Mastectomy

members of group 4 are: Wendy Hosang

 What is mastectomy
• Mastectomy is the medical term for the surgical
removal of one or both breasts, partially or
completely. A mastectomy is usually carried out
to treat breast cancer.

• One both
 Types of mastectomy
Types of breast surgery include:
• Total (simple) mastectomy - removal of breast
tissue and nipple.
• Modified radical mastectomy - removal of the
breast, most of the lymph nodes under the arm,
and often the lining over the chest muscles.
• Lumpectomy - surgery to remove the tumor and
a small amount of normal tissue around it.
 Breast cancer
Breast cancer is a disease in which cells in the breast
grow out of control.
The kind of breast cancer depends on which cells in the
breast turn into cancer.
• Breast cancer can begin in different parts of the breast.
A breast is made up of three main parts: lobules,
ducts, and connective tissue.
• The ducts are tubes that carry milk to the nipple.
• The connective tissue (which consists of fibrous and
fatty tissue) surrounds and holds everything together.
Picture of the breast
 Etiology
• Certain gene mutations that increase the risk of
breast cancer can be passed from parents to
children. The most well-known gene mutations
are referred to as BRCA1 and BRCA2. These
genes can greatly increase your risk of breast
cancer and other cancers, but they don't make
cancer inevitable.
• Radiation exposure.
Risk factors for developing breast cancer

• Some of the factors associated with breast

cancer
• being a woman
• your age, and your genetics
• being overweight
• Alcohol intake
• Dense breast
Other factors associated with breast cancer

• lack of exercise
• smoking cigarettes
• eating unhealthy food
• can be changed by making choices. By
choosing the healthiest lifestyle options
possible, you can empower yourself and
make sure your breast cancer risk is as low
as possible.
Pathophysiology of the breast
• Tumor of the breast arises in the epithelial cells
of either ductal or lobular tissue and referred to
as carcinomas. The breast is divided into four
quadrants, the upper inner quadrate, the upper
outer quadrant, the lower inner quadrant, and
the lower outer quadrant.
Pathophysiology of the breast
• Most breast tumors are located in the upper
outer quadrant, but they can occur in any area of
the breast. When the tumor is confined within a
duct or a lobule and has not invaded surrounding
tissue, it is considered localized or in situ
carcinoma of the breast.
Picture of the quadrants
 Kinds of cancer
• Invasive ductal carcinoma. The cancer cells grow
outside the ducts into other parts of the breast
tissue. Invasive cancer cells can also spread, or
metastasize, to other parts of the body.

• Invasive lobular carcinoma. Cancer cells spread

from the lobules to the breast tissues that are
close by. These invasive cancer cells can also
spread to other parts of the body.
 Clinical manifestation
• A lump or mass in the breast.
• Swelling of all or part of the breast, even if no
lump is felt.
• Skin irritation or dimpling.
• Breast or nipple pain.
• Nipple retraction (turning inward)
• The nipple or breast skin appears red, scaly, or
thickened.
• Nipple discharge.
 Health promotion
Breast cancer prevention and control measures
• Control of specific modifiable breast cancer risk factors
as well as effective integrated prevention of non-
communicable diseases which promotes healthy diet,
physical activity and control of alcohol intake,
overweight and obesity, could eventually have an
impact in reducing the incidence of breast cancer in
the long term
• Anything that increases your chance of developing
cancer is called a cancer risk factor; anything that
decreases your chance of developing cancer is called a
cancer protective factor
 Health promotion
• Some risk factors for cancer can be avoided, but
many cannot. For example, both smoking and
inheriting certain genes are risk factors for some
types of cancer, but only smoking can be
avoided.
• Regular exercise and a healthy diet may be
protective factors for some typed of cancer.
• Changing lifestyle or eating habits. Avoiding
things known to cause cancer.
• Screening is looking for cancer before a person
has any symptoms.
 Health promotion
• This can help find cancer at an early stage. When
abnormal tissue or cancer is found early, it may
be easier to treat. By the time symptoms appear,
cancer may have begun to spread. If screening
test result is abnormal, you may need to have
more tests done to find out if you have cancer.
These are called diagnostic tests.
General inspection

 Ask the patient to sit upright, ideally on the

side of the bed.

 Ask the patient to uncover the breasts at this

point.

 Note any obvious masses, scars or asymmetry.

Physical assessment of the breast

Skin changes:
Arms by side
Erythema – infection / superficial malignancy
Puckering – may indicate an underlying malignant mass
Peaud’orange – cutaneous oedema – inflammatory breast
cancer

Nipple changes:
Retraction – congenital / underlying tumour / ductal ectasia
Discharge – may indicate infection or malignancy
Scale – may indicate Eczema or Paget’s disease
Physical assessment of the breast
Hands on hip
• Repeat inspection.
• Observe for any masses once again

Arms above head

• Ask patient to place both hands behind their head.
• Inspect the breast tissue for any evidence of:
• Masses
• Asymmetry
• Dimpling / puckering
Arms above head
• Ask patient to place both hands behind their
head.
• Inspect the breast tissue for any evidence of:
• Masses
• Asymmetry
• Dimpling / puckering
 Arms above head

Repeat inspection of the

breast tissue as before.

This position will exacerbate

any skin dimpling / puckering
which may relate to an
underlying mass.
 Palpation Breast

Place the patient in a Supine position

• Examine the “normal” asymptomatic breast first. Ensure to warm your hands
before touching the patient.
• Position the patient laid on the bed at a 45 degree angle.

• Ask the patient to place their hand on the side being examined behind their
head.
• Use the flat of your fingers to compress the breast tissue against the chest
wall, feeling for any masses.

• Use a systematic approach to ensure all areas of the breast are examined:

• Clock face method – examine each “hour” of the breast

• Spiral method – start at the nipple and work outwards in a concentric circular
motion
Axillary tail
Palpate the axillary tail of breast tissue:
• Breast tissue often extends into the axilla and is
known as the axillary tail
• The majority of breast cancers develop in the
upper outer quadrant so it’s essential this area is
examined thoroughly
 nipple

• If the patient reports having nipple

discharge, ask them to squeeze the nipple
to demonstrate this.
• Yellow / green discharge – suggestive of
infection
• Bloody discharge – more suspicious of
malignancy – e.g. papilloma
• Repeat palpation on the other breast,
asking the patient to place their alternate
hand behind their head.
 How to examine a breast lump
Position

• Which quadrant of the breast is the mass located

within? e.g. upper outer quadrant
• Using the clock face metaphor, what “hour” on the
clock is the mass located at? e.g. 2 o’clock
• How far away from the nipple is the mass located?
e.g. 4cm
 How to examine a breast lump
• Size and shape
• What are the approximate dimensions of the mass?
e.g. 2cm x 3 cm
• What shape is the mass? – e.g. spherical / elongated /
irregular

• Consistency
• What is the consistency of the mass on palpation?
• Smooth / firm / stony / rubbery
How to examine a breast lump
Overlying skin changes

• Are there any changes to the skin surrounding /

overlying the mass? – e.g. erythema / puckering

Mobility
• Assess the degree of mobility the mass has:
• Does it move freely?
• Does it move with the overlying skin?
• Does it move with pectoral contraction?
How to examine a breast lump
• Fluctuance

• Hold the mass by its sides then apply pressure with

another finger to the centre of the mass.

• If the mass is fluid filled (e.g. cyst) then you should feel
the sides bulging outwards.
How to examine a breast lump
Axilla
• 1. Have the patient sit on the edge of the bed
facing you.

• 2. Support the patient’s arm on the side being

examined with your forearm.

• 3. If you’re examining the right axilla, use your

right arm to support the patient’s (vice versa for
left).
 How to examine for a breast lump

• 4. Palpate the axilla with your free hand, ensuring to

cover all areas of the axilla:
• Medial / lateral / anterior / posterior walls
• Apex of the axilla

• 5. Note any lymphadenopathy – malignancy /

infection
 How to examine for a breast lump

• Other lymph nodes

• Finally perform a general lymph node examination
of the following areas:

• Cervical
• Supraclavicular
• Infraclavicular
• Parasternal
 Complete examination
To complete the examination
• Thank patient

• Cover patient up with a blanket/sheet

• Leave the room and allow them time to re-dress

• Wash hands

• Summaries findings
 Diagnostic tests
• Tests and procedures used to diagnose breast
cancer include:
• Breast exam
• Mammogram
• Breast ultrasound
• Removing a sample of breast cells for testing
(biopsy)
• Breast magnetic resonance imaging (MRI)
Surgical Management:

• Halsted radical mastectomy – breast tissue,

nipple, underlying muscles, lymph nodes (rarely
performed)
• Modified radical mastectomy – breast tissue,
nipple, lymph nodes
• Simple mastectomy – breast tissue, nipple
(lymph nodes left intact)
• Lumpectomy – only tumour , small amount of
surrounding tissue removed
Surgical management
medical management
• The type of treatment recommended will
depend on the size and location of the tumor in
the breast, the results of lab tests done on the
cancer cells, and the stage, or extent, of the
disease.
• Breast cancer treatments are local or systemic.
 Medical management
• Local treatments are used to remove, destroy, or
control the cancer cells in a specific area, such as
the breast. Surgery and radiation treatment are
local treatments
• Systemic treatments are used to destroy or
control cancer cells all over the body.
Chemotherapy and hormone therapy are
systemic treatments. A patient may have just one
form of treatment or a combination, depending
on her individual diagnosis.
 NURSING DIAGNOSIS:

• Anxiety related to diagnosis of breast cancer

Collaborative Problem: Potential for Metastasis
• Anticipatory Grieving r/t loss and possible or
impending death
• Acute Pain r/t tumour compression on nerve
endings
• Disturbed Sleep Pattern r/t pain and anxiety
• Disturbed Body Image r/t loss of a body part
• Sexual Dysfunction r/t body image or self-esteem
disturbance
PSYCHOSOCIAL ASSESSMENT:

• Fear Threats to body image, intimate

relationships and survival
• Decisions regarding treatment options
• Explore client’s feelings, support system, client’s
& family’s knowledge
• Client’s level of education
• Sexuality – psychologic, physiologic, relational
• Evaluate need for additional resources
NURSING PLANNING
• Seek information to reduce anxiety
• Control anxiety responses
• Use effective coping strategies throughout the
treatment period
• Participate in decision making
• Discuss concerns
• Learn self-care measures
• Potential for Metastasis
• The client with breast cancer is expected to
remain free of metastases or recurrence of cancer
Colon cancer
Colon cancer overview

The colon also known as the large intestine, is part

of the digestive tract. The digestive tract includes
the mouth, esophagus, stomach, small intestine,
large intestine, and rectum. The large intestine is
approximately 5 feet long, making up one-fifth of
the length of the gastrointestinal (GI) tract.
 Colon cancer overview con’t
• The large intestine performs an essential role by
absorbing water, vitamins, and electrolytes from waste
material.
• Its function is to reabsorb fluids and process waste
products from the body and prepare for its
elimination.
• The colon consists of four parts: descending colon,
ascending colon, transverse colon, and sigmoid colon.
 Colon cancer overview con’t
• The role of the ascending colon is to absorb the
remaining water and other key nutrients from the
indigestible material, solidifying it to form stool.

• The descending colon stores feces that will eventually

be emptied into the rectum.

• The sigmoid colon contracts to increase the pressure

inside the colon, causing the stool to move into the
rectum. The rectum holds the feces awaiting
elimination by defecation.
Signs and symptoms of colon cancer
Signs and symptoms of colon cancer
Signs and symptoms of colon cancer

• A persistent change in your bowel habits,

including diarrhea or constipation or a change in
the consistency of your stool.
• Rectal bleeding or blood in your stool.
• Persistent abdominal discomfort, such as
cramps, gas or pain.
• A feeling that your bowel doesn't empty
completely.
Unhealthy and healthy
 Treatment and Management for Colon Cancer.

• The Medical management of colon cancer depends on

stage of disease and related complications.

• Obstruction is treated with intravenous fluids and

nasogastric suction and with blood therapy if bleeding
is significant.

• Supportive therapy and adjuvant therapy with the use

of Radiation therapy, chemotherapy and Immunology
therapy.
 Treatment and management

• Radiation therapy the usage high-energy rays

(such as x-rays) or to destroy cancer cells. It may
control malignant disease when a tumor cannot
be removed surgically or when local nodal
metastasis is present for some colon cancer.

• Supportive (palliative care) therapy is a

specialized medical management that focuses on
providing relief from pain and other symptoms of
illness
Treatment and management
• Palliative chemotherapy is another medical
management used when colorectal cancer is
advanced and has already spread to different
parts of the body. In this situation, surgery
cannot eliminate the cancer therefore palliative
chemotherapy is advice, which may shrink
tumors, alleviate symptoms, and prolong life.
The five stages of colon cancer
Nursing medical management of colon cancer

• Develop a rapport \ therapeutic relationship with

patient to allay fear and anxiety about illness
• Monitor patient for any toxic event of
chemotherapy medication and report promptly to
Physician
• Provide emotional and spiritual support for
client and family
• Administered analgesic as ordered for adequate
pain control
Pharmacological Management of Colon cancer

• Systemic therapies is given intravenously or in a pill

or capsule form.

• Chemotherapy is the use of drugs to destroy cancer

cells, usually by ending the cancer cells ability to
grow and divide

• Common use chemotherapy drugs is 5-Fluorouracil

(Adrucil) An Antimetabolite Antineoplastic agent it
has been the first-choice of chemotherapy drug for
colon cancer for many years according to literature
Surgical management
• Surgery is the most common treatment for colon
cancer. The type will depend on the stage of the
cancer and where it is in the colon
• The right hemi-colectomy the surgeon removes
the ascending colon and a portion of the
transverse colon and then connects the
transverse colon to the end of the small
intestine, sigmoid colectomy the removal of the
diseased portion of the sigmoid colon and then
connects the descending colon to the rectum
Surgical management
• Left hemi-colectomy the removal a portion of
the transverse colon, the descending colon, and
the sigmoid colon and then connects the
transverse colon to the rectum, and lower
anterior resection (LAR). The Removal of the
diseased portion of the rectum and then
reconnects it to the descending colon.
Pre-operative management

•Ensure full physical assessment is done this to

ensure client is in good condition for surgery
•Review all laboratory studies that was ordered and
report any abnormal finding any abnormal result can
affect outcome of surgery.
•Documentation of relevant recent information
example vital sign, Hemoglobin level that will
indicate patient’s physiological status.
•Explain surgical procedure to patient in order for
patient to get a better understanding about the
procedure
 Post-operative
•Monitor bowel sounds if normal bowel auscultate this
indicate colon function as returns and physician may order
clear fluid diet for patient.
•Monitor vital sign if blood pressure is low and pulse rate
increase this indicate the person is bleeding too much and
may cause shock

•Monitor oxygen saturation

•Monitor intravenous fluid this is to rehydrate and maintain

fluid and electrolyte balance
•Ensure NPO status is maintain until physician order to stop
 Discharge teaching of colon cancer

• Advise the patient not to perform any heavy lifting

pushing, or pulling for 6 weeks after surgery as this can
cause further complication to affected area.
• Encourage to take medication as prescribed and explain
the purpose, action, dosage, and side effects of all
medications.
• Advice patient to wash skin gently with mild soap, rinse
with luke warm water and pat dry the skin each day to
prevent irritation and infection
• Teach patient signs of infection and should incase area
is infected patient should seek medical attention
immediately
 Collaborative care

• Different types of doctors often collaborate to create a

patient’s overall treatment plan that usually includes
or combines different types of treatments. For
colorectal cancer, generally includes:
• A General Practitioner (GP) do a thorough assessment
of client and appropriate diagnostic tests are order to
diagnose (or exclude) cancer. A patient with a
suspected diagnosis of colorectal cancer may be
referred to a relevant specialist :
The end
References
• III Swierzewski, S. J. (2015, September 17). Gastrointestinal
Surgery. Retrieved from Remedies health.com communities:
http://www.healthcommunities.com/gastrointestinal-
surgery/preoperative-procedures-colostomy.htm
• Reference medical –surgical nursing demystified mary digiulia,
rn ,msn ,aprn,bc, Donna Jackson ,RN, msn ,Aprn ,bc published
2007 pg 285 , 287
References con’t
• Ehrenthal D, Carney P, Kottenhahn R, Charney P. Women's health
topics. In: Andreoli TE, Benjamin I, Griggs RC, Wing EJ, eds. Andreoli
and Carpenter's Cecil Essentials of Medicine. 8th ed. Philadelphia, PA:
Saunders Elsevier; 2010:730–749.
• Jensen S. Nursing Health Assessment: A Best Practice Approach.
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins;
2011.
• Reaby LL (1998) Breast restoration decision making: Enhancing the
process Cancer Nursing 21:3: 196-204
• Retrieved November 15,2019 from
https://www.uptodate.com/contents/colorectal-cancer-epidemiology-
risk-factors-and-protective-factors/print

• Retrieved November 20,2019 from

https://www.medscape.org/viewarticle/540706