RLE 80 Group 5

A CASE STUDY ON BREAST MASS EXCISION WITH FROZEN SECTIONMel Fitz Angelo Sabido Elaine May Rafols

INTRODUCTION DefinitionLipoma is a lump or mass that is made up of fat cells (adipocytes). Lipomas are a common, benign (noncancerous) type of slow-growing tumor. They most often develop just under the skin in the subcutaneous tissue, located beneath the skin and above the muscle.

Lipomas generally develop slowly, forming round, flattened lumps that are soft or spongy in texture and easily moved around under the skin. Lipomas can be unsightly, but they usually do not cause any pain, discomfort or tenderness. Lipomas may begin to grow after a tissue injury or trauma, and they tend to run in families.

CausesThe reason why some people develop lipomas is not known, although family history appears to play a role. You are more likely to develop a lipoma if you have a parent or sibling with a lipoma. People who develop more than one lipoma may have an extremely rare inherited disorder called familial multiple lipomatosis.

SymptomsThe symptoms of a lipoma typically include the formation of a lump or multiple lumps under the skin. Lipomas typically grow slowly, and you may not even notice the appearance of a lipoma for years. The most common sites for lipomas include the neck, shoulders, back, abdomen, arms or legs, but they can also grow on your internal organs.

DiagnosisA lipoma will show on a mammogram as a translucent gray mass. A clear diagnosis can be made with ultrasound and sometimes a minimally invasive needle biopsy.

TreatmentOnce a lump under your skin is diagnosed as a benign (noncancerous) lipoma, your physician or health care provider will determine your best treatment option. The common treatments for benign lipomas include:y Liposuction y Steroid injections, which can shrink but not completely

eliminate lipomasy Surgical procedures to remove lipomas (excision)

ComplicationThe complications of a lipoma vary depending on its location as well as whether surrounding tissues or organs are affected. Lipomas are generally not serious, but in rare cases they can press on nerves and cause pain or be associated with other serious conditions.

CLIENTS PROFILE

y Name: Patient B y Age: 64 years old y Sex: Female y Civil Status: Married y Final Diagnosis: Right Benign Lipoma

ANATOMY AND PHYSIOLOGY

The breast is a mass of glandular, fatty, and fibrous tissues positioned over the pectoral muscles of the chest wall and attached to the chest wall by fibrous strands called Coopers ligaments. A layer of fatty tissue surrounds the breast glands and extends throughout the breast. The fatty tissue gives the breast a soft consistency.

ANATOMY AND PHYSIOLOGY

The glandular tissues of the breast house the lobules (milk producing glands at the ends of the lobes) and the ducts (milk passages). Toward the nipple, each duct widens to form a sac (ampulla). During lactation, the bulbs on the ends of the lobules produce milk. Once milk is produced, it is transferred through the ducts to the nipple.

ANATOMY AND PHYSIOLOGY

y y y y y y

The breast is composed of: milk glands (lobules) that produce milk ducts that transport milk from the milk glands (lobules) to the nipple nipple areola (pink or brown pigmented region surrounding the nipple) connective (fibrous) tissue that surrounds the lobules and ducts fat

ANATOMY AND PHYSIOLOGY

BREAST SIZE, APPEARANCE, AND CHANGES OVER TIME The size and shape of womens breasts varies

considerably. Some women have a large amount of breast tissue, and therefore, have large breasts. Other women have a smaller amount of tissue with little breast fat.

ANATOMY AND PHYSIOLOGY

y y y y y y y y

Factors that may influence a womans breast size include: Volume of breast tissue Family history Age Weight loss or gain History of pregnancies and lactation Thickness and elasticity of the breast skin Degree of hormonal influences on the breast (particularly estrogen and progesterone) Menopause

ANATOMY AND PHYSIOLOGY

BREAST CHANGES AFTER MENOPAUSE y When a woman reaches menopause (typically in her late 40s or early 50s), her body stops producing estrogen and progesterone. The loss of these hormones causes a variety of symptoms in many women including hot flashes, night sweats, mood changes, vaginal dryness and difficulty sleeping. During this time, the breasts also undergo change. For some women, the breasts become more tender and lumpy, sometimes forming cysts (accumulated packets of fluid).

OPERATION PERFORMED

y Date of Operation: January 5, 2012 y Operation Performed: Breast Mass Excision

Right with Frozen Sectiony Type of Anesthesia: General Anesthesia

DefinitionBreast Mass Excision is a surgery to remove any breast mass and in the some tissues

surrounding

from the breast.

Overview and Descriptiony The patient will be given general anesthesia or

local anesthesia. The procedure takes about 1 to 2 hours.y The surgeon makes a small incision (cut) on your

breast. The surgeon then removes some of the lump and breast tissue around it.

If the lump is not breast cancer, surgeon will not remove very much breast tissue from around the lump. If the patient has a breast cancer, the amount of breast tissue around the lump the surgeon removes may depend on what type of breast cancer the patient has.

The surgeon will close the skin with stitches. These may dissolve or need to be removed later. A drain tube may be placed to remove excess fluid. The doctor will send the lump to a laboratory for testing.

PERIOPERATIVE NURSING MANAGEMENT Preoperative PhaseExplain the need for preoperative tests (e.g., laboratory, x-ray, ECG). Discuss bowel preparation, if required. Discuss skin preparation, including operative area and preoperative bath or shower. Discuss preoperative medications, if ordered.

PERIOPERATIVE NURSING MANAGEMENT Preoperative PhaseExplain individual therapies ordered by the primary care provider such as intravenous therapy, insertion of urinary catheter or nasogastric tube, use of a spirometer, or antiemboli stockings. Explain the need to restrict food and oral fluids at least 8 hours before surgery.

PERIOPERATIVE NURSING MANAGEMENT Preoperative PhaseDiscuss the need to remove jewelry, make-up, and all prostheses (e.g., eyeglasses, hearing aids, complete or partial dentures, wig) immediately before surgery. Inform client about the preoperative holding area, and give the location of the waiting room for the support people.

PERIOPERATIVE NURSING MANAGEMENT Preoperative PhaseTeach deep-breathing and coughing exercises, leg exercises, ways to turn and move, and splinting techniques. Complete the preoperative checklist.

PERIOPERATIVE NURSING MANAGEMENT Intraoperative PhaseMaintaining the clients safety is the over-all goal of nursing care during the intraoperative phase. A surgical skin preparation should be carried out as close to the time of surgery as possible. Positioning of the client during surgery is important to reduce the risk of tissue and nerve damage.

PERIOPERATIVE NURSING MANAGEMENT Intraoperative PhaseAssist in preparing and maintaining the sterile field. Open and dispense sterile supplies during surgery. Provide medications and solutions for the sterile field. Monitor and maintain a safe, aseptic environment.

PERIOPERATIVE NURSING MANAGEMENT Intraoperative PhaseManage catheters, tubes, drains, and specimens. Perform sponge, sharp, and instrument counts. Document nursing care provided and the clients response to interventions.

PERIOPERATIVE NURSING MANAGEMENT Postoperative PhaseImmediate postanesthetic care focuses on

assessment and monitoring parameters to prevent complications from anesthesia or surgery. Initial and ongoing assessment of the postoperative client includes level of consciousness, vital signs, oxygen saturation, skin color and temperature, comfort, fluid balance, dressings, drains, and tubes.

PERIOPERATIVE NURSING MANAGEMENT Postoperative PhaseThe overall goals of nursing care during the postoperative period are to promote comfort and healing, restore the highest possible level of wellness, and prevent associated risks such as infection or respiratory and cardiovascular

complications.

PERIOPERATIVE NURSING MANAGEMENT Postoperative PhaseOngoing postoperative nursing interventions include:a. Managing pain b. Appropriate positioning c. Encouraging

deep-breathing

and

coughing

exercises d. Promoting leg exercises and early ambulation. e. Maintaining adequate hydration and nutritional status. f. Providing wound care.

PERIOPERATIVE NURSING MANAGEMENT Postoperative PhaseSurgical aseptic technique is used when changing dressings on surgical wounds to promote healing and reduce the risk of infection.

CONCLUSION

As we all know, conditions affecting the female

breast is common nowadays. That is why there are a lot of existing procedures that aims to treat one of the leading causes of death among Filipino women, most commonly to women aging 40 years old and above.

The choice of which surgery is best for you can be

difficult. Sometimes, it is hard to know whether lumpectomy or mastectomy is best. You and the health care providers who are treating your breast cancer will decide together.

Before you agree to have your breast mass removed

it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here.

Because all patients, conditions and treatments

vary, it cannot cover everything. Use this information when making your breast mass treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

If there is any doubt about your breast problem, and

you do nothing, the problem will remain. We will not be clear what is going on. You may miss out on important treatment. That is why you have to undergo with the desired procedure as soon as possible to avoid any serious complications.