Exam 16: Breast Surgery

Research and understanding of the immune system,the development of methods to evaluate aspects of the immune response,and ongoing development of monoclonal antibodies are transforming the field of immunotherapy and breast cancer treatment.The ability for a breast cancer to bind with estrogen and progesterone identifies a patient with a hormone-dependent tumor.An alternative therapy for a patent who might not be able to receive trastuzumab (Herceptin)or lapatinib,which targets epidermal growth factor,would be:

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.

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

Maureen Gilroy,a 39-year-old mother of 5 children,was recently diagnosed with early stage,noninvasive ductal carcinoma in situ.She is an athletic woman who is very involved with her children and community activities.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 is concerned about the length of her recovery.The perioperative nurse recognizes Maureen's concern and assigns her a nursing diagnosis of:

Ductal ectasia is a benign breast disorder that is difficult to distinguish from cancer,primarily because it presents with:

A breast biopsy,performed after the patient has received a local anesthetic,will require adjunct sedation and monitoring equipment.What relevant considerations should the nurse note during the preoperative assessment?

Breast screening guidelines are developed and published by the American Cancer Society (ACS)for asymptomatic women of various age and risk groups.Select the statement that best reflects the ACS guidelines for women at high risk for breast cancer.

Gertrude Marshall,a 65-year-old recently retired nurse,was scheduled for a modified radical mastectomy.It has been over 40 years since she worked as a perioperative nurse and she vividly remembers the mutilating radical mastectomies of the past.She asks the perioperative nurse to describe the appearance of her incision at the end of the procedure.What description of the incision will the perioperative nurse explain to Gertrude?

Sarah Pergines,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.Sarah stated that the lump has existed for several years and she believed it was just part of old age.The surgeon examined Sarah 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 Sarah Pergines' probable cancer stage?

Denise Corson,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.Denise 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 Denise's concern would be:

Marsha Borden is in the phase II PACU after an excisional biopsy with sentinel lymph node dissection.She is receiving her patient education as she prepares for discharge.The perioperative nurse has asked Marsha 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?

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.Apply the description of a stage 0 carcinoma in situ to the appropriate disease description listed below.

Select the statement that best describes fine needle aspiration of a suspicious breast mass.

The catheter component of Talia's port system is inserted into what structure(s)?

Janice Coswell,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.This patient also has periods of atrial fibrillation,which is moderately controlled by antidysrhythmic medications.The patient is also taking anticoagulant medication.Janice 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.Appropriate nursing interventions for this patient would include:

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

Women of high socioeconomic status and higher education also have a high incidence of breast cancer,most likely due to:

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:

Identify the marginal boundaries of the breasts.

Fibrocystic changes in the breast describe many different breast changes.These changes affect almost all women at some time in their lives.Nipple discharge is more commonly associated with benign lesions than with cancer;however,discharge is usually significant only if it is spontaneous,persistent,and: