Lecture Eighteen: Care of the Client with Breast Dysfunction

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Lecture Eighteen Care of the Client with Breast
Dysfunction

• NURS 2208
• Fall 2002
• T. Dennis RNC, MSN

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Physiology

• The breast has regular cyclic changes in response
  to hormonal stimulation.
• Mastodynia premenstrual swelling and tenderness
  of the breast.
• Menopuase results in a loss of elasticity and
  adipose tissue turns into connective tissue.

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Breast Self Examination (pg. 54)

• Recommended monthly procedure by which women may
  detect changes or abnormalities in their breasts
  (pg. 55).
• Breast examination should be taught as early as
  possible and taught correctly.
• Should be performed one week after the menstrual
  cycle.
• Most effective when inspection and palpation are
  used (after menopause on the same day each
  month).

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Mammography (pg. 56)

• A soft tissue radiograph of the breast without
  injection of a contrast medium.
• Detects lesions in the breast before they can be
  felt.
• An accepted screening tool for breast cancer.
• Recommended every 1 to 2 years for women age 40
  to 49 and annually for all women 50 and older
  (age is a primary factor).
• 30 of women age 40 to 49 are likely to have a
  false-positive result requiring biopsy.
• 25 miss in breast cancers in women 40 to 49.
• Many women avoid mammograms due to the discomfort
  associated with procedure.
• Discomfort can be reduced by avoiding caffeine in
  the diet and scheduling the procedure 2 weeks
  after menses.

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Benign Breast Disease (pg. 63)

• Fibrocystic Breast disease
• Fibroadenoma
• Intraductal papilloma
• Duct ectasia

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Fibrocystic Breast Disease (pg. 62)

• Commonly occurs between age 30-50.
• Associate with breast tenderness
• Associated with a risk for cancer when the
  disorder is proliferative and with atypical
  hyperplasia.
• Nipple discharge may vary from none to clear,
  milky, straw colored or green.
• Location usually the upper outer quadrant.
• Multiple lumps may occur bilaterally, are
  influenced by menstrual cycles and be nodular.
• Needle aspiration, smear of nipple discharge,
  observation , sonography and biopsy may be used
  for diagnosis and treatment.

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Normal Breast
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Fibrocystic Breast
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Fibroadenoma (pg. 62)

• Commonly occurs between ages 15-25 (median age is
  20).
• No pain associated with the disorder.
• No cancer risk associated with the disorder.
• No discharge associated with the disorder (a
  milky discharge may occur with pregnancy).
• Location may be nipple or upper outer quadrant
  along the lateral side of the breast.
• Appears solid, well defined, sharply delineated,
  rubbery, and mobile.
• Diagnosis and treatment by mammography,
  observation and possible surgical excision.

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Intraductal Papilloma (pg. 62)

• Found in women 50-60.
• Pain noted on palpation.
• Cancer risk occurs with multiple papillomas.
• Drainage is typically serous, bloody, or brownish
  green.
• Occurs in no specific location.
• May be non-palpable or small, ball-like, poorly
  delineated.
• Diagnosis and treatment may consist of smear of
  nipple discharge, mammography, ductogram, or
  surgical excision.

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Duct Ectasia (pg. 63)

• Commonly occurs between ages 45-55.
• Pain occurs and may include burning and itching
  around the nipple.
• In perimenopausal women, discharge may be thick,
  sticky, green, greenish brown, or bloodstained.
• Mass is located behind or around the nipple.
• Poorly circumscribed, inflammation, nipple
  retraction, axillary lymph adenopathy.
• Diagnosis and treatment include smear of breast
  discharge, mammography, drug therapy for
  symptoms, observation and surgical excision.

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Malignant Breast Disease (pg. 62)

• Affects one in eight women in the United States.
• Predisposing factor include
• Age-incidence increases steadily with age
  (especially after 50)
• History of previous breast cancer
• Family history of mother or sister with bilateral
  pre-menopausal breast cancer
• High fat diet
• Alcohol consumption
• No history of pregnancy
• Longer reproductive phase
• Geographic location (North America, northern
  Europe in the US urban North Low risk areas
  Asia, Africa in the US, rural south.

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Malignant Breast Disease (pg. 62)

• 50 of breast cancers originate in the upper
  outer quadrant and spread or metastasize to
  axillary lymph nodes.
• Common sites of metastasis lymph nodes, lungs,
  liver, brain, and bone.
• Discovery may be by BSE, clinician, mammography,
  fine needle biopsy, ultrasonography,
  thermography, and MRI.
• Diagnosis is determined by biopsy.
• Treatment plan is based on lymph node involvement
  and clinical staging of the disease.
• .

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Malignant Breast Disease (pg. 62)

• Surgical treatment may include mastectomy
  followed by reconstructive surgery, lumpectomy
  with adjunct treatment including chemotherapy,
  radiation, and hormone therapy.
• Preoperative care teaching, emotional support,
  pain management, introduction to support groups.
• Postoperative care Minimize edema, BP cuff is
  never placed on the affected arm. Affected arm
  elevated, early arm movement encouraged, early
  ambulation encouraged. Physical therapy is
  usually prescribed.
• Convalescent care may include plans for
  reconstructive surgery and participation in
  support groups.

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Nursing Care (pg. 63)

• Assessment and Diagnosis
• Therapeutic communication
• Knowledge Deficit related to a lack of
  information about the diagnostic procedures.
• Anxiety related to threat to body image or her
  life.
• Plan and Implementation
• Clarify misconceptions
• Provide education on self breast care
• Provide psychological support.
• Allow client to discuss her fear.
• Refer to professional support groups.

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Questions?