Mastectomy Care

2. Mastectomy Care Prepared by Dr. Manal Moussa Ibrahim

3. *Outlines: • Postoperative Interventions. • Hand and Arm Care. • Exercises After Breast Surgery. • Drain Management. • Nursing Interventions. • Reduce anxiety. • Measures to relieve pain.

4. Postoperative Interventions: • Inform patient regarding common postoperative sensations. • Maintain privacy. • Provide bra with breast form. • Provide information. • Support coping and adjustment. • Provide counseling and referral. • Monitor for potential complications.

5. Hand and Arm Care Potential for lymphedema formation after auxiliary lymph node dissection (ALND). Patient education. Prevention is vital; follow guidelines for the rest of life. No blood pressure, injections, or blood draws in the affected arm. Perform exercises 3X a day for 20 minutes to increase circulation and muscle strength, prevent stiffness and contractures. A mild analgesic or a warm shower may be helpful prior to exercise. Initial limitation of lifting (over 5) and activity.

6. Exercises After Breast Surgery Wall climbing Rod lifting Pulley tugging Rope turning

7. Drain Management May need home care referral to assist with drain management. Drains are usually removed when drainage is less than 30 mL in a 24-hour period; usually occurs in 7 to 10 days. Drain site and incision care.

8. Question Which of the following would be an appropriate nursing diagnosis for an uncomplicated postoperative patient who has undergone a mastectomy? Altered nutrition. Disturbed body image Ineffective airway clearance. Risk for injury.

9. Answer Disturbed body image Rationale: Disturbed body image related to loss or alteration of the breast is the appropriate diagnosis.

10. Nursing Interventions • Discuss nursing interventions to: • Relieve pain. • Facilitate urinary elimination. • Reduce anxiety. • Educate patient.

11. Reduce anxiety: - Be sensitive to potentially embarrassing and culturally charged issues. - Establish a professional, trusting relationship Provide privacy. - Allow the patient to verbalize concerns. - Provide and reinforce information. - Provide patient teaching including explanations of anatomy and function, diagnostic tests and surgery, and the surgical experience.

12. Measures to relieve pain: • - Monitor urinary drainage and keep catheter patent. • Assessment of pain. • - Bladder spasms cause feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter. • - Medication and warm compresses or baths relieve spasms. • - Administer analgesics and antispasmodics as needed. • - Encourage patient to walk but to avoid sitting for prolonged periods. • - Prevent constipation. • - Irrigate catheter as prescribed.