nurse's notes

FIBRO ADENOMATA

• are benign tumor of the breast which are firm, round, movable and usually appearing in breast of young woman
• painless and not tender
• no malignant potential

T

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CARCINOMA -

• BREAST- is common sites of carcinoma in females
• unknown cause but common in woman who have family history
  
• most tumors of the breast in women who are at age of 40 and above
• those who had late menopause are carcinomatous
  
• those who are in higher economic level

Usually tumor grows at the upper outer quadrant of the breast. When it grows, it attaches to the chest wall on the overlying skin then tumor extends to the lymph gland of the adjacent axilla. If not treated, tendency to reach the medial half of the breast, it extends to the lymp nodes within the chest along the internal mammary artery until possibility to metastasize to other organs like lungs, bone, brain or liver

SIGNS AND SYMPTOMS:

• non tender lump, movable at the upper outer quadrant of the breast
  
• painless except in late stage
• dimpling or "orange peel" skin
• retracted nipple is evident
• assymmetry- that the breast affected is more elevated
• pain, ulceration and edema at later stage

DIAGNOSTIC EXAMINATION:

• physical examination
• mammography- most common to detect non-palpable lesion
• biopsy or aspiration
• metastatic work may include bone scan, liver scan, liver function test, chest x'ray brain scan and other laboratory works

Nursing Management:

• Psychosocial Preparation- listen and support the patient and alleviate patient's feels of disfigurement and her cancer disease
• explanation to patient and family about the purpose of surgery and sought to determine that the husband's genuine understanding and love
• carried out pre-operative skin preparation by shaving the areas for a possible maximal surge

Surgery

• Simple Mastectomy- removal of breast without lymph node dissection
• Radical Mastectomy-removal of the breast and the underlying muscles down to the chest wall after removal of the nodules and the lymphatic of the axilla

POST OPERATIVE CARE:

• Monitor vital signs every 30 minutes for first hour and record for doctors evaluation
• observe dressing for any signs of bleeding
• if recovered from anesthesia sedatives- must give pain reliever as ordered by physician
• turned head to one side
  
• encourage to have a deep breath to prevent pulmonary complication
• proper care of drainage catheter if there is any
• positioning of patient depends on the dressing and semi- fowlers is desirable
• encourage to stand from bed on the second or third day
  
• arms on the affected area must hold by a sling
• normal diet is to be given unless if patient is nauseated
• drainage tube removed on the second or third day