Mastectomy Flashcards
Occurance
- Breast cancer is the most common form of cancer in while females over 40
- 1 out of 6 women will develop
Reach to Recovery
- One-to-One pt education program sponsored by American Cancer Society
- Provides emotional support
- Also provides pt’s with information
Surgical Mastectomy Procedures
- Radial Mastectomy
- Modified Radical
- Simple
- Breast conserving surgery may be possible
Radial Mastectomy
- Breast, pectoralis mm, chest fascia and lymph nodes are removed
- Chemotherapy and radiation follow
- Some nerve tissue may be distrubed
Modified Radical
- Breast, chest fascia, and lymph nodes removed
- Pectoralis mm remain intact
- May be followed by radiation and chemotherapy
Simple
- Breast only removed
- Usually followed by radiation which can lead to lymphatic problems
Clinical problems or symptoms
- Post-op Pain
- Lymphedema
- Weakness of the involved UE
- Chest wall adhesions
Post-op Pain
- Incisional
- Posterior cervical and shoulder girdle pain secondary to mm guarding
- Decrease use of UE’s secondary to pain
Incisional
- Can lead to decreased ROM, postural deformities, pulmonary complications
- Healing may be delayed with radiation therapy
Posterior cervical and shoulder girdle pain secondary to mm guarding especially in…
- Levator scapulae
- Teres major and minor
- Infraspinatus
Decrease use of UE’s secondary to pain may lead to..
- Frozen shoulder
- Increased likelihood of lymphedema in the hand and arm
Lymphedema Symptoms
- Increase size of extremity
- Taut skin and increase risk of skin breakdown
- Stiffness and decrease ROM fingers
- Sensory distrubances in hand
- Decrease overall function UE
Weakness with radical mastectomy
- horizontal adductors, scapular protraction. scapular depression and downward rotation, internal rotation, adduction ,extension on fixed hand
Weakness serratus anterior
- due to removal of lymph nodes and/or scarring post radiation therapy causing possible trauma to the thoracic nerve which supplies serratus anterior
There for decrease active ______ and ______ due to decreased stabilization and movement of _______. Can also lead to faulty _______, ______, and increase risk of ______ ________.
- Flexion
- Abduction
- Scapula
- Biomechanics
- Impingement
- Frozen Shoulder
Chest wall adhesion’s secondary to..
- Scarring
- Infection
- Radiation
Chest wall adhesion’s contribute to
- Decrease in function of the involved UE
- Increased risk of post-op pulmonary complications
- Postural Dysfunction
- Pain in neck, shoulder girdle, and upper back
What type of massage is important to chest wall adhesion’s
- Cross fiber massage
Initially prevent..
- Postoperative pulmonary complication’s
- USE
Breathing Ex’s and Effective Coughing
Prevention or minimizing postoperative lymphedema
- Elevation of UE in bed and sitting (ie: sling)
- Wrapping UE with elastic bandages or wearing an elastic pressure-gradient sleeve and/ or glove
- Massage distal to proximal with arm elevated (open nodes 1st)
- Pumping exercises for involved UE
- Daily use of a mechanical pneumatic pump for at least 1 1/2-2 hours twice a day
- Early ROM ex’s and UE ergometry
- Encourage light functional use of involved UE
Prevent Postural Deformities
- Instructions in proper bed positioning preoperatively or on the first postoperative day, emphasize midline and symmetrical positioning of the shoulders and trunk
- Carryover of symmetric posture to sitting and standing
- Postural training with emphasis on scapular retraction and correct posturing
Prevent muscle tension in cervical musculature
- AROM ot cervical spine to promote relaxation
- Scapular mobility and UE ex’s
- Gentle massage to cervical and upper thoracic musculature
Maintain or increase strength in the involved shoulder
- Isometric ex’s to the shoulder musculature, initiated on the first postoperative day with the pt in bed
- Isotonic ex’s may be initiated 3-4 days postoperatively
Improve exercise tolerance, sense of well-being and reduce fatigue
- Graded low intensity ex’s
- Walking, cycling
