Chapter054

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 54: Caring for Clients with Breast Disorders


MastitisMastitis• Pathophysiology and Etiology: Plugged

lactiferous ducts; Staphylococcus aureus

• Assessment Findings

– Fever; Malaise; Breast tenderness, pain, redness, and hardness; Crack in the nipple or areola; Enlarged axillary lymph nodes

• Medical Management: Antibiotics; Analgesics; Heat; Emptied breasts (via pump); Systemic antibiotics

• Nursing Management


QuestionQuestion

Is the following statement true or false?

Mastitis occurs in lactating women as a result of plugged ducts.


AnswerAnswer

True.

Mastitis occurs in lactating women as a result of plugged lactiferous ducts. It is treated with oral antibiotics and heat to the affected breast. The breast milked must be pumped and dumped so the baby will not receive antibiotics via the mother’s milk.


Breast AbscessBreast Abscess

• Pathophysiology and Etiology: Complication of postpartum mastitis; S. aureus

• Assessment Findings: Signs and symptoms of mastitis; Purulent nipple drainage

• Medical, Surgical Management

– Hospitalization; Contact isolation; IV antibiotics; Incision and drainage (I&D) of abscess



Fibrocystic Breast DiseaseFibrocystic Breast Disease• Pathophysiology and Etiology: Benign breast cyst(s);

Exacerbated by caffeine and nicotine

– Women 30 – 50 y.o. primarily affected

• Assessment Findings: Signs and Symptoms

– Tender, painful breasts; Multiple breast lumps; Mastalgia; Hormonal influence

• Diagnostic Findings: Physical and cytologic exam; Incisional biopsy; Mammography; Ultrasonography

• Medical, Surgical Management: Analgesics; Oral contraceptives; Cyst removal; Mastectomy



QuestionQuestion


Fibrocystic breast disease occurs in women of late adolescence to young adulthood.


AnswerAnswer

False.

Fibrocystic breast disease generally occurs in women 30 to 50 years of age; fibroadenomas typically occur in women from late adolescence to young adulthood.


FibroadenomaFibroadenoma• Pathophysiology and Etiology: Benign breast

lesion; Hormonal influence; Single nodule: No change with menstrual cycle; Late adolescence – early adulthood

• Assessment Findings: Painless, nontender lump; Encapsulated, mobile, firm lesion

• Diagnostic Findings: Ultrasound; Excisional biopsy

• Medical, Surgical Management: Observation; Excision or tumor removal



Breast CancerBreast Cancer• Pathophysiology, Etiology: Mass of abnormal cells;

Risk factors: Female; >50 y.o.; Defective gene

• Assessment Finding: Signs and Symptoms - Painless mass in breast; Bloody discharge from nipple; Dimpling of skin; Nipple retraction; Asymmetrical breast size; Orange peel skin

• Diagnostic Findings: Mammography; Biopsy

• Medical, Surgical Management: Treatment dependent on tumor staging

– Surgery; Chemotherapy; Radiation therapy



Breast Cancer Locations (Primary)Breast Cancer Locations (Primary)

Figure 54 -2 Locations of primary malignant

breast tumors


Signs, Symptoms of Breast CancerSigns, Symptoms of Breast Cancer


Breast Cancer StagesBreast Cancer Stages


QuestionQuestion


Breast cancer is staged with Stage 1 being the most advanced.


AnswerAnswer

False.

Breast cancer is staged with Stage 1 being the least advanced, progressing to Stage 4, which is the most advanced.


Metastatic Breast CancerMetastatic Breast Cancer• Pathophysiology: Migration of cancer cells to

another part of the body - spread by direct extension

– Lymphatics; Bloodstream; CSF; Lymph node; Skeletal; Pulmonary systems; Brain; Liver

• Assessment Findings: Signs and Symptoms - Pain; Pathologic fractures

• Diagnostic Findings: Radiographs; MRI; CT; Lymph node dissection

• Medical Management: Palliative treatment; Intramuscular androgen therapy; Radiation therapy



Malignant Breast DisordersMalignant Breast Disorders

• Breast Cancer Prevention for women with increased risk

– Long-term follow-up

– Bilateral prophylactic mastectomy

– Chemoprevention

• Tamoxifen; Raloxifene; NSAIDs

• Side effects

• Dietary impact - inconclusive


Cosmetic Breast ProceduresCosmetic Breast Procedures• Breast Reconstruction

– Refashioning of area of a mastectomy

– Simulation of breast contour

– Optional: Nipple; Areola

• Artificial implants: Saline-filled

• Silicone gel

• High complication rates

• FDA approval

• Autogenous tissue: Natural look, feel


Cosmetic Breast ProceduresCosmetic Breast Procedures• Reduction Mammoplasty

– Breast size reduction

• Clients with D cup or larger brassiere

– Overnight surgical procedure

• Opposite Breast Reduction

– Corrects asymmetry

– Reduce healthy breast to resemble size of a reconstructed breast

– Similar to mammoplasty


Cosmetic Breast ProceduresCosmetic Breast Procedures• Breast Lift (Mastopexy)

– Corrects sagging, low nipple placement

• Breast Augmentation

– Breast enlargement using saline implant


– Pre- and post-operative care: Semi-Fowler’s position; Pain management

– Client teaching: Mammogram; BSE; Brassiere; Exercise


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Chapter054

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