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LSC Ch 73 Breast Prb
LSC Nursing
| Question | Answer |
|---|---|
| Fibroadenoma | Most common benign lesion, teenagers to 30's, oval freely mobile and rubbery, enlarges during pregnancy, symptoms resolve after menopause |
| Fibrocystic Breast | Imbalance estrogen/progesterone, Lobes, Ducts, Stromal(fibrous) tissues, 1st stage: premenstrual bilat tenderness, 2nd stage: bilateral multicentric nodules, 3rd stage: micro & macroscopic cysts |
| Interventions/Treatment for Fibrocystic Breast | US & Needle aspiration to reduce pressure, Mammogram check for Cancer, Oral BCP's suppress estrogen, decrease salt intake, hot pads or ice comfort |
| Ductal Ectasia | as approaching menopause, ductal dialation, walls thicken, duct blocks, nipple d/c, redness & edema over site, needle bx r/o cancer, skin orange peel appearance, warm compresses & antibiotics, surgical removal palpable mass |
| Intraductal papilloma | 35-40yrs, papilloma blocks duct, bloody or serous nipple d/c, no mass palpable, R/O breast Ca |
| Large Breasted Women | difficulty finding clothing to fit, out of proportion, expensive bras, straps cause dents in shoulders, fungal infections dvlp under breasts, pick them up, clean, & dry!, back problems, can affect breast feeding, Breast Reduction Mammoplasty Insurance cov |
| Small breasted Women | Breast Augmentation, Ins. doesn't pay- cosmetic procedure |
| Saline implants | placed behind chest muscle wall, graudally expand by adding saline to implant, if leaks- can be absorbed |
| Silicone Implants | Elastic gel-filled, if leaks, cannot be absorbed |
| Surgical Info for Breast Augmentation | Avoid Smoking, NSAIDs, Herbs (garlic, ginko biloba, ginsen), incision hidden, 1-2 drains, risk infection and leakage, expect chest soreness, breasts feel tight & sensative, warm, may itch, don't lift, pull, push, raise hands over head, |
| Gynecomastia | Breast enlargement in Men, Not normal aging, May be from metastatic CA Lung or testicular, anti-androgen & corticosteroids, malnutrition, kidney disease, alcoholism, liver disease, hypothyroidism, obesity |
| Non Invasive Breast Cancer | Ductal Carcinoma in situ: most common, may become invasive if not treated, Lobular Carcinoma In Situ: most often becomes invasive, not easily dx, even w/mammo |
| Invasive Breast Cancer | Infiltrationg Ductal Carcinoma: Palpable, Inflammatory: Orange peel Appearance, Most Malignant, Metastasis Sites: bones, lungs, brain, liver |
| Men Risks For Breast Cancer | <1%, Age >60, w/genetic mutation, hard, painless, irm subareolar mass, gynecomastia, nipple d/c, detected late |
| Young Women Risk Breast Cancer | <40, more aggressive forms, Screening more difficult, If treated, may have infertility |
| High Increased Risk | Females, Age >65, genetics, Family Hx, Hx, of previous breast cancer, breast density-denser breasts contain more glandular & connective tissue |
| Moderate Increased Risk | Family Hx, Bx confirmed, recieved ionizing radiation, high postmenopausal bone density |
| Low Increased Risk | Reporductive Hx (null or first child born after 30), menstraul hx- early menstration or late menopause, oral BCPs, HRT, Obesity |
| Other Risk Factors: | Alcohol, High socioeconomic status, Jewish heritage |
| BSE (Breast Self Exam) | Early detection, Palpation Teaching, Techniques: Need to know what breast normally feels like, thickening can be normal, stand in front of mirror: inspect, note dimpling, retraction, or areolar dimpling,raise arms up over head, lyingdown/standing up, fing |
| Assesing a breast mass | ID location of mass using face of clock method, describe shape, size, consistency, of mass, assess ifi t is fixed or movable, note skin changings, assess lymph nodes, any pain or soreness |
| Lab Results for Breast Cancer | Elevated Liver Enzymes & Se Calcium & Alkaline Phosphatase-bone elevated |
| Nursing Dx for Breast Ca | Ineffective coping, Anticipatory grieving, acute pain-tumor compression, distured sleeping pattern, disturbed body image, sexual dysfuction r/t surgery |
| Breast Conserving | Part of the breast removed, followed by rad, remove tumor & obtain clear margins, Lumpectomy: wide excision, Partial/Segmental Mastectomy, same day proc |
| Modified Radical Mastectomy | Breast completly removed, pectoral muscles remain, reconstruction: Plastic surgeon guides location of incisions, recon done at same time |
| POST OP Care after Mastectomy | Arm on surgical side- no blood draws, no bp, support on pillow Jackson Pratt Drains- gentle suction, removes fluids that impair healing, monitor for signs of infection, swelling, exercise-don't stress incision, squeeze soft ball,flex/extend elbow |
| Post Op care w/breast reconstruction | lessens psychological strain of mastect, can use implants or autologus recon, |
| TRAM Flap | blood supply from abdomen muscle is tunneled to breast site, compression type dressing |
| Adjunct Therapy Post OP | Based on: stage of disease, pathologic exam, hormone receptor status, Radiation tx, Chemo, HRT, Serum tumor antigens monitored to determine response to tx: Rise when there is still CA, Lower when tx is working |
| CHEMOTHERAPY | For Stage II or Higher: Dose dense chemo-more frequent dosing shorter intervals |
| Adjunct Therapy Post OP | Based on: stage of disease, pathologic exam, hormone receptor status, Radiation tx, Chemo, HRT, Serum tumor antigens monitored to determine response to tx: Rise when there is still CA, Lower when tx is working |
| CHEMOTHERAPY | For Stage II or Higher: Dose dense chemo-more frequent dosing shorter intervals |
| Chemotherapy Agents | Cytoxin, Adriamycin, 5-FU; Taxane combos: metatastic disease, SE: INFERTILITY and systemic SE |
| Targeted Therapy | Monoclonal antibody tratuzumab (HER2-gene) Herceptin, Bevacizumab (Avistan) stops new blood vessels that feed tumor SE Cardiac |
| LH-RH Agonists | Prevent Ovarian release of estrogen |
| Selective Estrogen Receptor Modulators (SERMS) | Estrogen Receptor breast CA, Take for 5 yrs after surgery/tx, Tamoxifen (Nolvadex) or Raloxifene (Evista) SE: Hot flashes & Wt Gain |
| Aromatase Inhibitors | Post menopausal women, Inhibits conversion of androgen to estrogen, give w/tamoxifen in post menopausal women, SE: Loss of bone density/Osteoporosis |
| Second Line Therapy | Post Menopausal Women, Fulvestrant (Faslodex) when other hormonal tx stop working |
| Stem Cell Transplantation | Option for those at high risk for reoccurance |
| Post Op Care after Breast Reconstruction | Monitor site and flap for infection during dressing changes, poor tissue perfusion (duskiness decreased cap refill), avoid pressure on flap & sutures, position pt on non-op side, monitor drainiage collec., opt appearance up to 3-6months |
| Patient & Family Education after Breast Reconstruction | change dressing if it becomes soiled, some leakage is norm from drainage site, if a lot notify physician, empty drains 2x/day and measure, drains removed when drainage is <25mL/24hrs 7-10days after surgery, numbness is normal from the inner side of arm |
| Health Teaching: Infection | Infection: Redness, swelling are normal 1st 2 weeks. If symptoms increase w/increased heat & tenderness, possible infection |
| Lymph Node Dissection | Elevate arm 30min/day first 6 months, avoid lymphodema: keep arm up more during night, compression sock for arm, loose fitting bra or just a t-shirt |
| Arm Exercises | 1 wk after surgery, reaching and stretching only to point of pain or pulling, exercise in water |
| AVOID Lymphedema and Infection in arm | Protect arm and hand, wear glove/mitt when using oven/gardening, treat cuts and scrapes promptly, if lymphedema occurs, Elevatie arm to promote drainage, prevention is easier than treating once developed |
Created by:
ginabeana
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