1. Patient Education
1.1. ACS Screening guidelines
1.1.1. Mammography
1.1.1.1. Average risk
1.1.1.1.1. Optional
1.1.1.1.2. Recommended
1.1.1.2. High risk
1.1.1.2.1. Start at age 30
1.1.1.2.2. Plus breast MRI
1.1.2. Clinical breast examination
1.1.2.1. Not recommended for breast screening
1.1.2.2. Done during regular annual physical exam
1.1.3. Breast Self-Examination
1.1.3.1. Age 20 and Above
1.1.3.1.1. Monthly
1.1.3.2. Not recommended for breast screening
1.2. Options for high-risk women
1.2.1. Prophylactic mastectomy
1.2.2. Prophylactic oopherectomy
1.2.2.1. Menopausal symptoms
1.2.3. Anti-estrogen drugs
1.2.3.1. Risk for blood clots
1.2.3.2. Risk for endometrial CA
1.3. Clarifying misconceptions
1.3.1. Diet
1.3.1.1. Dietary fats
1.3.1.1.1. Increase risk of breast CA in Postmenopausal
1.3.1.2. Red meat
1.3.1.2.1. Increase risk of breast CA
1.3.1.3. Fiber
1.3.1.3.1. Increment of every 10g/day significantly reduce cancer
1.3.1.4. Soy and soy products
1.3.1.4.1. Protective of breast CA and recommended moderate Lifelong consumption
1.3.1.4.2. Moderate soy intake (> 10 mg/day) reduces breast CA recurrences
1.3.1.5. Iodine
1.3.1.5.1. Iodine deficiency is linked to breast CA
1.3.1.6. Alcohol
1.3.1.6.1. Increase risk of breast CA, especially postmenopausal women
1.3.2. Obesity
1.3.2.1. Increase risk of breast CA in postmenopausal women
1.4. Post-op education
1.4.1. Post-mastectomy exercises
1.4.1.1. Should start on post-op day one
1.4.2. Lymphadema
1.4.2.1. S/S
1.4.2.1.1. Sensations of heaviness and aching
1.4.2.1.2. Numbness, tingling or swelling of affected arm
1.4.2.1.3. Swelling of upper chest
1.5. Questions
1.5.1. Question 1
1.5.1.1. Which action will the nurse include in the plan of care for a patient with right arm lymphedema?
1.5.1.1.1. a. Check blood pressure (BP) on both right and left arms.
1.5.1.1.2. b. Avoid isometric exercise on the right arm.
1.5.1.1.3. c. Assist with application of a compression sleeve.
1.5.1.1.4. d. Keep the right arm at or below the level of the heart.
1.5.2. Question 2
1.5.2.1. When the nurse is working in the women's health care clinic, which action is appropriate to take?
1.5.2.1.1. a. Teach a healthy 35-year-old about the need for an annual mammogram.
1.5.2.1.2. b. Discuss scheduling an annual clinical breast examination with a 22-year-old.
1.5.2.1.3. c. Explain to a 60-year-old that mammography frequency can be reduced to every 3 years.
1.5.2.1.4. d. Teach a 32-year-old with a BRCA-1 mutation about magnetic resonance imaging (MRI).
1.5.3. Question 3
1.5.3.1. The nurse provides discharge teaching for a 61-year-old patient who has had a left modified radical mastectomy and lymph node dissection. Which statement by the patient indicates that teaching has been successful?
1.5.3.1.1. a. "I will need to use my right arm and to rest the left one."
1.5.3.1.2. b. "I will avoid reaching over the stove with my left hand."
1.5.3.1.3. c. "I will keep my left arm in a sling until the incision is healed."
1.5.3.1.4. d. "I will stop the left arm exercises if moving the arm is painful."
2. Chemotherapy & Radiation Therapy
3. Hormonal Therapy
3.1. Prevention & treatment
3.1.1. Reduce estrogen availability
3.2. Types
3.2.1. Luteinizing hormone–releasing hormone (LH-RH) Agonists
3.2.1.1. Suppress hypothalamus from releasing LH-RH
3.2.1.1.1. Inhibits estrogen synthesis by ovaries
3.2.1.2. Used in premenopausal Women
3.2.1.3. Side effects
3.2.1.3.1. Menopausal symptoms
3.2.1.4. Examples
3.2.1.4.1. goserelin (Zoladex)
3.2.1.4.2. leuprolide (Lupron)
3.2.2. Selective estrogen receptor modulators (SERMs)
3.2.2.1. Block effects of estrogen in receptors
3.2.2.2. Adverse effects
3.2.2.2.1. Endometrial CA
3.2.2.2.2. Thromboembolic events
3.2.2.3. Examples
3.2.2.3.1. tamoxifen (Nolvadex)
3.2.2.3.2. raloxifene (Evista)
3.2.3. Aromatase inhibitors
3.2.3.1. Reduce conversion of androgen to estrogen in body fats
3.2.3.2. Used in Postmenopausal women
3.2.3.3. Adverse effects
3.2.3.3.1. Loss of bone density
3.2.3.4. Examples
3.2.3.4.1. anastrozole (Arimidex)
3.2.3.4.2. letrozole (Femara)
4. Surgeries
4.1. Pre-op care
4.1.1. Involve partners in teachings
4.1.1.1. Unless patient's culture does not permit
4.1.2. Use open-ended questions in teach back
4.2. Types of surgeries
4.2.1. Breast-conserving surgery
4.2.2. Mastectomies
4.2.2.1. Simple
4.2.2.2. Modified radical
4.3. Post-op care
4.3.1. Arm of surgical mastectomy side
4.3.1.1. Do not use for BP, blood draw, or injections
4.3.2. Post-axillary lymph node dissection
4.3.2.1. Elevate the affected arm on pillow
4.3.3. Question
4.3.3.1. The nurse is assigned to care for a client who has undergone a modified radical left mastectomy for breast cancer. When delegating care, which statement by the nursing assistant would require further teaching by the nurse?
4.3.3.1.1. A. “I will report urine intake and output to you.”
4.3.3.1.2. B. “If the client appears to be in pain, I will tell you right away.”
4.3.3.1.3. C. “It is important for me to take blood pressure on the client's left arm.”
4.3.3.1.4. D. “When ambulating, I will assist the client to stand straight with arms hanging at the side.”
4.3.3.2. A patient has had left-sided lumpectomy (breast-conservation surgery) and an axillary lymph node dissection. Which nursing intervention is appropriate to delegate to a licensed practical/vocational nurse (LPN/LVN)?
4.3.3.2.1. Teaching the patient how to avoid injury to the left arm
4.3.3.2.2. Assessing the patient's range of motion for the left arm
4.3.3.2.3. Evaluating the patient's understanding of instructions about drain care
4.3.3.2.4. Administering an analgesic 30 minutes before scheduled arm exercises