Timby/Smith: Introductory Medical-Surgical Nursing, 9/e
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1 Timby/Smith: Introductory Medical-Surgical Nursing, 9/e Chapter 60: Caring for Clients With Breast Disorders Slide 1 Infectious and Inflammatory Breast Disorders: Mastitis Pathophysiology and Etiology Plugged lactiferous ducts Staphylococcus aureus Fever; malaise Breast tenderness, pain, redness, and hardness Crack in the nipple or areola Enlarged axillary lymph nodes Culture and sensitivity test Slide 2 Infectious and Inflammatory Breast Disorders: Mastitis Medical Management Antibiotics; analgesics; heat application Breasts are emptied using a breast pump Systemic antibiotics Obtain health history Prepare client: Physical examination Collect breast milk specimen Client teaching: Self-administering antibiotics; principles of medical asepsis; breast feeding techniques and alternatives Slide 3 1
2 Infectious and Inflammatory Breast Disorders: Breast Abscess Pathophysiology and Etiology S. aureus Complication of postpartum mastitis Signs and symptoms of mastitis; pus may drain from the nipple Physical examination; culture and sensitivity test Hospitalization; contact isolation; IV antibiotics; incision and drainage of abscess Slide 4 Infectious and Inflammatory Breast Disorders: Breast Abscess Remove and reapply dressings Use aseptic technique Emotional support Promote comfort Binder; zinc oxide; arm and shoulder support; axillary hair; breast milk removal Application of tight-fitting brassiere Termination of breast feeding Slide 5 Benign Breast Lesions: Fibrocystic Breast Disease Pathophysiology and Etiology Hormonal changes during menstrual cycle Aggravated by caffeine and nicotine Breast cysts: Single; multiple Signs and Symptoms: Tender, painful breasts; multiple lumps in breast tissue; mastalgia; influence of menstrual cycle Diagnostic findings: Physical and cytologic examination; incisional biopsy; mammography; ultrasonography Slide 6 2
3 Benign Breast Lesions: Fibrocystic Breast Disease Analgesics; oral contraceptives Drug therapy Cyst removal; mastectomy Health history; questions related to symptoms menstrual cycle Diagnostic tests: Preparation and support Client teaching: BSE; medication use; physical examination; diet; activity; breast care Slide 7 Benign Breast Lesions: Fibroadenoma Pathophysiology and Etiology Hormonal influence Single nodule; no change with menstrual cycle Painless and nontender lump Encapsulated, mobile, and firm lesion Ultrasound Excisional biopsy Slide 8 Benign Breast Lesions: Fibroadenoma Observation Excision or tumor removal Provide emotional support Client teaching Monthly BSE; mammography Symptoms to report: Mass change; pregnancy Pre- and postoperative care: Wound care; brassiere; medication; emergencies Slide 9 3
4 Malignant Breast Disorders: Cancer of Pathology and Pathophysiology Mass of abnormal cells Risk factors: Female; >50 years; family history Signs and symptoms: Painless mass in breast; bloody discharge from nipple; dimpling of skin; nipple retraction; asymmetrical breast size; orange peel skin Diagnostic findings: Mammography; biopsy; microscopic cell examination Slide 10 Malignant Breast Disorders: Cancer of Figure 60-3 Locations of primary malignant breast tumors Slide 11 Malignant Breast Disorders: Cancer of Figure 60-4 Signs and symptoms of breast cancer Slide 12 4
5 Malignant Breast Disorders: Cancer of Treatment depends on stage of tumor Figure 60-5 Breast cancer stages Slide 13 Malignant Breast Disorders: Cancer of Surgery Lumpectomy; partial mastectomy; segmental mastectomy; mastectomy Sentinel lymph node mapping Lymphedema Chemotherapy Destruction of cancer cells that have escaped surgery Drugs administered: Tamoxifen Slide 14 Malignant Breast Disorders: Cancer of Radiation therapy Before or after surgery; prophylactically Side effects: Fatigue; skin redness; rash; minor discomfort; pain Emotional support: Sexuality or body image disturbance Pre- and postoperative care: Complications; pain; wound care Slide 15 5
6 Malignant Breast Disorders: Cancer of Discharge or client teaching Complications: Lymphedema Self-care measures Chemotherapy: Side effects Medication; alopecia Wound care; exercise; prosthesis care Slide 16 Malignant Breast Disorders: Metastatic Breast Cancer Pathophysiology Spread by direct extension: Lymphatics; bloodstream; CSF Lymph node; skeletal; pulmonary systems; brain; liver Signs and symptoms Pain; pathologic fractures Slide 17 Malignant Breast Disorders: Metastatic Breast Cancer Diagnostic findings Radiographs; MRI; CT; lymph node dissection Medical Management Palliative treatment Intramuscular androgen therapy Radiation therapy Slide 18 6
7 Malignant Breast Disorders Breast Cancer Prevention Long-term follow-up Bilateral prophylactic mastectomy Chemoprevention Tamoxifen; raloxifene Breast cancer vaccine: Under research Slide 19 Cosmetic Breast Procedures Breast Reconstruction Refashioning of area of a mastectomy Simulation of breast contour Optional: Nipple; areola Artificial implants Silicone gel; saline-filled FDA approval Autogenous tissue Natural look and feel Slide 20 Cosmetic Breast Procedures Reduction Mammoplasty Breast size reduction Clients with D cup or larger brassiere Overnight surgical procedure Opposite Breast Reduction Corrects asymmetry Reduce healthy breast to resemble size of a reconstructed breast Similar to mammoplasty Slide 21 7
8 Cosmetic Breast Procedures Breast Lift Mastopexy Corrects ptosis and drooping Breast Augmentation Breast enlargement using saline implant Nurse s role Pre- and postoperative care: Semi- Fowler s position; pain management Client teaching: Mammogram; BSE; brassiere; exercise Slide 22 General Considerations Nutritional Considerations Possible dietary considerations High-fat diet Role of fruits and vegetables Soy and fiber Alcohol consumption and risk of breast cancer Slide 23 General Considerations Pharmacologic Considerations Metastases of breast cancer: Antineoplastic drugs Pain management: Opioid analgesics Monitoring and client teaching: Drug administration; effects; side effects Gerontologic Considerations Risk for breast cancer increases with age Client teaching: Risks; prevention measures; physical examination; treatments Slide 24 8
9 End of Presentation Slide 25 9
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