INTRODUCTION

There are 15-20 lobes in the breast

Lobes are made by small lobules. Small ducts join the lactiferous duct.

-The lactiferous duct acts as a reservoir of milk after delivery and the dark brown areola is part of the breast.

Areola blood, Venus, nine supplies lift supply.

Blood supply:-

Branches of the thoracic artery and axillary artery provide blood supply to the breast.

Venous drainage :-

Thoracic. Axillary and mammary venous drainage

→ lymph drainage:

It includes the axillary lymphatic vessels

Nerve supply:-

Supply the thorax and axillary nine

(4th, 5th, 6th thoracic nerve)

function of the breast;

The secretion and ejection of milk depends on two types of hormones.

1) anterior pituitary

Prolactin stimulates the hormone, this hormone secretes milk from the breast.

2) Posterior pituitary stimulates the hormone oxytocin and it ejects milk after the baby sucks on the breast.

Anatomy of breast:

Breast is the tissue overlying the Chest (Pectoral) Muscles. Female breasts are made up of specialized tissue that produces milk (glandular tissue) as well as fibrous and fatty tissue.

The breast lies between the 2nd and 6th ribs, between the sternum and the mid-axillary line. The structure of the female breast is complex – including fat and connective tissue, as well as lobes, lobules, ducts and lymph nodes.

Each breast has a number of sections (lobules) that protrude from the nipple of the breast. Each lobule contains small, hollow sacs (alveoli). The lobules are connected by a network of thin tubes (ducts). Ducts carry milk from the alveoli to the dark area of ​​skin in the center of the breast (areola). From the areola, the ducts join together into larger ducts that end at the nipple of the breast.

The spaces around the lobules and ducts are filled with fat, ligaments and connective tissues. The amount of fat in the breasts largely determines their size. The actual milk-producing composition is almost the same in all women. Female breast tissue is sensitive to cyclical changes in hormone levels. Breast tissue may be denser and less fatty in younger women than in older women who have gone through menopause.

There is no muscle tissue in the breast. Muscles lie below the breasts, however, separating them from the ribs. Oxygen and nutrients travel through the blood to the breast tissue through arterioles and capillaries – thin, delicate blood vessels.

The lymphatic system is a network of lymph nodes and lymph vessels that help fight infection. Lymph nodes – found under the armpits, above the collarbone, behind the breastbone and in other parts of the body – trap harmful substances that may be in the lymphatic system and carry them safely out of the body.

Inspection of breast:

4 main sitting positions of the client are used for clinical breast examination. Every client should be examined in every situation.

1. The client is sitting with his arms at his sides.
2. The client is seated with arms raised above her head.
3. The client is seated and pushing her hands to the side of her hips, simultaneously eliciting a contraction of the pectoral muscles.
4. The client is sitting and learning while the examiner helps to support and balance him.

When the client is doing these maneuvers, observe the breast. Check symmetry, bulging, retraction, fixation in it.

When there is no abnormality in the breast and asking them to prevent position 2 and 4 position to prevent invasion of the suspensory ligament in the breast due to pressure on the suspensory ligament of the breast.

Normal finding of breast:

1. Chest should be overlying.
2. Satna may or may not be perfectly symmetrical at rest.
3. The areola is round or oval, with uniform color (color varies from light pink to dark brown).
4. Breast nipples are rounded, everted, same size and same color.
5. No “orange peel” like skin is noted indicating that edema is present.
6. Veins may be visible but not engorged and prominant.
7. No apparent mass noted.
8. Breasts are not stable and move bilaterally when arms are raised or lowered, or moved back and forth.
9. No retraction or dimpling.

Palpation of breast:

Palpate the breast with imaginary concentric circles, following a clockwise rotary motion from the periphery to the center of the breast towards the nipple. The best time for breast examination is one week after the menstrual cycle.

The nipple of each breast is gently compressed to assess for the presence of a mass or discharge.

General Conclusions:

1. No mass or lump is evident.
2. Temderness is not visible.
3. No discharge from breast nipple.

HEALTH HISTORY:

1.General information:

• age and marital status

•Past medical surgical history

•Injury

•Bleeding

Any breast problem

• Medication
• Use of any hormonal contraceptive
• Use of any over the counter products

•Vitamins

•Herbal supplements

2. Gynecological and obstetric history:

• menarche

•Date of last menstrual period

• Pregnancy • Miscarriage
• Abortion
• deliveries
• Lactation history • Family history of breast cancer Physical examination:

Screening and early detection:

It can be important to be screened for breast cancer before symptoms appear. Screening can help doctors detect and treat cancer early. A doctor may suggest the following screening tests for women to know how their breasts normally look and feel and to report any breast changes to their health care provider right away.

Breast self-exam (BSE) is an option for women in their 20s. Women can do breast self-examination to check monthly if any changes are found in the breast.

Annual mammograms are recommended starting at age 40 and continuing as long as a woman is in good health. A mammogram is an X-ray picture of the breast. Mammograms can often show breast lumps before they are felt.

Clinical Breast Examination (CBE) every 3 years for women in their 20s and 30s and every year for women 40 and older. A complete clinical breast exam can take about 10 minutes. During a clinical breast exam, the health care provider examines your breasts. The health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for rashes, dimpling, or other unusual signs. Breast nipple is squeezed to check breast milk.

Clinical breast examination:

A clinical breast examination (CBE) is a physical examination of the breast performed by a health professional. Clinical breast exams are used along with mammograms to screen women for breast cancer. Clinical breast exams are also used to check for other breast problems.

A clinical breast examination may be part of a routine examination. Talk to a health professional about how often you need to have breast exams. Women with breast implants should also undergo regular clinical breast examinations. A clinical breast examination is done to: 1. Find any lumps or changes in the breast that may mean a more serious problem is present, such as breast cancer 2. Check for other breast problems that may require further treatment , such as mastitis or fibroadenoma.

Procedure:

A clinical breast examination is performed by a health professional. A woman has to remove her clothes above her waist. He will be given a gown to wear during the examination.

First, the health professional will ask her questions about any problems, medical history, and risk factors for breast cancer. Talk to a health professional about any areas of the breast that may be of concern.

The health professional will then examine each breast, underarm, and collarbone area to check for changes in breast size, skin changes, or signs of injury or infection, such as bruising or redness. During this part of the exam, the woman is asked to raise her arms above her head, place her hands on her hips or lean forward, and press the muscle under each breast with her hands. She may lie flat on a table and place her hands behind her head while the health professional examines the breast tissue.

The health professional will feel each breast for any abnormal or painful areas or for enlarged lumps. A dominant lump in the breast is any lump that is new, large, hard, or different from other lumps or the rest of the breast tissue in any other way.

The health professional will gently press on the breast tissue from about 1 inch (2.5 cm) below the breast to the collarbone. He or she will also check her armpits (axillary area) and her neck for Swellon glands (lymph nodes).

The health professional will press gently on the nipple of the breast to check for any discharge and check whether there is any discharge or not.

Result of clinical breast examination:

Normal and abnormal

Normal:

The nipple, breast tissue, and surrounding areas of the breast appear normal and are normal in size and shape. One breast may be slightly larger than the other.

There may be a small area of ​​firm tissue in the lower curve of the breast below the nipple of the breast.

It is common for many women to experience tenderness or lumps in both breasts. Many women experience lumpiness or thickness in both breasts during the menstrual cycle.

There may be a clear or milky discharge (galactorrhea) when the nipple of the breast is squeezed. This can be due to nursing, breast stimulation, hormones or any other common cause.

One breast may have more glandular tissue (lump) than the other, especially in the upper outer quadrant of the breast.

Abnormal:

There may be a lump or thickened area in one of your breasts.

A change in the color of your breast or breast nipple or breast tenderness may be present. This may include wrinkling, dimpling, thickening, or puckering, or an area that feels grainy, stringy, or thickened.

The nipple may be indented in the breast. Breast nipple red, scaly rash and sore can be seen.

A painful lump or redness or warmth may be present over the entire breast. This may be due to infection (abscess or mastitis) or cancer.

Bloody or milky discharge (galactorrhea) may occur without stimulation.

BREAST SELF EXAMINATION:

Breast self-examination is done for the prevention of breast cancer

Presently breast self-examination is done for awareness towards women’s breast

Performed five to six days after menstruation

A breast self-examination is an examination performed by medical or paramedical staff

Best Self Examination can be started from the age of 20

Breast self examination is done in standing and lying position

It has total five steps

Step: 1

Stand in front of the mirror with upper clothes removed and place both hands on hip bone and observe both breasts.

Observe for any inflammation, redness, lesion, scar in the breast and observe for any discharge from the breast.

Step: 2

Leaning towards the mirror and filling the weight variety of both breasts

Step: 3

Raise either hand and palpate the breast with three to four fingertips to check for lymph nodes, masses, dimpling or tumors in the breast.

Palpation is done in three ways

Vertical

Wedge

Spiral

Similarly raise the opposite hand and palpate.

Step: 4

Finally squeeze the nipple and check whether there is any discharge or not.

Step: 5

Repeat the third step in the lying position

Using pillow while lying position

Palpate the breast even in this lying position

Keep the pillow under the arms ni

Then repeat the third step again in right and left side

Diagnostic test:

Breast MRI: An MRI scanner uses a high powered magnet and a computer to create a detailed image of the breast and surrounding structures. It is particularly useful in screening young women with dense breast tissue who may be at high risk of developing breast cancer.

MRI is also useful for determining the stage of breast cancer to help determine the most appropriate treatment. A breast MRI can add additional information to a mammogram and only in specific cases is the information added.

Breast ultrasound: Breast ultrasound, also known as sonography or ultrasonography, is used when there is an abnormal cyst (filled with fluid) seen on a mammogram or through a clinical physical examination.

Ultrasound does not provide as much detail as mammogram images and US. Not approved by the Food and Drug Administration (FDA) as a screening tool for breast cancer.

Ductogram: A ductogram is useful in evaluating patients with breast or nipple discharge. A thin plastic tube is inserted into the nipple of the breast, a contrast dye is injected into the breast.

Nipple smear (Nipple discharge exam):

A sample of blood or abnormal fluid leaked from the breast nipple is examined under a microscope to see if cancer cells are present.

Ductal lavage: Sterile water is injected into the nipple of the breast, then cancer cells are collected and examined. This test is used only in women at high risk for breast cancer

Mammography: This is a low-dose X-ray image of the internal structure

A breast mammography machine compresses each breast and takes low-dose x-rays. In a mammogram machine, each breast is compressed and then x-rayed. A mammogram is used for both detection and screening of breast cancer. A mammogram is used to evaluate tumor cysts and the evolution of a specific area of ​​a breast through screening and physical examination.

Digital Mammogram:

A mammogram is an electronic image of each breast in a digital, computer-readable format.

Biopsy:

A tissue sample is taken from an area of ​​the breast that appears normal through a mammogram or other imaging study.

Biopsy is done by needle or small surgery Biopsy na 5 type.

Fine needle aspiration (FNA) biopsy: The doctor inserts a thin needle into an abnormal-looking area of ​​the breast and removes fluid and tissue (aspirate). This is the simplest type of biopsy and is most often used for easily palpable lumps in the breast.

Core needle breast biopsy: A large, hollow needle is inserted into the breast, and a tube-shaped piece of breast tissue (core) is removed. More evaluation of breast tissue is done in core biopsy than in FNA biopsy.

Stereotactic breast biopsy:

A health care provider can determine the exact location of normal breast tissue through a computer-captured picture of this biopsy.

Surgical biopsy:

To check for cancer, part of the breast lump is surgically removed.

Sentinel node biopsy:

This type of biopsy is used to determine how far the cancer has spread.

In this type of biopsy, the health care provider locates the primary tumor and removes the lymph node.

DISORDER OF BREAST:

MASTITIS:

Mastitis is an infection and inflammation in the breast tissue which is seen in conditions like pain, swelling, redness in the breast.

There are 2 types of mastitis.

1. Puerperal
2. Non-puerperal
3. Puerperal mastitis:

This is seen due to blockage or excessive milk production after pregnancy, lactation and delivery.

2.Non-puerperal

This is not caused by pregnancy or lactation. This causes a lesion on the breast.

Etiology:

Bacteria: Streptococcus staphylococcus

Milk stasis– collection of milk occurs in the breast due to lack of lactation in the breast.

This is more common in the puerperial period (after 6 weeks of delivery).

Hormonal changes: estrogen

Progesterone

Due to the breakdown of dead cells in the milk duct

HIV

diabetes

By wearing too fit clothes

Maternal stress

If there is trauma to the breast due to an accident

Clinical manifestations:

Breast discharge

Swelling

Lump

Pain

High grade fever

Lesion on breast

Skin redness

Inflammation on breast

Tender or warm breast

Body ache

Malaise

Fatigue

Breast engorgement

Chills

Rigor

Management:

1. medical management
2. Surgical management
3. Nursing management
4. Medical management:

Analgesic medicine:

This medicine is given for chest pain.

Eg.ibrupofen

This medicine is safe during breast feeding.

This medicine also does not harm the baby.

Antibiotic medicine:

This medicine is given to reduce the infection in the breast.

Eg. cephalexin

Erthromycin

Antipyretic medicine:

This medicine is given to cure fever due to infection.

2.Surgical management:

If an abscess is found in the breast, drainage is done.

Local anesthesia is given in it after which the abscess accumulated in the breast is drained by needle aspiration.

If the abscess is deep, general anesthesia is given in the operation room and a small incision is made to drain it

And finally the abscess is treated with antibiotics.

Nursing management:

Encouraging mothers to breastfeed

Ask the mother to do breast feeding even if she feels pain in the affected breast.

Frequent breastfeeding can prevent engagement in the breast and block the milk duct.

Before doing breast feeding and after doing breast feeding, do left compression on the breast to relieve pain.

If left compression does not work, apply ice pack on breast only after breast feeding to provide comfort and release.

Do not use ice pack before breastfeeding as it reduces the flow of milk.

Encouraging the mother to take pain killer medicine to ease the pain

Instruct the patient to drink 10 glasses of water a day and take a well-balanced diet

A breastfeeding mother should take 500 extra calories a day.

Dehydration and undernutrition reduce milk supply so advise the patient to drink plenty of water and eat well.

If there is discharge from the nipple, wash the nipple gently and allow the nipple to dry. Then get dressed.

Ask to use a disposable breast pad if there is excessive discharge.

This disposable breast pad absorbs the discharge.

Ask the patient to keep cabbage leaves on the breast. As cabbage leaves are helpful in reducing infection, replace the cabbage leaves when they become wilted

Ask the patient to perform a breast massage.

Ask the patient to wear a supportive cloth (bra).

PREVENTION:

Equal breast feeding in both breasts.

While doing breast feeding, both the breasts should be completely emptied so that engorgement can be prevented and the duct can be prevented from blocking.

Use good breast feeding technique while breastfeeding to prevent sores.

Dehydration can be reduced by drinking plenty of fluids.

Wearing a supportive garment (bra).

to relax

Apply left compression on breast before breast feeding.

Maintain hygiene.

Hand washing

Clean the nipple

Clain the breast

Keep baby clean

BREAST ABSCESS:

Sometimes a bacterial infection can cause pus to collect in a localized area just under the skin. When this pus forms in the breast, it is known as breast abscess. It can be painful and requires immediate medical attention to avoid complications.

The type of bacteria that most commonly causes breast infections is Staphylococcus aureus. Bacteria can enter through a crack in the skin of the breast or in the nipple of the breast. The resulting infection, called mastitis, invades the fatty tissue of the breast, causing swelling and pressure on the milk ducts.

Causes and risk factors:

Breast abscess occurs most often in women between the ages of 18 and 50, especially if they are breastfeeding.

There are two categories of breast abscess:

1. Lactational (puerpereal) abscess

2.Non-lactational abscess

1. Lactational (puerperal) abscess:

Forms in the peripheral areas of the breast, usually

Found in upper and outer sections. Breast abscess can often be caused by mastitis. In this case, it is known as a lactational abscess. It can occur in the milk ducts that carry milk to the nipple of a breast feeding woman.

2. Non-lactational abscess: Occurs in the subareolar or lower parts of the breast. In women who are not breastfeeding, bacteria can enter the breast through a crack or sore.

Breast nipple – This is a non-breast feeding related abscess…

Symptoms:

Pain in the affected breast

Redness, swelling, and tenderness in an area of ​​the breast

Fever

Breast engorgement

Itching

Nipple discharge

Nipple tenderness

Tender or enlarged lymph nodes in the armpit on the affected side

Management:

First the lump needs to be examined. If there is an abscess, the patient will be immediately referred to a surgeon for diagnosis and treatment.

An ultrasound scan can confirm the diagnosis of an abscess and determine whether there is more than one pus collection.

An abscess will need to be drained to remove fluid (pus) from the breast

If the abscess is small, a needle and syringe will be used to remove the fluid. If there is a small or large abscess, an incision or incision will be made to remove the fluid.

The patient will first be given a local anesthetic to numb the skin

The pus is drained around the abscess and using ultrasound. Broad-spectrum antibiotic medicines used to treat breast abscess include the following…

Prevention:

1. Do not breastfeed with infected breast if abscess is present.

And if the patient wants to do breast feeding, consult the doctor.

2. Wash breasts daily with mild soap and water. Wipe away the dry secretions and gently dry the breast thoroughly with a clean towel.
3. After breast feeding, clean the nipple and areola of the breast with boiled, cooled water and cotton.
4. At the end of the breast feed, allow the breast to air dry naturally.
5. Apply lanolin cream daily to prevent nipple and areola from cracking.
6. Bathe with warm water and apply cold compress to the infected area.
7. Apply a warm, moist compress to the affected area several times a day
8. Maintaining a regular schedule of breast feeding or manually pumping milk.

GAYNECOMASTIA:

Gynecomastia is the overgrowth of male breasts. In response to too much estrogen (a female hormone) or too little testosterone (a male hormone), breast tissue swells and swells and becomes a breast bud. Gynecomastia can affect one or both breasts, sometimes unevenly.

Cause and risk factor: Causes and risk factors:

In New Born, gynecomastia is caused by estrogen from the mother. Breast buds are common in baby boys. Breast buds gradually disappear by the age of 6 months, but in some babies they may last longer.

In preteen boys, gynecomastia can also be caused by an estrogen-producing tumor.

Breast buds are normal during puberty. This bud can last up to 2 years, but it disappears within the first year.

In teenage boys, gynecomastia is caused by the hormonal changes of puberty. Gynecomastia occurs in many boys during early puberty to mid-puberty. It usually goes away in 6 months to 2 years

In adult men, gynecomastia is usually caused by other conditions

Grade of gynecomastia:

Grade one gynecomastia is small and can be seen with the trained eye but as you go up the grade and reach grade 4, it becomes obvious and severe.

Grade-1

Severity- very mild

In this, a localized button of tissue is deposited around the areola.

Grade-2

Severity-mild to high

Breast enlargement increases moderately and is seen up to the edge of the areloa.

Grade-3

Severity – high to indentifiable

In this, breast enlargement increases from the areolas and chest thi increases to the skin

Grade-4

Severity- severe to visibly feminine

In this, enlargement of the breast is seen along with the boundary of the skin and feminization of the breast is also seen.

Diagnostic investigation:

History collection

Physical examination blood test

Mammograms

CT scan

MRI

Testicular USG

Management:

1. Medicine:

Medicines used to treat breast cancer and other conditions, such as tamoxifen (Soltamox) and raloxifene (Evista), may be helpful for some men with gynecomastia.

2. Surgery to remove excess breast tissue:

If the patient has growth in the breast after initial treatment and observation, then the doctor advises surgery. There are two options for gynecomastia surgery:

Liposuction. This surgery removes fat from the breast, but the breast gland tissue is not removed.

Mastectomy. This type of surgery removes the breast gland tissue. Surgery is often performed endoscopically, which means that surgery is performed using only a small incision.

Tumor and malignancy of breast:

1. Breast cyst
2. breast cancer

Breast cyst:

A breast cyst is a fluid filled sac inside the breast. A patient may have one or several sacs in the breast. They are often seen as round or oval lumps with distinct edges. In this breast formation, the breast cyst usually looks like a soft grape or a water-filled balloon, but sometimes the breast cyst feels firm.

Cause

The cause of breast cysts is unknown. Some evidence suggests that excess estrogen in the body may play a role in the development of breast cysts. Breast cysts develop when an overgrowth of glands and connective tissues (fibrocystic changes) blocks the milk ducts, causing them to expand and fill with fluid.

Microcysts:

Microcysts appear very small when filled but can be seen during imaging tests, such as mammography or ultrasound.

Macrocysts:

Macrocysts are large enough to be felt and can grow to about 1 to 2 inches (2.5 to 5 cm) in diameter. Large breast cysts can put pressure on nearby breast tissues, causing pain and discomfort in the breast.

Clinical manifestations:

A smooth, easily movable round or oval breast lump is seen.

Breast pain or tenderness in the area of ​​the lump

Increase in lump size and tenderness before menstruation

Lump size reduction and resolution of other post-period signs and symptoms

Having one or more simple breast cysts does not increase the risk of breast cancer.

Management:

Breast cysts do not require treatment unless the cyst is large and painful or uncomfortable. In that case, draining the fluid from the breast cyst may relieve symptoms. Typical treatment involves needle aspiration biopsy. Aspirated cysts often recur; Certain treatments may require surgery. Surgical removal of breast cysts is only an option in unusual circumstances.

If the breast cyst recurs month after month, the breast cyst has blood-colored fluid and shows other worrisome signs, surgery may be considered.

Using oral contraceptives to regulate the menstrual cycle can help shrink breast cysts again.

Discontinuation of hormone replacement therapy during the postmenopausal years may also reduce cyst formation.

If the patient has breast pain from the cyst, encourage taking acetaminophen or ibuprofen medicine.

Encourage surrounding breast tissue to wear a supportive bra to relieve some discomfort.

Breast Cancer:

Definition:

Breast cancer starts from the lining of the breast duct and the lobe of the breast

affects

Etiological factors:

Age (40-45 years)

family history and personal history of cancer.

Gene changes (changes in DNA & RNA)

Reproductive & menstrual history (hormonal imbalance, birth control pills)

birth control pills.

weak immune system

lack of physical activity.

Human papilloma virus infection

STAGES:-

Stage-o :- carcinoma in situ

stage-1:- less than 02 cm tumor was grown.

Lymph node involvement is absent.

Stage-2 – more than 02 cm but less than 05 cm tumor was grown,

And still lymph node involvement is absent.

→ Stuge-3 :- Cannot find size of tumor

Lymph node involvement is seen and spread to axillary area.

Stage-4 :

In this stage, the cancer spreads from nearby to distant organs.

Clinical Manifestation :-

Feel the lump in breast

The most common metastasis of breast cancer is clavical bone or collar bone

change in size & shape of breast Breast tenderness. pain

in breast & nipple nipple discharge (it is not milk secretion)

enlargement in axillary area.

Redness in breast

Dimpling in breast

Skin irritation in breast area

Enlargement of areola

nipple inversion.

Diagnostic Evaluation:

History collection

Physical examination

ultrasound

MRI

memograph

fine needle biopsy

surgical biopsy

BSE (Breast Selly Examination

Management:

A. Surgery:

Surgery is the most common treatment for breast cancer. There are many types of surgery.

1. Mastectomy: Mastectomy is an operation to remove cancer. This procedure is usually done for carcinoma in situ (stage-0). In most cases, the surgeon removes the lymph node located in the armpit.

•Total mastectomy: In a total (simple) mastectomy, the surgeon removes the entire breast.

In it, the hand also removes the lymph node in the lower armpit.

•Radical mastectomy:

Radical mastectomy is removal of breast, pectoralis major-minor and axillary lymph node.

•Modified Radical Mastectomy:

The surgeon removes the entire breast, and most of it

Lymph nodes under the arm are removed.

Many times, the chest muscle is removed…

NURSING MANAGEMENT OF A PATIENT AFTER MASTECTOMY:

Nursing management:

Preoperative nursing intervention:

1 Monitoring the adverse effects of radiation therapy such as Weaknes, Sore throat, Cough, Nausea, Anorexia.

2. Monitoring adverse effects of chemotherapy, bone marrow suopression, Nausea and vomiting, alopecia, weight gain or loss, weakness, stomatitis, anxiety and depression.
3. Realize that a breast cancer diagnosis is a devastating and emotional shock for a woman. Provide psychological support to the patient throughout the diagnosis and treatment process.
4. Involve the patient in planning and treatment.
5. To describe surgical procedures to remove fear.
6. Explain to the patient about the effects of chemotherapy and treatment for alopecia, weakness.
7. Administer anti-inflammatory medications, as directed, to patients receiving therapy.

-postoperative nursing care:

Nursing diagnosis:

1.Risk for infection related to surgical incision

2. Ineffective tissue perfusion related to lymphedema
3. Acute pain related to surgery
4. Disturbed body image related to breast changes or loss of breast
5. Impaired skin integrity related to surgical incision and radiation
6. Decisional conflict about treatment related to concerns about risks and benefits
7. Interrupted family processes r/t effect of surgery & therapy on family roles and relationships
8. Fear related to disease process/prognosis Expected outcome:
9. Stay infection free.
10. Maintain adequate tissue perfusion.
11. To feel less pain or discomfort during the patient’s recovery.
12. Maintain a positive body image, regardless of her decision about recovery.
13. Maintaining skin integrity.

6.Evaluate individual value and treatment options and decide treatment no course of action.

7. Along with her daughters, advising her to support her during her illness.
8. Identify the sources of his fear and be kind to him to reduce the fear. Nursing interventions:
9. Elevate the extremity of the surgical site to relieve pain and edema. Elevating the arm reduces stress on the surgical incision and increases blood circulation.
10. Ice packs are helpful in reducing discomfort and swelling.
11. A small pillow placed in the armpit also reduces the discomfort level and increases fluid drainage by gravity.
12. Ask her to be careful when moving her arm to the side, avoid repetitive activity, avoid lifting heavy objects, and avoid vigorous exercise until the stitches are removed.
13. Administration of IV or IM opioid analgesics (Vicodin) for moderate pain. Instructing pain medicine to be taken when pain is experienced on a regular schedule.

Adding ibuprofen (Advil or Motrin) or Tylenol to vicodin…

Post masectomy exercise:

1.hand wall climbing:

Stand facing the wall with toes 6-12 inches from the wall.

Bend the elbow and place the hand against the wall at shoulder level. Slowly move both arms up,

Keep moving the arm up until you feel pain.

2.rope turning:

• Tie a rope to the door handle. Hold the rope with the hand that is side operated. Stand back away from the door until the arms extend parallel to the floor, away from the body. Swing the rope to make the circle as wide as possible.

1. Rod or broomstick lifting:

Grasp the rod with both hands about 2 feet apart. Keeping the arms straight, raise the bar above the head. Bend the elbows to lower the bar behind the head. Reverse maneuver and raise the bar overhead, then repeat all the way back.

4. Pulley tugging:

Toss a light rope over the shower curtain rod. Hold one end of the rope in each hand. Slowly raise the arms as comfortable as possible by pulling down on the rope on the opposite side. Reverse the nonoperated arm by lowering the operated side (in a see-saw motion). Instead of a rope, the patient can use a towel and move the towel like we use it to clean the back of our body.

5. Elbow circles:

When you sit or stand, keep your right hand on your right shoulder and your left hand on your left shoulder. Raise your elbows until you feel a stretch. Make circles with your elbows. Start small and then make larger circles. Change direction with your circles. Repeat this 2 or 3 times.