1. 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

2. 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

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

4. 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 

6. 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 .

7. 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

8. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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

16. Patient teaching
drainage system care

17. 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

18. 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.

19. Patient teaching
Hand and arm care

20. 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.

21. 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)

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

23. Equipments
Light rope
Rod\ broom sticking

24. 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

26. 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.

28. 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

29. 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

31. 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.

33. Summary

34. References Medical surgical nursing textbook Brunner's and saudraths

35. Thank you 