Interventions for Clients with Lung Cancer

Benign Breast Disorders • Fibroadenoma, most common cause of breast masses during adolescence; may occur in clients in their 30s • Solid, slowly enlarging, benign mass; round, firm, easily movable, nontender, and clearly delineated from the surrounding tissue • Usually located in the upper outer quadrant of the breast

Fibrocystic Breast Disease • Physiologic nodularity of the breast, most common breast problem of women between 20 and 30 years of age • Stage 1: premenstrual fullness and tenderness, symptoms occur on menstrual cycle • Stage 2: multiple nodular areas in both breasts (Continued)

Fibrocystic Breast Disease (Continued) • Stage 3: microscopic or macroscopic cysts associated with pain, tenderness, or burning occurring in women between 35 and 55 years of age

Collaborative Management • Symptomatic management • Hormonal manipulation • Drug therapy: vitamins C, E, and B complex • Diuretics • Avoidance of caffeine • Mild analgesics (Continued)

Collaborative Management (Continued) • Limited salt intake before menses • Well-padded supportive bra • Local application of heat or ice for pain relief

Ductal Ectasia • Benign breast problem of women approaching menopause caused by dilation and thickening of the collecting ducts in the subareolar area • Mass that is hard with irregular borders, tender • Greenish brown nipple discharge, enlarged axillary nodes and edema over the site of the mass

Intraductal Papilloma • Occurs most often in women 40 to 55 years of age • Benign process in the epithelial lining of the duct, forming an outgrowth of tissue (Continued)

Intraductal Papilloma (Continued) • Trauma and erosion within the duct, resulting in bloody or serous nipple discharge • Diagnosis aimed first at ruling out breast cancer

Gynecomastia • Benign condition of breast enlargement in men • Can be a result of primary cancer such as lung cancer • Causes include: – Drugs – Aging – Obesity (Continued)

Gynecomastia (Continued) – Underlying disease causing estrogen excess – Androgen deficiency – Breast cancer

Breast Cancer • Types of breast cancer • Complications include: – Invasion of lymph channels causing skin edema – Metastasis to lymph nodes – Bone, lungs, brain, and liver—sites of metastatic disease from breast cancer – Ulceration of overlying skin

Breast Cancer in Men • Of all breast cancers, only 1% occurs in men. • Breast cancer in men usually presents as a hard, nonpainful subareolar mass. • Breast cancer in men is often a widely spread disease because it is usually detected at a later stage than in women.

Mammography • Baseline screening mammography yearly at age 40 is recommended. • Barriers to mammography compliance can involve factors such as fear. • Increase compliance through education.

Breast Self-Examination • The goal of screening for breast cancer is early detection because breast self-examination cannot prevent breast cancer. • Early detection reduces mortality rate. • Teach breast self-examination.

Breast Care • Clinical breast examination • Cancer surveillance • Prophylactic mastectomy • Chemoprevention

Pathologic Examination • Key to diagnosis of breast cancer • Presence or absence of estrogen receptors or progesterone receptors • S-phase index, or growth rate • DNA ploidy • Histologic or nuclear grade • HER2/neu gene expression

Anxiety • Interventions: – Anxiety for the woman with breast cancer begins the moment the lump is discovered. – Level of anxiety may be related to past experiences and personal associations with the disease. – Allow the client to ventilate feelings. – Flexibility is the key to nursing care.

Potential for Metastasis • For clients with late-stage breast cancer, nonsurgical treatment may be the only alternative; tumor may be removed with local anesthetic, follow-up treatment with hormonal therapy, chemotherapy, and sometimes radiation. (Continued)

Potential for Metastasis (Continued) • For breast cancer at a stage for which surgery is the main treatment, follow-up with adjuvant radiation, chemotherapy, hormone therapy, or targeted therapy is commonly prescribed.

Surgical Management • Mass should be removed to reduce risk for local recurrence; but controversy exists concerning the best treatment. • Axillary lymph nodes (dissection or removal) • Sentinel lymph node biopsy • Preoperative care • Operative procedure

Postoperative Care • Avoidance of using the affected arm for blood pressure measurement, giving injections, or drawing blood • Monitoring of vital signs • Care of drainage tubes • Comfort measures • Mobility and diet • Breast reconstruction

Adjuvanat Therapy • To decrease the risk of recurrence, adjuvant therapy consists of: – Radiation therapy – Chemotherapy – Hormonal therapy – Stem cell transplantation – Targeted therapy