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Med Surg II > Exam 2 - Breast Cancer > Flashcards

Exam 2 - Breast Cancer Flashcards

1
Q

General screening education

A

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

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2
Q

Mammography education

A 
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
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3
Q

Galactography education

A

Injection of agent into ductal opening on areola then followed by mammogram

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4
Q

Ultrasound education

A

Helps distinguish fluid-filled cysts from other lesions

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5
Q

MRI education

A

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

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6
Q

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

A

Chemotherapy

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7
Q

Chemotherapy meds -Used in pts with heart issues and have high risk of cardiac toxicity
generally well tolerated

A

Cytoxan, Trexall, Fluroplex (CMF)

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8
Q

Chemotherapy meds - decreased death rates

A

Anthracycline-based regimens (Adriamycin, Ellence)

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9
Q

Chemotherapy meds used in higher risk pts

A

Combination therapies - CAF or AC

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10
Q

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

A

Taxanes (Taxol, Taxotere)

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11
Q

Chemotherapy meds - administration of chemotherapeutic agents at standard doses with shorter time intervals between each treatment show better survival rates

A

Dose-dense chemotherapy

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12
Q

Side effects of chemotherapy

A

N/v, bone marrow suppression, taste changes, alopecia, mucositis, neuropathy, skin changes, fatigue, amenorrhea

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13
Q

Nursing considerations with chemotherapy

A

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

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14
Q

Hematopoietic growth factors to boost WBC count and prevent infection

A

Neupogen (given SQ 7-10 days after chemo)

Neulasta (given 24 hrs after, lasts longer)

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15
Q

Hematopoietic growth factors to boost RBC

A

Epogen (given weekly)

Aransep (given q2-3 weeks, longer acting)

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16
Q

What should breast cancer pts avoid?

A

Meds with estrogen and progesterone

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17
Q

Example of hormone therapy - SERMS

A

Tamoxifen

18
Q

Example of hormone therapy - aromatase inhibitors

A

Arimidex, Femara, Aromasin

19
Q

WHat does herceptin do? (targeted therapy)

A

Slows tumor growth

20
Q

Adverse reactions of target therapy

A

Fever, chills, n/v, diarrhea, headache

21
Q

Examples of pain meds that pts are discharged home with

A

Percocet

Darvocet

22
Q

What should you teach pts about pain?

A

May have increased pain after a couple days but terrible pain needs to be assessed

23
Q

Common postoperative sensations

A

Tenderness, soreness, numbness, tightness, pulling, twinges, phantom sensations

24
Q

How do you promote positive body image?

A

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

25
Q

How do you improve sexual function?

A

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

26
Q

Risk factors for lymphedema

A 
Increased age
Obesity
Presence of extensive axillary disease
Radiation treatment
Injury or infection to extremity
27
Q

Interventions for lymphedema

A

Exercises
Elevate arm above the heart
Gentle muscle pumping
Prevent trauma to site

28
Q

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

A

Lymphedema

29
Q

Treatment for lymphedema

A

Antibiotics, referral, compression sleeves, exercise, manual lymph drainage

30
Q

When does hematoma usually occur?

A

within first 12 hours after surgery

31
Q

Sx of hematoma

A

Swelling, tightness, pain, bruising of the skin

32
Q

Treatments for hematoma

A

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

33
Q

May accumulate under breast incision after surgery
Sx - swelling, heaviness, discomfort, sloshing of fluid
Could lead to infection if not aspirated!

A

Serotoma

34
Q

Risk is higher in pts with diabetes, immune disorders, and advanced age

A

Infection

35
Q

When can drainage tubes be removed?

A

When output is less than 30 mL a day for 7-10 days

36
Q

When can the pt shower after surgery?

A

2nd day post op using water and gentle soap - but if immediate reconstruction took place, don’t shower until drain is removed

37
Q

Teach pt to do ROMs how often?

A

20 mins at a time until full ROM is restored

Might need to take analgesic 30 min prior to starting

38
Q

When should the pt follow up?

A

Every 3-6 months

39
Q

Staging - tumors are 2 cm or less with no involvement of axillary lymph nodes

A

Stage I

40
Q

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

A

Stages II and III

41
Q

Staging - tumors of any size, with distant metastases

A

Stage IV

42
Q

Staging - DCIS, LCIS, or Padgett’s

A

Stage 0

Med Surg II (17 decks)

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