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This is chapter 73

This is chapter 73. Care of Patients with Breast Disorders. Benign Breast Disorders. Fibroadenoma, most common cause of breast masses during adolescence; may occur in patients in their 30s

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This is chapter 73

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  1. This is chapter 73 Care of Patients with Breast Disorders

  2. Benign Breast Disorders • Fibroadenoma, most common cause of breast masses during adolescence; may occur in patients 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

  3. Fibrocystic Breast Condition • Fibrocystic changes of the breast that include a range of changes involving the lobules, ducts, and stromal tissues of the breast • Most often occurs in premenopausal women between 20 and 50 years of age • Thought to be caused by an imbalance in normal estrogen-to-progesterone ratio

  4. Collaborative Management • Symptomatic management • Hormonal manipulation • Drug therapy—vitamins C, E, and B complex • Diuretics • Avoidance of caffeine • Reduction of dietary fat • Mild analgesics

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

  6. 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

  7. 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

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

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

  10. Gynecomastia (Cont’d) • Underlying disease causing estrogen excess • Androgen deficiency • Breast cancer

  11. 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

  12. Nipple Retraction

  13. Peau d’orange

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

  15. Mammography • Baseline screening mammography yearly beginning at age 40 years is recommended. • Barriers to mammography.

  16. 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.

  17. BSE

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

  19. 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 patient to ventilate feelings. • Flexibility is the key to nursing care.

  20. Potential for Metastasis • For patients 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.

  21. Potential for Metastasis (Cont’d) • 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.

  22. Surgical Management

  23. Surgical Management (Cont’d) • Removal of the mass • Neoadjuvant therapy • Axillary node dissection • Sentinel lymph node biopsy • Breast-conserving surgery • Modified radical mastectomy

  24. 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

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

  26. This is chapter 74 Care of Patients with Gynecologic Problems

  27. Primary Dysmenorrhea • One of the most common gynecologic problems, occurring most often in women in their teens and early 20s. • Treatment: • NSAIDs, acetaminophen, anti-prostaglandins, oral contraceptives • Complementary and alternative therapies

  28. Premenstrual Syndrome • A collection of symptoms that are cyclic in nature • Nutrition therapy • Drug therapy—hormonal therapy. Oral contraceptives, gonadotropin-releasing hormone, serotonin-reuptake inhibitors • Complementary and alternative therapies

  29. Endometriosis • Endometriosis is endometrial tissue implantation outside the uterine cavity.

  30. Interventions • Drug therapy • Complementary and alternative therapy • Surgical management

  31. Dysfunctional Uterine Bleeding • Bleeding that is excessive or abnormal in amount or frequency

  32. Dysfunctional Uterine Bleeding (Cont’d) • Associated with: • Endocrine disturbances • Polycystic ovary disease • Stress • Obesity or underweight • Long-term drug use • Anatomic abnormalities

  33. Collaborative Management • Nonsurgical management includes hormone manipulation. • Surgical management includes: • Dilation and curettage procedure • Laser or balloon endometrial ablation • Myomectomy • Hysterectomy

  34. Menopause • Normal biologic event marked for most women by the end of menstrual periods (12 months of amenorrhea) • Role of hormone replacement therapy in the management of symptoms • Perimenopause indicated by changes in ovarian function • Management

  35. Vulvovaginitis • Vaginal discharge and itching • Inflammation of the lower genital tract resulting from a disturbance of the balance of hormones and flora in the vagina and vulva • Characterized by itching, change in vaginal discharge, odor, or lesions

  36. Toxic Shock Syndrome (TSS) • First recognized in 1980 when it was found to be related to menstruation and tampon use • Staphylococcus aureus • Abrupt onset of high temperature, headache, sore throat, vomiting, diarrhea, generalized rash, hypotension • Management

  37. Uterine Prolapse • Stages of uterine prolapse are described by the degree of descent of the uterus • Dyspareunia, backache, pressure in the pelvis, bowel or bladder problems • Pessaries • Surgery

  38. Uterine Prolapse (Cont’d)

  39. Cystocele and Rectocele

  40. Fistulas • Abnormal opening between two adjacent organs or structures • Urethrovaginal fistula • Vesicovaginal fistula • Rectovaginal fistula • Management

  41. Benign Neoplasms • Ovarian cyst • Uterine leiomyoma: • Nonsurgical management • Surgical management

  42. Uterine Leiomyomas

  43. Cervical Polyps • Pedunculated tumors (on stalks) arising from the mucosa and extending to the opening of the cervical os • Polyp removal—a simple office procedure

  44. Endometrial (Uterine) Cancer • Endometrial cancer is a reproductive cancer, of which adenocarcinoma is the most common type. • The main symptom is postmenopausal bleeding. • Diagnostic assessment includes these tests: • CA-125 tumor marker • Chest x-ray

  45. Endometrial (Uterine) Cancer (Cont’d) • Possible testing for gene causing HNPCC • IV pyelography • Barium enema • CT of the pelvis • Liver and bone scans • Hysteroscopic examination of the uterus • Proctosigmoidoscopy

  46. Surgical Management • Total hysterectomy and bilateral salpingectomy/oophorectomy

  47. Surgical Management (Cont’d) • Total abdominal hysterectomy and bilateral salpingo-oophorectomy • Radical hysterectomy with bilateral pelvic lymph node dissection for stage II cancer

  48. Nonsurgical Management • Radiation therapy: • Intracavitary radiation (brachytherapy) • External radiation • Drug therapy • Chemotherapy • Hormone therapy • Complementary and alternative therapies

  49. Cervical Cancer • Disorder is a progression—from totally normal cervical cells, to premalignant changes in appearance of cervical cells (dysplasia), to changes in function, and ultimately to transformation to cancer • Carcinoma in situ • Preinvasive or invasive

  50. Health Promotion and Maintenance • HPV vaccine (Gardasil)

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