– The main goal of mastectomy is to obtain local control of the breast cancer.
– With breast cancer being diagnosed today at earlier stages, options forless invasive surgical procedures are available.
Definition of MASTECTOMY
Mastectomy is defined as the removal of breast tissues, nipple, areola complex, and a portion of the axillary lymph nodes.
Types of Mastectomy
1- Modified Radical Mastectomy
– It is performed to treat invasive breast cancer. The procedure involves removal of the entire breast tissue, including the nipple-areola complex. In addition, a portion of the Axillary Lymph Node Dissection “ALND”.
– Unlike in radical mastectomy, the pectoralis major and minor muscles are left intact. Radical mastectomy is rarely performed today.
2- Total Mastectomy
– It involves removal of the breast , nipple and areola complex but doesn’t include “ALND”. Total mastectomy may be performed for patients with non-invasive breast cancer, which doesn’t have a tendency to spread to the lymph nodes. It may be performed prophylactically for patients who are at risk for breast cancer.
Nursing Process In Mastectomy
I- Nursing ASSESSMENT of Mastectomy
– The health history is used to assess the patient reaction to the diagnosis and the ability to cope with it. This assessment include:
– Response to diagnosis
– Coping mechanism
– Psychological or emotional support
– Educational needs
II- Nursing Diagnosis of Mastectomy
Preoperative Mastectomy Nursing Diagnosis
– Based on the health history and other assessment data, major preoperative nursing diagnosis may include the following.
– Deficient knowledge about planned surgical treatments.
– Anxiety related to the diagnosis of cancer.
– Fear related to specific treatments and body image changes.
– Risk for ineffective coping “ Individual or family” related to the diagnosis of breast cancer and related to treatment options.
– Decisional conflict related to treatment options.
Post operative Mastectomy Nursing Diagnosis
– Based on the health history and other assessment data, major post operative nursing diagnosis may include the following.
– Pain and discomfort related to surgical procedure.
– Disturbed sensory perception related to nerve irritation in affected arm, breast, or chest wall.
– Disturbed body image related to loss or alteration of the breast.
– Risk for impaired adjustment related to the diagnosis of cancer and surgical treatment.
– Self care deficit related to partial immobility of upper extremity on operative side.
– Deficient knowledge: drain management after breast surgery.
– Risk for sexual dysfunction related to loss of body part, change in self-image, and fear of partner’s responses.
– Deficient knowledge: arm exercises to regain mobility of affected extremity.
– Deficient knowledge: hand and arm care after an axillary lymph node dissection “ALND”.
Collaborative Problems Potential Complications of Mastectomy
– Based on the assessment data, potential complications may include the following:
– Hematoma / seroma formation
Nursing Planning and Goals for Mastectomy
– The major goals may include:
– Increased knowledge about disease and its treatment.
– Reduction of preoperative and post operative fear, anxiety, and emotional stress.
– Improvement of decision making ability
– Pain management
– Improvement in coping abilities
– Improvement of sexual function
– Absence of complications
Mastectomy Preoperative Nursing Interventions
1- Providing Education and Preparation about Surgical Treatments.
– Prepare the patient for what to expect before, during and after surgery.
– Inform the patient about post operative drain, inform about drain care instruction will be provided prior to discharge.
– Inform the patient about decrease arm and shoulder mobility after surgery
2- Reducing Fear, Anxiety and Improving Coping Ability.
– Providing the patient with realistic expectations about the healing process and expected recovery can help alleviate pain.
– Marinating open communication and assuring the patient .
– Increase patient awareness of available resource at the treatment facility such as psychiatrist, social workers, and support group.
3- Promoting Decision Making Ability.
– Give the patient treatment option and asked to make a choice.
– The nurse help the patient weigh the risks and benefits of each option.
– The patient may be presented with option of having breast conservation treatment followed by radiation or mastectomy.
Mastectomy Postoperative Nursing Interventions
1- Relieving Pain and Discomfort.
– Give analgesic
– Evaluate any complication such as infection or hematoma.
– Alternative method of pain management“ guided imagery, distraction” taking warm shower.
2- Managing Postoperative Sensations
– Patient may experience a variety of sensation include tingling, soreness, numbness, tightness, pulling and twinges.
– Phantom sensation.
– Reassure the patient that this is a normal part of healing and these sensations are not indicative of a problem.
3- Promoting Positive Body Image.
– Assess the patient readiness and provide gentle encouragement.
– Maintain patient privacy.
– Allow the patient to express her feelings.
– Asking the patient what she perceive, acknowledging her feelings and allowing her to express her emotions.
4- Promoting Positive Adjustment and Coping
– Ongoing assessment of how the patient is coping with her diagnosis and surgical treatment.
– Assist patient to identify and mobilizing her support system.
– Provide guidance , support and education to the patient partner.
5- Monitoring and Managing Potential Complications.
– Lymphedema result from inadequate return flow of lymph fluid to the general circulation.
– Hematoma or Seroma formation “ collection of blood inside the cavity”. The signs and symptoms of hematoma include swelling, tightness, pain and bruising of skin.
– Infection “ redness, warmth around incision, tenderness, foul smelling drainage, and fever
6- Promoting Home and Community Based Care.
– Teaching patient self care. “ shower, care of drainage
– Teaching exercises after surgery.
– Continuing care “ adequacy of pain management, follow up visit”.
Nursing Evaluation of Mastectomy
Expected Preoperative Mastectomy Patient Outcomes
1- Exhibits knowledge about diagnosis and surgical treatment options.
a- Asks relevant questions about diagnosis and available surgical treatment.
b- States rationale for surgery
c-Describes advantages and disadvantages of treatment options.
2- Verbalized willingness to deal with anxiety and fears related to diagnosis and the effects of surgery on self-image and sexual functioning.
3- Demonstrates ability to make decisions regarding treatment options in timely fashion.
4- Demonstrates ability to cope with diagnosis and treatment
a- Verbalizes feelings appropriately and recognizes normalcy of mood liability.
b- Proceeds with treatment in timely fashion.
c- Discusses impact of diagnosis and treatment on family and work.
Expected Postoperative Mastectomy Patient Outcomes
1. Reports that pain has decreased and states pain and discomfort management strategies are effective.
2. Exhibits clean, dry and intact surgical incisions without signs of inflammation or infection.
3. Identifies postoperative sensations and recognizes that they are a normal part of healing.
4. Lists the signs and symptoms of infection to be reported to the nurse or surgeon.
5- Verbalizes feelings regarding change in body image.
6- Discuss meaning of the diagnosis, surgical treatment, and fears appropriately.
7- Participates actively in self – care activities
A. Performs exercises as prescribed
B. Participates in all activities as prescribed
8- Experience no complications
A. Identifies signs and symptoms of complications.
B. Explain how to contact appropriate health care providers in case of complications.
9- Demonstrates knowledge of post discharge recommendations and restrictions.
A. Describes follow-up care and activities.
B. Demonstrates appropriate care of incisions and drainage system.
C. Demonstrates arm exercises and describes exercise regimen and activity limitations.
D. Describes care of affected arm and hand and lists indications to contact the surgeon or nurse.