of the body

Answer 25

Priority nursing diagnoses and collaborative probs

Question 26

Develop coping strategies
Decrease the risk for metastasis
Surgical management
Postoperative care
Breast reconstruction
Adjuvant therapy

Answer 26

Interventions

Question 27

Imp esp with new diagnosis with cancer and ongoing treatment
Decrease anxiety
Offer outside resources and offer support
Support pat and fams
Assess need for knowledge

Answer 27

Develop coping strategies

Question 28

Nonsurgical management

Answer 28

Decrease the risk for metastasis

Question 29

Oftentimes do surgery then chemo/radiation in addition - even not gotten + biopsy result from lymph nodes, if type of cancer cell fast growing do this because could have missed it and not biopsy all lymph nodes; not uncommon to surgery then chemo/radiation/therapies
Follow up with adjuvant (in addition to surgery) radiation, chemotherapy, hormone therapy, or targeted therapy
Promote comfort (palliation) for those who cannot have surgery or whose cancer is too advanced - sig metatasis
CAM

Answer 29

Nonsurgical management

Question 30

Meds and treatments - very pop
vitamins, special diets, herbal therapy, prayer, guided imagery, massage, etc
80% of women use some form of CAM during breast cancer treatment, should not be used in place of standard treatment, check for CAM always
check with HCP before using

Answer 30

CAM

Question 31

Preoperative care
Operative procedures - can be intense surgeries; depends on surgeon, oncologist, client; certain postop requirements vary (lymphedema)

Answer 31

Surgical management

Question 32

Imp discuss esp if having mastectomy - talk about changes in that and those associated with it and provide support related to anxiety
Relieve anxiety and provide information to increase patient knowledge
Include the spouse or partner
Address body image issues before surgery

Answer 32

Preoperative care

Question 33

Related to lymphedema as well
Avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood - especially imp for those cut into lymph area because want promote lymphatic fluid from returning and preventing lymphadema; immediately postop not mess with that side
Observe for signs of swelling and infection - any client with breast surgery
Wound care - any client with breast surgery
Drainage tube care - any client with breast surgery
HOB elevated 30 degrees - any client with breast surgery
Elevate arm of affected side on a pillow while awake (promotes lymphatic fluid return) - especially imp for those cut into lymph area because want promote lymphatic fluid from returning and preventing lymphadema; immediately postop not mess with that side
Repositioning - any client with breast surgery
Analgesics - any client with breast surgery

Answer 33

Postoperative care

Question 34

Radiation therapy
Drug therapy
Use depends on:

Answer 34

Adjuvant therapy

Question 35

Chemotherapy, targeted therapy and hormonal therapy

Answer 35

Drug therapy

Question 36

Provider’s and patients decision if do addition of radiation/drug therapy
the stage of the disease
Patient’s age and menopausal status - situation with each client
Patient preferences
Pathologic examination
Hormone receptor status
Presence of a known genetic predisposition

Answer 36

Use depends on:

Question 37

Wound care - imp
Care of drains - always have drain; sometimes go home with them - if do imp talk with them about
No lotions or ointments on affect area/side as healing
No use of deodorant under the affected arm until healing is complete
Observe for infection
Elevate affected arm on a pillow 30 minutes a day for the first 6 months (long time)
Sponge baths or tub baths only until stitches, staples, or drains are removed - not submerge area
Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in almost all women - most likely have this; very common because all nerves cut during surgery
Wear loose fitting clothes - encourage until heal completely
Active range of motion exercises should begin 1 week after surgery or when sutures and drains are removed - not immediately but want start doing ASAP (1 wk postop)

Answer 37

patient/fam teaching post op-masectomy

Question 38

swelling, redness, increased heat, and tenderness

Answer 38

Observe for infection

Question 39

After mastectomy with lymph node dissection

Answer 39

Elevate affected arm on a pillow 30 minutes a day for the first 6 months (long time)

Question 40

Usually resolves within one year

Answer 40

Numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow occurs in almost all women - most likely have this; very common because all nerves cut during surgery

Question 41

Very imp for clients if have lymph node dissection - not do sticks/BP/etc
Lymphedema: Abnormal accumulation of protein fluid in the subcutaneous tissue of the affected limb after a mastectomy
Once it develops, can be difficult to manage, and lifelong measures must be taken to prevent it and reverse it; may have wear sleeves for rest of their lives; want avoid if can so not have deal with it
Symptoms:
Prevention:

Answer 41

Prevention of lymphedema - Patient teaching lymphedema

Question 42

sensation of heaviness, aching, fatigue, numbness, tingling and/or swelling in the affected arm, as well as swelling in the upper chest - feel uncomfy - sleeves compress that - prevent so best for can

Answer 42

Symptoms:

Question 43

Avoid blood pressure measurements, injections in, or blood drawn from the affected side - where sticking into vessels of affected side
Wear a mitt when using the oven - protecting side
Wear gloves when gardening
Treats cuts and scrapes
Elevate arm when possible
Measures are lifelong
Referral to a specialist may be necessary - if do have issues lymphedema OT typ go see

Answer 43

Prevention: