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Chapter 48

Management of Clients with

Breast Disorders

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Etiology and Risk Factors of

Breast Cancer in Women

Age and ethnicity

Ovarian and hormonal function

Benign breast disease

Family history

Environmental and dietary factors

Health promotion activities

Long-Term Surveillance

Chemoprevention

Prophylactic Mastectomy

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Pathophysiology of

Breast Cancer in Women

Carcinoma in situ

Ductal carcinoma in situ (DCIS)

Lobular carcinoma in situ (LCIS)

Invasive Cancer Infiltrating Ductal Carcinomas

Infiltrating Lobular Carcinomas

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Diagnostic Evaluation

Procedures For TissueAnalysis

Breast Self Exam (BSE) Mammography

US and MRI

Fine needle aspiration

Stereotactic needleguided biopsy

Ultrasound core biopsy

Open biopsy

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Staging and Prognosis

Tumor node metastasis (TNM) staging Prognosis depends on:

Size of the primary tumor

Extent of axillary lymph nodeinvolvement

Extension to the chest wall or skin

Presence of distant metastasis

HER-2 gene

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Benign Conditions

of the Breast Breast Pain

Cysts

Fibrocystic breast

Benign Proliferative Breast Disease

Atypical Hyperplasia

Lobular Carcinoma in Situ

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Breast-Preserving

Indications Stages I and II breast cancers

Contraindications Cannot tolerate radiation

Extensive intraductal involvement

Presence of two cancers in the same breast

Complications Infection, cellulitis, hematoma, and/or

lymphedema

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Mastectomy

Modified Radical Mastectomy

Total (Simple) Mastectomy

Breast Conservation Treatment

Indications

Axillary Dissection

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Nursing Management

Preoperative

Reinforce physicians instructions

Encourage client to express feeling

PostoperativeAssess the flap or breast area for color,

temperature, and capillary refill

Education

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Radiation Therapy

Indications Stage I or II cancer

Poor surgical candidates

After mastectomy with positive margins

Positive axillary nodes

With chemotherapy for early stage

Administration

External beam Brachytherapy

Iridium implants

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Side Effects of

Radiation Therapy

Temporary skin changes

Moist desquamation

Fatigue

Dry throat

Pneumonitis

Arm edema

Increased susceptibility to rib fracture

Dosing issues

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Systemic Chemotherapy

Localized breast cancer

Stages I and II

Local surgical intervention

Combination therapy Plan is tumor size dependent

Advanced localized breast cancer

Stage III

Preoperative chemotherapy

Surgery and radiotherapy

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Reconstructive

Breast Surgery

Reduction Mammoplasty

Augmentation Mammoplasty

Mastopexy

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Breast Cancer

Self-Care Post-Op Exercises (1491)

Reach for Recovery

Breast Prosthesis

Quality of Life

Gerontology

Reconstruction

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Breast Cancer in Men

Etiology and risk factors

Symptoms

Treatment

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Nursing Diagnosis, Outcomes,

and Interventions

Nursing diagnosis

Deficient Knowledgerelated to inexperience

and new information regarding options for

treatment Outcomes

Understanding of treatment options

Interventions

Explain options

Initiate teaching plan

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Nursing diagnosis

Ineffective Copingand Compromised Family

Copingrelated to diagnosis of cancer and

surgical changes in breast Outcomes

Client will cope with diagnosis and surgical

changes in the breast

InterventionsAssess and identify coping mechanisms

Nursing Diagnosis, Outcomes,

and Interventions

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Nursing diagnosis Disturbed Body Imagerelated to impending

changes in breast and sexuality

Outcomes Exhibit positive body image

Interventions Initiate referral

Assess coping strategies

Explore body image concerns

Nursing Diagnosis, Outcomes,

and Interventions

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Nursing diagnosis Risk for Injuryrelated to increased risk of

infection and lymphedema secondary toaxillary node dissection

Outcomes Client will not experience injury

Interventions

Prevent lymphedema, teach arm exercisesAdminister antibiotics

Promote self-care

Nursing Diagnosis, Outcomes,

and Interventions

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Nursing Diagnosis, Outcomes,

and Interventions

Nursing diagnosis

Effective Therapeutic Regimen Management

related to chemotherapy and radiation therapy

Outcomes Client will understand the purpose and goals of

chemotherapy and radiation therapy

Interventions

Education

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Nursing diagnosis

Imbalanced Nutrition: Less Than Body

Requirementsrelated to nausea, vomiting, and

stomatitis, secondary to chemotherapy Outcomes

Client will maintain adequate nutrition

Interventions

Provide oral hygiene

Prevent nausea and vomiting

Nursing Diagnosis, Outcomes,

and Interventions

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Breast Cancer Self-Care

Lifelong surveillance

Promote acceptance of body image

Inform of outside resources

Knowledge of recurrence