Breast Cancer

Published on February 2017 | Categories: Documents | Downloads: 60 | Comments: 0 | Views: 933
of 5
Download PDF   Embed   Report

Comments

Content

 

BREAST CANCER PREOPERATIVE CARE   Psychological support- involve the husband as necessary 

            





 

 

Teach arm exercise to prevent lymph edema Inform about wound suction drainage e.g. Hemovac, Jackson Pratt Deep breathing exercise to prevent post-operative respiratory complications Explain breast cancer and treatment options Reduce fear and anxiety and improve coping abilities Promote decision making abilities Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise.

DO’S AFTER THE SURGERY   Before exercising actively, be certain that post-surgery swelling subsides and that surgical wounds are healing. Try to start moving as soon as possible after surgery. Keep arm elevated after surgery to prevent swelling. Use two pillows to support arm when lying down or sitting. Stretch both sides of upper body a few times per day. 3-5 slow repetitions of each stretch.  After surgery, try to walk around (indoors) for a f ew minutes 2-3 times daily to regain stamina.  Avoid lifting anything over 2-3 pounds, particularly with the involved arm.  Enlist anyone you can to accompany you and encourage you to walk frequently.   Above all, strive for a little improvement every day. PERSEVERE!  Continue an exercise upon unusual discomfort o r persistent pain.  Continue an exercise upon unusual fatigue. Rest for a moment, breathe, relax , and then continue slowly and carefully. If fatigue persists,  stop exercising.    Don’t hesitate to call your physician immediately when experiencing unusual or persistent pain or swelling.   

                 



DON’TS AFTER THE SURGERY   Let mastectomy arm hang down, especially when holding or carrying objects.   Move arm quickly, or with jerking, pulling motions. Learn to move slowly and smoothly, especial ly when changing positions, lifting bags, opening doors, etc.   Avoid lifting anything over 2-3 pounds, particularly with the involved arm.

 

POST-OPERATIVE CARE   Move arm quickly, or with jerking, pulling motions. Monitor Hemovac output (serosanguinous for the fi rst 24hours)   Check behind of the patient for bleeding. Blood flows to back for gravity.   Post signs warning against taking BP, starting IV line or drawi ng blood on affected side. 

               















Initiate exercise to prevent stiffness and contracture of the shoulder girdle. Reinforce special mastectomy exercise as prescribed. Provide adequate analgesia to promote ambulation and exercise. Encourage regular coughing and deep breathing exercises. Prepare client for size and appearance of the incision and provide support when incision is viewed for the first time. A temporary prosthesis or lightly padded bras worn until healing is completed. Teach patient to avoid constrictive clothing and report persistent edema, redness or i nfection of incision. Teach patient the importance of continuing monthly BSE on the remaining brea st.

PREVENTION OF LYMPH EDEMA AVOID   Cuts, scratches, pinpricks, hangnails, insect bites, burns and strong detergent. DON’T’S ON THE AFFECTED ARM  ARM    Carry purse or anything heavy   Wear wrist watch or jewelry   Pick and cut cuticles, work near thorny plants   Dig garden DO’S  DO’S    Wear loose rubber gloves when washing dishes   Wear a thimble when sewing   Apply lanolin hand cream to prevent dryness   Contact physician if arms get red, warm or swollen   Return for check-up “CAUTION-LYMPHEDEMA” LYMPHEDEMA”     Wear tag “CAUTION-

       

   

Reach into hot oven Hold a cigarette Injections BP taking

 

  Chemotherapy and Hormonal Therapy for Breast Cancer Type of Treatment

Goals of Therapy

Possible Side Effects CHEMOTHERAPHY

1.  Doxorubicin (Adriamycin) (A)

  ECG changes, tachycardia,



  Destroy neoplastic cells.

2.  Cyclophosphamide (Cytoxan) (C)

  Decrease or prevent

metastasis. 3.  Methotrexate (M) 5-flourouracil (F)

4.  Paclitaxel (Taxol) (T)

5.  Epirubicin (Ellence) (E) 6.  Docetaxel (Taxotere) (T)

nausea, vomiting, stomatitis, hair loss, severe cellulitis if  infiltration occurs.   Nausea, vomiting, anorexia, menstrual abnormalities, hemorrhagic cystitis.   Stomatitis, CNS changes, hair loss, neurotoxicity, nausea, vomiting, stomatitis.constipation,   Hypersensitivity, peripheral neuropathy, nausea, vomiting, diarrhea, stomatitis, hair loss.   Myelosuppression, cardiac toxicity, nausea, vomiting and mucositis.   Hypersensitivity, neurosensory disturbances, nausea, vomiting, stomatitis.

Combination Therapy: CMF     CAF AC   ACT   CEF  

Nursing Interventions

  Nausea and vomiting.



 



 



 



 



  Side effects of all agents



used.

 



Administer antiemetic as prescribed and monitor fluid intake and output. Anorexia. Assist patient and family to identify appetizing foods, provide frequent small meals if better tolerated than three regular meals, refer to dietitian for assistance in planning palatable, nutritious meals. Stomatitis. Avoid commercial mouthwashes, use baking soda, salt and water rinses or oral anesthetic agents.  Hair loss. Avoid brushing, blow drying, frequent shampooing, encourage patient to obtain wigs before hair loss occurs.   CNS changes. Monitor for weakness, fatigue, seizures, change in cognitive status, and assist with ADL if fatigue and malaise occurs.  Neurotoxicity. Monitor deep tendon reflexes, assess gait and muscle strength, and monitor changes in sensory

 

function. 

  Fluid retention. Monitor



weight, fluid intake and output, skin turgor.  changes. Monitor ECG,   Cardiac cardiac rate and rhythm.     Hypercalcemia. Monitor





serum calcium levels, monitor cardiac rate and rhythm.     Constipation. Monitor bowel function, consider that constipation may be indicative of neurotoxicity; administer stool softeners, laxatives as prescribed, encourage adequate intake of fluids and fiber.    Anxiety. Administer tranquillizers as prescribed, encourage use of strategies to minimize anxiety (imagery, relaxation).  HORMONAL THERAPY 1.  Androgens

  Suppress estrogens



Fluorymestrone (Halotestin) 2.  Estrogens  Diethylstilbestrol (DES) 3.  Corticosteroids  Prednisone

  Suppress FSH and LH



  Suppress estrogen



production by the adrenals and decrease urinary

 

  4.  Antihormonal agents  Tamoxifen (Nolvadex) Megestrel acetate (Megace) Aminoglutethimide (Cytadren) Anastrazole (Arimidix)

estrogen metabolites.

  Estrogen antagonist;



Sponsor Documents

Or use your account on DocShare.tips

Hide

Forgot your password?

Or register your new account on DocShare.tips

Hide

Lost your password? Please enter your email address. You will receive a link to create a new password.

Back to log-in

Close