Care modalities after mastectomy Umm Al-Qura University Applied Medical Sciences Collage Nursing Department Medical & surgical nursing course 2 Care modalities after mastectomy Ms. Ahdab Faisal Eskandar

Objectives: Define mastectomy List types of mastectomy Describe post operative nursing interventions Enumerate possible complication and its nursing managements Patient teaching Demonstrate exercise after mastectomy

What is the meaning of mastectomy? It is surgical operation done to remove malignant breast tissues

Types Simple mastectomy Partial mastectomy Radical mastectomy (the entire breast is removed, but the lymph nodes and surrounding muscle are left intact) Partial mastectomy (a larger amount of breast tissue and some skin are removed with the tumor.) Radical mastectomy (to remove all affected tissues and even the surrounding one as well ). used in cases of extensive tumors 

Post operative nursing interventions Reliving pain and discomfort Many patients tolerate the breast surgery quite well and have minimal pain during the postoperative periods. N.I : Analgesic medication, warm bath or relaxation and distraction methods .

Post operative nursing interventions Managing post operative sensation Common sensation such as tenderness , numbness , tightness , , and pulling. Phantom sensation( feeling post mastectomy that breast \ and or nipple are still present).May persist for 2 years or longer . N.I: reassure the patient and these sensations are not indication of problem

Post operative nursing interventions Promoting positive body image N.I :Emotional distress patient need (Conversation treatment) or -Breast reconstructions - Temporary breast form to place in her bra

Post operative nursing interventions Promoting positive adjustment and coping N.I : Identifying supporting system and providing information -Anxiety related to treatment (e.g. chemotherapy) Ineffective coping need consultation of mental health practitioner

Monitoring and managing potential complications Complications post mastectomy are: Lymphedma Hematoma or seroma formation Infection

complications Lymphedma: It results if functioning lymphatic channels are inadequate to ensure a return flow of lymph fluids to general circulation . -Performing exercises can help reduce transient edema

complications Hematoma or seroma formation: Hematoma :is collection of blood inside cavity Usually develops within first 12 hours after surgery The nurse should assess Sign & symptoms : swelling, tightness, pain and bruising of skin Patient may take warm shower or apply warm compressor

complications Hematoma or seroma formation: Seroma :collection of serous fluid under mastectomy incision .If drain being removed or obstructed Sign and Symptoms: swelling , discomfort , heaviness and sloshing of fluid If large amount doctor manually aspirating fluid with needle and syringe

complications Infection Risk factor for infection such as: Diabetes , older age, poor hygiene and immune disorder. Sign and symptoms : Redness Tenderness Foul smelling drainage Fever and chills

Patient teaching drainage system care

1- Patient should report infection , arm swelling , hematoma or seroma 1- Patient should report infection , arm swelling , hematoma or seroma . 2- Hygiene is important to prevent infection ( shower can be on 2nd day post operative) 4- The drains usually removed when the output is less than 30 ml in 24 hours

Home care: * Patient can empty and measure fluids from drainage devices. *Patient should contact her doctor if ( sudden change in color of drainage or sudden cessation of drainage ) *Patient know how to milk clots through tubing of drainage devices.

Patient teaching Hand and arm care

1- Avoid blood pressure , injections & blood extraction in affected extremity. 2- Avoid insect bites. 3- Avoid lifting objects greater than 5-10 pounds 4- Use sunscreen for extended exposure to sun.

Exercises after breast surgery Range of motion exercies are initial on the 2nd day post op. Goals of exercises: 1- increase circulation and muscles strength 2- Prevent joint stiffness and contractures 3- Restore full range of motion Exercise done 3 times a day for 20 minutes at a time (4-6 weeks)

Exercises after breast surgery Rod broomstick lifting Rope turning Wall hand climbing Pulley tugging

Equipments Light rope Rod\ broom sticking

Rod or broomstick lifting Grasp rod with both hands held about 20 cm apart Keeping arms straight raise the rod over head Bend elbows to lower rod behind the head Reverse maneuver

Wall hand climbing Stand facing wall with feet apart and toes as close as possible Balm slightly bent , place palms of the hand on the wall at shoulders level By flexing fingers works hand up the wall until arm are fully extended Reverse process, working hands down to starting point.

Rope turning Tie light rope to doorknob Stand facing the door Take free end of rope in hand on side of surgery Place other hands on hip

Rope turning 5. With rope holding arm extended and held away from body (nearly parallel with the floor) Turn the rope , making as wide swings as possible Begin slowly at first ; speed up later

Pulley tugging 1. Toss light rope over a shower curtain rod or doorway curtain rod. 2. Stand as nearly under rope as possible. 3. Grasp end in each hand 4. Extend arm straight and away from body 5. Pull the left arm up by tugging down with right arm , continue in see- sawing motion.

Summary

References Medical surgical nursing textbook Brunner's and saudraths http://integra-med.com/exercises-after-mastectomy.html http://surgery.about.com/od/proceduresaz/ss/Mastectomy_6.htm

Thank you 