learning Objectives - Describe the disorders of breast and breast cancer. Demonstrate skill in giving nursing care to patients with breast disorders
Hours - 5
Teaching and Learning Activities - Lecture cum discussion Models and exhibits
Assessment Methods - Short answer Objective type Essay
Content of the chapter
a) Assessment of breast
– History
– Physical examination
– Diagnostic tests
– Breast self examination
b) Disorders of breast
– Mastitis
– Breast abscess
– Gynaecomastia
– Tumors and Malignancy of breast
c) Nursing management of a patient after
mastectomy
Nursing Management of Patients with Disorders of the Breast
Breast disorders include infections, benign tumors, hormonal conditions, and malignancies. Nursing management focuses on early detection, treatment, prevention of complications, and psychosocial support.
a) Assessment of the Breast
1. History
- Presenting complaints: pain, swelling, discharge, lumps, redness, or skin changes
- Duration and progression of symptoms
- Menstrual and reproductive history (menarche, menopause, pregnancies, lactation)
- Past breast disorders, surgeries, trauma
- Family history of breast cancer
- Lifestyle factors: smoking, alcohol, diet
- Medication history (hormonal therapy, contraceptives)
2. Physical Examination
- Inspection:
- Size, symmetry, skin changes (redness, dimpling, peau d’orange)
- Nipple changes: retraction, discharge, ulceration
- Swelling or inflammation
- Palpation:
- Lumps: size, shape, consistency, mobility, tenderness
- Lymph nodes: axillary, supraclavicular, and cervical
- Assessment of surrounding tissue for induration or edema
3. Diagnostic Tests
- Mammography: detects tumors or microcalcifications
- Ultrasonography: differentiates cystic vs. solid masses
- Fine Needle Aspiration Cytology (FNAC) / Core Biopsy: confirms malignancy
- MRI breast: for high-risk patients
- Blood tests: tumor markers (e.g., CA 15-3, CEA)
4. Breast Self-Examination (BSE)
- Monthly self-check by women from age 20 onwards
- Helps early detection of lumps or changes
- Steps:
- Visual inspection in front of mirror
- Palpation in lying and standing positions
- Reporting any changes promptly
b) Disorders of the Breast
1. Mastitis
- Inflammation of breast tissue, often in lactating women
- Symptoms: pain, redness, swelling, fever
- Nursing care:
- Supportive measures: warm compress, analgesics
- Encourage breastfeeding to maintain milk flow
- Educate on hygiene and correct breastfeeding techniques
2. Breast Abscess
- Localized collection of pus, often secondary to mastitis
- Symptoms: swelling, pain, redness, fever
- Nursing care:
- Monitor vital signs and signs of systemic infection
- Assist in drainage procedures (needle aspiration or surgical)
- Pain management and wound care
- Educate patient on post-procedure care
3. Gynaecomastia
- Enlargement of male breast due to hormonal imbalance
- Causes: puberty, medications, liver disease, tumors
- Nursing care:
- Supportive counseling and reassurance
- Monitor for underlying causes
- Surgical intervention if persistent and distressing
4. Tumors and Malignancy of the Breast
- Benign: fibroadenoma, cysts—painless, mobile lumps
- Malignant: invasive ductal carcinoma, lobular carcinoma—hard, irregular, fixed, may have skin/nipple changes
- Nursing care:
- Preoperative education and emotional support
- Postoperative care after biopsy or surgery
- Education on lifestyle modification, regular follow-up, and BSE
c) Nursing Management of a Patient After Mastectomy
Immediate Postoperative Care
- Monitor vital signs, bleeding, and drainage from surgical site
- Observe flap and wound for color, edema, and signs of infection
- Positioning:
- Elevate the affected arm on a pillow to reduce edema
- Avoid compression of surgical site
Pain Management
- Administer prescribed analgesics
- Encourage relaxation techniques
Prevention of Complications
- Shoulder stiffness: start gentle exercises as per physiotherapist guidance
- Lymphedema: avoid venipuncture, injections, and tight clothing on affected side
- Infection prevention: maintain aseptic wound care
Emotional and Psychosocial Support
- Address body image issues
- Encourage counseling and support groups
- Involve family in care
Long-Term Care
- Teach arm exercises to improve mobility
- Educate about signs of recurrence
- Encourage regular follow-up and BSE of the remaining breast
Conclusion
Nursing management of breast disorders emphasizes early detection, accurate assessment, infection prevention, pain management, and psychosocial support. Post-mastectomy care focuses on wound care, mobility, lymphedema prevention, emotional support, and rehabilitation, which are crucial for improving quality of life.