Exam 17: Breast Surgery

An 82-year-old woman was referred to the breast surgery service by her gerontologist because of a large inflammatory mass in her left breast.The patient stated that the lump has existed for several years,and she believed it was just part of old age.The surgeon examined her and found tumor nodules growing into the skin of the breast,with breast swelling and redness.Diagnostic imaging results described a tumor that had grown into the chest wall and may have spread to axillary lymph nodes and to other lymph nodes behind the breastbone and below the collarbone.Based on this description,what is the patient's probable cancer stage?

Breast cancer is usually staged to measure the extent of the disease and to design a specific treatment plan,using the TNM (T = tumor; N = node; M = metastasis)classification system.Review the list below and select the option that most closely describes a stage 0 carcinoma in situ (CIS).

Identify the marginal boundaries of the breasts.

Before surgery,the perioperative nurse should procure the necessary medical and surgical supplies,instruments,and equipment for the planned operation.Mammograms,ultrasound,MRI,or other imaging studies should be available in the operating room (OR)for the surgeon's review.The reason for the imaging studies' availability in the OR is to:

A 39-year-old mother of five children was recently diagnosed with early-stage,noninvasive DCIS.She has decided to have a bilateral preemptive modified radical mastectomy to minimize her risk of metastatic disease.She is calm and confident that she has made the right decision but she is concerned about the length of her recovery.The perioperative nurse recognizes the patient's concern and assigns her a nursing diagnosis of:

Which factors are considered high increased risk for breast cancer?

A patient undergoing breast surgery will likely be extremely apprehensive about the possibilities of having a malignancy,losing a body part,facing a negative reaction from her spouse and family,and experiencing a negative change in self-image.The preoperative interview of the breast surgery patient should consider:

A 46-year-old woman is in the phase II postanesthesia care unit (PACU)after an excisional biopsy with sentinel lymph node (SLN)dissection.She is receiving her patient education as she prepares for discharge.The perioperative nurse has asked her to teach back the complications and side effects that could be observed after sentinel lymph node dissection.What information does the nurse expect to hear?

A 35-year-old mother of twins was scheduled for a left breast lumpectomy.This is her third lumpectomy in 6 years for benign fibrocystic disease.The patient shared her concerns with the perioperative nurse,worrying about her breast's appearance after three similar surgeries in the same breast.The nurse noticed,on assessment,how much smaller the left breast was in comparison with the right.An appropriate action for the nurse to take in response to the patient's concern would be to:

Many breast cancer patients subscribe to various complementary and alternative (CAM)and integrative therapies to provide relief from anxiety,depression,pain,and the complications and side effects associated with chemotherapy and radiation therapy.Quality-of-life issues become important in providing comfort and life balance.Breast cancer patients who are interested in the benefits of CAM and integrative therapies would most likely seek assistance for their cancer care from which group of providers?

The mammary glands are affected by physiologic changes throughout a woman's life span.Select the option that best reflects the life cycle events that impact the anatomy and physiology of the breasts.

A 27-year-old patient,who had a lumpectomy for early-onset breast cancer,arrived at the ambulatory surgery center for infusion port insertion.She is scheduled to begin adjuvant chemotherapy next week.The patient is very nervous because during the previous lumpectomy,performed using a local anesthetic,she was not entirely sedated.The patient tells the perioperative nurse that she was uncomfortable and heard everything in the room but admitted that she did not feel pain.The nurse recognized the patient's anxiety related to the surgical intervention and prepared to implement corrective actions in the OR.What nursing intervention best reflects one that would ensure support or contribute to the patient realizing her expected outcome?

Review the list below and select the option that most accurately describes the action taken after a fine-needle aspiration biopsy (FNAB)of a suspicious breast mass.

The catheter component of an infusion port system is inserted into which structure(s)?

In 2012,pertuzumab was approved for use in combination with trastuzumab and with the chemotherapy agent docetaxel.These agents are specifically indicated for which patients?

Which breast surgery procedure is also called the nipple-sparing technique (NSM)?

A breast biopsy,performed after the patient has received a local anesthetic,will require adjunct sedation and monitoring equipment.What is the highest priority consideration for the nurse to note during the preoperative assessment?

An experienced nurse in the breast surgery service is preparing the OR for a radical mastectomy procedure on a 72-year-old patient with invasive breast cancer.The nurse realizes that judicious use of electrosurgery will be important to maintain adequate hemostasis for this patient.She has assigned this patient a nursing diagnosis of risk for injury related to use of electrosurgery and is determined to achieve the desired relevant nursing outcome.What appropriate nursing interventions will provide a safe environment for both the patient and the intraoperative team?

The internal thoracic lymph nodes,which drain the inner half of the breast,can also be a channel for the:

The Centers for Disease Control and Prevention (CDC)wound classification system considers breast surgery as "clean." The Surgical Site Infection (SSI)rate for clean surgical procedures is projected to be less than 2%.Olsen (2015)looked at the SSI rate for mastectomies performed between 2004 and 2011.What key information impacts the perioperative team?