UNDERSTANDING CANCER

ONCOLOGY NURSING
Essential Concepts of
Cancer
– What is Cancer?
– Normal Cell Growth vs.
Cancer Cell Growth
– Etiology and Causative
Factors
– Pathophysiology
– Classification of Tumors
– Effects of Cancer
NURSING PROCESS

– Assessment
– Laboratory & Diagnostic Tests
– Tumor Staging and Grading
– Nursing Diagnoses & Planning
– Implementation and Management
• Treatment Modalities
– Chemotherapy
• End-of-life Issues
WHAT IS CANCER?

CANCER is a complex of diseases

which occurs when normal cells
mutate into abnormal cells that
take over normal tissue,
eventually harming and
destroying the host.
WHAT IS CANCER
A large group of diseases characterized
by:
– Uncontrolled growth and spread of abnormal cells
– Proliferation (rapid reproduction by cell division)
– Metastasis (spread or transfer of cancer cells from
one organ or part to another not directly connected)
ONCOLOGY DEFINED

Branch of medicine that

deals with the study,
detection, treatment and
management of cancer and
neoplasia
“ROOT WORDS”
Neo- new
Plasia- growth
Plasm- substance
Trophy- size
+Oma- tumor
Statis- location
 “ROOT WORDS”
A-none
Ana- lack
Hyper- excessive
Meta- change
Dys- bad, deranged
CHARACTERISTICS OF NEOPLASIA
Uncontrolled growth of Abnormal
cells
1. Benign
2. Malignant
3. Borderline
CHARACTERISTICS OF NEOPLASIA
BENIGN
 Well-differentiated
 Slow growth
 Encapsulated
 Non-invasive
 Does NOT metastasize
CHARACTERISTICS OF NEOPLASIA
MALIGNANT
 Undifferentiated
 Erratic and Uncontrolled Growth
 Expansive and Invasive
 Secretes abnormal proteins
 METASTASIZES
LOSS OF NORMAL GROWTH CONTROL
NOMENCLATURE OF NEOPLASIA
Tumor is named according to:

1.Parenchyma, Organ or Cell

Hepatoma- liver
Osteoma- bone
Myoma- muscle
NOMENCLATURE OF NEOPLASIA
Tumor is named according to:
2. Pattern and Structure, either GROSS or MICROSCOPIC
 Fluid-filled CYST
 Glandular ADENO
 Finger-like PAPILLO
 Stalk POLYP
 CYST-abnormal pocket of fluid, form in many different areas of the body
including the skin, genitals and internal organs.
 ADENOMA-non-cancerous tumor or benign that may affect various organs.

 PAPILLOMA- Tumor arising from an epithelial surface and usually known to

grow in an outward direction.
 POLYP-projecting growth of tissue from a surface in the body, usually a mucous
membrane.
NOMENCLATURE OF NEOPLASIA

Tumor is named according to:

3. Embryonic origin
Ectoderm ( usually gives rise to epithelium)
Endoderm (usually gives rise to glands)
Mesoderm (usually gives rise to Connective
tissues)
 BENIGN TUMORS
Suffix-“OMA” is used
Adipose tissue- LipOMA
Bone- osteOMA
Muscle- myOMA
Blood vessels- angiOMA
Fibrous tissue- fibrOMA
 MALIGNANT TUMOR
Named according to embryonic cell origin
1. Ectodermal, Endodermal, Glandular, Epithelial
Use the suffix- “CARCINOMA”
Pancreatic AdenoCarcinoma
Squamos cell Carcinoma
 MALIGNANT TUMOR
Named according to embryonic cell origin
2. Mesodermal, connective tissue origin
Use the suffix “SARCOMA
FibroSarcoma
Myosarcoma
AngioSarcoma
 “PASAWAY”

1. “OMA” but Malignant

HepatOMA, lymphOMA, gliOMA, melanOMA
2. THREE germ layers
“TERATOMA”

3. Non-neoplastic but “OMA”

Choristoma
Hematoma
ETIOLOGY/CAUSATIVE FACTORS
• Viruses
• Chemical carcinogens
• Physical stressors
• Hormonal factors
• Genetic factors
 CANCER NURSING
Etiology of cancer
1. PHYSICAL AGENTS
Radiation
Exposure to irritants
Exposure to sunlight
Altitude, humidity
CANCER NURSING

Etiology of cancer
2. CHEMICAL AGENTS
 Smoking
 Dietary ingredients
 Drugs
 CANCER NURSING
Etiology of cancer
3. Genetics and Family History
 Colon Cancer
 Premenopausal breast cancer
CANCER NURSING

Etiology of cancer
4. Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
 CANCER NURSING
Etiology of cancer
5. Viruses and Bacteria
DNA viruses- HepaB, Herpes, EBV, CMV,
Papilloma Virus
RNA Viruses- HIV, HTCLV
Bacterium- H. pylori
 CANCER NURSING
Etiology of cancer
6. Hormonal agents
DES
OCP especially estrogen
 CANCER NURSING
Etiology of cancer
7. Immune Disease
AIDS
BURKITT’S LYMPHOMA -
a cancer of the
lymphatic system
Classification of Cancer
According to Behavior of Tumor
• Benign - tumors that cannot spread by
invasion or metastasis; hence, they only grow
locally
• Malignant - tumors that are capable of
spreading by invasion and metastasis. By
definition, the term “cancer”
Patterns of cell Proliferation
• Hyperplasia
• Dysplasia
• Metaplasia
• Anaplasia
• Neoplasia
Patterns of cell Proliferation
•Metaplasia
• conversion of one type of cell in a tissue to another
type not normal for that tissue
•Anaplasia
• change in the DNA cell structure and orientation to
one another, characterized by loss of differentiation
and a return to a more primitive form.
Neoplasia
• uncontrolled cell growth, either benign or malignant
Metastasis
• Metastasis: 3 stages
– Invasion – neoplastic cells from primary tumor invade into
surrounding tissue with penetration of blood or lymph.
– Spread – tumor cells spread through lymph or circulation or by
direct expansion
– Establishment and growth – tumor cells are established and grow
in secondary site: lymph nodes or in organs from venous
circulation
 CANCER NURSING
Spread of Cancer
1. LYMPHATIC
 Most common
2. HEMATOGENOUS
Blood-borne, commonly to Liver and Lungs
3. DIRECT SPREAD
Seeding of tumors
CANCER NURSING
Body Defenses Against TUMOR
1. T cell System/ Cellular Immunity
Cytotoxic T cells kill tumor cells
2. B cell System/ Humoral immunity
B cells can produce antibody
3. Phagocytic cells
Macrophages can engulf cancer cell debris
Classification of Tumors
• CARCINOMAS: EPITHELIAL TISSUE
– BODY SURFACES, LINING OF BODY CAVITIES ETC:
(ADENOCARCINOMA)
• SARCOMAS: CONNECTIVE TISSUE
– STRIATED MUSCLE, BONE, ETC (OSTEOSARCOMA)
• LYMPHOMAS AND LEUKEMIAS
– HEMATOPOIETIC SYSTEM
• NERVOUS TISSUE TUMORS
– EX. NERVE CELLS-NEUROBLASTOMA
• MYELOMA
– Develops in the plasma cells of bone marrow
Effects of Cancer
• Disruption of Function- can be due to obstruction or pressure
• Hematologic Alterations: can impair function of blood cells
• Hemorrhage: tumor erosion, bleeding, severe anemia
• Anorexia-Cachexia Syndrome: wasted appearance of client
Effects of Cancer
• Paraneoplastic Syndromes: ectopic sites with excess hormone
production
– ↑ Parathyroid hormone→ hypercalcemia
– ↑ secretion of insulin→ hypoglycemia
– ↑ Antidiuretic hormone (ADH) → fluid retention, HTN &
peripheral edema
• ↑ Adrenocorticotropic hormone (ACTH): cause excessive
secretion of cortisone (ie: fluid retention, ↑ glucose levels)
Effects of Cancer
• Pain: major concern of clients and families
associated with cancer
• Physical Stress: body tries to respond and destroy
neoplasm
ASSESSMENT
• Nursing History
– Health History – chief complaint and history of
present illness (onset, course, duration, location,
precipitating and alleviating factors)
– Cancer signs: CAUTION US!
WARNING SIGNS OF CANCER
CAUTION US!
– Change in bowel or bladder habits
– A sore that does not heal
– Unusual bleeding or discharge
– Thickenings or lumps
– Indigestion or difficulty in swallowing
– Obvious change in a wart or mole
– Nagging or persistent cough or hoarseness
– Unexplained anemia
– Sudden unexplained weight loss
Change in bowel or bladder habits
– A person with colon cancer may have diarrhea or
constipation, or he may notice that the stool has
become smaller in diameter
– A person with bladder or kidney cancer
A sore that does not heal
– Small, scaly patches on the skin that bleed or do
not heal may be a sign of skin cancer
– A sore in the mouth that does not heal can
indicate oral cancer
• Unusual bleeding or discharge
– Blood in the stool is often the first sign of colon
cancer
– Similarly, blood in the urine is usually the first
sign of bladder or kidney cancer
– Postmenopausal bleeding (bleeding after
menopause) may be a sign of uterine cancer
• Thickenings or lumps
– Enlargement of the lymph nodes or glands (such
as the thyroid gland) can be an early sign of
cancer
– Breast and testicular cancers may also present as
a lump
• Indigestion or difficulty in swallowing
– Cancers of the digestive system, including those
of the esophagus, stomach, and pancreas, may
cause indigestion, heartburn, or difficulty
swallowing
• Obvious change in a wart or mole
– Moles or other skin lesions that change in shape,
size, or color should be reported
• Nagging or persistent cough or hoarseness
– Cancers of the respiratory tract, including lung
cancer and laryngeal cancer, may cause a cough
that does not go away or a hoarse (rough) voice
• Unexplained anemia
• Sudden unexplained weight loss
PHYSICAL ASSESSMENT
• Inspection – skin and mucus membranes for lesions,
bleeding, petechiae, and irritation
– Assess stools, urine, sputum, vomitus for acute or occult
bleeding
– Scalp noting hair texture and hair loss
• Palpation
– Abdomen for any masses, bulges or abnormalities
– Lymph nodes for enlargement
• Auscultation – of lung sounds, heart sounds and bowel
sounds
Laboratory & Diagnostic
Tests • Cancer detection examination
• Laboratory tests
– Complete blood cell count (CBC)
– Tumor markers – identify substance (specific proteins) in
the blood that are made by the tumor
• PSA (Prostatic-specific antigen): prostate cancer
• CEA (Carcinoembryonic antigen): colon cancer
• Alkaline Phosphatase: bone metastasis
– Biopsy
Diagnostic Tests
• Determine location of cancer:
– X-rays
– Computed tomography
– Ultrasounds
– Magnetic resonance imaging
– Nuclear imaging
– Angiography
• Diagnosis of cell type:
– ▪Tissue samples: from biopsies,
shedded cells (e.g. Papanicolaou
(PAP) smear), & washings
– ▪ Cytologic Examination: tissue
examined under microscope
• Direct Visualization:
– ▪ Sigmoidoscopy
– ▪ Cystoscopy
– ▪ Endoscopy
– ▪ Bronchoscopy
– ▪ Exploratory surgery; lymph node
biopsies to determine metastases
Tumor Staging and Grading
• Staging determines size of tumor and existence of metastasis
• Grading classifies tumor cells by type of tissue
• The TNM system is based on the extent of the tumor (T), the
extent of spread to the lymph nodes (N), and the presence of
metastasis (M).
Primary Tumor (T)
TX - Primary tumor cannot be evaluated
T0 - No evidence of primary tumor
Tis - Carcinoma in situ (early cancer that has not spread to neighboring
tissue)
T1, T2, T3, T4 - Size and/or extent of the primary tumor
Regional Lymph Nodes (N)
NX - Regional lymph nodes cannot be evaluated
N0 - No regional lymph node involvement (no cancer found in the lymph nodes)
N1, N2, N3 - Involvement of regional lymph nodes (number and/or extent of spread)
Distant Metastasis (M)
MX - Distant metastasis cannot be evaluated
M0 - No distant metastasis (cancer has not spread to other parts of the body)
M1 - Distant metastasis (cancer has spread to distant parts of the body)
NURSING DIAGNOSES
• Acute or chronic pain
• Impaired skin integrity
• Impaired oral mucous membrane
• Risk for injury
• Risk for infection
• Fatigue
• Imbalanced nutrition: less than body
requirements
NURSING DIAGNOSES
• Risk for imbalanced fluid volume
• Anxiety
• Disturbed body image
• Deficient knowledge
• Ineffective coping
• Social isolation
OUTCOME IDENTIFICATION
1. Pain relief
2. Integrity of skin and oral mucosa
3. Absence of injury and infection
4. Fatigue relief
5. Maintenance of nutritional intake and fluid and
electrolyte balance
6. Improved body image
7. Absence of complications
OUTCOME IDENTIFICATION
1. Knowledge of prevention and cancer
treatment
2. Effective coping through recovery and
grieving process
3. Optimal social interaction
IMPLEMENTATION/MANAGE MENT
• Prevention and detection
– Primary Prevention
• Reducing modifiable risk factors in the external and
internal environment
– Secondary Prevention
• Recognizing early signs and symptoms and seeking
prompt treatment
• Prompt intervention to halt cancerous process
SOME CARCINOGENS IN THE WORKPLACE
TREATMENT MODALITIES
• Aimed towards:
– CURE - free of disease after treatment → normal life
– Control - Goal for chronic cancers
– Palliative Care: Quality of life maintained at highest level
for the longest possible time
• Surgery – surgical removal of tumors; most commonly
used treatment
• Preventive or prophylactic
• Diagnostic surgery
• Curative surgery
• Reconstructive surgery
• Palliative surgery
• Chemotherapy – use of antineoplastic drugs to
promote tumor cell death, by interfering with
cellular functions and reproduction
• Radiotherapy – directing high-energy ionizing radiation to
destroy malignant tumor cells without harming surrounding
tissues
Types:
– Teletherapy (external): radiation delivered in uniform dose to
tumor; Teletherapy is external beam irradiation and uses a device
located at a distance from the patient. It produces X-rays of
varying energies and is administered by machines a distance from
the body 31½ to 39 inches (80 to 100 cm).
– Brachytherapy: delivers high dose to tumor and less to
other tissues; radiation source is placed in tumor or next
to it; In brachytherapy, the radiation device is placed
within or close to the target tissue. Radiation is
delivered in a high dose to a small tissue volume with
less radiation to adjacent normal tissue, but requires
direct tumor access.
BRACHYTHERAPY
• Immunotherapy – use of chemical or microbial
agents to induce mobilization of immune defenses.
• Biologic response modifiers (BRMs) – use of agents
that alters immunologic relationship between tumor
and host in a beneficial way
• Bone marrow peripheral stem cell transplantation –
aspirating bone marrow cells from compatible
donor and infusing them into the recipient
• Gene therapy – transfer of genetic materials into
the client’s DNA
NURSING MANAGEMENT
1. Promote measures that relieve pain and discomfort.
• Pharmacologic and non-pharmacologic interventions
2. Promote measures to maintain intact skin integrity
3. Promote measures that maintain oral mucosa
4. Promote measures to prevent injury from abnormal bleeding
• Monitor platelet count; avoid aspiring products, etc
NURSING MANAGEMENT
1. Promote measures that identify and prevent infection
• Monitor WBC count; encourage frequent handwashing and
overall cleanliness
2. Help decrease the client’s fatigue and increase his activity level
3. Promote measures that ensure adequate nutritional intake
• High protein, high calorie diet
4. Ensure adequate fluid and electrolyte balance
NURSING MANAGEMENT
1. Promote measures to enhance body image.
• Take an honest gentle, caring approach; encourage client to
express and verbalize feelings
2. Promote measures that address preventing complications of
cancer therapy
3. Instruct client and family about the disease process and
treatments; provide necessary information for self-care.
4. Help client and family cope effectively
5. Promote measures to reduce social isolation.
Care of Clients Receiving Chemotherapy
• Classes of Chemotherapy Drugs:
• Alkylating agents:
– Action: create defects in tumor DNA
– Ex: Nitrogen Mustard, Cisplatin
– Toxic Effects: reversible renal tubular necrosis
Classes of Chemotherapy Drugs
• Antimetabolites:
– Action: phase specific
– Ex: Methotrexate; 5 fluorouracil
– Toxic Effects: nausea, vomiting, stomatitis, diarrhea,
alopecia, leukopenia
Classes of Chemotherapy Drugs
• Antitumor Antibiotics:
– Action: non- phase specific; interfere with DNA
– Ex: Actinomycin D, Bleomycin, adriamycin
(doxorubicin)
– Toxic Effect: damage to cardiac muscle
Classes of Chemotherapy Drugs
• Miotic inhibitors:
– Action: Prevent cell division during M phase of cell
division
– Ex: Vincristine, Vinblastine
– Toxic Effects: affects neurotransmission, alopecia, bone
marrow depression
Classes of Chemotherapy Drugs
• Hormones:
– Action: stage specific G1
– Ex: Corticosteroids
• Hormone Antagonist:
– Action: block hormones on hormone- binding tumors ie: breast,
prostate, endometrium; cause tumor regression
– Ex: Tamoxifen (breast); Flutamide (prostate)
– Toxic Effects: altered secondary sex characteristics
Effects of Chemotherapy
• Tissues: (fast growing) frequently affected
• Examples: mucous membranes, hair cells, bone marrow,
specific organs with specific agents, reproductive organs
(all are fetal toxic; impair ability to reproduce)
Chemotherapy Administration
• Routes of administration:
– Oral
– Body cavity (intraperitoneal or intrapleural)
– Intravenous
• Use of vascular access devices because of threat
of extravasation (leakage into tissues) & long term
therapy
Chemotherapy Administration
• Types of vascular access devices:
– PICC lines: (peripherally inserted central catheters)
– Tunneled catheters: (Hickman, Groshong)
– Surgically implanted ports: (accessed with 90-degree
angle needle- Huber needles)
Nursing care of clients receiving chemotherapy
• Assess and manage:
– Toxic effects of drugs (report to physician)
– Side effects of drugs: manage nausea and vomiting,
inflammation and ulceration of mucous membranes, hair loss,
anorexia, nausea and vomiting with specific nursing and
medical interventions
Nursing care of clients receiving chemotherapy
• Monitor lab results (drugs withheld if blood counts
seriously low); blood and blood product administration
• Assess for dehydration, oncologic emergencies
• Teach regarding fatigue, immunosuppression precautions
• Provide emotional and spiritual support to clients and
families
COLON CANCER
 COLON CANCER
Risk factors
1. Increasing age
2. Family history
3. Previous colon CA or polyps
4. History of IBD
5. High fat, High protein, LOW fiber
6. Breast Ca and Genital Ca
 COLON CANCER
 Sigmoid colon is the most common site
 Predominantly adenocarcinoma

 If early 90% survival

 34 % diagnosed early

 66% late diagnosis

 COLON CANCER
PATHOPHYSIOLOGY
 Benign neoplasm DNA alteration malignant
transformation malignant neoplasm  cancer growth
and invasion  metastasis (liver)
 COLON CANCER
 ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
2. Blood in the stool
3. Anemia
4. Anorexia and weight loss
5. Fatigue
6. Rectal lesions- tenesmus, alternating D and C
 COLON CANCER
 Diagnostic findings
1. Fecal occult blood
2. Sigmoidoscopy and colonoscopy
3. BIOPSY
4. CEA- carcino-embryonic antigen
 COLON CANCER
 Complications of colorectal CA
1. Obstruction
2. Hemorrhage
3. Peritonitis
4. Sepsis
 COLON CANCER
 MEDICAL MANAGEMENT
1. Chemotherapy- 5-FU
2. Radiation therapy
 COLON CANCER
 SURGICAL MANAGEMENT
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy (temporary or
permanent)
 COLON CANCER
NURSING INTERVENTION: COLOSTOMY CARE
 Colostomy begins to function 3-6 days after surgery

 The drainage maybe soft/mushy or semi-solid depending

on the site
 COLON CANCER
NURSING INTERVENTION: COLOSTOMY CARE
 BEST time to do skin care is after shower
 Apply tape to the sides of the pouch before shower
 Assume a sitting or standing position in changing the
pouch
 COLON CANCER
NURSING INTERVENTION: COLOSTOMY CARE
 Instruct to GENTLY push the skin down and the pouch
pulling UP
 Wash the peri-stomal area with soap and water
 Cover the stoma while washing the peri-stomal area
 COLON CANCER
NURSING INTERVENTION: COLOSTOMY CARE
 Lightly pat dry the area and NEVER rub

 Lightly dust the peri-stomal area with nystatin powder

 COLON CANCER
NURSING INTERVENTION: COLOSTOMY CARE
 Measure the stomal opening

 The pouch opening is about 0.3 cm larger than the

stomal opening
 Apply adhesive surface over the stoma and press for 30
seconds
 COLON CANCER
NURSING INTERVENTION: COLOSTOMY CARE
 Empty the pouch or change the pouch when
 1/3 to ¼ full (Brunner)
 ½ to 1/3 full (Kozier)
COLON CANCER
 BREAST CANCER
 The most common cancer in FEMALES
 Numerous etiologies implicated
BREAST CANCER
 BREAST CANCER
RISK FACTORS
1. Genetics
2. Increasing age ( > 50 yo)
3. Family History of breast cancer
4. Early menarche and late menopause
5. Nulliparity
6. Late age at pregnancy
 BREAST CANCER
RISK FACTORS
7. Obesity
8. Hormonal replacement
9. Alcohol
10. Exposure to radiation
 BREAST CANCER
PROTECTIVE FACTORS
1. Exercise-
2. Breast feeding
3. Pregnancy before 30 yo
 BREAST CANCER
ASSESSMENT FINDINGS
1. MASS- the most common location is the upper outer
quadrant
2. Mass is NON-tender. Fixed, hard with irregular borders
3. Skin dimpling
4. Nipple retraction
5. Peau d’ orange
S/SX OF BREAST CANCER
 A lump or mass felt in the breast
 An area of thickened tissue in the breast

 A change in the size of shape of your breast

 Swelling in or around the breast

 Irritation of the skin of the breast

 Dimpling of the skin of the breast

 Rashes on the breast

 Pain in the breast or nipple area

 Changes in the appearance of the nipple or surrounding skin.

 Discharge from the nipple

 Lump in the underarm area

 BREAST CANCER
LABORATORY FINDINGS
1. Biopsy procedures
2. Mammography
 BREAST CANCER
Breast cancer Staging
 I - < 2cm

 II - 2 to 5 cm, (+) LN

 III - > 5 cm, (+) LN

 IV- metastasis
 BREAST CANCER
MEDICAL MANAGEMENT
 1. Chemotherapy

 2. Tamoxifen therapy

 3. Radiation therapy
 BREAST CANCER
 SURGICAL MANAGEMENT
1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy
LUMPECTOMY
QUADRANTECTOMY
 Mastectomy – removal of the whole breast
 .Modified radical mastectomy- is a procedure in which the entire breast is
removed, including the skin, areola, nipple, and most axillary lymph nodes,
but the pectoralis major muscle is spared.
 Lumpectomy (wide local excision) – removal of the tumour mass and a
narrow rim of surrounding healthy tissue.
 Quadrantectomy (partial or segmental mastectomy) – removal of
approximately a quarter of the breast tissue, with 2-3 cm of healthy tissue
surrounding the tumour, a wide excision of the overlying skin, and of the
underlying connective tissue (fascia).
 BREAST CANCER
NURSING INTERVENTION : PRE-OP
1. Explain breast cancer and treatment options
2. Reduce fear and anxiety and improve coping
abilities
3. Promote decision making abilities
4. Provide routine pre-op care:
 Consent, NPO, Meds, Teaching about
breathing exercise
 BREAST CANCER
NURSING INTERVENTION : Post-OP
1. Position patient:
 Supine

 Affected extremity elevated to reduce edema

 BREAST CANCER
NURSING INTERVENTION : Post-OP
2. Relieve pain and discomfort
 Moderate elevation of extremity

 IM/IV injection of pain meds

 Warm shower on 2nd day post-op

 BREAST CANCER
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
 Immediate post-op: snug dressing with drainage

 Maintain patency of drain (JP)

 Monitor for hematoma w/in 12H and apply bandage and

ice, refer to surgeon
 BREAST CANCER
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
 Drainage is removed when the discharge is less than
30 ml in 24 H
 Lotions, Creams are applied ONLY when the incision
is healed in 4-6 weeks
BREAST CANCER
NURSING INTERVENTION : Post-OP
Promote activity
 Support operative site when moving

 Hand, shoulder exercise done on 2ndday

 Post-op mastectomy exercise 20 mins TID

 NO BP or IV procedure on operative site

BREAST CANCER

NURSING INTERVENTION : Post-OP

Promote activity
 Heavy lifting is avoided

 Elevate the arm at the level of the heart

 On a pillow for 45 minutes TID to relieve transient

edema
BREAST CANCER

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS
 Lymphedema

 10-20% of patients

 Elevate arms, elbow above shoulder and hand

above elbow
 Hand exercise while elevated

 Refer to surgeon and physical therapist

BREAST CANCER

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS
 Hematoma

 Notify the surgeon

 Apply bandage wrap (Ace wrap) and ICE pack

 BREAST CANCER
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Infection
 Monitor temperature, redness, swelling and foul-odor

 IV antibiotics

 No procedure on affected extremity

 BREAST CANCER
NURSING INTERVENTION : Post-OP
TEACH FOLLOW-UP care
 Regular check-up

 Monthly BSE on the other breast

 Annual mammography
THE END