management of women w breast disorder

8/9/2019 Management of Women w Breast Disorder

1/32


2/32

DISORDERS OF THE BREAST> most breast disease may be described as

benign or cancerous.> Breast tissue is never static.> Breast is constantly responding to changes in:

- hormonal- nutritional- psychological- environmental stimuli that cause continual

cellular changes.> benign breast conditions are nonprogressive,however, increase the risk of malignantdisease.


3/32

GALACTORRHEA> is the secretion of breast milk in a nonlactating

breast.> May result from vigorous nipple stimulation during

lovemaking, exogenous hormones, internal

hormonal imbalance, or local chest infectionor trauma.

> A pituitary tumor may produce large amount ofprolactin and cause galactorrhea.

> Occurs both in men and women and is usually

benign.> Observations may be continue for several months

before diagnostic and hormonal screening.


4/32


5/32

MASTITIS

> is an inflammation of the breast.> Most frequently occurs during lactation but may also

result from other conditions.> In lactacting mother:

- inflammation results from ascending thattravels from the nipple to the ductile structures.- The most common organism isolated are :Staphylococcus and Streptococcus.- The offending organism originates from the

infants nasopharynx or the mothers hands.- During early weeks of nursing, the breast isparticularly vulnerable to bacterial invasionbecause the of minor cracks and fissures thatoccur with vigorous sucking.


6/32


7/32

- Infection and inflammation cause obstructionof the ductile system.- The breast becomes hard, inflamed, and

tender if not treated early.- Without treatment the area becomes walledof and may abscess, requiring incision anddrainage.- It is advisable for the mother to continuebreastfeeding during antibiotic therapy toprevent mastitis.


8/32

> mastitis is not confined to the postpartum period, it can occur asa result of hormonal fluctuations, tumors, trauma, or skininfection.

> Cyclic inflammation of the breast occurs most frequently inadolescents, who commonly have fluctuating hormonelevel.

> Tumors may cause mastitis secondary to skin involvement or

lymphatic obstruction.> Local trauma or infection- may develop into mastitis because of

ductal blockage of trapped blood, cellular debris, or theextension of superficial inflammation.

Treatment:- application of heat or cold- excision- aspiration- mild analgesics- antibiotic- supportive brassiere or breast binder


9/32

DUCTAL DISORDERS1. Ductal ectasia2. Ectasia

Treatment removal of the involved ductal mass.1. Intraductal papillomas are benign epithelial tissue tumors

that range in size from 2mm to 5cm.2. Papillomas usually manifest with a bloody nipple discharge.3. The tumor may be palpated in the areolar area.

4. The papilloma is probed through the nipple, and the involvedduct is removed


10/32

Ductal Ectasia


11/32

FIBROADENOMA AND FIBROCYSTICDISEASE

> is seen in premenopausal women, mostcommonly in the third and fourth decade.

> Clinical findings a firm, rubbery, sharplydefined round mass.

> On palpation, the mass slides between thefingers and is easily movable .

> The masses are singular; only 15% are multipleor bilateral.

> Is asymptomatic and is usually found by

accident.> Not thought to be precancerous.> Treatment involves simple excision.


12/32


13/32

FIBROCYSTIC BREAST DISEASE most frequent lesionof the breast.

> Most common in women 30 to 50 years of age and is rare inpostmenopausal women not receiving hormonereplacement.

> Usually presents as nodular ( i.e. shotty), granular breastmasses that are more prominent and painful during theluteal or progesterone dominant portion of the menstrualcycle.

> Discomfort ranges from heaviness to exquisite tenderness,depending on the vascular engorgement and cysticdistention.

> Microscopically fibrocystic disease refers to a constellation of

morphologic changes manifested by:- cystic dilation of terminal ducts.- relative increase in fibrous tissue- variable proliferation of terminal duct epithelial elements


14/32

> Fibrocystic disease with giant cyst and proliferative epitheliallesions with atypia are more common in women whoare at increased risk for developing breast cancer.

> The nonproliferative form does not carry an increased riskfor development of breast cancer is more common.Diagnosis :

> made by physical examination> biopsy ( aspiration of tissue sample)> mammography

Treatment for fibrocystic disease is usually symptomatic.> Aspirin> Mild analgesics> Local application of heat or cold may be recommended

advised to avoid foods that contain xanthines ( coffee,

cola, chocolates and tea) in their daily diet,particularly premenstrually.> Vitamin E may be helpful in reducing mastalgia ( breast

pain)> Encouraged to wear a good supportive brassiere> Danazol can be used forwomen in severe pain.


15/32


16/32

Tumor Sizes


17/32

Risk factors:1. sex2. increasing age3. personal or family history of breast cancer4. history of benign breast disease ( primary atypical

hyperplasia)

5. hormonal influences6. approximately 8% of breast cancer are hereditary.- two breast cancer susceptibility genes = BRCA1 onchromosome 17 and BRCA2 on chromosome 13, mayaccount for most inherited forms of breast cancer.- BRCA1- known to be involved in tumor suppression

a woman with BRCA1 mutation has a lifetime risk of56% to 85% for breast cancer and an increased riskfor ovarian CA.


18/32

Prevention:1. Breast self examination:

- start from age 20.- Done after menstruation- Postmenopausal women and women who

had hysterectomy should perform

BSE on the same day of everymonth.

- Done on shower or bath or at bed time- Palpate the breast from periphery to the

center in circular motion

2. Mammogram- this involves x-ray examination of the

breast.- The breast is supported on flat, firm

surface.

- This involves use of two x-ray films.


19/32

Mammogram


20/32

Classic symptoms that define breast cancerinclude:

> firm nontender, nonmobile mass> solitary irregularly shaped mass

> adherence to muscle or skin causing dimpling effect> involvement of upper quadrant or central nippleportion of breast.> Asymmetry of the breast

> orange peel skin> Retraction of nipple> Abnormaldischarge from nipple


21/32

Stages of Breast Cancer

Stage I. Tumor size is up to 2cm.

Stage II. Tumor size is up to 5cm with axillary lymphnode involvement.

Stage III. Tumor size is more than 5cm, with axillaryand neck lymph node involvement.

Stage IV. Metastasis to distant organs ( liver, lungs,

bones, and brain).


22/32

Collaborative Management for the client withbreast cancer:1. Surgery

a. Lumpectomy/tylectomy. Involves removal of the lump.b. Simple mastectomy- involves removal of the entire

breast, the pectoralis muscles and the nipplesremain intact.

c. Modified Radical Mastectomy ( MRM) involves removalof the entire breast, pectoralis major muscles andthe axillary lymph nodes.

d. Radical Mastectomy involves removal of the entire

breast, pectoralis major and minor muscles,axillary and neck lymph nodes. It is followed byskin grafting..

2. Chemotherapy3. Radiation therapy


23/32

Lumpectomy


24/32

Simple Mastectomy


25/32


26/32

Radical Mastectomy


27/32


28/32

Surgery : Preoperative care:1. Psychosocial support. Include the husband when

necessary.2. Teach arm exercises to prevent lymph edema.

3. Inform about wound suction drainage, E.G.hemovac, Jackson-Pratt.4. Deep breathing, coughing and turning exercises

to prevent postop respiratory complications.


29/32

Postoperative Care:

1. Place client in semi-Fowlers position with arm elevated

on pillows, abducted

to promote venous return.2. Monitor Hemovac output ( serosanguinous for the first

24 hours)3. Check behind patient for bleeding - Blood flows to the

back by gravity.4. Post signs warning against taking blood pressure,starting IVs or drawing blood on affected side.

5. Initiate exercise to prevent stiffness and contractures ofshoulder girdle.

6. Reinforce special mastectomy exercises as prescribed.7. Provide adequate analgesia to promote ambulation

and exercise.8. Encourage regular coughing and deep breathing

exercises.


30/32

9. Prepare client : for size and appearance of the incisionand provide support when incision is is viewed forthe first time.

10. Provide client with detailed information with detailedinformation concerning breast prosthesis.

11.Fitting is not possible for 4 to 6 weeks.12. A temporary prosthesis or lightly padded bras worn

until healing is complete.13. teach to avoid constrictive clothing and report

persistent edema, redness, or infection of incision.14. Teach the client about the importance of continuingmonthly breast examination on remaining breast.


31/32

Prevention of LymphedemaAVOIDS

- Cuts- Scratches- Pinpricks- Hangnails- Insect bites- Burns- Strong detergents

DONTS ( on the affected side)- carry purse/ anything heavy- wear wrist watch/ jewelry- pick at/ cut cuticles

- work near thorny plants/ dig in garden- reach into hot oven- hold a cigarette- injections/ withdrawal of blood, Bp taking


32/32

DOs

> wear loose rubber gloves when washing dishes

> wear a thimble when sewing> Apply lanolin hand cream to prevent dryness> Contact AMD if arm gets red, warm, or hard/

swollen> Return for check-up

> Wear Life Guard Med..Aid tag: CAUTION-LYMPHEDEMA

management of women w breast disorder

Documents