NUR 105 Final Study Guide

NUR 105 Final Study Guide Glaucoma: Patho: Increased intraocular pressure (IOP) or Glaucoma is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness. There are two primary categories of glaucoma: • Open-angle (90% of cases are chronic open-angle) • Closed-angle (or narrow angle) Assessment • Assess pt for history or presence of risk factors • Positive family history (believed to be associated with primary open angle glaucoma) • Tumors of the eye • Hemorrhage intraocular • Inflammatory intraocular uveiti • Eye contusion from trauma. Upon Physical examination For primary open angle • Pt may report a loss of peripheral vision slow (see tunnel) For primary angle closure : • Incidence of sudden severe pain in the eye is often accompanied by headache, nausea and vomiting. • Complaints halo light, blurred vision, and decreased light perception. • The pupils are being fixed with redness due to inflammation of the sclera and cornea looks cloudy. Diagnostic Examination • Tonometri used to measure intra-ocular pressure. Glaucoma is suspected when IOP greater than 22 mmHg. • Gonioskopi possible to see directly the anterior chamber angle glaucoma to distinguish between closed and open-angle glaucoma. • Optalmoskopi allow inspectors to see directly optic disc and internal eye structure. Diagnosis • Chronic pain- related to increased intra ocular pressure in the eye. • Impaired sensory reception/ visual- related to progressive vision loss resulting in changes in perception of the environment • Anxiety-related to change in physical status, presence of changes in lifestyle and the unknown results • Knowledge deficit- related to poor understanding of the source of the disease due to lack of resources. Need to learn about prognosis and treatment Planning • Encourage Patient to express fears about surgery in order ensure comfortably. • Explain procedure that is related to recovery • Instruct patient on avoiding shutting eyelids tightly post op, as well as sneezing, coughing, straining BM, bending over, and heavy lifting is to be kept at a minimum. • Explain and demonstrate the procedure for administering eye drops, encourage patient to demonstrate using the teach back method. • Provide verbal as well as written instructions about post-op care including potential complications and what actions to take • Recommend measures to assist patient to manage visual limitations, e.g., reducing clutter, arranging furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night vision. • Provide sedation, analgesics as necessary Nursing interventions • Assess the patient's understanding about the condition and emotional response to the condition and plan of action. • administer cycloplegic eyedrops in the affected eye only. In the affected eye, these drops may precipitate an attack of angle-closure glaucoma and threaten the patient’s residual vision. • After trabeculectomy, give medications as ordered to dilate pupila. • Apply topical corticostroids as ordered to rest the pupil. • Post surgery, protect the affected eye by applying an eye patch and eye shield. • Position the patient on his back or unaffected side, and following general safety measures. • Administer pain medications as ordered. • Encourage ambulation immediately after surgery. • Encourage the patient to express his concerns related to having a chronic condition. • Monitor the patient’s ability to see clearly. Question the patient regularly about the occurrence of visual changes. • Monitor the patient’s intra-occular pressures. • Stress the importance of meticulous compliance with prescribed drug therapy. • Instruct the patient’s family how to modify the patient’s environment for safety. • Teach the patient the signs and symptoms that require immediate medical attention, such as sudden vision change or eye pain. Evaluation • Ascertain that the patient understands prescribed medications – uses and their effectiveness in lowering eye pressure/fluid balance. • Patient demonstrates instillation of drops correctly. • Patient understands Glaucoma medicines need to be taken regularly as directed by physician/ optomologist, hence stopping progression of disease. • Patient is aware of Potential side effects of therapy; headaches, stinging, burning, and redness in the eyes from instillation of drops. • Patient understands medications can be changed in the event of reaction. • Patient receives current reading material relating to glaucoma, & links to informative websites. • Patient is aware of follow up appointments and the importance of regular check-ups with this disease. Breast Disorders ADPIE Assessment of Breast • Mammograms starting at age 40 (yearly) • CBE every 3 years for women in 20s, 30s, and every year for women over 40 • BSE is recommended on a monthly schedule. For women who are having regular menstrual periods, this would be right after menstruation when breasts are less lumpy and tender • Mammography is a method used to visualize the breast’s internal structure using x-rays o Well-tolerated, detects lumps that cannot be felt. o 3D mammography provides a clear view of overlapping breast tissues. It can help diagnose/ detect breast cancer o Calcifications (from aging, trauma, inflammation) are detected, usually benign but may be associated with preinvasive cancer o Allows for earlier treatment and the prevention of metastasis. o If the clinical findings are suspicious and the mammogram is normal, an ultrasound or MRI may be used. Based on these additional findings, a biopsy may be done. • Gynecomastia In Men Pathophysiology o Transient, noninflammatory enlargement of one or both breasts, is the most common breast problem in men. o Usually Temporary or benign; not a risk for breast cancer o The most common cause is disturbance of the normal ratio of active androgen to estrogen in plasma or within the breast itself. o Can be seen in developmental abnormalities of the male reproductive organs o May accompany diseases such as testicular tumors, adrenal cancer, pituitary adenomas, hyperthyroidism, and liver disease. o May be caused by certain medications such as estrogens, androgens, digitalis, isoniazid (INH), ranitidine, and spironolactone. o The use of heroin and marijuana can also cause gynecomastia Senescent gynecomastia occurs in many older men. ▪ May be caused by elevation of plasma estrogen in older men as a result of increased conversion of androgens to estrogens in peripheral circulation. ▪ May become bilateral ▪ If mass is felt, it must be biopsied to rule or the possibility of breast cancer ▪ No treatment, can regress in 6-12 months ▪ May be a side effect to a specific drug therapy Lymphedema Pathophysiology: (accumulation of lymph in soft tissue) can occur as a result of the excision or radiation of lymph nodes. When the axillary nodes cannot return lymph fluid to the central circulation, the fluid accumulates in the arm, hand, or breast, causing obstructive pressure on the veins and venous return. Assessment: • Patient may feel heaviness, pain, impaired motor function in the arm, and numbness and paresthesia. • Fever and a red, painful rash may also be present with infection of the affected arm (may indicate the beginning of a worsening of lymphedema) • Assess for cellulitis and progressive fibrosis of the skin can result from lymphedema. Intervention • Elevation of the arm so that it is level with the heart, diuretics, and isometric exercises may be used to reduce the fluid volume in the arm. • When the patient’s lymphedema is acute, complete decongestive therapy may be recommended. o This therapy consists of a massage-like technique to mobilize the subcutaneous accumulation of fluid. This may then be followed by use of compression bandaging and an intermittent pneumatic compression sleeve. • To maintain maximum volume reduction, the patient may need to wear a fitted compression sleeve during waking hours and preventively during air travel. • Masectomy Intervention • Restoring arm function on the affected side after mastectomy and ALND is a key nursing goal. • In the hospital, place the woman in a semi-Fowler’s position with the arm on the affected side elevated on a pillow. • Flexing and extending the fingers should begin in the recovery room with progressive increases in activity encouraged. • Postoperative arm and shoulder exercises are instituted gradually (prevent contractures, and muscle shortening, maintain muscle tone and improve lymph node circulation) • The goal of all exercise is a gradual return to full range of motion within 4 to 6 weeks. • Postoperative discomfort can be minimized by administering analgesics regularly when the patient is in pain and about 30 minutes before initiating exercises. • Application of ice, except where contraindicated with plastic surgery procedures, can reduce swelling, inflammation, and pain. • The incidence of arm lymphedema ranges from 2% to 65%, and it can develop 1 to 5 years after surgery. – higher risk when the woman is obese • Teach the woman measures to prevent and reduce lymphedema, including no blood pressure readings, venipunctures, or injections on the affected arm. • The affected arm should not be dependent for long periods. If trauma occurs wash with soap and water and observe for complications o Advise the patient to report to the health care provider symptoms such as fever, inflammation at the surgical site, erythema, postoperative constipation, and unusual swelling. Other changes to report are new back pain, weakness, shortness of breath, and change in mental status, including confusion. • For women who have had a mastectomy without breast reconstruction, a variety of products are available. These include garments such as camisoles with soft breast prosthetic inserts or a fitted prosthesis with bra. o Should the woman choose a breast prosthesis, a certified fitter can help her select a comfortable, more permanent weighted prosthesis and bra, generally at 4 to 8 weeks postoperatively. Your role is to present the choices and resources without judgment. o There are no physical reasons why a mastectomy would prevent sexual satisfaction. The woman taking hormone therapy may have a decreased sexual drive or vaginal dryness. She may need to use lubrication to prevent discomfort during intercourse. Colon Cancer Patho: • More common in men • Highest mortality rates among African American men and women • Risk of contracting the disease increases with age • CRC has an insidious onset, and symptoms do not appear until the disease is advanced. Regular screening is necessary to detect precancerous lesions. • Approximately one half of all colon cancers occur in the rectosigmoid area Risk factors Diet • High in red or processed meat • Low in fruits and vegetables Lifestyle factors • Obesity • Physical inactivity • Alcohol • Mortality rates are highest among African American men and women. • About 90% of new CRC cases are detected in people older than 50, and about a third occur in patients with a family history of CRC. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome (also called Lynch syndrome) is the most common inherited form of hereditary CRC • Long-term smoking • Genetic conditions such as FAP (Account for 5% to 10% of CRC cases) • Personal history of IBD • Individual or family history of colorectal cancer • Colorectal polyps • Age (50+) • Adenocarcinoma is the most common type of CRC. About 85% arise from adenomatous polyps Tumors spread through the walls of the colon into musculature and into the lymphatic and vascular systems. Because venous blood leaving the colon and rectum flows through the portal vein and the inferior rectal vein, the liver is commonly a site of metastasis. The cancer spreads from the liver to other sites, including the lungs, bones, and brain. CRC can also spread directly into adjacent structures. Assessments: Insidious onset Symptoms often do not appear until disease is in advanced stages ▪ Change in bowel habits ▪ Unexplained weight loss ▪ Vague abdominal pain Symptoms of cancer in the left side of the colon appear earlier Symptoms of cancerous lesions ▪ Rectal bleeding is most common ▪ Alternating constipation and diarrhea ▪ Change in stool caliber (Narrow, ribbon-like) ▪ Sensation of incomplete evacuation ▪ Obstruction ▪ Weakness and fatigue ▪ Iron-deficiency anemia and occult bleeding Complications ▪ Obstruction ▪ Bleeding ▪ Perforation ▪ Peritonitis ▪ Fistula formation NUR 105 Final Study Guide Glaucoma: Patho: Increased intraocular pressure (IOP) or Glaucoma is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness. There are two primary categories of glaucoma: • Open-angle (90% of cases are chronic open-angle) • Closed-angle (or narrow angle) Assessment • Assess pt for history or presence of risk factors • Positive family history (believed to be associated with primary open angle glaucoma) • Tumors of the eye • Hemorrhage intraocular • Inflammatory intraocular uveiti • Eye contusion from trauma. Upon Physical examination For primary open angle • Pt may report a loss of peripheral vision slow (see tunnel) For primary angle closure : • Incidence of sudden severe pain in the eye is often accompanied by headache, nausea and vomiting. • Complaints halo light, blurred vision, and decreased light perception. • The pupils are being fixed with redness due to inflammation of the sclera and cornea looks cloudy. Diagnostic Examination • Tonometri used to measure intra-ocular pressure. Glaucoma is suspected when IOP greater than 22 mmHg. • Gonioskopi possible to see directly the anterior chamber angle glaucoma to distinguish between closed and open-angle glaucoma. • Optalmoskopi allow inspectors to see directly optic disc and internal eye structure. Diagnosis • Chronic pain- related to increased intra ocular pressure in the eye. • Impaired sensory reception/ visual- related to progressive vision loss resulting in changes in perception of the environment • Anxiety-related to change in physical status, presence of changes in lifestyle and the unknown results • Knowledge deficit- related to poor understanding of the source of the disease due to lack of resources. Need to learn about prognosis and treatment Planning • Encourage Patient to express fears about surgery in order ensure comfortably. • Explain procedure that is related to recovery • Instruct patient on avoiding shutting eyelids tightly post op, as well as sneezing, coughing, straining BM, bending over, and heavy lifting is to be kept at a minimum. • Explain and demonstrate the procedure for administering eye drops, encourage patient to demonstrate using the teach back method. • Provide verbal as well as written instructions about post-op care including potential complications and what actions to take • Recommend measures to assist patient to manage visual limitations, e.g., reducing clutter, arranging furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night vision. • Provide sedation, analgesics as necessary Nursing interventions • Assess the patient's understanding about the condition and emotional response to the condition and plan of action. • administer cycloplegic eyedrops in the affected eye only. In the affected eye, these drops may precipitate an attack of angle-closure glaucoma and threaten the patient’s residual vision. • After trabeculectomy, give medications as ordered to dilate pupila. • Apply topical corticostroids as ordered to rest the pupil. • Post surgery, protect the affected eye by applying an eye patch and eye shield. • Position the patient on his back or unaffected side, and following general safety measures. • Administer pain medications as ordered. • Encourage ambulation immediately after surgery. • Encourage the patient to express his concerns related to having a chronic condition. • Monitor the patient’s ability to see clearly. Question the patient regularly about the occurrence of visual changes. • Monitor the patient’s intra-occular pressures. • Stress the importance of meticulous compliance with prescribed drug therapy. • Instruct the patient’s family how to modify the patient’s environment for safety. • Teach the patient the signs and symptoms that require immediate medical attention, such as sudden vision change or eye pain. Evaluation • Ascertain that the patient understands prescribed medications – uses and their effectiveness in lowering eye pressure/fluid balance. • Patient demonstrates instillation of drops correctly. • Patient understands Glaucoma medicines need to be taken regularly as directed by physician/ optomologist, hence stopping progression of disease. • Patient is aware of Potential side effects of therapy; headaches, stinging, burning, and redness in the eyes from instillation of drops. • Patient understands medications can be changed in the event of reaction. • Patient receives current reading material relating to glaucoma, & links to informative websites. • Patient is aware of follow up appointments and the importance of regular check-ups with this disease. Breast Disorders ADPIE Assessment of Breast • Mammograms starting at age 40 (yearly) • CBE every 3 years for women in 20s, 30s, and every year for women over 40 • BSE is recommended on a monthly schedule. For women who are having regular menstrual periods, this would be right after menstruation when breasts are less lumpy and tender • Mammography is a method used to visualize the breast’s internal structure using x-rays o Well-tolerated, detects lumps that cannot be felt. o 3D mammography provides a clear view of overlapping breast tissues. It can help diagnose/ detect breast cancer o Calcifications (from aging, trauma, inflammation) are detected, usually benign but may be associated with preinvasive cancer o Allows for earlier treatment and the prevention of metastasis. o If the clinical findings are suspicious and the mammogram is normal, an ultrasound or MRI may be used. Based on these additional findings, a biopsy may be done. • Gynecomastia In Men Pathophysiology o Transient, noninflammatory enlargement of one or both breasts, is the most common breast problem in men. o Usually Temporary or benign; not a risk for breast cancer o The most common cause is disturbance of the normal ratio of active androgen to estrogen in plasma or within the breast itself. o Can be seen in developmental abnormalities of the male reproductive organs o May accompany diseases such as testicular tumors, adrenal cancer, pituitary adenomas, hyperthyroidism, and liver disease. o May be caused by certain medications such as estrogens, androgens, digitalis, isoniazid (INH), ranitidine, and spironolactone. o The use of heroin and marijuana can also cause gynecomastia Senescent gynecomastia occurs in many older men. ▪ May be caused by elevation of plasma estrogen in older men as a result of increased conversion of androgens to estrogens in peripheral circulation. ▪ May become bilateral ▪ If mass is felt, it must be biopsied to rule or the possibility of breast cancer ▪ No treatment, can regress in 6-12 months ▪ May be a side effect to a specific drug therapy Lymphedema Pathophysiology: (accumulation of lymph in soft tissue) can occur as a result of the excision or radiation of lymph nodes. When the axillary nodes cannot return lymph fluid to the central circulation, the fluid accumulates in the arm, hand, or breast, causing obstructive pressure on the veins and venous return. Assessment: • Patient may feel heaviness, pain, impaired motor function in the arm, and numbness and paresthesia. • Fever and a red, painful rash may also be present with infection of the affected arm (may indicate the beginning of a worsening of lymphedema) • Assess for cellulitis and progressive fibrosis of the skin can result from lymphedema. Intervention • Elevation of the arm so that it is level with the heart, diuretics, and isometric exercises may be used to reduce the fluid volume in the arm. • When the patient’s lymphedema is acute, complete decongestive therapy may be recommended. o This therapy consists of a massage-like technique to mobilize the subcutaneous accumulation of fluid. This may then be followed by use of compression bandaging and an intermittent pneumatic compression sleeve. • To maintain maximum volume reduction, the patient may need to wear a fitted compression sleeve during waking hours and preventively during air travel. • Masectomy Intervention • Restoring arm function on the affected side after mastectomy and ALND is a key nursing goal. • In the hospital, place the woman in a semi-Fowler’s position with the arm on the affected side elevated on a pillow. • Flexing and extending the fingers should begin in the recovery room with progressive increases in activity encouraged. • Postoperative arm and shoulder exercises are instituted gradually (prevent contractures, and muscle shortening, maintain muscle tone and improve lymph node circulation) • The goal of all exercise is a gradual return to full range of motion within 4 to 6 weeks. • Postoperative discomfort can be minimized by administering analgesics regularly when the patient is in pain and about 30 minutes before initiating exercises. • Application of ice, except where contraindicated with plastic surgery procedures, can reduce swelling, inflammation, and pain. • The incidence of arm lymphedema ranges from 2% to 65%, and it can develop 1 to 5 years after surgery. – higher risk when the woman is obese • Teach the woman measures to prevent and reduce lymphedema, including no blood pressure readings, venipunctures, or injections on the affected arm. • The affected arm should not be dependent for long periods. If trauma occurs wash with soap and water and observe for complications o Advise the patient to report to the health care provider symptoms such as fever, inflammation at the surgical site, erythema, postoperative constipation, and unusual swelling. Other changes to report are new back pain, weakness, shortness of breath, and change in mental status, including confusion. • For women who have had a mastectomy without breast reconstruction, a variety of products are available. These include garments such as camisoles with soft breast prosthetic inserts or a fitted prosthesis with bra. o Should the woman choose a breast prosthesis, a certified fitter can help her select a comfortable, more permanent weighted prosthesis and bra, generally at 4 to 8 weeks postoperatively. Your role is to present the choices and resources without judgment. o There are no physical reasons why a mastectomy would prevent sexual satisfaction. The woman taking hormone therapy may have a decreased sexual drive or vaginal dryness. She may need to use lubrication to prevent discomfort during intercourse. Colon Cancer Patho: • More common in men • Highest mortality rates among African American men and women • Risk of contracting the disease increases with age • CRC has an insidious onset, and symptoms do not appear until the disease is advanced. Regular screening is necessary to detect precancerous lesions. • Approximately one half of all colon cancers occur in the rectosigmoid area Risk factors Diet • High in red or processed meat • Low in fruits and vegetables Lifestyle factors • Obesity • Physical inactivity • Alcohol • Mortality rates are highest among African American men and women. • About 90% of new CRC cases are detected in people older than 50, and about a third occur in patients with a family history of CRC. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome (also called Lynch syndrome) is the most common inherited form of hereditary CRC • Long-term smoking • Genetic conditions such as FAP (Account for 5% to 10% of CRC cases) • Personal history of IBD • Individual or family history of colorectal cancer • Colorectal polyps • Age (50+) • Adenocarcinoma is the most common type of CRC. About 85% arise from adenomatous polyps Tumors spread through the walls of the colon into musculature and into the lymphatic and vascular systems. Because venous blood leaving the colon and rectum flows through the portal vein and the inferior rectal vein, the liver is commonly a site of metastasis. The cancer spreads from the liver to other sites, including the lungs, bones, and brain. CRC can also spread directly into adjacent structures. Assessments: Insidious onset Symptoms often do not appear until disease is in advanced stages ▪ Change in bowel habits ▪ Unexplained weight loss ▪ Vague abdominal pain Symptoms of cancer in the left side of the colon appear earlier Symptoms of cancerous lesions ▪ Rectal bleeding is most common ▪ Alternating constipation and diarrhea ▪ Change in stool caliber (Narrow, ribbon-like) ▪ Sensation of incomplete evacuation ▪ Obstruction ▪ Weakness and fatigue ▪ Iron-deficiency anemia and occult bleeding Complications ▪ Obstruction ▪ Bleeding ▪ Perforation ▪ Peritonitis ▪ Fistula formation NUR 105 Final Study Guide Glaucoma: Patho: Increased intraocular pressure (IOP) or Glaucoma is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness. There are two primary categories of glaucoma: • Open-angle (90% of cases are chronic open-angle) • Closed-angle (or narrow angle) Assessment • Assess pt for history or presence of risk factors • Positive family history (believed to be associated with primary open angle glaucoma) • Tumors of the eye • Hemorrhage intraocular • Inflammatory intraocular uveiti • Eye contusion from trauma. Upon Physical examination For primary open angle • Pt may report a loss of peripheral vision slow (see tunnel) For primary angle closure : • Incidence of sudden severe pain in the eye is often accompanied by headache, nausea and vomiting. • Complaints halo light, blurred vision, and decreased light perception. • The pupils are being fixed with redness due to inflammation of the sclera and cornea looks cloudy. Diagnostic Examination • Tonometri used to measure intra-ocular pressure. Glaucoma is suspected when IOP greater than 22 mmHg. • Gonioskopi possible to see directly the anterior chamber angle glaucoma to distinguish between closed and open-angle glaucoma. • Optalmoskopi allow inspectors to see directly optic disc and internal eye structure. Diagnosis • Chronic pain- related to increased intra ocular pressure in the eye. • Impaired sensory reception/ visual- related to progressive vision loss resulting in changes in perception of the environment • Anxiety-related to change in physical status, presence of changes in lifestyle and the unknown results • Knowledge deficit- related to poor understanding of the source of the disease due to lack of resources. Need to learn about prognosis and treatment Planning • Encourage Patient to express fears about surgery in order ensure comfortably. • Explain procedure that is related to recovery • Instruct patient on avoiding shutting eyelids tightly post op, as well as sneezing, coughing, straining BM, bending over, and heavy lifting is to be kept at a minimum. • Explain and demonstrate the procedure for administering eye drops, encourage patient to demonstrate using the teach back method. • Provide verbal as well as written instructions about post-op care including potential complications and what actions to take • Recommend measures to assist patient to manage visual limitations, e.g., reducing clutter, arranging furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night vision. • Provide sedation, analgesics as necessary Nursing interventions • Assess the patient's understanding about the condition and emotional response to the condition and plan of action. • administer cycloplegic eyedrops in the affected eye only. In the affected eye, these drops may precipitate an attack of angle-closure glaucoma and threaten the patient’s residual vision. • After trabeculectomy, give medications as ordered to dilate pupila. • Apply topical corticostroids as ordered to rest the pupil. • Post surgery, protect the affected eye by applying an eye patch and eye shield. • Position the patient on his back or unaffected side, and following general safety measures. • Administer pain medications as ordered. • Encourage ambulation immediately after surgery. • Encourage the patient to express his concerns related to having a chronic condition. • Monitor the patient’s ability to see clearly. Question the patient regularly about the occurrence of visual changes. • Monitor the patient’s intra-occular pressures. • Stress the importance of meticulous compliance with prescribed drug therapy. • Instruct the patient’s family how to modify the patient’s environment for safety. • Teach the patient the signs and symptoms that require immediate medical attention, such as sudden vision change or eye pain. Evaluation • Ascertain that the patient understands prescribed medications – uses and their effectiveness in lowering eye pressure/fluid balance. • Patient demonstrates instillation of drops correctly. • Patient understands Glaucoma medicines need to be taken regularly as directed by physician/ optomologist, hence stopping progression of disease. • Patient is aware of Potential side effects of therapy; headaches, stinging, burning, and redness in the eyes from instillation of drops. • Patient understands medications can be changed in the event of reaction. • Patient receives current reading material relating to glaucoma, & links to informative websites. • Patient is aware of follow up appointments and the importance of regular check-ups with this disease. Breast Disorders ADPIE Assessment of Breast • Mammograms starting at age 40 (yearly) • CBE every 3 years for women in 20s, 30s, and every year for women over 40 • BSE is recommended on a monthly schedule. For women who are having regular menstrual periods, this would be right after menstruation when breasts are less lumpy and tender • Mammography is a method used to visualize the breast’s internal structure using x-rays o Well-tolerated, detects lumps that cannot be felt. o 3D mammography provides a clear view of overlapping breast tissues. It can help diagnose/ detect breast cancer o Calcifications (from aging, trauma, inflammation) are detected, usually benign but may be associated with preinvasive cancer o Allows for earlier treatment and the prevention of metastasis. o If the clinical findings are suspicious and the mammogram is normal, an ultrasound or MRI may be used. Based on these additional findings, a biopsy may be done. • Gynecomastia In Men Pathophysiology o Transient, noninflammatory enlargement of one or both breasts, is the most common breast problem in men. o Usually Temporary or benign; not a risk for breast cancer o The most common cause is disturbance of the normal ratio of active androgen to estrogen in plasma or within the breast itself. o Can be seen in developmental abnormalities of the male reproductive organs o May accompany diseases such as testicular tumors, adrenal cancer, pituitary adenomas, hyperthyroidism, and liver disease. o May be caused by certain medications such as estrogens, androgens, digitalis, isoniazid (INH), ranitidine, and spironolactone. o The use of heroin and marijuana can also cause gynecomastia Senescent gynecomastia occurs in many older men. ▪ May be caused by elevation of plasma estrogen in older men as a result of increased conversion of androgens to estrogens in peripheral circulation. ▪ May become bilateral ▪ If mass is felt, it must be biopsied to rule or the possibility of breast cancer ▪ No treatment, can regress in 6-12 months ▪ May be a side effect to a specific drug therapy Lymphedema Pathophysiology: (accumulation of lymph in soft tissue) can occur as a result of the excision or radiation of lymph nodes. When the axillary nodes cannot return lymph fluid to the central circulation, the fluid accumulates in the arm, hand, or breast, causing obstructive pressure on the veins and venous return. Assessment: • Patient may feel heaviness, pain, impaired motor function in the arm, and numbness and paresthesia. • Fever and a red, painful rash may also be present with infection of the affected arm (may indicate the beginning of a worsening of lymphedema) • Assess for cellulitis and progressive fibrosis of the skin can result from lymphedema. Intervention • Elevation of the arm so that it is level with the heart, diuretics, and isometric exercises may be used to reduce the fluid volume in the arm. • When the patient’s lymphedema is acute, complete decongestive therapy may be recommended. o This therapy consists of a massage-like technique to mobilize the subcutaneous accumulation of fluid. This may then be followed by use of compression bandaging and an intermittent pneumatic compression sleeve. • To maintain maximum volume reduction, the patient may need to wear a fitted compression sleeve during waking hours and preventively during air travel. • Masectomy Intervention • Restoring arm function on the affected side after mastectomy and ALND is a key nursing goal. • In the hospital, place the woman in a semi-Fowler’s position with the arm on the affected side elevated on a pillow. • Flexing and extending the fingers should begin in the recovery room with progressive increases in activity encouraged. • Postoperative arm and shoulder exercises are instituted gradually (prevent contractures, and muscle shortening, maintain muscle tone and improve lymph node circulation) • The goal of all exercise is a gradual return to full range of motion within 4 to 6 weeks. • Postoperative discomfort can be minimized by administering analgesics regularly when the patient is in pain and about 30 minutes before initiating exercises. • Application of ice, except where contraindicated with plastic surgery procedures, can reduce swelling, inflammation, and pain. • The incidence of arm lymphedema ranges from 2% to 65%, and it can develop 1 to 5 years after surgery. – higher risk when the woman is obese • Teach the woman measures to prevent and reduce lymphedema, including no blood pressure readings, venipunctures, or injections on the affected arm. • The affected arm should not be dependent for long periods. If trauma occurs wash with soap and water and observe for complications o Advise the patient to report to the health care provider symptoms such as fever, inflammation at the surgical site, erythema, postoperative constipation, and unusual swelling. Other changes to report are new back pain, weakness, shortness of breath, and change in mental status, including confusion. • For women who have had a mastectomy without breast reconstruction, a variety of products are available. These include garments such as camisoles with soft breast prosthetic inserts or a fitted prosthesis with bra. o Should the woman choose a breast prosthesis, a certified fitter can help her select a comfortable, more permanent weighted prosthesis and bra, generally at 4 to 8 weeks postoperatively. Your role is to present the choices and resources without judgment. o There are no physical reasons why a mastectomy would prevent sexual satisfaction. The woman taking hormone therapy may have a decreased sexual drive or vaginal dryness. She may need to use lubrication to prevent discomfort during intercourse. Colon Cancer Patho: • More common in men • Highest mortality rates among African American men and women • Risk of contracting the disease increases with age • CRC has an insidious onset, and symptoms do not appear until the disease is advanced. Regular screening is necessary to detect precancerous lesions. • Approximately one half of all colon cancers occur in the rectosigmoid area Risk factors Diet • High in red or processed meat • Low in fruits and vegetables Lifestyle factors • Obesity • Physical inactivity • Alcohol • Mortality rates are highest among African American men and women. • About 90% of new CRC cases are detected in people older than 50, and about a third occur in patients with a family history of CRC. Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome (also called Lynch syndrome) is the most common inherited form of hereditary CRC • Long-term smoking • Genetic conditions such as FAP (Account for 5% to 10% of CRC cases) • Personal history of IBD • Individual or family history of colorectal cancer • Colorectal polyps • Age (50+) • Adenocarcinoma is the most common type of CRC. About 85% arise from adenomatous polyps Tumors spread through the walls of the colon into musculature and into the lymphatic and vascular systems. Because venous blood leaving the colon and rectum flows through the portal vein and the inferior rectal vein, the liver is commonly a site of metastasis. The cancer spreads from the liver to other sites, including the lungs, bones, and brain. CRC can also spread directly into adjacent structures. Assessments: Insidious onset Symptoms often do not appear until disease is in advanced stages ▪ Change in bowel habits ▪ Unexplained weight loss ▪ Vague abdominal pain Symptoms of cancer in the left side of the colon appear earlier Symptoms of cancerous lesions ▪ Rectal bleeding is most common ▪ Alternating constipation and diarrhea ▪ Change in stool caliber (Narrow, ribbon-like) ▪ Sensation of incomplete evacuation ▪ Obstruction ▪ Weakness and fatigue ▪ Iron-deficiency anemia and occult bleeding Complications ▪ Obstruction ▪ Bleeding ▪ Perforation ▪ Peritonitis ▪ Fistula formation