Post operative nursing interventions

Reliving pain and discomfortMany patients tolerate the breast surgery quite well and have minimal pain during the
postoperative periods.N.I : Analgesic medication, warm bath or relaxation and distraction methods .

7 Post operative nursing interventions

Managing post operative sensationCommon sensation such as tenderness , numbness , tightness , , and
pulling.Phantom sensation( feeling post mastectomy that breast \ and or nipple are still present).May persist for 2 years
or longer .N.I: reassure the patient and these sensations are not indication of problem

8 Post operative nursing interventions

Promoting positive body imageN.I :Emotional distress patient need (Conversation treatment)or-Breast reconstructions-
Temporary breast form to place in her bra

10 Post operative nursing interventions

Promoting positive adjustment and copingN.I : Identifying supporting system and providing information-Anxiety related
to treatment (e.g. chemotherapy)Ineffective coping need consultation of mental health practitioner

11 Monitoring and managing potential complications

Complications post mastectomy are:LymphedmaHematoma or seroma formationInfection

12 complications Lymphedma:
It results if functioning lymphatic channels are inadequate to ensure a return flow of lymph fluids to general
circulation .-Performing exercises can help reduce transient edema

13 complications Hematoma or seroma formation:

Hematoma :is collection of blood inside cavityUsually develops within first 12 hours after surgeryThe nurse should
assessSign & symptoms : swelling, tightness, pain and bruising of skinPatient may take warm shower or apply warm
compressor

14 complications Hematoma or seroma formation:

Seroma :collection of serous fluid under mastectomy incision .If drain being removed or obstructedSign and Symptoms:
swelling , discomfort , heaviness and sloshing of fluidIf large amount doctor manually aspirating fluid with needle and
syringe

15 complications Infection Risk factor for infection such as:

Diabetes , older age, poor hygiene and immune disorder.Sign and symptoms :RednessTendernessFoul smelling
drainageFever and chills

16 Patient teachingdrainage system care

17 1- Patient should report infection , arm swelling , hematoma or seroma

1- Patient should report infection , arm swelling , hematoma or seroma . 2- Hygiene is important to prevent infection
( shower can be on 2nd day post operative) 4- The drains usually removed when the output is less than 30 ml in 24
hours

18 Home care:* Patient can empty and measure fluids from drainage devices.*Patient should contact her doctor if
( sudden change in color of drainage or sudden cessation of drainage )*Patient know how to milk clots through tubing of
drainage devices.

19 Patient teachingHand and arm care

20 1- Avoid blood pressure , injections & blood extraction in affected extremity.

2- Avoid insect bites.3- Avoid lifting objects greater than 5-10 pounds4- Use sunscreen for extended exposure to sun.

21 Exercises after breast surgery

Range of motion exercies are initial on the 2nd day post op.Goals of exercises:1- increase circulation and muscles
strength2- Prevent joint stiffness and contractures3- Restore full range of motionExercise done 3 times a day for 20
minutes at a time (4-6 weeks)

22 Exercises after breast surgery

Rod broomstick liftingRope turningWall hand climbingPulley tugging
23 EquipmentsLight ropeRod\ broom sticking

24 Rod or broomstick lifting

Grasp rod with both hands held about 20 cm apartKeeping arms straight raise the rod over headBend elbows to lower
rod behind the headReverse maneuver

26 Wall hand climbingStand facing wall with feet apart and toes as close as possibleBalm slightly bent , place palms of
the hand on the wall at shoulders levelBy flexing fingers works hand up the wall until arm are fully extendedReverse
process, working hands down to starting point.

28 Rope turning Tie light rope to doorknob Stand facing the door
Take free end of rope in hand on side of surgeryPlace other hands on hip

29 Rope turning5. With rope holding arm extended and held away from body (nearly parallel with the floor)Turn the
rope , making as wide swings as possibleBegin slowly at first ; speed up later

31 Pulley tugging1. Toss light rope over a shower curtain rod or doorway curtain rod. 2. Stand as nearly under rope as
possible. 3. Grasp end in each hand 4. Extend arm straight and away from body 5. Pull the left arm up by tugging down
with right arm , continue in see- sawing motion.

33 Summary