Nursing 211

N211: Health Differences Across the Lifespan I of 148 Include surgery, radiation therapy, chemotherapy and hormonal therapy. Radiation therapy is used to destroy remaining cancer cells after surgery and to shrink the tumor prior to surgery. Simple mastectomy is the removal of the complete breast but no other structures. Segmental mastectomy or lumpectomy is the removal of the tumor and a margin of breast tissue surrounding the tumor. Radical mastectomy is removal of the breast, axillary lymph nodes and underlying chest wall muscles; this is seldom performed. Breast reconstruction may be performed at the time of mastectomy or at a later time. This can be accomplished through a sub muscular breast implant, placing an implant after using a tissue expander, using muscles with intact blood supply form abdomen and back, or creating a free muscle flap with gluteus Maximus muscle. Medication Therapy Includes Novadex (Tamoxifen) which interferes with the estrogen activity for treating advanced breast cancer, and chemotherapy when axillary nodes are involved. This is used to suppress hormone dependent tumors. Chemotherapy agents that are frequently used are cyclophosphamide (Cytoxan), methotrexate (Methotrexate), fluorouracil (5-FU), and doxorubicin (Adriamycin) Nursing Assessment Includes assessment of the lesion, location, size, shape, consistency, lymph node involvement and fixation to surrounding tissues. Assess client’s pain rating, using a scale of 0-10, assist client into a position of comfort. Administer analgesics as ordered to relieve pain. Explore client’s expectations of surgery and what the surgical site will look like postoperatively. Post procedure monitor bleeding, check dressing, hemovac and under client’s back; position arm on operative side on a pillow slightly elevated. Avoid BP measurements, injections, and venipuncture in affected arm. Instruct client to avoid injuries such as burns and scrapes to the affected arm. Encourage hand activity such as squeezing a small rubber ball. Teach client to perform post-mastectomy exercises such as wall climbing with affected arm. Encourage the client to verbalize concerns about cancer, death and loss of breast. Be with the client when she looks at the operative site for the first time and offer emotional support. Arrange for Reach for Recovery to visit with client, if client desires. Recognize the grief process and allow the client to cry. Discuss with client the use of temporary or permanent prosthesis. Encourage the client to turn, cough and deep breathe to prevent respiratory complications. Position client on back or on unaffected side. Maintain Jackson Pratt or Hemovac to drain fluid that accumulates when lymph nodes are removed. 3.18 Cervical Cancer ©2012 Achieve Page 105

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