If your patient is diagnosed with a Benign or Malignant Breast Tumour, she will most likely be advised to have surgical treatment known as Mastectomy. The aim here is to have control over the tumour and possibly even cure the patient.
There are 3 Major Types of Mastectomy, depending on how large your patient’s tumour is:
Total (Simple) Mastectomy: removes the nipple and breast tissue (lobules, ducts and fatty tissue)
Modified Radical Mastectomy: removes the breast tissue, armpit lymph nodes, and part of the chest muscles
Lumpectomy: removes the tumour and the affected area around it
Once you know which surgery your patient will be having, you can go ahead and start the Nursing Process.
Pre-Operative Nursing Care for Mastectomy
Pre- Operative Nursing Assessment for Mastectomy
Start by having a chat with your patient to establish a safe and therapeutic relationship. While having the conversation, make sure to ask specific questions that will explain your patient’s situation. So ask her:
How she feels about the diagnosis
Whether she knows how the surgery works, and why it’s being done
If she is coping with it
Whether she needs any psychological or emotional support
If she has a relative or friend who can support her
Is she experiencing any pain or discomfort
During the nursing assessment you should also obtain a full medical and family history of your patient, as well as baseline Vital Signs.
Pre- Operative Nursing Diagnosis for Mastectomy
Having finished the conversation, you can now build your nursing diagnosis, and you’ll most likely find the following:
Lack of knowledge about the surgery
Stress caused by the diagnosis
Fear from having the surgery
Concern about changes in body image
Ineffective coping mechanism
Pre-operative Nursing Interventions for Mastectomy
1. Education and Preparation for Surgery
Being diagnosed with a breast tumour is not a walk in the park, and so your patient is most likely anxious and shocked. It is highly likely that she did not understand all the information given to her by the medical team. Which, in turn, creates an atmosphere of confusion, stress and anxiety.
As a nurse, you play a significant role in effectively educating your patient and addressing any concerns. Start by giving her an overview of what she can expect before, during and after the surgery. Explain that she will most likely spend the first night after the operation in the hospital and that she might have a surgical drain inserted. If a drain is inserted, she will probably have to go home with it. In that case, information about drain care will be given before discharge.
Your patient will have limited arm mobility immediately after the surgery, and she will be expected to perform arm exercises frequently. So, you must explain these in the pre-operative phase to ensure maximum compliance post-operatively. Lastly, reassure your patient that the post-operative pain will be addressed through analgesia and supportive measures.
2. Managing Anxiety & Fear
Your work as a nurse should aim to treat the patient from all aspects, including the psychological, emotional and social struggles. So take note of your patient’s feelings, because often a Mastectomy raises fear about body image, dependency, the recovery period and the healing process.
Start off by answering any questions that your patient might have and explain to her that she can contact you or the clinic at any time if she wants. Advise your patient that you have additional healthcare staff who can help her, including social workers, spiritual advisors, psychologists and support groups.
Lastly, reassure your patient that once she is fully recovered, she will be able to function normally and go on with her daily life. Luckily, there are now many options that will help her regain her body image and self-confidence, such as breast reconstruction surgery and mastectomy bras.
3. Preparation on the Day of Surgery
The final step is to make sure that your patient is ready for surgery from the medical perspective. Your patient should be starved for at least 6 hours before the surgery, and make sure that she is kept hydrated through adequate IVI infusions.
On the morning of the surgery, ask her to take a pregnancy test to rule out any unexpected pregnancies. Check that her incision site is marked and confirm whether she needs to shave.
Finally, make sure that your patient has the following:
Allergy Bracelet (if applicable)
Changed into a hospital gown and removed her underwear
Removed all jewellery/ foreign teeth/ hearing aid/ contact-lenses/ glasses/ make-up
Before going down to the Operating Theatre, your patient’s file should have:
All medical notes and treatment charts
A signed consent form
Pre-operative medical assessment
An ECG done in the last 2weeks
Blood results, and Blood type from the past 3 days (often found online)
Post-Operative Nursing Care for Mastectomy
Post Mastectomy Nursing Assessment
Start by having a quick chat with your patient to determine her consciousness level. While having the conversation, ask her if she is in pain or feeling nauseous as these are expected after surgery. And you will also be assessing her airway and breathing patterns.
The next thing to do is to check:
Circulation in her hands and feet
Incision site (look out for swelling, bleeding, redness)
The drain (volume and colour)
Before leaving her side, ensure that the environment is safe; Place the bed rails up and give the nurse call bell to the patient. Check that all IV lines are secure and that the drain is not kinked. Lastly, ask the patient if she wants a relative or a friend to be by her side.
Post Mastectomy Nursing Diagnosis
The nursing assessment is likely to highlight the following nursing diagnoses:
Acute pain and discomfort
Peripheral Neurovascular Dysfunction
Disturbed Body Image
Struggles with Activities of Daily Living
Post Mastectomy Nursing Interventions
1. Relieving Pain and Discomfort
Overall, patients undergoing Mastectomy are expected to have minimal to moderate pain post-operatively. So if your patient is screaming in excruciating pain, then you should contact the surgical team to rule out any complications.
To manage the pain effectively, explain to your patient that she should take the prescribed analgesia regularly for the next few days. You should also advise her to take warm showers, rest the affected arm on a pillow on the table and use distraction methods.
2. Managing sensations
During a Mastectomy, some of the nerves in the affected area might be injured, and this will create strange sensations post-operatively. Your patient might complain of tenderness, soreness, tightness or numbness, and she might also experience phantom sensations were the body believes that the removed breast/ nipple is still there.
Unfortunately, not much can be done to stop these sensations; so you should explain to your patient that what she is feeling is normal. The sensations are not distressing or painful and will go away by time.
3. Coping with body image
Particularly in women, breasts are seen as sexual and a part of motherhood. So removing a breast, or changing its shape can negatively affect your patient’s self-esteem. In fact, many patients find it emotionally stressful to look at the incision site.
When your patient is ready, you should gently encourage her to look at her incision. Ideally, you should be with her, to provide support and a safe place to express her feelings. Reassure your patient that it is normal to feel overwhelmed, but by time she will accept it.
Keep in mind that the patient’s partner might also need guidance on how to react around the patient and accept her new body image. Encourage your patient and her partner to show affection through hugging, kissing and manual stimulation. This will promote confidence and improve the patient’s outlook.
Post Mastectomy Complications
Having a mastectomy surgery can put patients at risk of:
So during your post-operative nursing care make sure to monitor your patient for any signs of complications.
Post Hysterectomy Discharge Planning
Before sending your patient home make sure that she has:
Anxiety under control
Accepted her body image
Minimal pain and discomfort
Verbalised knowledge of self-care at home
No Complications present
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