NURSING MANAGEMENT

OF A PATIENT WITH
BREAST DISORDER

PRESENTED BY:
MS.M.THUJOVELU VESHUME
B.SC(N) TUTOR
CON,CIHSR.
 General objectives

The students will review the anatomy of

breast and differentiate the normal
breast from breast disorder and will
develop positive attitude and
demonstrate skills in providing care to
patients with breast disorder.
 Specific objectives
At the end of the class the students will be able to :
▪ Revise the anatomy and physiology of breast.
▪ Collect the history with breast disorder.
▪ Perform the Breast self Examination.
▪ Identify the breast disorder.
▪ Manage the client with breast disorder.
 Anatomy and Physiology
• The breasts or mammary glands are accessory
glands of the female reproductive system. They
grow and develop to their mature size under the
influence of oestrogen and progesterone.
• Breast consists of about 20 lobes of glandular
tissue, each lobe being made up of a number
of lobules that radiate around the nipple.
• The lobules consist of a cluster of alveoli which
open into small ducts and these unite to form
large excretory ducts, called lactiferous ducts.
• The lactiferous ducts converge towards the
centre of the breast where they form dilatations
or reservoirs for milk.
• Fibrous tissue supports the glandular tissue and
ducts, and fat covers the surface of the gland
and is found between the lobes
 HISTORY
• Onset of mass or pain
• Location and duration
• Complaints varying with menses – benign
• Presence of symptoms on contralateral side – benign
• Colour and consistency of nipple discharge
• Family history
• 50 % breast cancers - age > 65 years
 Physical examination
• Supine position with ipsilateral hand behind the head.
• Upper outer quadrant – origin of half of breast Ca
• Asymmetry in glandular consistency, nodules
• Nipple areolar complex, axilla , anterior and posterior
neck
 BREAST SELF EXAMINATION

• Provide instruction regarding BSE.

• Encourage BSE but do not over emphasize it.
 STEREOTACTIC CORE
BIOPSY
A biopsy procedure that uses a computer and imaging
performed in at least two planes to localize a target
lesion (such as a tumor or micro calcifications in the
breast) in three-dimensional space and guide the
removal of tissue for examination by a pathologist
under a microscope
 Galactography or ductography

• A medical diagnostic procedure for viewing

the milk ducts. The procedure involves the
radiography of the ducts after injection of a
radio paque substance into the duct system.
The procedure is used for investigating the
pathology of nipple discharge.
DISORDERS OF BREAST
 Mastitis
• Mastitis is a condition in which a woman’s
breast tissue becomes abnormally swollen or
inflamed. It is usually caused by an infection of
the breast ducts.
• Staphylococcus aureus is the most common
pathogen responsible, but Staphylococcus.
epidermidis and streptococci are occasionally
isolated as well.
 Mastitis can be classified as:

• Milk stasis.
• Non-infectious or infectious inflammation and
abscess.
 Causes
• Poor technique of breast feeding can lead to
mastitis
• Bacteria entering your breast.
• The baby not attaching to the breast properly.
• The baby having difficulty sucking the milk out
of the breast.
• The baby being breast-fed infrequently.
• A blocked milk duct
• Milk ducts being blocked because of pressure on the
breast caused by tight clothing, for example.
• Anything that stops the milk from being properly
expressed will usually result in milk stasis, which
often leads to milk duct blockages.
 Risk factors

• Breast feeding during the first few weeks after childbirth

• Sore or cracked nipples
• Using only one position to breast feed
• Wearing a tight fitting bra or putting pressure on breast
• Overly tired or stressed
• Poor nutrition
 Sign and symptoms
• Breast tenderness or warmth to touch
• Malaise
• Breast swelling
• Pain or a burning sensation continuously or while breast
feeding
• Skin redness
• Fever of 101*F or greater
• The affected breast can then start to appear lumpy and red.
 DIAGNOSIS

• Physical examination.
• Breast milk sample test.
 Treatment
• Antibiotics
• Pain relievers eg. Acetaminophen or ibuprofen
• Adjustments of breast feeding technique
• Self care
 Life style and home management
• To relieve discomfort:
- Continue to breast feed
- Rest as much as possible
- Avoid breast engorgement
- Breast feeding technique
- Drink plenty of fluids
- Trouble emptying the breast milk, apply warm compress or
warm shower
- Wear supportive bra
 The 7 Warning Signs Of Cancer Spell
C.A.U.T.I.O.N.
• C – Change in bowel or bladder habits. This is a common sign of
colorectal cancer.
• A – A sore that does not heal in a normal amount of time. If
located on the skin or in the mouth, skin cancer or oral cancer
could be the cause.
• U – Unusual bleeding or discharge. Any bleeding from the
bladder, vagina, or rectum could mean prostate, cervical, or
colorectal cancer.
• T – Thickening of breast tissue or a lump. Any thickening of
tissue or a lump on the breast can be a sign of cancer. A lump on a
testicle can mean testicular cancer.
• I – Indigestion. Indigestion and/or difficulty swallowing can be a
symptom of stomach, throat, esophagus, or mouth cancer.
• O – Obvious changes to moles or warts. This is the most common
sign of skin cancer.
• N – Nagging cough. A cough that lasts for four weeks or longer
can be a symptom of lung and/or throat cancer.
• U- Unexplained weight loss.
• P_Pernicious anemia.
 Breast cancer
• Breast cancer is an uncontrolled growth of breast cells.
• There is no single, specific cause of breast cancer; rather, a
combination of hormonal, genetic, and possibly environmental
events may contribute to its development.
 Causes

• Hormonal, lifestyle and environmental factors may

increase risk of breast cancer
• Inherited breast cancer: common breast cancer
gene 1(BRCA1) and gene 2(BRCA2) both increase
the risk for breast and ovarian cancer
 Risk factors
• Being female
• Increasing age
• A personal history of breast cancer
• A family history of breast cancer
• Inherited gene that increase cancer risk
• Radiation exposure
• Beginning period at younger age
• Beginning menopause at an older age
• Having never been pregnant
• Postmenopausal hormone therapy
• Drinking alcohol
 COMMON SITE OF BREAST CANCER
RECURRENCE AND METASTASIS

• Local recurrence (skin)

• Regional recurrence (lymph nodes)
• Distant metastasis (skeletal, spinal cord, brain,
pulmonary, liver and bone marrow.
 TYPES OF BREAST CANCER
1.Infiltrating ductal carcinoma:
Invasive ductal carcinoma (IDC), sometimes called infiltrating
ductal carcinoma, is the most common type of breast cancer.
About 80% of all breast cancers are invasive ductal
carcinomas.Invasive ductal carcinoma” refers to cancer that has
broken through the wall of the milk duct and begun to invade the
tissues of the breast
2.INVASIVE LOBULAR CARCINOMA: Invasive
lobular carcinoma is a type of breast cancer that begins
in the milk-producing glands (lobules) of the breast.It
accounts for about 10%.

3.Medullary,mucinous and tubular carcinomas: These

are three slow growing types of breast cancer .Together
they represent about 10% of all breast cancer.
4.Paget’s disease:This type represents about 1% of
breast cancers.It starts in the milk ducts of the nipple
and can spread to the areola.
5.Inflammatory carcinoma: This accounts for about 1%
of all cases. Of all Ca breast, inflammatory carcinoma
is most aggressive and difficult to treat ,because it spread
so quickly.
6.DUCTAL CELL CARCINOMA IN SITU
(DCIS):DCIS occurs when cancer cells fill the ducts
but haven’t yet spread through the wall into fatty
tissue.
7.LOBULAR CARCINOMA INSITU: It develops in
the breast milk-producing lobules. LCIS doesn’t require
treatment ,but it does increase a woman’s risk of
developing breast cancer
• Peeling, scaling or flaking of the pigmented area of
skin surrounding the nipple
• Redness or pitting of the skin over breast, like the
skin of an orange (peau D’ orange).
 Stages of breast ca
• Stage 0: cancer that is non invasive or
contained within the milk ducts.
• Stage I: Tumors are less than 2 cm in
diameter and confined to breast.
• Stage II: Tumors are less than 5 cm, or
tumors are smaller with mobile axillary
lymph node involvement.
❖Stage III: a: Tumors are greater than 5 cm, or
tumors are accompanied by enlarged axillary lymph
nodes fixed to one another or to adjacent tissue.
❖Stage III: b: More advanced lesions with satellite
nodules, fixation to the skin or chest wall,
ulceration, edema, or with supraclavicular or
intraclavicular nodal involvement.
❖Stage IV: All tumors with distant metastases.
 Diagnostic studies
• History including risk factors
• Physical examination including breast and
lymphatics
• Mammography
• Ultrasound, biopsy
• MRI
• CBC, platelet count
• Cal. And pho. Level
• LFT
• Bone scan
• CT of chest, abdomen, pelvis
 Radiation therapy

• Uses :
✓ Primary treatment to prevent local breast recurrence after
Breast Conservation Surgery.
✓ Adjuvant treatment following mastectomy to prevent local
and nodal recurrences
✓ Brachytherapy.(Internal radiation)
✓ Palliative treatment for pain caused by local recurrence and
metastases
 Chemotherapy

• Chemotherapy refers to the use of cytotoxic

drugs to destroy cancer cells
• Some of the drug are doxorubicin,
cyclophosphamide, methotrexate and 5-
fluorouracil
 Management
SURGICAL:
• Breast-conserving procedures(Lumpectomy): Wide
excision of tumor, sentinel lymph node dissection and
ALND, radiation therapy
• Axillary lymph node dissection: Removal of some or all
fat-enmeshed axillary lymph nodes for determination of
extent of disease spread
• Total mastectomy: Removal of the breast tissue
• Modified radical mastectomy: Removal of the breast
tissue and an axillary lymph node dissection; the pectoralis
major and minor muscles remain intact
• Radical mastectomy: Removal of the breast tissue along
with pectoralis major and minor muscles in conjunction
with an axillary lymph node dissection
• Tissue expansion and breast implants
• Musculocutaneous flap procedures
• CRYOTHERAPY:Cryotherapy uses extreme cold to
freeze and kill cancer cells.
 Complication after mastectomy

• Bleeding.
• Infection.
• Pain.
• Swelling (lymphedema) in your arm.
• Formation of hard scar tissue at the surgical site.
• Shoulder pain and stiffness.
• Numbness, particularly under your arm, from lymph node removal.
• Buildup of blood in the surgical site (hematoma)
 Preoperative nursing diagnosis
• Deficient knowledge about breast cancer and
treatment options
• Anxiety related to cancer diagnosis
• Fear related to specific treatments, body image
changes, or possible death
• Risk for ineffective coping (individual or family)
related to the diagnosis of breast cancer and related
treatment options
• Decisional conflict related to treatment options
Post operative nursing diagnosis
• Acute pain related to surgical procedure
• Impaired skin integrity due to surgical incision
• Risk for infection related to surgical incision and presence of
surgical drain
• Disturbed body image related to loss or alteration of the
breast related to the surgical procedure
• Self-care deficit related to partial immobility of upper
extremity on operative side
• Disturbed sensory perception (kinesthesia) related to
sensations in affected arm, breast, or chest wall.
• Explaining breast ca and treatment option
• Reducing fear and anxiety and improving coping ability
• Promoting decision making ability
• Relieving pain and discomfort
• Maintaining skin integrity and preventing infection
• Promoting positive body image
 Nursing management
• Use mild soap with minimal rubbing.
• Avoid perfumed soaps or deodorants.
• Use hydrophilic lotions for dryness.
• Use a nondrying, antipruritic soap if itching occurs.
• Avoid tight clothes, underwire bras, excessive temperatures,
and ultraviolet light
 Exercises After Breast Surgery
• Wall handclimbing: Stand facing the wall with feet apart
and toes as close to the wall as possible. With elbows
slightly bent, place the palms of the hand on the wall
at shoulder level. By flexing the fingers, work the
hands up the wall until arms are fully extended.
Then reverse the process, working the hands down
to the starting point.
• Rope turning: Tie a light rope to a doorknob. Stand facing the
door. Take the free end of the rope in the hand on
the side of surgery. Place the other hand on the hip.
With the rope-holding arm extended and held away
from the body (nearly parallel with the floor), turn
the rope, making as wide swings as possible. Begin
slowly at first; speed up later.
• Rod or broomstick lifting.
Grasp a rod with both hands, held about 2 feet
apart. Keeping the arms straight, raise
the rod over the head. Bend elbows to
lower the rod behind the head. Reverse
maneuver, raising the rod above the
head, then return to the starting
position.
• Pulley tugging: Toss a light rope over a shower curtain
rod or doorway curtain rod. Stand as nearly under the
rope as possible. Grasp an end in each hand. Extend
the arms straight and away from the body. Pull the
left arm up by tugging down with the right arm, then
the right arm up and the left down in a see-sawing
motion.
 Psychologic care

• Assisting her to develop a positive but realistic

attitude
• Helping her identify sources of support and
strength
• Encouraging her to verbalize her anger and fear
• Promoting open communication of thought and
feelings
• Providing accurate and complete answers to
questions about her disease, Rx options and
reproductive or lactation issues
Thank you