Exam 2 - Breast Cancer Flashcards
General screening education
Best performed after period
Breasts become easier to examine with age
Screening should begin in early 20s
Education should also be provided to men
Person should understand their own abnormalities
If pt has had/does have breast cancer, need to perform self-examinations to monitor for recurrence
Mammography education
Takes 15 min Easier on older woman d/t denser breasts Small radiation exposure Should have done annually at 40yoa Begin screening 10 years earlier than the age of the youngest person in your family that developed breast cancer if genetically prone
Galactography education
Injection of agent into ductal opening on areola then followed by mammogram
Ultrasound education
Helps distinguish fluid-filled cysts from other lesions
MRI education
detailed images w/o exposure to radiation
Takes 30-40 min
Good for assessing multifocal or multicentric diseases
Now recommending that high risk women get MRI and mammogram
Can delay or prevent recurrence of cancer
Used in positive lymph nodes or who have invasive tumors greater than 1 cm in size, tumors sized at 0.6 to 1.0 cm
Started after surgery and before radiation
Chemotherapy
Chemotherapy meds -Used in pts with heart issues and have high risk of cardiac toxicity
generally well tolerated
Cytoxan, Trexall, Fluroplex (CMF)
Chemotherapy meds - decreased death rates
Anthracycline-based regimens (Adriamycin, Ellence)
Chemotherapy meds used in higher risk pts
Combination therapies - CAF or AC
Chemotherapy meds - incorporated into regimens with pts who have larger node-negative cancers and those with positive axillary lymph nodes
Four cycles of Taxol after AC regimen has been found to increase disease-free period and improve survival
Taxanes (Taxol, Taxotere)
Chemotherapy meds - administration of chemotherapeutic agents at standard doses with shorter time intervals between each treatment show better survival rates
Dose-dense chemotherapy
Side effects of chemotherapy
N/v, bone marrow suppression, taste changes, alopecia, mucositis, neuropathy, skin changes, fatigue, amenorrhea
Nursing considerations with chemotherapy
Give antiemetics
Hematopoietic growth factors to fight neutropenia and anemia
Obtain a wig before hair loss sets in and teach that hair will grow back when treatment is finished
Hematopoietic growth factors to boost WBC count and prevent infection
Neupogen (given SQ 7-10 days after chemo)
Neulasta (given 24 hrs after, lasts longer)
Hematopoietic growth factors to boost RBC
Epogen (given weekly)
Aransep (given q2-3 weeks, longer acting)
What should breast cancer pts avoid?
Meds with estrogen and progesterone
Example of hormone therapy - SERMS
Tamoxifen
Example of hormone therapy - aromatase inhibitors
Arimidex, Femara, Aromasin
WHat does herceptin do? (targeted therapy)
Slows tumor growth
Adverse reactions of target therapy
Fever, chills, n/v, diarrhea, headache
Examples of pain meds that pts are discharged home with
Percocet
Darvocet
What should you teach pts about pain?
May have increased pain after a couple days but terrible pain needs to be assessed
Common postoperative sensations
Tenderness, soreness, numbness, tightness, pulling, twinges, phantom sensations
How do you promote positive body image?
Make sure first look is with someone who can provide support
First assess level of readiness and provide gentle encouragement
Provide privacy
Allow expression of feelings and reassure normalcy
May provide fake breast for discharge
How do you improve sexual function?
After discharge, most can have sex but change in body image and self-esteem could hinder this
Address partner’s concerns
Encourage her to talk about it
Teach her to have sex when she has energy, use comfortable positions, and have other means of intimacy
Risk factors for lymphedema
Increased age Obesity Presence of extensive axillary disease Radiation treatment Injury or infection to extremity
Interventions for lymphedema
Exercises
Elevate arm above the heart
Gentle muscle pumping
Prevent trauma to site
Occurs if functioning channels are inadequate to ensure a return flow of fluid to the general circulation. Edema occurs until the body’s collateral circulation has taken over, usually within a month
Lymphedema
Treatment for lymphedema
Antibiotics, referral, compression sleeves, exercise, manual lymph drainage
When does hematoma usually occur?
within first 12 hours after surgery
Sx of hematoma
Swelling, tightness, pain, bruising of the skin
Treatments for hematoma
Compression wrap may be applied for 12 hours if gross swelling or excessive drainage
Incision done to identify location of bleeding
Take warm showers or apply warm compresses
Should resolve in 2-5 weeks
May accumulate under breast incision after surgery
Sx - swelling, heaviness, discomfort, sloshing of fluid
Could lead to infection if not aspirated!
Serotoma
Risk is higher in pts with diabetes, immune disorders, and advanced age
Infection
When can drainage tubes be removed?
When output is less than 30 mL a day for 7-10 days
When can the pt shower after surgery?
2nd day post op using water and gentle soap - but if immediate reconstruction took place, don’t shower until drain is removed
Teach pt to do ROMs how often?
20 mins at a time until full ROM is restored
Might need to take analgesic 30 min prior to starting
When should the pt follow up?
Every 3-6 months
Staging - tumors are 2 cm or less with no involvement of axillary lymph nodes
Stage I
Difficult to differentiate these stages because factors include the numbe rand characteristics of axillary lymph nodes, status of other regional lymph nodes, and presence or absence of involvement of skin or underlying muscle
Stages II and III
Staging - tumors of any size, with distant metastases
Stage IV
Staging - DCIS, LCIS, or Padgett’s
Stage 0
