Chapter 73

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Author:
alicia0309
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259865
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Chapter 73
Updated:
2014-02-02 22:46:09
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nursing 114
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Chapter 73 Breast Disorders
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  1. what are some benign breast disorders
    • Fibroadenoma
    • Fibrocystic Breast Disease
    • Ductal Ectasia
    • Intraductal Papilloma
    • Gynomastia
  2. Fibroadenoma
    • most common cause of breast disease in adolescence
    • S/S: solid, slowly enlarging, benign mass, round firm, easily movable, non-tender
    • usually located in the upper outer quadrnt of the breast
  3. Fibrocystic Breast Disease
    • Physiologic nodularity of the breast
    • most common women 20-30
    • can increase in severity until menopause
    • cyclic in nature, accompanied by pain, tenderness, and cysts in breasts
    • Worsens with menstrual cycles
  4. Management of fibrocystic breast disease
    • symptom management
    • ¬†hormonal manipulation (oral contraceptives)
    • Danazole suppresses ovarian function and stimulation of breast tissue (only in severe cases)
    • Vit c, E & B complex
    • Diuretics to decrease premenstrual breast enlargment
    • Avoid caffeine
    • Mild analgesic
    • Limit salt intake
    • well padded sports bra
    • local application of heat and ice
  5. ductal ectasia
    • benign breast disease of women approaching menopause caused by dilation and thickening of the collecting ducts in the subareolar area
    • Mass is hard with irregular borders
    • Greenish brown nipple discharge
    • accurate dx is vital because the risk for breast cancer increases in menopausal women
  6. itraductal papilloma
    • occurs most often in women 40-55
    • benign process of the epithelial lining of the duct, forming an out growth of tissue
    • as the papilloma grows trauma and erosion occur within the dict resulting in bloody or serous nipple d/c
    • dx is aimed a r/o ca
  7. gynomastia
    • benign condition of breast enlargement in men
    • can be a result of primary cancer such as lug cancer
    • also caused by drugs, aging, obesity
    • underlying disease causing estrogen excesses (malnutrition, liver disease, hyperthyroidism)
    • can be unilateral in teenagers bu tusually bilateral assess closely for ca if only unilateral
  8. breast cancer risk factors
    • start period at young age or end at late age
    • not having 1st child by 30
    • never breast feeding
    • prolonged hormonal¬† stimulation (oral contraceptives are protection from this)
    • Family 1st degree (parent, sibling, child)
    • the more times you ovulate in life the higher the chance of breast cancer
  9. Noninvasive Breast Cancer
    (like PreCancer)
    • DCIS: ductal carcinoma
    • at this stage cancer cells lie with in the mammary ducts.
    • this stage is not dangerous
    • Some Pts stay in DCIS but some develop invasive carcinoma, therefore most surgeons will treat DCIS aggressively
  10. Invasive types of Breast Cancer
    Ductal Carcinoma
    • 80%
    • originates in the mammary ducts and grows in the epithelial cells lining the ducts.
    • Rate of growth varies and depends on hormonal influences
    • Once palpable it is an irregular and poorly defines mass
  11. Invasive types of breast cancer
    Lobular Carcinoma
    • 10%
    • more likely to effect both breasts and have multiple sites in each breast
    • Forms palpable lump but does not always show up on mammography
  12. medullary carcinoma
    • 1-5%
    • occurs more frequently in younger women
  13. colloid carcinoma
    • 1-6%
    • occurs more frequently in older women
    • Good Prognosis
  14. Inflammatory Carcinoma
    • >1%
    • Rapid growing, often with metastasis present at dx.
    • first manifestations are breast skin edema and redness (peau d' Orange)
  15. of all breast cancers ____ occurs in men.
    1%
  16. breast cancer in men usually presents as
    • a hard nonpainful subareolar mass
    • it is often wide spread disease because it is detected at later stage than women
  17. negative margins in breast biopsy means ...
    • the tumor and healthy tissue around it was removed
    • Neg is Good they got it all
  18. positive margins
    • did not get it all
    • the tumor was removed but there was some left behind
  19. Breast Cancer complications include
    • invasion of the lymph nodes causing skin edema
    • extension of the lymph nodes
    • Bone, Lungs, brain and liver sites of metastatic disease from breast cancer
    • Bone is the most frequent area of early metastatic
  20. early detection screenings
    • mammography yearly at age 40
    • Self Breast Exam: the goal of screening is early detection. Teach starting at age 20
  21. Primary Prevention
    • Dietary Changes
    • Prophylactic Mastectomy or Oorpherectomy (remove ovaries to stop estrogen)
  22. Secondary Prevention
    • Early Detection, 3 pronged attack
    • Mammogram
    • Clinical Breast Exam
    • Self Breast Exam
  23. if you have lumpectomy you must have ...
    radiation to prevent reoccurence
  24. cancer cells that have estrogen or progesterone receptors.....
    have a better prognosis and usually respond to hormone therapy
  25. what is the worst kind of breast cancer tumors
    • triple negative
    • occurs when the pts cancer does not have estrogen receptors or progesterone receptors or DOES NOT over express the HER2neu gene
  26. Characteristics of triple negative breast cancer
    • more aggressive tumors
    • reoccur more quickly
    • found in younger pt, African Americans and pt with + BRCA1 & BRCA2 genes
    • ONLY TREATMENT IS CHEMO
  27. what drug do we give to + Breast Cancer
    Tamoxifen
  28. estrogen + is feed by
    estrogen, so if stop production of estrogen it slows the cancer
  29. Stage IV BC
    tumor of any size with ot without lymph nodes positive for cancer cells and distant metastases present

    Not curable but is treatable
  30. Lumpectomy
    gross resection of the tumor
  31. partial mastectomy
    removal of the portion of the breast that contains the tumor
  32. surgical procedures
    Simple Mastectomy
    Modified Mastectomy
    Simple; breast tissue and nipple are removed but the lymph nodes are left intact

    Modified; breast tissue, nipple, and lymph nodes are removed but muscle are left intact

    Radical; takes everything including muscles
  33. what is the most common surgical procedure
    modified mastectomy
  34. postop care
    • avoid using arm for blood pressure, injections or drawing blood
    • Monitor VS
    • Care of Drains
  35. Post op
    Comfort measures
    • assess position to promote fluid drainage
    • HOB 30* with affected arm elevated
    • no shoulder movement for 2 weeks
    • Analgesics
  36. Post op Mobility and Diet
    • regular diet
    • support arm with sling
    • begin exercise that will not stress the incision site
  37. tram procedure
    • long procedure
    • take tissue from the belly and reattach it
    • all tiny blood vessels have to match up and take
  38. tissue expanders
    • inserted in the breast to make room for the prosthetic
    • very painful

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