Psychosocial assessment

Fear

 Threats to body image, intimate relationships and survival  Decisions regarding treatment options

 Explore client’s feelings, support system, client’s & family’s knowledge
 Client’s level of education  Sexuality – psychologic, physiologic, relational  Evaluate need for additional resources

Possible Chief Complaint      Inflammatory breast cancer of the left breast Breast CA – patient recently diagnosed with left breast cancer (Inflammatory) needs port for chemotherapy Inflammatory breast cancer Left breast cancer – patient with inflammatory breast carcinoma currently receiving chemo and now presents for mastectomy EPAL TO wag nlng kaya to .

Related Nsg. Disturbed body image related to loss or alteration of the breast . Diagnosis       Deficient knowledge about the planned surgical treatments. Anxiety related to the diagnosis of cancer Fear related to specific treatments and body image changes Risk for ineffective coping related to the diagnosis of breast cancer Decisional conflict related to treatment options.

A ductogram also is known as a galactogram. Ductogram A type of X-ray that helps determine the cause of nipple discharge. Biopsy It is the examination of affected tissue in detecting presence of cancer cells. . It involves use of 2 x-ray films. The use of radio waves and strong magnets to visualize the entire breast. firm surface.PLANNING Diagnostic exams in Breast CA Breast Self Examination Starts from age 20. Palpate the breast from periphery to the center in circular motion. done after menstruation. Mammogram It involves x-ray examination of the breast. it is supported on flat. A ductogram can show if there is a mass inside the duct at the nipple. Note for symmetry of the breast. MRIs may be used to characterize a cancer found through mammography or to take a closer look at the breasts of women who are at high risk of developing breast cancer. Nuclear Magnetic Resonance Imaging This is viewing the structure of the breast using a high tech radiation imaging in detecting presence of mass or tumors.

If you have a large tumor but still want to consider the possibility of lumpectomy. noninvasive cancers are involved. and in most cases survival rates for both operations are similar. But when very small. or if you have already had radiation therapy. deep within your breast. In general. have two or more widely separated areas of cancer in the same breast. lumpectomy is almost always followed by radiation therapy to destroy any remaining cancer cells. But lumpectomy may not be an option if a tumor is very large. . some studies question the role and benefits of radiation therapy — especially for older women. have a connective tissue disease that makes you sensitive to radiation. Many women can have lumpectomy — often followed by radiation therapy — instead of mastectomy. chemotherapy before surgery may be an option to shrink the tumor and make you eligible for the procedure.Surgery This operation saves as much of your breast as possible by removing only the lump plus a surrounding area of normal tissue. These studies haven't shown that lumpectomy plus radiation prolongs a woman's life any better than does lumpectomy alone. or if you have inflammatory breast cancer. Lumpectomy.

fatty tissue and skin. This makes breast reconstruction less complicated. . Depending on the results of the operation and follow-up tests. your surgeon removes all your breast tissue — the lobules. Another breast-sparing operation. In almost all cases.Partial or segmental mastectomy. chemotherapy or hormone therapy. partial mastectomy involves removing the tumor as well as some of the breast tissue around the tumor and the lining of the chest muscles that lie beneath it. In this procedure. During a simple mastectomy. Modified radical mastectomy. and some underarm lymph nodes (axillary lymph node dissection). you'll have a course of radiation therapy following your operation. a surgeon removes your entire breast. Simple mastectomy. ducts. including the overlying skin. but leaves your chest muscles intact. including the nipple and areola. similar to if you had a lumpectomy. you may also need further treatment with radiation to the chest wall.

including whether you'll need chemotherapy or radiation therapy. the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed. . surgeons now focus on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first place cancer cells will travel. examined and found to be normal. Knowing if cancer has spread to the lymph nodes is important in determining the best course of treatment. but newer surgical techniques make this complication much less likely. Axillary lymph node dissection If the sentinel lymph node does show the presence of cancer. The removal of these lymph nodes does increase the risk of serious arm swelling (lymphedema). This spares many women the need for a more extensive operation and greatly decreases the risk of complications.Sentinel lymph node biopsy Because breast cancer first spreads to the lymph nodes under the arm. then your surgeon removes additional lymph nodes in your armpit (axilla). If a sentinel node is removed. Rather than remove as many lymph nodes as possible. all women with invasive cancer need to have these nodes examined.

for inflammatory breast cancer. as if it had been sunburned. In a small percentage of women.Radiation therapy Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. The treatments are painless and are similar to getting an X-ray. If you won't be receiving chemotherapy. It's administered by a radiation oncologist at a radiation center. Radiation therapy also makes it somewhat more likely that you'll develop another tumor. radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancers. For these reasons. damage to the lungs. and you may become tired toward the end of the series. heart or nerves. for cancer that has invaded the chest wall or for cancer that has spread to more than four lymph nodes in your armpit. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor. or a change in the appearance and consistency of breast tissue. . If your doctors recommend chemotherapy. In general. puffy and somewhat tender. more serious problems may occur. You may also want to talk to a radiation oncologist about clinical trials investigating shorter courses of radiation or focal application of radiation. You'll typically receive radiation treatment five days a week for five to six consecutive weeks. Your breast may be pink. it's usually administered before you undergo radiation therapy. radiation is usually started three to four weeks after surgery. Each takes about 30 minutes. The effects are cumulative. however. it's important to learn about the risks and benefits of radiation therapy when deciding between lumpectomy and mastectomy. including arm swelling.

Chemotherapy Chemotherapy uses drugs to destroy cancer cells. The size of the tumor. hair and bone marrow — all composed of fast-growing cells — tend to take the brunt of this toxicity. nausea. more effective drugs are now available to help prevent or reduce nausea and vomiting. and extent of spread of the cancer help determine your need for chemotherapy. leading to hair loss. your doctor may recommend chemotherapy after surgery to decrease the chance that the cancer will recur. Because chemotherapy affects healthy cells as well as cancerous ones. vomiting and fatigue. in pill form or both. . and methods to control chemotherapy side effects have improved greatly in the past few decades. Your digestive tract. Not everyone has all of these side effects. If your cancer has already spread to other parts of your body. chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing. Treatment often involves receiving two or more drugs in different combinations. This is known as adjuvant chemotherapy. You may have between four and eight treatments spread over three to six months. however. These may be administered intravenously. Notably. If your cancer has a high chance of returning or spreading to another part of your body. characteristics of the cancer cells. side effects are common.

including fat and muscle. leak-proof shell — to replace surgically removed breast tissue. although surgeons sometimes may use tissue from your back or buttocks instead. and your doctor gradually fills it with fluid — usually over a period of several months. your doctor may use a tissue expander. Reconstruction with a tissue flap. If you have a low percentage of body fat. this type of reconstruction may not be an option for you. recovery may take six to eight weeks. which is an empty implant shell that inflates as fluid is injected. this surgery reconstructs your breast using tissue. the expander is removed and replaced with a permanent implant. in an implantable. It's placed under your skin and muscle. This technique uses artificial material — silicone gel or saline. When your muscle and skin have stretched enough. . Complications include the risk of infection and tissue death. Known as a transverse rectus abdominal muscle (TRAM) flap. from your abdomen. If you don't have enough muscle and skin to cover an implant. Because the procedure is fairly complicated.Reconstructive surgery Reconstruction with implants.

In this procedure. Using tissue from elsewhere in your body. He or she may then tattoo the skin around the nipple to create an areola.Deep inferior epigastric perforator (DIEP) reconstruction. Reconstruction of your nipple and areola. you're less likely to experience complications than you are with traditional TRAM flap breast reconstruction. fat tissue from your abdomen is used to create a naturallooking breast. After initial surgery with either tissue transfer or an implant. place it around the reconstructed nipple to slightly raise the skin and then tattoo the skin graft. and your healing time may be reduced. You may also have less pain. you may have further surgery to make a nipple and areola. Your surgeon may also take a skin graft from elsewhere on your body. But because your abdominal muscles are left intact. your surgeon first creates a small mound to resemble a nipple. .

which may be referred to as breast-sparing surgery or wide local excision. including the nipple and areola (simple mastectomy). To determine whether cancer has spread to your lymph nodes.Eto pinadaling surgery…. •Removing the entire breast (mastectomy). your surgeon will discuss with you the role of removing additional lymph nodes in your armpit. ducts. Discuss your breast cancer risk with your doctor. •Removing a limited number of lymph nodes (sentinel node biopsy). In a skin-sparing mastectomy. If no cancer is found in those lymph nodes. •Removing both breasts. During lumpectomy. the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed. Some women with cancer in one breast may choose to have their other (healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased risk of cancer in the other breast. your surgeon will discuss with you the role of removing the lymph nodes that receive the lymph drainage from your tumor. Mastectomy is surgery to remove all of your breast tissue. If cancer is found in the sentinel node. along with the benefits and risks of this procedure . •Removing several lymph nodes (axillary lymph node dissection). Most mastectomy procedures remove all of the breast tissue — the lobules. Breast cancer surgery Operations used to treat breast cancer include: •Removing the breast cancer (lumpectomy). the surgeon removes the tumor and a small margin of surrounding healthy tissue. the skin over the breast is left intact to improve reconstruction and appearance. fatty tissue and some skin. Lumpectomy is typically reserved for smaller tumors.

Intervention Pre-operative  Obtain informed consent  Provide good care for a breast care  Be sure to know what kind of surgery to be performed in order to prepare the patient  If mastectomy is scheduled:  Prevent pulmonary complications and thromboembolism  Place patient on the affected side .

Post-operative  inspect dressing anteriorly and posteriorly  Check circulatory status  Encourage coughing exercises and turning schedule every two hours  Provide psychological and emotional support  Explain to the patient that she may experience phantom breast syndrome .

bleeding and ulcers. or gastrointestinal bleeding. but be sure to talk to your doctor before you start. There's a clear link between obesity — weighing more than is appropriate for your age and height — and breast cancer. More serious aspirin side effects include bleeding in the intestinal and urinary tracts and hemorrhagic stroke. beer or mixed drinks — seems to make no difference. Maintain a healthy weight. When used for long periods of time. In general. . liver or kidney disease. you're not a candidate for aspirin therapy if you have a history of ulcers. The association is stronger if you gain the weight later in life. limit the amount of alcohol you drink to less than one drink a day or avoid alcohol completely. bleeding disorders. Taking an aspirin just once a week may help protect against breast cancer. Limit alcohol.Other Intervention Ask your doctor about aspirin. aspirin can cause stomach irritation. particularly after menopause. To help protect against breast cancer. The type of alcohol consumed — wine. Drinking alcohol is strongly linked to breast cancer.

These have the added benefit of keeping your bones strong. Any longer does increase your breast cancer risk. Stay physically active. Among its many health benefits. but for most women. without conferring any clear benefits. The same is true of hormone therapy after age 60. jogging or dancing.Avoid long-term hormone therapy. Estrogen exposure clearly contributes to breast cancer risk. If you're approaching menopause and having frequent symptoms. the size of the contribution over a lifetime is small — particularly in the absence of other risk factors. Foods high in fiber include fresh fruits and vegetables and whole grains. it's probably safe to take hormones for as long as four to five years. Try to increase the amount of fiber you eat to between 20 and 30 grams daily — about twice that in an average American diet. Try to include weight-bearing exercises such as walking. No matter what your age. The link between postmenopausal hormone therapy and breast cancer has been a subject of debate for years. fiber may help reduce the amount of circulating estrogen in your body. aim for at least 30 minutes of exercise on most days. partly because research results have been mixed. such as family history of the disease. Eat foods high in fiber. .

Avoid exposure to pesticides. The molecular structure of some pesticides closely resembles that of estrogen. . Although studies have not found a definite link between most pesticides and breast cancer.Emphasize olive oil. Oleic acid. appears both to suppress the action of the most important oncogene in breast cancer and to increase the effectiveness of the drug Herceptin. the main component of olive oil. This means they may attach to receptor sites in your body. it is known that women with elevated levels of pesticides in their breast tissue have a greater breast cancer risk.

. Potential side effects include diarrhea. Bevacizumab is no longer approved for the treatment of breast cancer in the United States. Side effects of pertuzumab may include diarrhea. Adotrastuzumab emtansine may be an option for women with metastatic breast cancer who've already tried trastuzumab and chemotherapy. •Pertuzumab (Perjeta).MEDICATIONS Targeted drugs Targeted drug treatments attack specific abnormalities within cancer cells. The cell-killing drug is then released into the cancer cells. trastuzumab may help block that protein and cause the cancer cells to die. the trastuzumab helps it find the cancer cells because it is attracted to HER2. Some breast cancers make excessive amounts of a protein called human growth factor receptor 2 (HER2). and heart problems. Lapatinib targets HER2 and is approved for use in advanced or metastatic breast cancer. nausea. If your breast cancer cells make too much HER2. painful hands and feet. Side effects may include headaches. hair loss and heart problems. •Bevacizumab (Avastin). Targeted drugs approved to treat breast cancer include: •Trastuzumab (Herceptin). •Lapatinib (Tykerb). This combination of treatments is reserved for women who haven't yet received other drug treatments for their cancer. it doesn't appear to increase survival times. diarrhea and heart problems. which helps breast cancer cells grow and survive. Pertuzumab targets HER2 and is approved for use in metastatic breast cancer in combination with trastuzumab and chemotherapy. When the combination drug enters the body. This drug combines trastuzumab with a cell-killing drug. Lapatinib can be used in combination with chemotherapy or hormone therapy. •Ado-trastuzumab emtansine (Kadcyla). Research suggests that although this medication may help slow the growth of breast cancer.