Chapter 62 Breast Conditions PDF

64 Slide 1 ___________________________________ ___________________________________...

64 Slide 1 ___________________________________ ___________________________________ Anxiety !!! CHAPTER 62 ___________________________________ Care of Clients with Breast Conditions-NURS 355 Adult Health III ___________________________________ ___________________________________ ___________________________________ breast examI once year ___________________________________ men do have a risk Slide 2 ___________________________________ ___________________________________ The priority concepts for this chapter are ___________________________________ ___________________________________ Cellular Regulation Infection CONCEPTS Pain The interrelated concept in this chapter is ___________________________________ ___________________________________ Sexuality ___________________________________ Slide 3 BENIGN BREAST DISORDERS intra ductal-bloody discharge ___________________________________ ___________________________________ (BBD) ___________________________________ >___________________________________ Proliferative breast lesion with atypica – Atypical hyperplasia Proliferative breast lesion without atypia – Fibroadenoma - most common Nonproliferative breast lesions – Fibrocystic changes (FCCs) and cysts ___________________________________ 1x month Ul find own problem. Same time in shower ___________________________________ SBE ___________________________________ 4-7 days after Period upper outer quad. Slide 4 ___________________________________ ___________________________________ ___________________________________  caffiere in lake ___________________________________ ↓ Analgesics for discomfort ___________________________________ Ice or heat ___________________________________ TAKE ACTION: INTERVENTIONS Draining cysts ___________________________________ Limit salt and caffeine/stimulant intake Oral contraceptives, SERMs, diuretics Slide 5 hard lump aroundnipple ___________________________________ LARGE BREASTS ___________________________________ ___________________________________ spirlactone , insulin ___________________________________ In men Gynecomastia Certain drugs can cause this SERMs or surgery In women ___________________________________ Pain; fungal infection under the breasts; backache Reduction mammoplasty checkpain ___________________________________ ___________________________________ Slide 6 ___________________________________ SMALL BREASTS ___________________________________ ___________________________________ ___________________________________ Some women choose breast augmentation surgery Saline Silicone Patient’s own tissue Teach how to care for incision and drains (if applicable) ___________________________________ Breast cancer surveillance ___________________________________ ___________________________________ Slide 7 age 18-50 ___________________________________ ___________________________________ BREAST ABSCESS Non-lactational breast abscess are often related to diabetes, clogged sweat glands, acne, or trauma ___________________________________ Risk factors include smoking, obesity, nipple piercings Treatment = broad-spectrum antibiotics, ultrasound-guided ___________________________________ aspiration, and/or incision and drainage ___________________________________ ___________________________________ ___________________________________ Slide 8 red Warm to touch get milk out. ___________________________________ , ___________________________________ MASTITIS cold compress, Cabbage leaves Inflammation, infection, pain ___________________________________ ___________________________________ Can occur in women whether they are lactating/breastfeeding or not More common in women who smoke or have nipple piercings Treatment = antibiotic therapy, steroid therapy, watchful waiting ___________________________________ ___________________________________ ___________________________________ Slide 9 CELLULAR REGULATION CONCEPT ___________________________________ ___________________________________ EXEMPLAR: BREAST CANCER Pathophysiology Review ___________________________________ ___________________________________ Heterogeneous disease with different presentations and therapy responses Sometimes presents as a lump; other times presents only on mammogram Noninvasive versus invasive Most common sites of metastasis are brain, bones, liver, and lung ___________________________________ ___________________________________ ___________________________________ Slide 10 ___________________________________ cancer in duct ___________________________________ ___________________________________ good prognosis NONINVASIVE (IN SITU) BREAST Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS) ___________________________________ CANCERS ___________________________________ ___________________________________ ⑭ ___________________________________ Slide 11 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________  ___________________________________ INVASIVE BREAST CANCERS & Inflammatory breast cancer Invasive ductal carcinoma (IBC) Originates in mammary Diffuse erythema, edema ducts and break through Breast pain wall of ducts into Rapidly growing breast lump surrounding tissue Fibrosis develops around the cancer Peau d’orange really agressive Slide 12 ___________________________________ # ake off I bleed. PAGET’S DISEASE ___________________________________ race can occur in men/women Occurs in or around the nipple ___________________________________ ___________________________________ Scaly, red, irritated May have other types of breast cancer ___________________________________ ___________________________________ ___________________________________ Slide 13 TRIPLE NEGATIVE BREAST ___________________________________ lacks etrogen Progesterone , CANCER (TNBC) ___________________________________ Grows rapidly ___________________________________ B2CA ___________________________________ Often found in with with BRCA mutation who are premenopausal ___________________________________ 2nd leading cause of Ca ___________________________________ ___________________________________ Slide 14 ___________________________________ INCIDENCE AND PREVALENCE ___________________________________ ___________________________________ ___________________________________ One of every eight women in the U.S. will develop breast cancer Second leading cause of cancer death in ___________________________________ in her lifetime (similar in Canada) women ___________________________________ ___________________________________ mets 35 % Murtality 87 % 1 node Slide 15 ___________________________________ ETIOLOGY AND GENETIC RISK ___________________________________ Increased age ___________________________________ Family and genetic history Early menarche, late menopause Overweight and obesity ___________________________________ Physical inactivity Use of combination postmenopausal HRT ___________________________________ ___________________________________ Alcohol consumption Mutations in BRCA1 and BRCA2 D2 2. ___________________________________ IS Slide 16 ___________________________________ American Cancer Society (ACS) and Canadian Cancer Society (CCS) ___________________________________ establish evidence-based guidelines for screening in women ___________________________________ Encourage men with family history, HEALTH PROMOTION/DISEASE genetic mutations to talk with primary health care provider ___________________________________ PREVENTION Teach to use multiple methods for early detection Mammography ___________________________________ ___________________________________ Clinical breast examination Breast self-awareness Options for high-risk women annual MRI ___________________________________ after Ss[ Pay years 1st insurance won't Slide 17 take goodhx ___________________________________ ___________________________________ of anxiety, ANALYZE CUES & PRIORITIZE HYPOTHESIS: ANALYSIS concerns sexuality ___________________________________ ___________________________________ Potential for cancer metastasis due to lack Potential for impaired coping due to breast ___________________________________ of, or inadequate, cancer diagnosis and treatment treatment ___________________________________ ___________________________________ Slide 18 GENERATE SOLUTIONS & TAKE ACTION: Pre banxiety , ↓ Surgical risk assess leds ___________________________________ : , ___________________________________ PLANNING AND IMPLEMENTATION: (1 OF 2) Decreasing the risk for metastasis Nonsurgical management ___________________________________ Post : vs 1S min go 4hr , hop fever pain , ___________________________________ bleeding Complementary and integrative health Surgical management (including breast reconstruction) , Preoperative care , , , Operative procedures Postoperative care ___________________________________ incentive spirometer , get them up !! ___________________________________ Adjuvant therapy Systemic chemotherapy, radiation, or combination ___________________________________ drain care Slide 19 GENERATE SOLUTIONS & TAKE ACTION: ___________________________________ ___________________________________ PLANNING AND IMPLEMENTATION (2 OF 2) Enhancing coping strategies ___________________________________ ___________________________________ Assess need for knowledge Use outside resources Full-service cancer center ___________________________________ ___________________________________ ___________________________________ Slide 20 Avoid side w/ hode extraction ___________________________________ CARE COORDINATION AND TRANSITION MANAGEMENT ___________________________________ ___________________________________ ___________________________________ Home care management May need assistance with drains, dressings, ADLs Teach about activities and restrictions Self-management education Post-surgical care Avoidance of lymphedema ___________________________________ ___________________________________ Improvement of body image, coping, relationships, etc. Health care resources : Support groups ___________________________________ National breast cancer organizations Slide 21 w/mets Chronic ___________________________________ - EVALUATE OUTCOMES: EVALUATION ___________________________________ comfortable ___________________________________ , ___________________________________ ___________________________________ No recurrence or metastasis of breast cancer after Reports adequately coping completion of treatment; if with the uncertainty of metastasis occurs, have having breast cancer and its optimal palliative and end-of- life care. treatment. ___________________________________ ___________________________________ Pg 1450 Slide 22 ___________________________________ ___________________________________ ___________________________________  ___________________________________ ___________________________________ CASE STUDY The nurse is taking a history for a 66-year-old female client whose mother has breast cancer. She is married and has never been ___________________________________ pregnant. History reveals smoking ½ pack daily and drinking two glasses of wine each night with dinner. ___________________________________ 1. What factors place this client at risk for breast cancer? (List all that apply.) Slide 23 ___________________________________ ___________________________________ CASE STUDY 2. What information will the nurse include when teaching this client about breast cancer? (Select all that apply.) ___________________________________ A. B. Annual MRI of the breasts is recommended Mammograms are ordered only if necessary. ___________________________________ C. D. The provider can perform a clinical breast examination (CBE) at visits. Notify the provider if you notice any changes in your breasts. ___________________________________ E. Breast self-examination (BSE) is the best way to detect breast cancer early. ___________________________________ ___________________________________ Slide 24 ___________________________________ ___________________________________ CASE STUDY A year later, the client returns reporting lump in her left breast. Upon examination, a small mass is palpated. A diagnostic ___________________________________ mammogram is ordered and confirms the presence of a 2 × 2 cm mass. The client is scheduled for a surgical excisional biopsy. ___________________________________ 3. How will the nurse describe this procedure to the client? ___________________________________ goforpath,generalanthesiaaa ___________________________________ care ___________________________________ Slide 25 ___________________________________ ___________________________________ CASE STUDY Pathologic examination of the removed breast lump tissue reveals malignancy. The client undergoes a modified radical mastectomy with lymph node dissection, to be ___________________________________ ___________________________________ followed by radiation and chemotherapy. 4. Which immediate postoperative intervention will the nurse delegate to the AP? nurse A. B. C. Assess pain level Administer pain medication as ordered Measure the Jackson-Pratt tube drainage. ___________________________________ D. Collect vital signs every 30 minutes then hourly for 4 hours ___________________________________ ___________________________________ Slide 26 ___________________________________ The nurse is caring for four female ___________________________________ ___________________________________ clients. Which client does the nurse identify at the highest risk for triple negative breast cancer? QUESTION 1 A. 32-year-old Black American with early menarche ___________________________________ ___________________________________ B. 40-year-old Asian-American with 3 children C. 51-year-old Native American with ___________________________________ family history of lung cancer D. 60-year-old White American with ongoing menarche ___________________________________ Slide 27 ___________________________________ The nurse is caring for a client who just had a bilateral mastectomy. When the ___________________________________ ___________________________________ client states, “my partner is going to hate how I look”, which nursing response is appropriate? QUESTION 2 A. “I’m sure your partner will be accepting.” ___________________________________ B. C. “Why haven’t you asked your partner about their feelings?” “We can work on that after you are ___________________________________ ___________________________________ feeling stronger.” D. “It sounds like you are concerned about how your body looks after surgery.” ___________________________________ Slide 28 tylenoll Advil ___________________________________ The nurse is caring for a client who has ___________________________________ been recently diagnosed with fibrocystic changes (FCCs). Which teaching will the nurse provide? ___________________________________ QUESTION 3 A. Use analgesics for pain control ___________________________________ wear Supportive bra ___________________________________ B. Eat yogurt to increase calcium intake C. Do not wear a bra at home to maintain comfort D. Increase salt intake before menses each month ___________________________________ ___________________________________