1. The client/caregiver can define the types of breast surgery used in the treatment of breast cancer.
   1. Lumpectomy is a wide incision and removal of a tumor, including a margin of healthy tissue.
   2. Partial mastectomy is the excision of a tumor with a wider margin of healthy tissue.
   3. Modified radical mastectomy is the removal of breast and axillary lymph nodes.
   4. Radical mastectomy is the removal of breast, underlying muscles, and axillary lymph nodes.
   5. Breast reconstruction is surgery to rebuild a breast’s shape after a mastectomy.
2. The client/caregiver can list factors that increase the risk of breast cancer.
   1. Positive family history of breast cancer
   2. Onset of menstruation before age 12
   3. Late age at menopause (after 55)
   4. No children or first pregnancy after 30 years old
   5. Fibrocystic breast changes
   6. Previous history of breast cancer
   7. Personal history of other cancers
3. The client can follow exercises as ordered and also incorporate the full range of motion into daily activities.
   1. Wall climbing (client sits next to the wall and moves both hands up the wall until pain occurs)
   2. Pendulum arm swinging (client bends at the waist and swings arms from side to side without bending the elbows)
   3. Rope pulling (client hangs a rope over the door and pulls one at a time, which alternately raises the arms)
   4. Elbow spread (client locks hands behind the neck and then gradually brings elbows together)
4. The client/caregiver can describe post-procedure instructions to follow at home.
   1. Assess incision daily.
   2. Keep area clean and dry.
   3. Call physician if signs and symptoms of infection occur.
      1. Increased redness
      2. Increased pain
      3. Swelling
      4. Yellow, thick drainage from incision
      5. Fever over 100°F
      6. Increased drainage or bleeding
5. The client/caregiver can list measures to protect the arm and to prevent injury to arm.
   1. Avoid constrictive clothing, jewelry, or wristwatches.
   2. Avoid blood pressure, venipunctures, or injections.
   3. Avoid carrying heavy objects on the affected arm.
   4. Avoid burns, cuts, scratches, or trauma to the affected arm.
   5. Avoid sunburn.
   6. Avoid the use of deodorants or antiperspirants if the incision reaches the axilla area.
   7. Avoid burns, cuts, scratches, or trauma to the affected arm.
   8. Avoid strong detergents and other chemicals.
   9. Use a thimble when sewing.
   10. Wear heavy garden gloves when gardening.
   11. Wear heavy thermal gloves when reaching in the oven.
   12. Use hand lotion to prevent skin dryness.
   13. Elevate arm frequently to prevent swelling.
6. The client/caregiver can list measures to prevent recurrent cancer.
   1. Continue to do breast self-exams (give “breast self-exam” teaching guide).
   2. Have regular medical checkups and keep follow-up appointments with physicians.
7. The client/caregiver can list possible complications.
   1. Lymphedema (an accumulation of the fluid) in arm
   2. Infection

Resources

Cancer Response Information
800-227-2345

“Reach for Recovery” Program

• Provides opportunity to talk to another person who has had a mastectomy.
• Provides brochures to show exercises, breast prosthesis information, and so forth.
• Provides a free temporary fluff prosthesis until the client is ready for weighted prosthesis.

Sources for breast prosthesis

Support groups

Counseling

References

Ackley, B. J., & Ladwig, G. B. (2006).Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.
Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Taylor, C., Lillis, C., & LeMone, P. (2005). Fundamentals of nursing . Philadelphia: Lippincott, Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.