Cancer

Essential Concepts of Cancer

– What is Cancer?
– Normal Cell Growth vs.Cancer Cell
Growth
– Etiology and CausativeFactors
– Pathophysiology
– Classification of Tumors
– Effects of Cancer
• WHAT IS CANCER?
• CANCER is a complex of diseaseswhich occurs when normal
cellsmutate into abnormal cells thattake over normal tissue,eventually
harming anddestroying the host
• WHAT IS CANCER
• A large group of diseases characterizedby:– Uncontrolled growth and
spread of abnormal cells– Proliferation (rapid reproduction by
celldivision)– Metastasis (spread or transfer of cancer cells from one
organ or part toanother not directly connected)
• ONCOLOGY DEFINED
•
• Branch of medicinethat deals with thestudy, detection,treatment
andmanagement of cancer and neoplasia
• “ROOT WORDS”
•
• Neo- new
•
• Plasia- growth
•
• Plasm- substance
•
• Trophy- size
•
• +Oma- tumor
•
• Statis- location
• “ROOT WORDS”
•
• A- none
•
• Ana- lack
•
• Hyper- excessive
•
• Meta- change
•
• Dys- bad, deranged
• CHARACTERISTICS OF NEOPLASIA
•
• Uncontrolled growth of Abnormal cells
•
• 1. Benign
•
• 2. Malignant
•
• 3. Borderline
CHARACTERISTICS OF NEOPLASIA
BENIGN

Well-differentiated

Slow growth

Encapsulated

Non-invasive

Does NOT metastasize
• CHARACTERISTICS OF NEOPLASIA
• MALIGNANT
•
• Undifferentiated
•
• Erratic and Uncontrolled Growth
•
• Expansive and Invasive
•
• Secretes abnormal proteins
•
• METASTASIZES
• NOMENCLATURE OF NEOPLASIA
• Tumor is named according to:1. Parenchyma, Organ or Cell
•
• Hepatoma- liver
•
• Osteoma- bone
•
• Myoma- muscle
• NOMENCLATURE OF NEOPLASIA
• Tumor is named according to:2. Pattern and Structure, either GROSS orMICROSCOPIC
•
• Fluid-filled
•
• CYST
•
• Glandular
•
• ADENO
•
• Finger-like
•
• PAPILLO
•
• Stalk
•
• POLYP
• NOMENCLATURE OF NEOPLASIA
• Tumor is named according to:3. Embryonic origin
•
• Ectoderm ( usually gives rise to epithelium)
•
• Endoderm (usually gives rise to glands)
•
• Mesoderm (usually gives rise to Connectivetissues)
• BENIGN TUMORS
•
• Suffix- “OMA” is used
•
• Adipose tissue- LipOMA
•
• Bone- osteOMA
•
• Muscle- myOMA
•
• Blood vessels- angiOMA
•
• Fibrous tissue- fibrOMA
• MALIGNANT TUMOR
•
• Named according to embryonic cell origin1. Ectodermal, Endodermal,
Glandular,Epithelial
•
• Use the suffix- “CARCINOMA”
•
• Pancreatic AdenoCarcinoma
•
• Squamos cell Carcinoma
• MALIGNANT TUMOR
•
• Named according to embryonic cell origin2. Mesodermal, connective tissue origin
•
• Use the suffix “SARCOMA
•
• FibroSarcoma
•
• Myosarcoma
•
• AngioSarcoma
• “PASAWAY”
• 1. “OMA” but Malignant
•
• HepatOMA, lymphOMA, gliOMA, melanOMA
• 2. THREE germ layers
•
• “TERATOMA”
• 3. Non-neoplastic but “OMA”
•
• Choristoma
•
• Hamatoma
• ETIOLOGY/CAUSATIVE FACTORS
••
• Viruses
••
• Chemical carcinogens
••
• Physical stressors
••
• Hormonal factors
••
• Genetic factors
• CANCER NURSING
• Etiology of cancer1. PHYSICAL AGENTS
•
• Radiation
•
• Exposure to irritants
•
• Exposure to sunlight
•
• Altitude, humidity
• CANCER NURSING
• Etiology of cancer2. CHEMICAL AGENTS
•
• Smoking
•
• Dietary ingredients
•
• Drugs
• CANCER NURSING
• Etiology of cancer3. Genetics and Family History
•
• Colon Cancer
•
• Premenopausal breast cancer
• CANCER NURSING
•
• Etiology of cancer
• 4. Dietary Habits
•
• Low-Fiber
•
• High-fat
•
• Processed foods
•
• alcohol
• CANCER NURSING
• Etiology of cancer5. Viruses and Bacteria
•
• DNA viruses- HepaB, Herpes, EBV, CMV,Papilloma Virus
•
• RNA Viruses- HIV, HTCLV
•
• Bacterium- H. pylori
• CANCER NURSING
• Etiology of cancer
•
• 6. Hormonal agents
•
• DES
•
• OCP especially estrogen
• CANCER NURSING
• Etiology of cancer
•
• 7. Immune Disease
•
• AIDS
• BURKITT’S LYMPHOMA - a cancer of thelymphatic system
• Classification of Cancer
• According to Behavior of Tumor
••
• Benign - tumors that cannot spread by
• invasion or metastasis; hence, they onlygrow locally•
• Malignant - tumors that are capable of
• spreading by invasion and metastasis. Bydefinition, the term “cancer”
• Patterns of cell Proliferation•
• Hyperplasia
••
• Dysplasia
••
• Metaplasia
••
• Anaplasia
••
• Neoplasia
• Patterns of cell Proliferation•
• Metaplasia
• • conversion of one type of cell in a tissue toanother type not normal for
that tissue•
• Anaplasia
• • change in the DNA cell structure andorientation to one another,
characterized byloss of differentiation and a return to a moreprimitive form.
• Neoplasia
• • uncontrolled cell growth, either benign ormalignant
• Metastasis•
• Metastasis: 3 stages
•–
• Invasion – neoplastic cells from primarytumor invade into surrounding
tissuewith penetration of blood or lymph.
•–
• Spread – tumor cells spread throughlymph or circulation or by directexpansion
•–
• Establishment and growth – tumor cellsare established and grow in
secondarysite: lymph nodes or in organs fromvenous circulation
• CANCER NURSING
• Spread of Cancer
•
• 1. LYMPHATIC
•
• Most common
•
• 2. HEMATOGENOUS
•
• Blood-borne, commonly to Liver and Lungs
•
• 3. DIRECT SPREAD
•
• Seeding of tumors
• CANCER NURSING
• Body Defenses Against TUMOR
•
• 1. T cell System/ Cellular Immunity
•
• Cytotoxic T cells kill tumor cells
•
• 2. B cell System/ Humoral immunity
•
• B cells can produce antibody
•
• 3. Phagocytic cells
•
• Macrophages can engulf cancer cell debris
• Classification of Tumors• CARCINOMAS: EPITHELIAL TISSUE– BODY
SURFACES, LINING OF BODY CAVITIES ETC:(ADENOCARCINOMA)•
SARCOMAS: CONNECTIVE TISSUE– STRIATED MUSCLE, BONE, ETC
(OSTEOSARCOMA)• LYMPHOMAS AND LEUKEMIAS– HEMATOPOIETIC
SYSTEM• NERVOUS TISSUE TUMORS– EX. NERVE CELLS-
NEUROBLASTOMA• MYELOMA– Develops in the plasma cells of bone
marrow
• Effects of Cancer• Disruption of Function- can be due toobstruction or
pressure• Hematologic Alterations: can impairfunction of blood cells•
Hemorrhage: tumor erosion, bleeding,severe anemia• Anorexia-
Cachexia Syndrome: wastedappearance of client
• Effects of Cancer• Paraneoplastic Syndromes: ectopicsites with excess
hormone production– ↑ Parathyroid hormone→hypercalcemia– ↑
secretion of insulin→ hypoglycemia– ↑ Antidiuretic hormone (ADH)
→ fluidretention, HTN & peripheral edema• ↑ Adrenocorticotropic
hormone(ACTH): cause excessive secretion of cortisone (ie: fluid
retention, ↑ glucoselevels)
• Effects of Cancer• Pain: major concern of clients andfamilies
associated with cancer• Physical Stress: body tries to respondand
destroy neoplasm
• ASSESSMENT
• • Nursing History– Health History – chief complaint andhistory of
present illness (onset,course, duration, location,precipitating and
alleviating factors)– Cancer signs: CAUTION US!
• WARNING SIGNS OF CANCER
• CAUTION US!
• – Change in bowel or bladder habits
• – A sore that does not heal
• – Unusual bleeding or discharge
• – Thickenings or lumps
• – Indigestion or difficulty in swallowing
• – Obvious change in a wart or mole
• – Nagging or persistent cough or hoarseness
• – Unexplained anemia
• – Sudden unexplained weight loss
• Change in bowel or bladder habits
• – A person with colon cancer may havediarrhea or constipation, or he
maynotice that the stool has becomesmaller in diameter– A person
with bladder or kidneycancer
• A sore that does not heal
• – Small, scaly patches on the skin thatbleed or do not heal may be a
sign of skin cancer– A sore in the mouth that does not healcan indicate
oral cancer

• Unusual bleeding or discharge

• – Blood in the stool is often the first signof colon cancer– Similarly,
blood in the urine is usuallythe first sign of bladder or kidneycancer–
Postmenopausal bleeding (bleedingafter menopause) may be a sign of
uterine cancer
• Thickenings or lumps
• – Enlargement of the lymph nodes orglands (such as the thyroid
gland) canbe an early sign of cancer– Breast and testicular cancers
may alsopresent as a lump
• Indigestion or difficulty inswallowing
• – Cancers of the digestive system,including those of the
esophagus,stomach, and pancreas, may causeindigestion, heartburn,
or difficultyswallowing
•
••
• Obvious change in a wart or mole
• – Moles or other skin lesions that changein shape, size, or color should bereported

•
••
• Nagging or persistent cough orhoarseness
• – Cancers of the respiratory tract,including lung cancer and laryngealcancer, may cause a cough that doesnot go away or a hoarse (rough)
voice

•
••
• Unexplained anemia
••
• Sudden unexplained weight loss
• PHYSICAL ASSESSMENT
••
• Inspection – skin and mucus membranesfor
• lesions, bleeding, petechiae, and irritation– Assess stools, urine, sputum,
vomitus foracute or occult bleeding– Scalp noting hair texture and hair loss•
• Palpation
• – Abdomen for any masses, bulges orabnormalities– Lymph nodes for
enlargement•
• Auscultation – of lung sounds, heartsounds
• and bowel sounds
• Laboratory & DiagnosticTests • Cancer detection examination
• • Laboratory tests– Complete blood cell count (CBC)– Tumor markers
– identify substance (specificproteins) in the blood that are made by
the tumor• PSA (Prostatic-specific antigen): prostate cancer• CEA
(Carcinoembryonic antigen): colon cancer• Alkaline Phosphatase:
bone metastasis– Biopsy
• Diagnostic Tests
• • Determine location of cancer:– X-rays– Computed tomography–
Ultrasounds– Magnetic resonance imaging– Nuclear imaging–
Angiography
• Diagnosis of cell type:– ▪Tissue samples: from biopsies, sheddedcells
(e.g. Papanicolaou (PAP) smear), &washings– ▪ Cytologic Examination:
tissue examinedunder microscope
• Direct Visualization:– ▪ Sigmoidoscopy– ▪ Cystoscopy– ▪ Endoscopy– ▪
Bronchoscopy– ▪ Exploratory surgery; lymph node biopsiesto
determine metastases
• Tumor Staging and Grading
• • Staging determines size of tumor and existence of metastasis•
Grading classifies tumor cells by type of tissue• The TNM system is
based on the extent of thetumor
• (T), the extent of spread to
• the lymphnodes
• (N), and the presence of
• metastasis
• (M).
• Primary Tumor (T)
•  TX - Primary tumor cannot be evaluated T0 - No evidence of primary tumor Tis -
Carcinoma in situ (early cancer that has not spread toneighboringtissue) T1, T2, T3,
T4 - Size and/or extent of the primary tumor
• Regional Lymph Nodes (N)
• NX - Regional lymph nodes cannot be evaluatedN0 - No regional lymph
node involvement (no cancer found inthe lymph nodes)N1, N2, N3 - Involvement of
regional lymph nodes (numberand/or extent of spread)
• Distant Metastasis (M)
• MX - Distant metastasis cannot be evaluatedM0 - No distant metastasis (cancer has not
spread to other partsof the body)M1 - Distant metastasis (cancer has spread to distant
parts of thebody)
• NURSING DIAGNOSES
• • Acute or chronic pain• Impaired skin integrity• Impaired oral
mucous membrane• Risk for injury• Risk for infection• Fatigue•
Imbalanced nutrition: less than body requirements
• NURSING DIAGNOSES
• • Risk for imbalanced fluid volume• Anxiety• Disturbed body image•
Deficient knowledge• Ineffective coping• Social isolation
• OUTCOME IDENTIFICATION
• 1. Pain relief 2. Integrity of skin and oral mucosa3. Absence of injury
and infection4. Fatigue relief 5. Maintenance of nutritional intake and
fluidand electrolyte balance6. Improved body image7. Absence of
complications
• OUTCOME IDENTIFICATION1. Knowledge of prevention and
cancertreatment2. Effective coping through recovery andgrieving
process3. Optimal social interaction
• IMPLEMENTATION/MANAGE MENT
• • Prevention and detection– Primary Prevention• Reducing
modifiable risk factors in theexternal and internal environment–
Secondary Prevention• Recognizing early signs and symptoms
andseeking prompt treatment• Prompt intervention to halt
cancerousprocess
SOME CARCINOGENS IN
THEWORKPLACE
• TREATMENT MODALITIES
• • Aimed towards:– CURE - free of disease after treatment →normal
life– Control - Goal for chronic cancers– Palliative Care: Quality of life
maintained athighest level for the longest possible time
• Surgery – surgical removal of tumors; mostcommonly used treatment•
• Preventive or prophylactic
••
• Diagnostic surgery
••
• Curative surgery
••
• Reconstructive surgery
••
• Palliative surgery
••
• Chemotherapy – use of antineoplastic drugstopromote tumor cell death, by interfering withcellular
functions and reproduction
• • Radiotherapy – directing high-energy ionizingradiation to destroy
malignant tumor cellswithout harming surrounding tissues Types:–
Teletherapy (external): radiation delivered inuniform dose to tumor;
Teletherapy isexternal beam irradiation and uses a devicelocated at a
distance from the patient. Itproduces X-rays of varying energies and
isadministered by machines a distance fromthe body 31½ to 39
inches (80 to 100 cm).
• Brachytherapy: delivers high dose to tumorand less to other tissues;
radiation source isplaced in tumor or next to it; Inbrachytherapy, the
radiation device is placedwithin or close to the target tissue.
Radiationis delivered in a high dose to a small tissuevolume with less
radiation to adjacent normaltissue, but requires direct tumor access.
• • Immunotherapy – use of chemical ormicrobial agents to induce
mobilization of immune defenses.• Biologic response modifiers
(BRMs) – use of agents that alters immunologic relationshipbetween
tumor and host in a beneficial way
• Bone marrow peripheral stem celltransplantation – aspirating bone
marrowcells from compatible donor and infusingthem into the
recipient• Gene therapy – transfer of genetic materialsinto the client’s
DNA
• NURSING MANAGEMENT
• 1. Promote measures that relieve pain anddiscomfort.• Pharmacologic
and non-pharmacologicinterventions2. Promote measures to maintain
intact skinintegrity3. Promote measures that maintain oral mucosa4.
Promote measures to prevent injury fromabnormal bleeding• Monitor
platelet count; avoid aspiring products,etc
• NURSING MANAGEMENT
• 1. Promote measures that identify and preventinfection• Monitor
WBC count; encourage frequenthandwashing and overall
cleanliness2. Help decrease the client’s fatigue and increasehis
activity level3. Promote measures that ensure adequatenutritional
intake• High protein, high calorie diet4. Ensure adequate fluid and
electrolyte balance
• NURSING MANAGEMENT
• 1. Promote measures to enhance body image.• Take an honest gentle,
caring approach;encourage client to express and verbalize feelings2.
Promote measures that address preventingcomplications of cancer
therapy3. Instruct client and family about the diseaseprocess and
treatments; provide necessaryinformation for self-care.4. Help client
and family cope effectively5. Promote measures to reduce social
isolation.
• Care of Clients Receiving Chemotherapy
• • Classes of Chemotherapy Drugs:• Alkylating agents:– Action: create
defects in tumor DNA– Ex: Nitrogen Mustard, Cisplatin– Toxic Effects:
reversible renal tubular necrosis
• Classes of Chemotherapy Drugs• Antimetabolites:– Action: phase
specific– Ex: Methotrexate; 5 fluorouracil– Toxic Effects: nausea,
vomiting, stomatitis,diarrhea, alopecia, leukopenia
• Classes of Chemotherapy Drugs• Antitumor Antibiotics:– Action: non-
phase specific; interfere withDNA– Ex: Actinomycin D, Bleomycin,
adriamycin(doxorubicin)– Toxic Effect: damage to cardiac muscle

•
• Classes of Chemotherapy Drugs• Miotic inhibitors:– Action: Prevent
cell division during M phaseof cell division– Ex: Vincristine,
Vinblastine– Toxic Effects: affects neurotransmission,alopecia, bone
marrow depression
• Classes of Chemotherapy Drugs•
• Hormones:
• – Action: stage specific G1– Ex: Corticosteroids•
• Hormone Antagonist:
• – Action: block hormones on hormone- bindingtumors ie: breast,
prostate, endometrium; causetumor regression– Ex: Tamoxifen
(breast); Flutamide (prostate)– Toxic Effects: altered secondary sex
characteristics
• Effects of Chemotherapy
• • Tissues: (fast growing) frequently affected• Examples: mucous
membranes, hair cells,bone marrow, specific organs with
specificagents, reproductive organs (all are fetaltoxic; impair ability to
reproduce)
• Chemotherapy Administration
• • Routes of administration:– Oral– Body cavity (intraperitoneal or
intrapleural)– Intravenous• Use of vascular access devices because of
threatof extravasation (leakage into tissues) & longtermtherapy
• Chemotherapy Administration• Types of vascular access devices:–
PICC lines: (peripherally inserted centralcatheters)– Tunneled
catheters: (Hickman, Groshong)– Surgically implanted ports:
(accessed with90o angle needle- Huber needles)
• Nursing care of clients receivingchemotherapy
• • Assess and manage:– Toxic effects of drugs (report to physician)–
Side effects of drugs: manage nausea andvomiting, inflammation and
ulceration of mucousmembranes, hair loss, anorexia, nausea
andvomiting with specific nursing and medicalinterventions
• Nursing care of clientsreceiving chemotherapy• Monitor lab results
(drugs withheld if bloodcounts seriously low); blood and
bloodproduct administration• Assess for dehydration,
oncologicemergencies• Teach regarding fatigue,
immunosuppressionprecautions• Provide emotional and spiritual
support toclients and families
Colon cancer
• COLON CANCER
• Risk factors1. Increasing age2. Family history3. Previous colon CA or
polyps4. History of IBD5. High fat, High protein, LOW fiber6. Breast Ca
and Genital Ca
• COLON CANCER
•
• Sigmoid colon is the most common site
•
• Predominantly adenocarcinoma
•
• If early
•
• 90% survival
•
• 34 % diagnosed early
•
• 66% late diagnosis
• COLON CANCER
• PATHOPHYSIOLOGY
•
• Benign neoplasm
•
• DNA alteration
•
• malignant transformation
•
• malignantneoplasm
•
• cancer growth and invasion
•
• metastasis (liver)
• COLON CANCER
•
• ASSESSMENT FINDINGS1.
• Change in bowel habits- Most common
• 2. Blood in the stool3. Anemia4. Anorexia and weight loss5. Fatigue6.
Rectal lesions- tenesmus, alternatingD and C
• COLON CANCER
•
• Diagnostic findings1. Fecal occult blood2. Sigmoidoscopy and
colonoscopy3. BIOPSY4. CEA- carcino-embryonic antigen
• COLON CANCER
•
• Complications of colorectal CA1. Obstruction2. Hemorrhage3.
Peritonitis4. Sepsis
• COLON CANCER
•
• MEDICAL MANAGEMENT1. Chemotherapy- 5-FU2. Radiation
therapy
• COLON CANCER
•
• SURGICAL MANAGEMENTSurgery is the primary treatmentBased on
location and tumor sizeResection, anastomosis, and
colostomy(temporary or permanent)
• COLON CANCER
• NURSING INTERVENTION: COLOSTOMY CARE
•
• Colostomy begins to function 3-6 days aftersurgery
•
• The drainage maybe soft/mushy or semi-soliddepending on the site
• COLON CANCER
• NURSING INTERVENTION: COLOSTOMY CARE
•
• BEST time to do skin care is after shower
•
• Apply tape to the sides of the pouch beforeshower
•
• Assume a sitting or standing position inchanging the pouch
• COLON CANCER
• NURSING INTERVENTION: COLOSTOMY CARE
•
• Instruct to GENTLY push the skin down andthe pouch pulling UP
•
• Wash the peri-stomal area with soap andwater
•
• Cover the stoma while washing the peri-stomal area
• COLON CANCER
• NURSING INTERVENTION: COLOSTOMY CARE
•
• Lightly pat dry the area and NEVER rub
•
• Lightly dust the peri-stomal area withnystatin powder
• COLON CANCER
• NURSING INTERVENTION: COLOSTOMY CARE
•
• Measure the stomal opening
•
•  The pouch opening is about 0.3 cm largerthan the stomal opening
•
• Apply adhesive surface over the stoma andpress for 30 seconds
• COLON CANCER
• NURSING INTERVENTION: COLOSTOMY CARE
•
• Empty the pouch or change the pouchwhen
•
• 1/3 to ¼ full (Brunner)
•
• ½ to 1/3 full (Kozier)
• BREAST CANCER
•
•  The most common cancer in FEMALES
•
• Numerous etiologies implicated
• BREAST CANCER
• RISK FACTORS1. Genetics2. Increasing age ( > 50 yo)3. Family History
of breast cancer4. Early menarche and late menopause5. Nulliparity6.
Late age at pregnancy
• BREAST CANCER
• RISK FACTORS7. Obesity8. Hormonal replacement9. Alcohol10.
Exposure to radiation
• BREAST CANCER
• PROTECTIVE FACTORS1. Exercise2. Breast feeding3. Pregnancy before
30 yo
• BREAST CANCER
• ASSESSMENT FINDINGS
• 1. MASS- the most common location is theupper outer quadrant
• 2. Mass is NON-tender. Fixed, hard withirregular borders3. Skin
dimpling4. Nipple retraction5. Peau d’ orange
• BREAST CANCER
• LABORATORY FINDINGS1. Biopsy procedures2. Mammography
• BREAST CANCER
• Breast cancer Staging
•
• I - < 2cm
•
• II - 2 to 5 cm, (+) LN
•
• III - > 5 cm, (+) LN
•
• IV- metastasis
• BREAST CANCER
• MEDICAL MANAGEMENT
•
• 1. Chemotherapy
•
• 2. Tamoxifen therapy
•
• 3. Radiation therapy
• BREAST CANCER
•
• SURGICAL MANAGEMENT1. Radical mastectomy2. Modified radical
mastectomy3. Lumpectomy4. Quadrantectomy
• BREAST CANCER
• NURSING INTERVENTION : PRE-OP1. Explain breast cancer
andtreatment options2. Reduce fear and anxiety andimprove coping
abilities3. Promote decision makingabilities4. Provide routine pre-op
care:
•
• Consent, NPO, Meds, Teachingabout breathing exercise
• BREAST CANCER
• NURSING INTERVENTION :
• Post-OP
• 1. Position patient:
•
• Supine
•
• Affected extremity elevated to reduceedema
• BREAST CANCER
• NURSING INTERVENTION : Post-OP2. Relieve pain and discomfort
•
• Moderate elevation of extremity
•
• IM/IV injection of pain meds
•
• Warm shower on 2
• nd
• day post-op
• BREAST CANCER
• NURSING INTERVENTION : Post-OP3. Maintain skin integrity
•
• Immediate post-op: snug dressing withdrainage
•
• Maintain patency of drain (JP)
•
• Monitor for hematoma w/in 12H and applybandage and ice, refer to
surgeon
• BREAST CANCER
• NURSING INTERVENTION : Post-OP3. Maintain skin integrity
•
• Drainage is removed when thedischarge is less than 30 ml in 24 H
•
• Lotions, Creams are applied ONLY whenthe incision is healed in
4-6 weeks
• BREAST CANCER
• NURSING INTERVENTION : Post-OPPromote activity
•
• Support operative site when moving
•
• Hand, shoulder exercise done on 2
• nd
• day
•
• Post-op mastectomy exercise 20 mins TID
•
• NO BP or IV procedure on operative site
• BREAST CANCER
• NURSING INTERVENTION : Post-OPPromote activity
•
• Heavy lifting is avoided
•
• Elevate the arm at the level of the heart
•
• On a pillow for 45 minutes TID to relievetransient edema
• BREAST CANCER
• NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONS
•
• Lymphedema
•
• 10-20% of patients
•
• Elevate arms, elbow above shoulderand hand above elbow
•
• Hand exercise while elevated
•
• Refer to surgeon and physicaltherapist
• BREAST CANCER
• NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONS
•
• Hematoma
•
• Notify the surgeon
•
•  Apply bandage wrap (Ace wrap) and ICE pack
• BREAST CANCER
• NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONS
• Infection
•
• Monitor temperature, redness, swellingand foul-odor 
•
• IV antibiotics
•
• No procedure on affected extremity
• BREAST CANCER
• NURSING INTERVENTION : Post-OP
• TEACH FOLLOW-UP care
•
• Regular check-up
•
• Monthly BSE on the other breast 
•
•  Annual mammography